Social Security Administration

Social Security Disability Benefits

SSA Publication No. 05-10029

May 1996

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Who Should Read This Information

You should, if you want to know more about the various kinds of disability benefits available from Social Security. This booklet will tell you who is eligible, how to apply, and what you need to know once benefits start.

We pay disability benefits under two programs: the Social Security disability insurance program and the Supplemental Security Income (SSI) program. The medical requirements for disability payments are the same under both programs and a person’s disability is determined by the same process. While eligibility for Social Security disability is based on prior work under Social Security, SSI disability payments are made on the basis of financial need. And there are other differences in the eligibility rules for the two programs. This booklet deals primarily with the Social Security disability program. For information on SSI disability payments, ask at any Social Security office for the booklet, SSI (Publication No. 05-11000).

Please Note: This booklet provides a general overview of the Social Security disability program. The information it contains is not intended to cover all provisions of the law. For specific information about your case, contact Social Security.

Part 1–Introduction To Disability And Social Security
What We Mean By Disability
Who Can Get Social Security Disability Benefits?
Disability Benefits For People With HIV Infection
Disability Benefits For Children
How Much Work You Need

Part 2–Signing Up For Disability
How To Apply
How To Speed Up Your Claim
Who Decides If You Are Disabled?
How We Determine Disability
Rules For Blind Persons
If Your Claim Is Denied

Part 3–When Your Claim Is Approved
Your First Check
How Much You Will Get From Social Security
How Other Payments Affect Benefits
Benefits May Be Taxed
You Can Get Medicare If You’re Disabled
Reviewing Your Disability
What Can Cause Benefits To Stop?

Part 4–Going Back To Work
Benefits While You Work

For More Information

Other Booklets Available

Part 1–Introduction To Disability And Social Security

Disability is something most people don’t like to think about. But the chances of your becoming disabled are probably greater than you realize. In fact, studies show that one out of four young workers will become disabled some time during his or her lifetime.

It’s a fact that, while most people spend time working to succeed in their jobs and careers, few think about ensuring that they have a safety net to fall back on should the unthinkable happen. This is where Social Security comes in. We pay cash benefits to people who are unable to work for a year or more because of a disability. Benefits continue until a person is able to work again on a regular basis, and a number of work incentives are available to ease the transition back to work.

What We Mean By Disability

It’s important that you understand how Social Security defines disability. That’s because different programs have different bases for determining disability. Some programs may pay for partial disability or for short-term disability. Social Security does not.

Disability under Social Security is based on your inability to work. You will be considered disabled if you are unable to do any kind of work for which you are suited and your disability is expected to last for at least a year or to result in death.

Some consider this a strict definition of disability and it is. The program assumes that working families have access to other resources to provide support during periods of short-term disabilities, including workers compensation, insurance, savings, and investments. It is designed to provide a continuing income to you and your family when you are unable to do so. Benefits continue as long as you remain disabled.

Who Can Get Social Security Disability Benefits?

You can receive Social Security disability benefits at any age. If you are receiving disability benefits at age 65, they become retirement benefits, although the amount remains the same. Certain members of your family may also qualify for benefits on your record. They include:

• Your unmarried son or daughter, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under 18 or under 19 if in high school full time.
• Your unmarried son or daughter, 18 or older, if he or she has a disability that started before 22. (If a disabled child under 18 is receiving benefits as a dependent of a retired, deceased, or disabled worker, someone should contact Social Security to have his or her checks continued at 18 on the basis of disability.)
• Your spouse who is 62 or older, or any age if he or she is caring for a child of yours who is under 16 or disabled and also receiving checks.

Certain family members may qualify for disability benefits if you should die. They include:

• Your disabled widow or widower 50 or older. The disability must have started before your death or within seven years after your death. (If your widow or widower caring for your children receives Social Security checks, she or he is eligible if she or he becomes disabled before those payments end or within seven years after they end.)

Disability Benefits For People With HIV Infection

People with HIV infection or AIDS may also qualify for disability benefits when they are no longer able to work. Some people with HIV infection that has not progressed to AIDS may be just as severely disabled as a person with AIDS and, therefore, just as likely to qualify for disability. For more information, ask for the booklet A Guide to Social Security And SSI Disability Benefits For People With HIV Infection (Publication No. 05-10020).

Disability Benefits For Children

In recent years, there has been a growing concern about whether parents are aware of the disability benefits that are available for their disabled children. More than 900,000 children under 18 who have disabilities currently receive such benefits; many suffer some form of mental retardation, others from various childhood conditions.

