Social Security Disability

Social Security Disability Benefits: SSI and SSDI

Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are federal benefits available to disabled individuals who are unable to work. Both programs are administered by the Social Security Administration (SSA), and the process of applying for the two programs is very similar. However, there are a few important differences in the eligibility requirements for Social Security Income and Social Security Disability Insurance.

The difference between SSI and SSDI

For both SSI and SSDI, medical eligibility is determined in the same way. A person suffering from a chronic illness or other debilitating condition would qualify for either program.

However, the two programs have different financial and legal requirements that must be met. SSI is strictly need-based, so it is available to persons with disabilities with no or low income and assets. Your work history does not factor into whether you are eligible to receive SSI. The program is funded by general taxes, and all recipients get the same amount each month.

On the other hand, SSDI is an insurance program funded through payroll taxes. In order to be eligible, you need to have worked for many years and have paid into to the Social Security trust fund. The amount of benefits that you will receive will depend on your wages before you became disabled.

The amount of benefits that you will be entitled to also differs between the two programs.

Who Is Eligible for SSI or SSDI?

In order to receive benefits under either program, you must be a U.S. citizen, national, or a qualified immigrant.

The eligibility rules for SSI and SSDI are identical with respect to current income and underlying medical conditions, but there are some different financial qualifications for the two programs.

Financial Requirements

In order to be eligible for SSI or SSDI, you cannot currently be earning a substantial income. For SSI, you also must not own assets above a certain amount. On the other hand, in order to be eligible for SSDI, you must have “paid into the system” through Social Security payroll taxes for a certain amount of time. Additionally, you cannot receive either SSI or SSDI while you are receiving disability benefits from your state. Most states provide disability benefits for a maximum of one year, after which you are able to qualify for SSI or SSDI, if you meet the other requirements.

Current Income

To qualify for either SSI or SSDI, you must be unable to perform substantial work. Substantial work is defined by how much you earn: currently, if you earn over $1,090 per month, you will not qualify to receive either SSI or SSDI. This limit is known as Substantial Gainful Activity, or SGA. If you are self-employed, SSA uses a different test to determine whether you are doing SGA.

If you are working and earning above SGA when you apply for SSI or SSDI, your application will be denied. However, you can continue to work part-time when you apply, as long as you are earning less that the SGA amount. However, you should be warned that working part-time could lead SSA to believe that you could manage full-time work.

Current Assets

If you are applying for SSI, you must not own more than $2,000 in assets (or $3,000 for a couple). Assets for Social Security purposes can include cash, bank accounts, cars (your first car is not counted), household goods, and other property.

Previous Income

To qualify for SSDI, you must have worked for at least 40 qualifying quarters. A qualifying quarter is a period of 3 months in which you earned at least the SGA amount. If you were working consistently, always earning above this amount, and paying payroll taxes, you would qualify for SSDI after 10 years. The twists and turns of life can prevent you from accruing these qualifying quarters, so it could take much more than 10 years to become eligible for SSDI. In addition, you must be younger than 65 in order to qualify for SSDI. These age and earnings requirements do not apply to SSI.

Medical Requirements

To qualify for either SSDI or SSI, you must have an impairment that keeps you from being able to work. Your impairment can be medical, psychological, or psychiatric in nature, or a combination of impairments can keep you from working.

The Social Security Administration (SSA) has a manual that lists a broad range of impairments. If you have one or more of the listed impairments, you may automatically qualify for SSDI or SSI, if you have proof that your condition meets or equals the criteria of the listing.

You may still be eligible for disability benefits even if you don’t meet or equal the criteria for a listed impairment, as long as your condition limits your ability to function so much that you are unable to work. The SSA will ask about your daily activities and work, and will use that information, along with your medical records, to decide whether there is job that would be possible for you to do. The central issue here is whether you have a medically determinable impairment that prevents you from doing your job.

Evidence of Your Disability

In order to convince SSA that you qualify for disability benefits, you must present your medical records to show evidence of your physical or mental impairment. Information that details exactly how your impairment impacts you and makes it impossible for you to work is necessary in order for SSA to agree that you are disabled.

