SSA Disability Benefits Determination Process
In order to determine if you are eligible for Social Security disability benefits, you must first understand the SSA disability benefits determination process. It is broken into two parts: non-medical eligibility & medical eligibility requirements.
Am I Disabled According to the SSA?
To meet social security’s definition of disability, you must be unable to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s):
- That is expected to result in death, or
- That has lasted or is expected to last for a continuous period of at least 12 months.
There are some exceptions to this rule that are based on your work history, acquired work skill and your age.
These exceptions are referred to as the grid rules. Essentially those exceptions hold that if you are (1) at a certain age, the key ages being 50, 55 and 60, and (2) the work skills that you have acquired do not transfer easily into less physically demanding work, then you are disabled.
What is Substantial Gainful Activity (SSG)?
The first test a decision-maker must go through in determining whether or not you can work is through the "Are you working?" test.
If you are working, you can’t be found unable to work.
That determination has two parts.
- You need to be making less than a certain amount of money. SSA calls this substantial gainful activity (SGA).
- You must not be engaging in a work activity consisting of 40 hours a week or more.
If you are earning more than an SGA person who is earning more than a certain monthly amount (net of impairment-related work expenses), it is ordinarily considered to be engaging in SGA.
The amount of monthly earnings considered as SGA depends on the nature of a person's disability. The Social Security Act specifies a higher SGA amount for statutorily blind individuals; Federal regulations specify a lower SGA amount for non-blind individuals.
Both SGA amounts generally change with changes in the national average wage index.
Am I Insured by the SSA?
In order to be eligible for the SSD program, as discussed in our earlier blog, you must first be disabled. The second requirement is that you must be “insured”. It is possible to be insured for retirement benefits and not insured for disability benefits, but because I already discussed the disability aspect of the social security program, we will only discuss the word “insured” as it applies to the disability program.
The buzzword used in the social security disability world is “quarters of coverage”, but we will often use the term “credits” or “work credits”. A quarter refers to the different quarters of a calendar year, for instance Jan – Mar, April – June, July – Sept, Oct – Dec. In order to obtain a work credit, a person must earn a specific amount of income during that quarter. For the year 2015, that amount is $1,220. Like the new cell phone commercials, you do get to keep your rollover credits. So if you earned $3,000 in one quarter, but failed to work in the next, you would get the $1,220 credit for the first quarter and the remainder would roll over and count as a credit for the next quarter.
Most workers must satisfy the “20/40” rule. This means that you must have at least 20 quarters out of the last 40 quarters ending in the quarter that you became disabled. A good rule of thumb is that you must have worked 5 out of the last 10 years.
Workers under the age of 31 don’t have to satisfy the 20/40 requirement. They need to have work credits in half of the quarters between age 21 and the date of onset of disability. So a worker who becomes disabled at age 25, would have four years, times four quarters per year or 16 total quarters of potential work periods. Those workers would have to have accumulated 8 credits, which is half the number of potential quarters in order to be eligible for the program. The minimum amount of work credits to be eligible under this program is 6 however.
What is Social Security Disability Insurance?
Social Security Disability Insurance is a program run by the Social Security Administration.
As discussed earlier, this program came into existence in 1956.
The current goal of the program is to provide a disability benefit to individuals covered under the program when they are no longer able to work or their acquired work skills do not easily transfer into other types of work.
The primary beneficiary of this program is an individual who has worked on a regular basis and who through a physical or mental impairment is no longer able to participate in the workforce and is expected to be unable to return to the workforce for at least a year.
It’s easy to think of SSD as any other type of insurance like car or health. Once you accumulate enough work credits, which is done by working, you are covered by this insurance policy.
If you become ill or injured the policy is there to provide you a safety net by giving you not only a monthly income stream, but it also provides you with Generally, the federal health insurance program for people 65 and older or those that have been found disabled by Social Security for 24 months or longer. More. Also just like car insurance, if you fail to purchase it or fail to pay the premiums the policy expires and you are not covered.
In the case of SSD, if you have not worked and thus have not accumulated enough work credits or if it has been so long since you have worked that you are no longer insured by the program, you cannot receive benefits under the program.
Social Security Disability Benefits Amounts 2021
The monthly SGA amount for statutorily blind individuals for 2021 is $2190. For non-blind individuals, the monthly SGA amount for 2021 is $1310. SGA for the blind does not apply to Supplemental Security Income (SSI) benefits, while SGA for the non-blind disabled applies to Social Security and SSI benefits. See historical series of SGA amounts below.
Trial Work Period
After a person becomes eligible for disability benefits, the person may attempt to return to the workforce. As an incentive, we provide a trial work period in which a beneficiary may have earnings and still collect benefits.