Social Security Articles Basics of Social Security Disability
Basics of Social Security Disability

Supplemental Security Income (SSI) makes monthly payments to people with low income and limited resources who are 65 or older, or blind or disabled. Your child younger than age 18 can qualify if he or she meets Social Security’s definition of disability for children, and if his or her income and resources fall within the eligibility limits. The amount of the SSI payment is different from one state to another because some states add to the SSI payment.

When Social Security Administration (SSA) decides if your child can get SSI, they consider your child’s income and resources. They also consider the income and resources of family members living in the child’s household. These rules apply if your child lives at home. They also apply if he or she is away at school but returns home from time to time and is subject to your control. If your child’s income and resources, or the income and resources of family members living in the child’s household, are more than the amount allowed, they will deny the child’s application for SSI payments.

SSA limits the monthly SSI payment to $30 when a child is in a medical facility where health insurance pays for his or her care. Your child must meet all of the following requirements to be considered disabled and therefore eligible for SSI:

  1. The child must not be working and earning more than $1,070 a month in 2014. (This earnings amount usually changes every year.) If he or she is working and earning that much money, we will find that your child is not disabled.
  2. The child must have a physical or mental condition, or a combination of conditions, that results in “marked and severe functional limitations.” This means that the condition(s) must very seriously limit your child’s activities.
  3. The child’s condition(s) must have been disabling, or be expected to be disabling, for at least 12 months; or
  4. must be expected to result in death. If your child’s condition(s) results in “marked and severe functional limitations” for at least 12 continuous months, we will find that your child is disabled. But if it does not result in those limitations, or does not result in those limitations for at least 12 months, we will find that your child is not disabled.

When you apply for benefits for your child, SSA will ask you for detailed information about the child’s medical condition and how it affects his or her ability to function on a daily basis. They also will ask you to give permission for the doctors, teachers, therapists and other professionals who have information about your child’s condition to send the information to us. If you have any of your child’s medical or school records, please bring them with you. This will help speed up the decision on your application.

SSA will then send all of the information you give them to the Disability Determination Services in your state. Doctors and other trained staff in that state agency will review the information, and will request your child’s medical and school records, and any other information needed to decide if your child is disabled.

If the state agency cannot make a disability decision using only the medical information, school records and other facts they have, they may ask you to take your child for a medical examination or test. SSA will may make immediate SSI payments to your child.  It can take three to five months for the state agency to decide if your child is disabled. However, for some medical conditions, they make SSI payments right away and for up to six months while the state agency decides if your child is disabled.

The following are some conditions that may qualify:

  1. HIV infection;
  2. Total blindness;
  3. Total deafness;
  4. Cerebral palsy;
  5. Down syndrome;
  6. Muscular dystrophy;
  7. Severe intellectual disorder (child age 7 or older); and
  8. Birth weight below 2 pounds,10 ounces.

If your child has one of the qualifying conditions, he or she will get SSI payments right away. However, the state agency may finally decide that your child’s disability is not severe enough for SSI. If that happens, you will not have to pay back the SSI payments that your child got.

Once your child starts receiving SSI, the law requires that they review your child’s medical condition from time to time to verify that he or she is still disabled. This review must be done:

  1. At least every three years for children younger than age 18whose conditions are expected to improve; and
  2. By age 1 for babies who are getting SSI payments because of their low birth weight, unless they determine

their medical condition is not expected to improve by their first birthday and schedule the review for a later date.

SSA may perform a disability review even if your child’s condition is not expected to improve. When they do a review, you must present evidence that your child is and has been receiving treatment that is considered medically necessary for your child’s medical condition. For disability purposes in the SSI program, a child becomes an adult at age 18, and we use different medical and nonmedical rules when deciding if an adult can get SSI disability payments. For example, we do not count the income and resources of family members when deciding whether an adult meets the financial limits for SSI. They count only the adult’s income and resources. They also use the disability rules for adults when deciding whether an adult is disabled. If your child is already receiving SSI payments, we must review the child’s medical condition when he or she turns age 18. They usually do this review during the one-year period that begins on your child’s 18th birthday. If your child was not eligible for SSI before his or her 18th birthday because you and your spouse had too much income or resources, he or she may become eligible for SSI at age 18.

In general, to get disability benefits, you must meet two different earnings tests:

  • A “recent work” test based on your age at the time you became disabled; and
  • A “duration of work” test to show that you worked long enough under Social Security.

Certain blind workers have to meet only the “duration of work” test. The following table shows the rules for how much work you need for the “recent work” test based on your age when your disability began. The rules in this table are based on the calendar quarter in which you turned or will turn a certain age.