SSI disability benefits are payable to people of any age with a disability, including children. For more information, ask Social Security for the booklets SSI (Publication No. 05-11000) and Benefits For Children With Disabilities (Publication No. 05-10026).

Social Security dependents benefits are payable to children under 18 if a parent is receiving retirement or disability benefits or is deceased. These benefits may also be paid to children 18 or older who were disabled before age 22. Benefits will continue into their adult years as long as they remain disabled.

How Much Work You Need

To qualify for Social Security disability benefits, you must have worked long enough and recently enough under Social Security. You earn up to a maximum of four credits per year. The amount of earnings required for a credit increases each year as general wage levels rise. Family members who qualify for benefits on your work record do not need work credits. The number of work credits needed for disability benefits depends on your age when you become disabled. Generally you need 20 credits earned in the last 10 years ending with the year you become disabled. However, younger workers may also qualify with fewer credits: The rules are as follows:

• Before age 24–You may qualify if you have six credits earned in the three-year period ending when your disability starts.
• Age 24 to 31–You may qualify if you have credit for having worked half the time between 21 and the time you become disabled. For example, if you become disabled at age 27 you would need credit for three years of work (12 credits) out of the past six years (between age 21 and age 27).
• Age 31 or older–In general, you will need to have the number of work credits shown in the chart shown below. Unless you are blind, at least 20 of the credits must have been earned in the 10 years immediately before you became disabled.

Born After 1929,    CreditsBecome Disabled At Age   You Need31 through 42    20 44     22 46     24 48     26 50     28 52     30 54     32 56     34 58     36 60     3862 or older     40

Part 2–Signing Up For Disability

How To Apply

You should apply at any Social Security office as soon as you become disabled. (You may file by phone, mail, or by visiting the nearest office.) However, Social Security disability benefits will not begin until the sixth full month of disability. This waiting period begins with the first full month after the date we decide your disability began.

How To Speed Up Your Claim

The claims process for disability benefits is generally longer than for other types of Social Security benefits from 60 to 90 days. It takes longer to obtain medical information and to assess the nature of the disability in terms of your ability to work. However, you can help shorten the process by bringing certain documents with you when you apply and helping us to get any other medical evidence you need to show you are disabled. These include:

• The Social Security number and proof of age for each person applying for payments. This includes your spouse and children, if they are applying for benefits.
• Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment.
• Names of all medications you are taking.
• Medical records from your doctors, therapists, hospitals, clinics, and caseworkers.
• Laboratory and test results.
• A summary of where you worked in the past 15 years and the kind of work you did.
• A copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year.
• Dates of prior marriages if your spouse is applying.

Do not delay filing for benefits just because you do not have all of the information you need. The Social Security office will be glad to help you.

Who Decides If You Are Disabled?

After helping you complete your application, the Social Security office will review it to see if you are eligible to apply for disability benefits. These include such factors as whether you have worked long enough and recently enough to qualify for disability benefits, your age, and,if you are applying for benefits as a family member, your relationship to the worker. The office will then send your application to the Disability Determination Services (DDS) office in your state. There, a decision will be made as to whether you are disabled under the Social Security law.

In the DDS office, a team consisting of a physician (or psychologist) and a disability evaluation specialist will consider all the facts in your case and decide if you are disabled. They will use the medical evidence from your doctors and from hospitals, clinics, or institutions where you have been treated. Again, the quicker we get the evidence, the faster your claim will be processed. This is why we suggest you bring any copies of your medical reports you have with you. You should also be sure to contact the doctors and treatment facilities to let them know we will be requesting medical evidence in your case.

On the medical report forms, your doctors or other sources are asked for a medical history of your condition: what is wrong with you; when it began; how it limits your activities; what the medical tests have shown; and what treatment has been provided. They are also asked for information about your ability to do work-related activities, such as walking, sitting, lifting, and carrying. They are not asked to decide whether you are disabled.

Additional medical information may be needed before the DDS team can decide your case. If it is not available from your current medical sources, you may be asked to take a special examination called a consultative examination. Your doctor or the medical facility where you have been treated is the preferred source to perform this examination. Social Security will pay for the examination or any other additional medical tests you may need, and for certain travel expenses related to it.

Social Security’s rules for determining disability differ from those in other government and private programs. However, a decision made by another agency and the medical reports it obtains may be considered in determining whether you are disabled under Social Security rules.

Once a decision on your claim is reached, you will receive a written notice from the Social Security Administration. If your claim is approved, the notice will show the amount of your benefit and when payments start. If it is not approved, the notice will explain why.

