Social Security Disability Insurance and Supplemental Security Income (SSI)
The Social Security Administration administers two disability programs for adults: Social Security Disability Insurance (“SSDI,” “DIB,” or “Title 2 benefits”) and Supplemental Security Income (“SSI” or “Title 16 benefits”).
These programs are similar in that they offer monthly cash benefits to claimants who meet Social Security’s standard of disability. Disability is a legal term. It is not a medical term. Only the Social Security Administration can determine whether you meet its standard for disability; your doctor cannot make this determination.
Social Security determines whether you are disabled by undertaking a 5-step sequential evaluation.
Social Security’s evaluation proceeds as follows:
Substantial gainful activity (“SGA”) is a threshold for monthly earnings. SGA for 2020 is $1,260.00 ($2,110.00 for blind individuals) in gross (pre-tax) monthly earnings. If you currently earn over SGA your claim will be denied. If you have no earnings or if your earnings are under SGA your claim will proceed to step 2.
There are 2 elements to this inquiry: SSA will determine that your medical impairment (SSA’s term for a diagnosis) is “medically determinable” if there are medical/mental health records to support the diagnosis/impairment.
SSA will determine that your medical impairment is “severe” if the medical evidence establishes that the impairment or impairments interferes with basic work-related activities. If you have no medically determinable severe impairments your claim will be denied. If you have at least one medically determinable severe impairment your claim will proceed to step 3.
The Listings of Impairment is a text describing certain criteria for different impairments. You can view the Listings here: https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm.
At this step in the evaluation SSA determines whether your medical impairment “meets” all the criteria of any Listing. It may also determine that you do not have an impairment that meets every element of the Listing, but that your impairment nonetheless “equals” a Listing if it is of such a severity as to be equal to the criteria of a listed impairment.
If your impairment is found to meet or equal the Listings you will be found disabled. If your impairment is not found to meet or equal the Listings your claim will proceed to step 4. Before proceeding to this step, however, SSA will formulate your Residual Functional Capacity.
Your “RFC” is a function-by-function assessment of your maximum ability to do sustained work-related physical and mental activities on a regular and continuing basis (8 hours a day, for 5 days a week) despite the limitations and restrictions resulting from your medically determinable impairments. In short, it is SSA’s finding of what you can do at work on a full-time basis.
Once SSA formulates your RFC, it moves on to steps 4 and 5.
SSA compares your RFC to the requirements of any work you performed at the SGA level over the previous 15 years (your past relevant work). If they determine in comparing the two that you can do your PRW as you performed it or as its generally performed in the national economy, your claim will be denied.
If they determine that your RFC precludes your ability to perform your PRW then your claim will proceed to step 5.
SSA will compare your RFC to all jobs available in the national economy. In short, at this step it is determining if you can do any full-time work activity. At this step SSA considers your age, education level, and work experience to determine what jobs you may be able to perform.
If they determine that your RFC precludes your ability to perform any other work in the national economy, then your claim will be approved. If they find you can do work in the national economy your claim will be denied.
Age: different rules apply to some individuals over the age of 50 and 55. In short, for many people a disability finding is easier to obtain once these age thresholds are met. However, this is not always the case. You should speak to an attorney for more detail on the impact of age on a disability finding.
Duration: your disability must last or be expected to last 12 or more months or result in death. Consider a situation where you are off work 9 months due to a medical impairment, but return to work full time at the end of that 9 month period. You will not qualify for SSDI or SSI, as your disability did not last 12 months. You do not need to wait to apply until after you’ve been off work for 12 months. You can apply as soon as your earnings have dropped below the SGA threshold.
Under both the SSDI program and the SSI program SSA undertakes the analysis above to determine if you meet the “medical” requirements for disability. For each program there are also “non-medical” criteria.
To be eligible for SSDI from a “non-medical” perspective you must have worked for a long enough period to be “currently” and “fully” insured. In short, when you work and pay taxes you receive “credits” on your Social Security account. These credits accumulate over time as you continue to work and will eventually qualify you for Social Security Retirement benefits. However, if you become unable to work before retirement age, and if you have accumulated enough credits, you may be eligible for SSDI benefits. It’s important to understand that the number of credits required to qualify for disability varies by age. As such, even if you’re a younger individual you may have accumulated enough credits to qualify for SSDI from a “non-medical” perspective. It is also important to understand that in certain relatively rare circumstances an individual may be able to qualify for SSDI benefits on another person’s account, such as a parent or spouse. If you apply for benefits through Social Security an inquiry will be run to determine if you qualify for benefits on your own account or on the account of a relative.
To be eligible for SSI from a “non-medical” perspective you must have limited income and resources.
In short, an individual who has never worked or who has rarely worked will not qualify for SSDI benefits on their SS account because they will not have accumulated enough credits. However, if they have limited income and resources they may qualify for SSI benefits.
The SSDI benefit rate is based on your earnings history, and may be as high as $3,011. Most people receive a benefit between $800.00 and $1,800.00, with an average of $1,258.00. The SSI base benefit is the same for everyone: $783.00.
It is not uncommon to qualify for both SSDI and SSI benefits. However, benefits from the 2 programs offset.
If you believe you have a medical impairment that prevents you from performing full time work, you may file an application for SSDI or SSI benefits with your local Social Security office. You may file your application by going to your local SSA office, by calling your local SSA office (to find your local SSA office, follow this link: https://secure.ssa.gov/ICON/main.jsp), or by applying online at this web address: https://www.ssa.gov/applyfordisability/.
We encourage claimants to apply on their own. If your claim is denied, we encourage you to contact our office and speak with one of our SSDI/SSI attorneys.