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Monday, October 6, 2014

Social Security Disability: The Two Types of Programs Available

"SoDisability Rightscial Security Disability" is used generally by people to refer to programs in place at the federal level that allow you to receive benefits to support yourself when you are suffering from a disability and are unable to obtain gainful employment due to that disability. In reality, there are two distinct programs run by the Social Security Administration (SSA) that make up "Social Security Disability": Social Security Disability Insurance (SSDI) and Supplement Security Income (SSI). Each serves a unique purpose and it is important to know the similarities and differences of both programs if you or a loved one is applying for federal assistance under these two programs.

Both programs require that the applicant be medically qualified (i.e. disabled). Unlike other disability programs (such as the VA and some state workers' compensation programs), the SSA requires total disability: you are either 100% disabled or you are not disabled at all. The requirements to determine whether someone is disabled is essentially the same under both programs. Both programs require for an adult (meaning someone over the age of 18, there are different rules for children under 18 that will be discussed below) to meet a five step process. They are:

1. Are you working at a job where you are making more than $1,070/week? If the answer is yes, then you are not disabled and do not qualify for SSDI or SSI. If no, then...

2. Is your condition severe enough that you are unable to perform your job? If it is not, then you do not qualify for SSDI or SSI. If yes, then...

3. Is your condition one that is under the "listings": a list of conditions listed in the Social Security Regulations that if you are proven to have will automatically be evidence that you are disabled. If yes, then you are medically qualified to be eligible to receive SSDI or SSI provided you meet the non-medical qualifications from each program. If not, then...

4.  A determination is made to determine whether your condition, if it is not a condition that is in the listings, is one that causes you to be unable to perform your old job. If that is the case, then you are medically qualified. If not, then...

5. A final determination is made to determine whether you can perform any type of work. By any type of work, the SSA means anything. If you can work as greeter at Wal-Mart, you meet their requirements. If not, and all of the other steps above are met, then you are medically qualified to be eligible for disability benefits.

Finally, it has to be medically determined that you had this condition for 12 months.

Where the two programs differ is in the non-medical requirements for eligibility.

SSDI is a benefit that comes out of Social Security taxes. Because of this, there are requirements that the Claimant (applicant for benefits) worked long enough to pay enough Social Security taxes to qualify for this benefit.  While it varies due to age, after age 31, you had to have worked at least five of the last ten years, so you have recently paid Social Security taxes. You also have to have worked long enough over your life to meet the SSA's requirements to have paid in the system long enough over your life. If you do not meet those requirements, then you will not qualify. It is important to note that there are no net worth requirements to qualify under SSDI. Even Bill Gates would be eligible to receive SSDI if he was eligible!

He would not, however, qualify for SSI. SSI is income and asset based, and was created to help people who are disabled, blind or over 65. For those of you who are familiar with Medicaid eligibility, the asset requirements are almost identical. Income requirements are determined by a formula that the SSA uses for each state. The important thing to remember is that there is no requirement to have worked at all in the past. The determining factor (besides being disabled) is how much you have and how much you make.

For children, the disability requirement for SSI (almost all children are not going to have the work requirements for SSDI) takes the ability to work out of the equation and instead looks at "physical or mental impairment that results [in] marked physical and severe functional limitations."

Now that you understand the similarities and differences between SSDI and SSI, in the next post I will lay out the procedure for appealing a claim for benefits if you are denied.