How We Determine Disability

You should be familiar with the process we use to determine if you are disabled. It’s a step-by-step process involving five questions. They are:

1. Are you working? If you are and your earnings average more than $500 a month, you generally cannot be considered disabled.

2. Is your condition severe? Your impairments must interfere with basic work-related activities for your claim to be considered.

3. Is your condition found in the list of disabling impairments? We maintain a list of impairments for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step.

4. Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then we must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.

5. Can you do any other type of work? If you cannot do the work you did in the last 15 years, we then look to see if you can do any other type of work. We consider your age, education, past work experience, and transferable skills, and we review the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.

Rules For Blind Persons

You are considered blind under Social Security rules 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, even with a corrective lens.

There are a number of special rules for persons who are blind. The rules recognize the severe impact of blindness on a person’s ability to work. For example, the earnings limit for people who are blind is generally higher than the $500 limit that applies to non-blind disabled workers. This figure changes annually. For current figures and other information on special rules for persons who are blind, ask for the leaflet If You Are Blind…How We Can Help (Publication No. 05-10052).

If Your Claim Is Denied

If your claim is denied or you disagree with any other decision we make, you may appeal the decision. The Social Security office will help you complete the paperwork.

There are four levels of appeal. If you disagree with the decision at one level, you may appeal to the next level. You have 60 days from the time you receive the decision to file an appeal to the next level. We assume that you receive the decision five days after the date on it, unless you can show us that you received it later. For more information about appeals, ask for the factsheet, The Appeals Process (Publication No. 05-10041).

Part 3–When Your Claim Is Approved

Your First Check

Once a decision is made that you are disabled, you will receive your first Social Security disability check dating back to the sixth full month from the date we decide your disability began (but no more than one year of back benefits can be paid). You also will receive a booklet describing your responsibilities as a Social Security beneficiary: What You Need To Know When You Get Disability Benefits (Publication No. 05-10153). You should read this booklet carefully and keep it in a safe place with your other valuable papers in order to refer to it whenever questions arise.

How Much You Will Get From Social Security

The amount of your monthly disability benefits is based on your lifetime average earnings covered by Social Security. If you would like an estimate of your disability benefit, all you have to do is call or visit Social Security and ask for it. We’ll send you a form you can use to get a Personal Earnings and Benefit Estimate Statement.

How Other Payments Affect Benefits

Eligibility for other government benefits can affect the amount of your Social Security disability benefits.

Other Disability Benefits

Social Security benefits may be affected if you are also eligible for workers’ compensation (including black lung) or for disability benefits from certain federal, state, local government, Civil Service, or military disability programs. Total combined payments to you and your family from Social Security and any of these other programs generally cannot exceed 80 percent of your average current earnings before becoming disabled. (Note that for income tax purposes, your unreduced benefit is counted.)

Government Pension Offset

If you are a disabled widow or widower or the spouse of a disabled worker, a government pension offset may reduce your Social Security payment. The offset applies if you become eligible for a federal, state, or local government pension based on your own work not covered by Social Security. The amount of your Social Security spouse’s benefit may be reduced by two-thirds of the amount of your government pension.

There are some exceptions when the offset would not apply. For more information, call or visit Social Security to ask for a free copy of the factsheet Government Pension Offset (Publication No. 05-10007).

Pension From Work Not Covered By Social Security If you become disabled and entitled to a Social Security disability benefit and you also receive a monthly pension based on work not covered by Social Security, your disability payment will be smaller than normal. That’s because we use a different formula to figure the Social Security benefit of people who get other public pensions.

For more information, call or visit Social Security to ask for a free copy of the factsheet A Pension From Work Not Covered By Social Security (Publication No.05-10045).

Benefits May Be Taxed

Some people have to pay federal income taxes on their Social Security benefits. This usually happens only if your total income is high. At the end of the year, you will receive a Social Security Benefit Statement (Form SSA-1099) showing the amount of benefits you received. The statement is to be used for completing your federal income tax return if any of your benefits are subject to tax. You may use the Internal Revenue Service Publication 915 for additional information on the tax.

You Can Get Medicare If You’re Disabled

You will be automatically enrolled in Medicare after you have been getting disability benefits for two years.

Medicare has two parts hospital insurance and medical insurance. Hospital insurance helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this coverage, so it’s premium free if you’re eligible. The other part of Medicare, medical insurance, helps pay doctors’ bills and other services. You pay a monthly premium for this coverage if you want it. Most people have both parts of Medicare.

