Understanding Social Security Disability Benefits

Living with a chronic health condition can have a huge impact on your life. Unfortunately, despite advanced treatments and laws to protect us from discrimination in the workplace, not everyone with a chronic illness is able to continue working. If you are considering applying for Social Security disability benefits, this article will provide an overview of the process– but it probably won’t answer all of your questions. For specific information about your situation, you should speak with a Social Security representative or a lawyer.

What is Social Security?

The Social Security Administration is a branch of the United States federal government that provides disability benefits to individuals who cannot work due to long-term disabilities. The benefits are paid through two programs. Social Security disability insurance (SSDI) pays benefits to people with disabilities who can prove they have worked long enough to qualify. Supplemental Security Income (SSI) provides benefits based on financial need.

Who can qualify for Social Security disability benefits?

While there are some programs that may provide benefits to people with partial or short-term disabilities, federal law requires you to meet a very strict definition of long-term disability to qualify for Social Security disability benefits. You also must meet the earnings requirements. Once you qualify to receive benefits, certain family members may also qualify to receive money from Social Security. Separate programs also exist for children with disabilities (see Benefits for Children With Disabilities at www.socialsecurity.gov).

How can I meet the earnings requirement for disability benefits?

To qualify for Social Security disability benefits, you typically must meet two earnings tests. The first is a recent work test, which is based on your age at the time you became disabled. If you became disabled after the age of 31, you generally must be able to prove that you worked five years out of the 10-year period prior to when your disability began. If you became disabled prior to turning 31, there is a different formula that allows you to prove fewer than five years of recent work depending on your current age. The second earning test is a duration work test, to show that you worked long enough under Social Security to qualify. The amount of work you need to prove varies depending on your current age. For this test, your work does not have to fall within a certain period of time.

Who decides if I am disabled? 

Once you pass the two earnings tests, the initial disability determination will be made by your state’s Disability Determination Services office. If you are currently working and earn more than a certain amount each month (the exact amount changes each year, see the annual Update), you generally will not be considered to have a qualifying disability. But if you are not working or you earn less than the current monthly amount, the state agency will then look into your medical condition.

The agency will talk to your doctors and other healthcare providers about your medical condition(s), when your medical condition(s) began, how your medical condition(s) limit your activities, your medical test results, and what treatment you’ve received. If your doctors can’t provide all the information necessary, the state agency may ask you to go for a special examination. In that case, Social Security will pay for the exam and for some of the related travel costs.

To have a qualifying disability under the Social Security definition, your medical condition must significantly limit your ability to do basic work activities – such as lifting, standing, walking, sitting, and remembering – for at least 12 months. If your medical condition meets these criteria, the agency will then check the Social Security Listing of Impairments. If your condition is on their list, there will be specific criteria to help determine whether your impairment is severe enough to warrant benefits. If your condition is not specifically listed, the agency will look to see if your condition is medically equal, or as severe, as another condition on the list.

Then, if the agency does determine that your medical impairment prevents you from performing your past work, they will look to see if there is any other work you would be capable of performing. In making this determination they will consider your age, education, past work experience, and any other skills you may have. If you cannot do any other type of work, the agency will determine that you have a qualifying disability.

How do I apply for disability benefits?

 There are two ways that you can apply for Social Security disability benefits:

  1. Apply online at socialsecurity.gov; or
  2. Call the toll-free number (1-800-772-1213) to make an appointment to either file a disability claim at your local office or have someone take your claim over the phone.

Make sure to have all the required information ready, including:

  • Your Social Security number;
  • Your birth certificate;
  • Contact information for doctors, caseworkers, hospitals and clinics where you have been treated;
  • Names and dosages of all the medications you take;
  • Medical records and lab results;
  • A summary of where you worked and what kind of work you did; and
  • A copy of your most recent W-2 (or most recent tax return if you’re self-employed).

Remember that you have the right to representation by a lawyer of your choice whenever you do business with Social Security.

What happens after I apply?

Processing an application for disability benefits usually takes at least three to five months. When the state agency finally makes a decision, they will send you a letter. If your application is approved, the letter will show the amount of your benefits and when you can expect the payments will start. If your application is not approved, the letter will explain why and tell you how to appeal (see The Appeals Process at www.socialsecurity.gov).

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The COPD.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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