The “technical” criteria for social security disability

There are two disability programs available if you are unable to work due to medical impairments.  These programs are often confusing.  I have had potential clients tell me, “I don’t want SSI, I want disability.”  But both Disability Insurance and Supplemental Security Income are disability benefits.  The difference is how a disabled person becomes technically qualified for each program.  It’s really confusing, I know.  Some people qualify for both benefits or only one.   Here are some basic facts about each program which may be helpful.

About Disability Insurance (“DIB”)

You qualify for DIB by earning Social Security credits when you work in a job and pay Social Security taxes (FICA, learn more at http://www.ssa.gov/mystatement/fica.htm). Most of us know that the payroll tax that our employer takes out of our paycheck and sends to the federal government is for our retirement.  But that money is also an insurance premium toward coverage for DIB.

How prior work qualifies you for Disability Insurance Benefits

This premium is called a credit or a quarter of coverage. In general, every three months of work earns us one quarter of coverage.  So a full year of work earns us 4 quarters of coverage.  You need 20 quarters during the last 10 years in order to be insured.  So if you have worked full time for the past 10 years, you should be covered for DIB for the next 5 years.

These rules are very complicated and apply differently to everyone because everyone has a different work history.

Also, there are different rules if you are under age 31 or if you were born before 1929.

You can learn more about qualifying for DIB by reading the SSA pamphlet called “How You Earn Credits” and you can find it online at http://www.socialsecurity.gov/pubs/10072.html

Even if you have worked, you may not qualify for DIB

If you have not worked a lot you may not be covered.  Also, some employers do not pay your payroll taxes (like school districts in Texas).  Some people who are self-employed don’t pay their payroll taxes (when their businesses don’t make a profit).  If you are an owner/operator, independent contractor, etc. you may fall into this category.  You can find out if you will be covered for Disability Insurance by reviewing your earnings statement.

About your earnings statement

Your earnings statement includes a record of your earnings history and an estimate of how much you and your employer paid in Social Security taxes; and estimates of benefits you (and your family) may be eligible for now and in the future.

How to get your earnings statement

You can request your earnings statement online at http://www.socialsecurity.gov/mystatement/.  Allow 2-4 weeks to receive your statement.

Or you can go to your local SSA office to request the statement.  You can find your local office address at https://secure.ssa.gov/apps6z/FOLO/fo001.jsp (add your zip code at the prompt).

About Supplemental Security Income (“SSI”)

The other disability program is called Supplemental Security Income (SSI).  It pays benefits to disabled adults and children who have limited income and resources. SSA will ask you about your income and resources and count some in their calculation when they determine whether you are poor enough to qualify.

Counted income

Some income is not counted by SSA (food stamps, tax refund, grants/scholarships for tuition, money from nonprofits to live on, loans you will pay back, the value of impairment-related work expenses).  See a full list at http://ssa.gov/ssi/text-income-ussi.htm.

Other counted income

SSA will want to know the wages of other household residents (spouse, etc) who are working.  Also, SSA will count benefits like WC, Veteran’s, Unemployment.  And you may be asked to figure out the value of free food and shelter from a family member or friend.  SSA will estimate the value of free food and shelter if you are not planning to pay this money back.

Resourses not counted

SSA does not count the following:

  • the home you live in and the land it is on;
  • household goods and personal effects;
  • your wedding and engagement rings;
  • burial spaces for you or your immediate family;
  • burial funds for you and your spouse, each valued at $1,500 or less;
  • life insurance policies with a combined face value of $1,500 or less;
  • one vehicle, regardless of value, if it is used for transportation for you or a member of your household;
  • retroactive SSI or Social Security benefits for up to nine months after you receive them (including payments received in installments);
  • grants, scholarships, fellowships, or gifts set aside to pay educational expenses for 9 months after receipt.

See a complete list and more information at http://ssa.gov/ssi/text-resources-ussi.htm.

Getting rid of resources

If you give away a resource or sell it for less than it is worth in order to reduce your resources below the SSI resource limit, you may be ineligible for SSI for up to 36 months.  See http://www.socialsecurity.gov/ssi/spotlights/spot-transfer-resources.htm

Resource limits

The limit for countable resources is $2,000 for an individual and $3,000 for a couple.

SSA will count the following:

  • cash, bank accounts, stocks, U.S. savings bonds,
  • land,
  • life insurance,
  • personal property,
  • vehicles,
  • anything else you own which could be changed to cash and used for food or shelter.

Also, SSA will consider a portion of these resources if they belong to your spouse.

Other SSI criteria

There are other criteria for SSI.  You must be a legal resident (although some non-citizens can qualify).  You also are ineligible if you live in a public institution, live in Puerto Rico, etc. Learn more at  http://www.socialsecurity.gov/ssi/text-eligibility-ussi.htm.

Bottomline

It’s not enough to just be unable to work due to one or more medical conditions to receive social security disability benefits.  You have to have paid payroll taxes and be “insured” at the time of disability and/or also be poor.  Unfortunately, there will be disabled individuals who do not meet these criteria and who will therefore not “technically” qualify for benefits.  Also, some people will qualify at a certain time but not at other times.  For instance, if you are not insured today but were a year ago and you were disabled a year ago, you may still be able to establish entitlement for DIB.  Or if you are receiving workers compensation benefits now but they will end in a few months, you may not be eligible for SSI now but will when workers compensation benefits end.

Every case is different.  And the amount of a social security disability benefit will be different for each person.

My advice

Don’t let this discourage you from finding out if you are “technically” eligible.  Visit your local social security office and find out about your own eligibility status.

If you need more help with Social Security Disability, Call toll free at 1-800-481-0302.  You can also visit our website.

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