Help For Low-Income Medicare Beneficiaries

If you get Medicare and have low income and few resources, your state may pay your Medicare premiums and, in some cases, other out-of-pocket Medicare expenses such as deductibles and coinsurance. Only your state can decide if you qualify. To find out if you do, contact your state or local welfare office or Medicaid agency. For more general information about the program, contact Social Security and ask for the leaflet Medicare Savings For Qualified Beneficiaries (HCFA Publication No. 02184).

Reviewing Your Disability

Your benefits will continue as long as you are disabled. However, your case will be reviewed periodically to see if you are still disabled. The frequency of the reviews depends on the expectation of recovery.

If medical improvement is expected, your case will normally be reviewed within six to 18 months.

If medical improvement is possible, your case will normally be reviewed no sooner than three years.

If medical improvement is not expected, your case may be reviewed no sooner than seven years.

What Can Cause Benefits To Stop?

There are two things that can cause us to decide that you are no longer disabled and to stop your benefits.

Your benefits will stop if you work at a level we consider substantial. Usually, average earnings of $500 or more a month are considered substantial.

Your disability benefits would also stop if we decide that your medical condition has improved to the point that you are no longer disabled.

You must promptly report any improvement in your condition, your return to work, and certain other events as long as you are receiving benefits. These responsibilities are explained in the booklet you will receive when benefits start.

Part 4–Going Back To Work

Benefits While You Work

If you’re like most people, you would rather work than try to live on disability benefits. There are a number of special rules that provide cash benefits and Medicare while you attempt to work. We call these rules work incentives. You should be familiar with these disability work incentives so you can use them to your advantage.

If you are receiving Social Security disability benefits, the following work incentives apply:

• Trial Work Period–For nine months (not necessarily consecutive), you may earn as much as you can without affecting your benefits. (The nine months of work must fall within a five-year period before your trial work period can end.) A trial work month is any month in which you earn more than $200. After your trial work period ends, your work is evaluated to see if it is substantial. If your earnings do not average more than $500 a month, benefits will generally continue. If earnings do average more than $500 a month, benefits will continue for a three-month grace period before they stop.
• Extended Period of Eligibility–For 36 months after a successful trial work period, if you are still disabled, you will be eligible to receive a monthly benefit without a new application for any month your earnings drop below $500.
• Deductions for Impairment-Related Expenses–Work expenses related to your disability will be discounted in figuring whether your earnings constitute substantial work.
• Medicare Continuation–Your Medicare coverage will continue for 39 months beyond the trial work period. If your Medicare coverage stops because of your work, you may purchase it for a monthly premium.

Different rules apply to SSI recipients who work. For more information about Social Security and SSI work incentives, ask for a copy of the booklet Working While Disabled … How We Can Help (Publication No. 05-10095).

For More Information

You can get more information 24 hours a day by calling Social Security’s toll-free number: 1-800-772-1213. You can speak to a service representative between the hours of 7 a.m. and 7 p.m. on business days. Pre-recorded information and services also are available during and after normal business hours.

If you want to speak to a representative, it’s best to call later in the week and later in the month. When you call, have your Social Security number handy.

Hearing-impaired callers using TTY equipment can reach Social Security between 7 a.m. and 7 p.m. weekdays by calling 1-800-325-0778.

The Social Security Administration treats all calls confidentially–whether they’re made to our toll-free numbers or to one of our local offices. We also want to ensure that you receive accurate and courteous service. That is why we have a second Social Security representative monitor some incoming and outgoing telephone calls.

Other Booklets Available

Social Security has a number of publications that contain information about other Social Security programs. Contact Social Security to get a free copy of any of these publications. They include:

Understanding The Benefits (Publication No.05-10024)–A comprehensive explanation of all the Social Security programs.

Retirement (Publication No. 05-10035)–Explains Social Security retirement benefits.

Survivors (Publication No. 05-10084)–Explains Social Security survivors benefits.

Medicare (Publication No. 05-10043)–Explains Medicare hospital insurance and medical insurance.

SSI (Publication No. 05-11000)–Explains this program, which provides a basic income to people who are 65 or older, disabled, or blind and have limited income and resources.

Benefits For Children With Disabilities (Publication No. 05-10026)–Explains benefits available to children with disabilities.

Working While Disabled . . . How We Can Help (Publication No. 05-10095) Explains work incentives for Social Security and SSI beneficiaries.

If You Are Blind . . . How We Can Help (Publication No. 05-10052)–Explains benefits available to persons who are blind.

Most of these publications are also available in Spanish. Social Security information is also available to users of the Internet. Type https://www.ssa.gov to access Social Security information on the Internet.

Social Security Administration
SSA Publication No. 05-10029
May 1996
ICN 456000

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