You must provide SSA with up-to-date medical records, and be sure to include new medical records and lab tests within 60 to 90 days.

Timeline of Your Disability

In addition to showing that your condition currently prevents you from working, you must convince SSA that your impairment prevented you from doing SGA for at least a year, or that it is expected to prevent you from doing SGA for at least a year. Unlike under most state disability programs, temporary disabilities, lasting less than a year, will not qualify you for SSI or SSDI.

Overview of SSI and SSDI Benefits

If you are approved for SSI, you will receive a fixed amount of cash benefits each month. Every recipient receives the same amount, regardless of the nature of their disability. SSA updates the benefits amount each year, based on the changing cost of living. The monthly amount for 2015 is $733. States with higher costs of living can also opt to provide a supplemental amount.

If you are approved for SSDI, your benefit amount will depend on your average earnings before your disability. SSA applies a complicated formula to determine how much you are owed each month if you become unable to work. The usual range of monthly SSDI payments is from $300 to $2,200. The average SSDI payment in 2015 is $1,165. The maximum benefit in 2015 is $2,663.

If you qualify to receive SSDI benefits in less than the current SSI rate, the difference will be paid by the SSI fund. So, if you qualify to receive $300 in SSDI, you will also receive $433 in SSI, bringing your monthly total to $733, the SSI benefits amount.

If you are approved for SSI, you will be able to receive benefits from the month when you submitted your application onwards. This means that if you waited for a year for SSA to decide your case, you will receive benefits covering the entire period, not just starting from the month that you are approved. However, there is a five-month waiting period, so SSA won’t pay you benefits for the first five months after you become disabled.

Associated Benefits

If you are eligible for SSI, you will also be eligible for Medicaid benefits, including prescription coverage under Part D. Most people whose incomes qualify for SSI also are eligible to receive SNAP benefits (formerly known as food stamps).

If you are approved for SSDI, you will automatically be enrolled in Medicare after two years.

Overview of the claims and litigation process

The process of obtaining SSI or SSDI benefits can be long and difficult, especially on top of facing a debilitating medical condition.

The first step is to submit a claim for benefits to your local Social Security Administration office. You can fill the claims form with the assistance of a claim representative, either in person at the office, or over the phone, if that is more convenient for you. You can also submit a claim online, by visiting www.ssa.gov and clicking on the link that says “Apply online for disability benefits.”

A claims representative at the Social Security Administration will screen your application to see whether you are eligible on the basis of your non-medical situation. If you are still working, and earning over a certain amount (SGA), you will be disqualified. You can also be disqualified for having too much in assets, or for not having enough work quarters to qualify for SSDI (remember that the work quarters requirement does not apply to SSI). If you meet the financial criteria for either SSDI or SSI, your claim will be sent to Disability Determination Services (DDS), where disability claims examiners will evaluate your medical condition, with assistance from a medical consultant.

Waiting for a determination from the Social Security Administration take several months, and statistically, most applicants are not granted benefits at this first stage. Nationwide, nearly 70% of disability cases are denied at the initial application stage. You should prepare yourself for a denial, and you should be ready to appeal this decisions.

If you receive notification that your Social Security Disability  claim has been denied, you will have a chance to request an appeal. As part of the appeal process, you will need to appear before an administrative law judge at a disability hearing. Due to the large backlog of cases pending before the SSA judges, it can often take a year or more to schedule a hearing for your case. A knowledgeable and experienced disability lawyer can help you prepare for your Social Security disability hearing, and will greatly improve your chances of approval.

If you still do not receive a favorable Social Security determination at your hearing before the administrative law judge, it is possible to appeal your case to the federal court of appeals for your circuit.

Sending us information about your potential case does not mean we will automatically represent you – you are telling us about your situation in order for us to evaluate whether we believe you have a case which we may choose to handle on your behalf. We will review your circumstances and let you know as soon as possible whether we can discuss your potential case with you further. The information you give us is confidential and can’t be shared with anyone outside of our office.