The Basics of a Disability Case

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The Social Security Administration (SSA) estimates that a twenty-year-old worker in the U.S. has a three-in-ten chance of becoming disabled before he/she reaches the age of retirement. The SSA pays out disability benefits through two separate programs designed to provide financial assistance to disabled or blind persons that are unable to work. The SSA offers disability benefits through the Supplemental Security Income (SSI) program. The SSA manages the SIS program but the U.S. Treasury pays for the program through the general tax fund. The program provides economic support to low-income persons that have suffered a disability, are 65 years-of-age or older, or are blind and have limited resources.

The SSA also provides financial assistance to disabled workers through the Social Security Disability Insurance (SSDI) program. This is a social insurance program that American workers have through a payroll tax plan established by the Federal Insurance Contributions Act (FICA). The amount of monthly benefit afforded to a disabled worker is based on the amount of credits a worker has earned on his/her earnings record. The credits are earned through the payroll tax contributions to FICA.

Supplemental Security Income (SSI)

SSI is a Federal program designed to supplement the funds of disabled Americans with low income and limited resources. The program provides economic assistance for basic needs like shelter, food, and clothing. The program provides monthly benefit payments to assist afflicted individuals. No money is taken from the Social Security Tax Fund to pay for SSI benefits; the program is funded through general tax funds.

In order for a disabled person to qualify for SSI benefits, he/she must meet the financial and living arrangement requirements designated by the SSA. To be eligible for SSI benefits a person must be:

  • Age 65 or older
  • Blind or disabled adult
  • Blind or disabled child under 18 years of age

The SSA takes into account the income and assets of a disabled person when considering the eligibility for benefits. If the person is married, the administration will consider the income and assets of the spouse as well. If the disabled person is employed, he/she is allowed to deduct any assistance items or services used to help the person work. These items and services may include a wheelchair for a disabled person or transportation expenses for a blind person. Some of the resources or assets that the SSA takes into account when considering someone for SSI eligibility include cash, real estate, bank accounts, investments, and stocks and bonds.

Some of the resources and assets that are not considered by the administration when determining SSI eligibility include:

  • Personal residence
  • Life insurance policy with a face value of $1,500 or less
  • Burial plots for the claimant and immediate family members
  • Personal automobile (generally)
  • Burial funds of up to $1,500 each for the claimant and spouse

In the case of a disabled child, the SSA will consider the income the child earns as well as the income and resources of the entire household. If the child is a student, the SSA will not include a portion of the wages earned by the student or scholarships received. The child must suffer from a mental or physical condition that seriously limits his/her activities and the condition must last or be expected to last twelve months or more or end in death. The SSA regards some medical conditions so sever and limiting that they will make immediate payments for up to six months if a child is afflicted with any of these conditions.

These severe and limiting conditions include:

  • HIV infection
  • Complete blindness
  • Complete deafness
  • Cerebral palsy
  • Downs syndrome
  • Muscular dystrophy
  • Severe mental retardation in a child seven years of age or older
  • Extremely low birth weight (less than two pounds, 10 ounces)

Social Security Disability Insurance (SSDI)

SSDI pays disability benefits through payroll taxes collected by Social Security from employers, employees, and self-employed American workers. A worker is eligible for SSDI as an insured worker through the Social Security program if he/she paid FICA taxes. As a worker pays into these taxes, he/she earns social insurance credits. A disabled person must meet certain criteria outlined by the SSA in order to qualify for disability benefits.

To qualify for SSDI benefits a person must be:

  • A disabled or blind worker
  • Widow/widower of a disabled worker
  • An adult child that became disabled before the age of 22
  • The divorced spouse of a qualifying disabled spouse if:
  • The couple was married for at least 10 years
  • The divorced spouse is not remarried
  • The divorced spouse is age 62 or older

Any benefits paid to a divorced spouse will not decrease the benefits owed to the insured worker or to his/her present spouse or dependants.

Certain family members of an insured worker can qualify for benefits based on the work and earnings record of that worker.

Family members that can qualify for benefits include:

  • The spouse of a disabled worker that is at least 62 years of age
  • The spouse of a disabled worker of any age that is caring for a child of the disabled worker if the child is younger than 16 years old or disabled
  • The unmarried child or adopted child of a disabled worker under the age 18 or under the age 19 if the child is in elementary or secondary school full time
  • The unmarried stepchild or grandchild of a disabled worker under the age 18 or under the age 19 if the child is in elementary or secondary school full time (in certain situations)
  • The unmarried child of a disabled worker that is 18 years of age or older if he/she has a disability that began before the age of 22

The SSA uses two earnings tests to decide if a worker qualifies for SSDI benefits, they are:

  • The Recent Work Test – This test is used to determine the eligibility of the claimant based on the age of the worker at the time he/she became disabled
  • The Duration of Work Test – This test is used to determine whether the worker has worked long enough to qualify for Social Security disability benefits

Documentation Required by the Social Security Administration

In order for the SSA to process a claim, the administration will need certain and very specific documentation from the claimant and any qualifying family member applying for disability benefits. The SSA has a basic application for disability benefits that must be completed. In addition to this application, the administration will require other forms and documentation that will have to be completed and turned in with the application.

The SSA will require a form that assembles information about the medical condition of the disabled person and how it affects their ability to work. The claimant will also need to sign a form that gives the SSA the authority to collect personal treatment, healthcare, and medical condition information from any doctors, hospitals, and any other health care professionals that have provided treatment to the claimant.

Other personal information documentation required by the SSA includes:

  • The Social Security number of the disabled worker and any family member applying for benefits
  • The birth or baptismal certificate of the disabled worker and any family member applying for benefits
  • Names, addresses, phone numbers, of any doctors, caseworkers, hospitals, and clinics that treated the disabled worker as well as the dates of visits
  • Names and dosage of all medicines the disabled worker may be taking
  • Medical records from any doctors, therapists, hospitals, clinics, and caseworkers that the claimant may have in their possession
  • Laboratory and test results
  • A summary describing the employer and type of employment the claimant did before he/she became disabled
  • A copy of the most recent W-2 or, if self-employed, the federal tax return for the past year.

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