February 27, 2018 |
by the National Care Planning Council
The issue of becoming disabled during working years is often ignored. But the probability is very high that someone will become disabled and may even not be able to work because of it. According to the Social Security website on disability there is a 33% chance that a 20-year-old worker will become disabled before reaching retirement age. This does not necessarily mean the disability would prevent that person from working or allow that person to receive a Social Security disability benefit. Nevertheless, the importance of receiving replacement income in case of disability should not be overlooked.
As part of the planning process, individuals who most recently have experienced an accident, injury or debilitating illness may need some guidance in applying for Social Security disability. We have included information here on some of the basics.
Generally, anyone receiving Social Security disability will continue to receive that income until reaching normal retirement age which for everyone currently younger than 65 is anywhere between 66 and 67 years old. At normal retirement age, the disability income reverts to standard social security income.
Social Security pays benefits to people who cannot work because they have a medical condition that is expected to last at least one year or result in death. Federal law requires this very strict definition of disability. While some programs give money to people with partial disability or short-term disability, Social Security does not.
Certain family members of disabled workers also can receive money from Social Security.
In general, to get disability benefits, an applicant must meet two different earnings tests:
- A "recent work" test based on the age at the time the disability manifested itself; and
- A "duration of work" test to show that the person worked long enough under Social Security.
Certain blind workers have to meet only the "duration of work" test.
Rules for work needed for the "recent work test"
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.
The following table shows examples of how much is needed to meet the "duration of work test" if the disability manifested at various selected ages. For the "duration of work" test, the work does not have to fall within a certain period of time.
NOTE: This table does not cover all situations.
Examples of work needed for the "duration of work" test
If you become disabled... Then you generally need:
Before age 28 1.5 years of work
Age 30 2 years
Age 34 3 years
Age 38 4 years
Age 42 5 years
Age 44 5.5 years
Age 46 6 years
Age 48 6.5 years
Age 50 7 years
Age 52 7.5 years
Age 54 8 years
Age 56 8.5 years
Age 58 9 years
Age 60 9.5 years
Social Security will review a disability application to make sure the applicant meets some basic requirements for disability benefits. They will check whether the person worked enough years to qualify. They will also evaluate any current work activities. If these requirements are met, they will send the application to the Disability Determination Services office in the applicant's state.
This state agency completes the disability decision. Doctors and disability specialists in the state agency ask attending doctors for information about the condition. They will use the medical evidence from doctors and hospitals, clinics or institutions where the applicant has been treated.
The state agency staff may need more medical information before they can decide about disability. If more information is not available from the applicants current medical sources, the state agency may schedule a special examination. Social Security will pay for the exam and for some of the related travel costs.
Social Security uses a five step process to determine disability
1. Is the applicant working?
If the applicant is working and earnings average more than a certain amount each month, Social Security generally will not consider there is a disability. The amount changes each year. For the current figure, see the annual Update (Publication No. 05-10003).
If the applicant is not working, or they monthly earnings average the current amount or less, the state agency then looks at the applicant's medical condition.
2. Is the medical condition "severe"?
For the state agency to decide that a disability exists, they medical condition must significantly limit the applicant's ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If they medical condition is not that severe, the state agency will not consider a disability. If the condition is indeed that severe, the state agency goes on to step three.
3. Is the medical condition on the List of Impairments?
The state agency has a List of Impairments http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm that describes medical conditions that are considered so severe that they automatically result in a determination of disability as defined by law. If the condition (or combination of medical conditions) is not on this list, the state agency looks to see if the applicant's condition is as severe as a condition that is on the list. If the severity of the medical condition meets or equals that of a listed impairment, the state agency will decide that disability will be awarded. If it does not awarded disability, the state agency goes on to step four.
4.Can the applicant do the work he or she did before?
At this step, the state agency decides if the applicant's medical condition prevents him or her from being able to do the work that person did before. The disability allows for the same type of work, the state agency will decide that there is no disability. Otherwise, the state agency goes on to step five.
5.Can the applicant do any other type of work?
If the applicant cannot do the work he or she did in the past, the state agency looks to see if he or she would be able to do other work. It evaluates the medical condition, age, education, past work experience and any skills that could be used to do other work. If the person cannot do other work, the state agency will decide that that person is disabled. If the applicant can do other work, the state agency will decide that there is no disability.
If a person disagrees with a decision made on a claim, it can be appealed. The steps are explained in The Appeals Process (Publication No. 05-10041), which is available from Social Security.
A spouse 62 years or older may also qualify for benefits based on a disabled applicant's work history. In some situations, a divorced spouse may qualify for benefits based on the applicant' s earnings if the marriage lasted at least 10 years, if the divorced spouse is is not currently married and is at least age 62. The money paid to a divorced spouse does not reduce the benefit or any benefits due to a current spouse or children.
Medicare coverage is provided automatically after a beneficiary has received disability benefits for two years.