The calendar quarters are:

First Quarter: January 1 through March 31;

Second Quarter: April 1 through June 30;

Third Quarter: July 1 through September 30; and

Fourth Quarter: October 1 through December 31.

If you become disabled, then you generally need: In or before the quarter you turn age 24 1.5 years of work during the three-year period ending with the quarter your disability began. In the quarter after you turn age 24 but before the quarter you turn age 31. Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled.

Example: If you become disabled in the quarter you turned age 27, then you would need three years of work out of the six-year period ending with the quarter you became disabled. In the quarter you turn age 31 or later, work during five years out of the 10- year period ending with the quarter your disability began.

If you have never asked Social Security about receiving benefits based on your ex-spouse’s work, you should do so. Many women get a higher benefit based on their ex-spouse’s work, especially if that spouse is deceased. When you apply, you will need to give your spouse’s Social Security number. If you do not know your spouse’s number, you will need to provide your spouse’s date and place of birth and your spouse's parents’ names.

The following requirements also apply to your divorced spouse if your ex-spouse’s eligibility for benefits is based on your work.

If your ex-spouse is living.

If you are divorced, you can receive benefits based on your ex-spouse’s work if:

  • Your marriage lasted 10 years or longer;
  • You are unmarried;
  • You are age 62 or older;
  • The benefit you are entitled to receive based on your own work is less than the benefits you would receive on your
  • spouse’s work; and
  • Your ex-spouse is entitled to Social Security retirement or disability benefits.

If your spouse has not applied for benefits, but can qualify for them and is age 62 or older, you can receive benefits on your ex-spouse’s work if you two have been divorced for at least two years. Former spouses who are full retirement age may both file on each other’s record and postpone applying on their own to earn delayed retirement credits.

If your ex-spouse is deceased, you can receive benefits:

  • At age 60, or age 50 if you are disabled, if your marriage lasted at least 10 years, and you are not entitled to a higher benefit on your own record.
  • At any age if you are caring for your ex-spouse’s child who also is your natural or legally adopted child and younger than 16 or disabled and entitled to benefits. Your benefits will continue until the child reaches age16 or is no longer disabled. You can receive this benefit even though you were not married to your ex-spouse for10 years.

The Social Security Administration (SSA) has a five step process when reviewing a disability claim.

Are you working?

If you are working and your earnings average more than a certain amount each month, we generally will not

consider you disabled. The amount changes each year. For the current figure, see SSA annual update (Publication No. 05-10003). If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.

Is your medical condition “severe”?

For the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state agency goes on to step three.

Is your medical condition on the List of Impairments?

The state agency has a List of Impairments that describes medical conditions that are considered so severe that they

automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.

Can you do the work you did before?

At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.

Can you do any other type of work?

If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.

An adult disabled before age 22 may be eligible for child's benefits if a parent is deceased or starts receiving retirement or disability benefits. We consider this a "child's" benefit because it is paid on a parent's Social Security earnings record. The "adult child"—including an adopted child, or, in some cases, a stepchild, grandchild, or step grandchild and must be unmarried, age 18 or older, and have a disability that started before age 22. It is not necessary that the adult child ever worked. Benefits are paid based on the parent's earnings record.

However, an adult child must not have substantial earnings. The amount of earnings we consider "substantial" increases each year. In 2014, this means working and earning more than $1,070 a month. Certain expenses the adult child incurs in order to work may be excluded from these earnings. For more information about work and disability, refer to Social Security Administration (SSA)'s book, Working While Disabled--How We Can Help. SSA will evaluate his or her disability the same way we would evaluate the disability for any adult. We send the application to the Disability Determination Services in your state that completes the disability decision for us.

If you are blind, Social Security has special rules that allow you to receive benefits when you are unable to work. They pay benefits to people who are blind under two programs:

  • the Social Security disability insurance program; and
  • the Supplemental Security Income (SSI) program.

The medical rules that they use to decide whether you are blind are the same for each program. Disability benefits if you are “legally blind”.  You may qualify for Social Security or SSI disability benefits if you are considered “legally blind.” They consider you to be legally blind if your vision cannot be corrected to better than 20/200 in your better eye, or if your visual field is 20 degrees or less in your better eye.

Disability benefits even if you are not legally blind. If your vision does not meet the legal definition of blindness, you may still qualify for disability benefits if your vision problems alone or combined with other health problems prevent you from working. For Social Security disability benefits, you also must have worked long enough in a job where you paid Social Security taxes. For SSI payments based on disability and blindness, you need not have worked, but your income and resources must be under certain dollar limits.

 

SSA - Social Security Handbook