The federal government provides benefits to disabled individuals. There are two programs: SSDI (Supplemental Security Disability Insurance Benefits) and SSI (Social Security Income). SSDI provides benefits to disabled individuals, their spouses, and dependents. SSI provides benefits to disabled individuals whose income and total assets fall below certain thresholds.
Determining Eligibility for Benefits
Eligibility differs under the two programs, but the standards for determining whether a person is disabled are similar. A person is considered disabled and eligible for disability benefits when he has a medically determinable physical or mental impairment that can result in death or has lasted or is expected to last for a continuous period not less than twelve (12) months.
These impairments must so severe that a person can not perform their previous work requirements and considering their “age, education, and work experience, engage in any other type of substantial gainful work existing in the national economy.”
Five-Step Evaluation Process
The Social Security Administration (“SSA”) uses a five-step sequential evaluation process to determine disability. The SSA determines whether a person:
- Engages in a substantial gainful activity – Regardless of a person’s age, medical condition or work experience, if a person engages in a substantial gainful activity, there is no disability.
- Has a severe impairment – If a person is not engaging in a substantial gainful activity, the SSA must determine whether the person suffers from a severe impairment. A severe impairment is “severe” if it prevents a person’s physical or mental ability to do basic work is significantly limited.
- Has an impairment appearing on the list of impairments – If the person meets the above requirements or has an impairment appearing on the SSA’s list of impairments, the individual is disabled. If not, the next steps are evaluated.
- Is capable of performing past relevant work – The SSA considers whether a person is capable of performing the type of work he has performed in the past. If so, he is not disabled. If he cannot, the next step is considered.
- Is capable of performing other work – The SSA will consider whether a person is capable of performing any other type of work existing in significant numbers in the national economy. The SSA will consider whether, despite the person’s impairment, there is a functional residual capacity to perform work. If not, the person is considered disabled.
Payment of Disability Benefits
Following a five month waiting period, a disabled person is entitled to the payment of disability benefits. Disability benefits will end once the person is able to engage in a substantial gainful activity or the disability improves significantly.
Reduction and Termination of Benefits
Benefits are reduced or terminated under certain circumstances. Benefits will terminate when the person obtains full retirement age or dies. A person may receive reduced benefits if he receives other government payments for lost earning capacity. A person may go back to work for a trial period to determine if he is able to work without losing benefits.
Continuing Periodic Disability Review
The SSA conducts reviews of relevant evidence and requires periodic medical examinations of recipients to determine their continued right to benefits. The SSA notifies a recipient in writing of the review and its requirements.
A person may be eligible for Social Security Disability benefits is he is no longer able to engage in a substantial gainful activity, suffers from a severe physical or mental impairment, is incapable of performing the type of work he performed in the past, or is incapable of performing any other type of work.