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Social Security Disability Insurance (SSDI) is a payroll tax-funded, federal insurance program of the United States government. SSDI, managed by the Social Security Administration, is designed to provide income to people who are unable to work because of a disability. SSDI is intended to be provided until their condition improves, and is intended to guarantee income if the individual's condition does not improve.

SSDI is a social insurance program, and benefits are only granted after a lengthy determination process, whereby the applicant must prove that they are disabled. SSDI is contrasted with Supplemental Security Income ("SSI"), a welfare, or needs-based program administered by the Social Security Administration for people who demonstrate financial and resource poverty, in addition to medical disability. Applicants for SSDI are often required to concurrently apply for SSI if they may qualify, and vice versa.

Informal names for SSDI include Disability Insurance Benefits (DIB) and Title II benefits, named for the chapter title of the governing section of the Social Security Act.

Contents

Qualification

According to the Social Security Administration (SSA), a person qualifies for SSDI if they:

  • have a physical or mental condition that prevents them from engaging in any "substantial gainful activity" ("SGA"), and
  • the condition is expected to last at least 12 months or result in death, and
  • they are under the age of 65, and
  • generally, have worked 5 out of the last 10 years[1] as of the determined date of onset of disability

The work requirement is waived for applicants who can prove that they became disabled at or before the age of 22, as these individuals may be allowed to collect on their parent's or parents' work credits. The parent(s) experience no loss of benefits.

Medical evidence that demonstrates the applicant's inability to work is required. The applicant may meet a SSA medical listing for their condition.[2] If their condition does not meet the requirements of a listing, their residual functional capacity is considered, along with their age, past relevant work, and education, in determining their ability to perform either their past work, or other work generally available in the national economy. It may take up to five years or more to prove. In most cases, the people who need this are DEAD before they are able to excercise this right. Most people are pushed to the standard attorney (if they can afford one), or stuck in the system. Two years seems to be the minimum, and five the average.

Determination of a residual functional capacity often constitutes the bulk of the SSDI application and appeal process. A residual functional capacity is assessed in accordance with Title 20 of the Code of Federal Regulations, part 404, section 1545[3] by a disability determination service (DDS) or, on appeal, by an administrative law judge (ALJ), and is generally based upon the opinions of treating and examining physicians, if available. The DDS or ALJ may also require the applicant to visit a third-party physician for a medical opinion.

Residual functional capacity is classified according to the five exertional levels of work defined in the Dictionary of Occupational Titles, which are: Sedentary, Light, Medium, Heavy, and Very Heavy. A person is generally not considered disabled if they are found to retain the capacity for work at or above the sedentary level, but persons over 49 or who cannot read or speak English may be found disabled at the light or medium exertional level.

Wait time for applications

The amount of time it takes for an application to be approved or denied varies, depending on the level of the process at which the award is made. In 2006, there were 2,532,264 applications for SSDI.[4] As of March 31, 2007, the number of pending applications (or "backlog") was 1,463,153.[5] Experts have asserted that this backlog is being caused by the increase in applicants, the increase in retiring SSA workers, the inability of the SSA to replace the retiring workers and budget limitations.[6]

The Social Security Administration estimates that the initial benefits application will take 90–120 days, but in practice filings can take up to eight months to complete. The appeals process for denied filings can likewise take 90 days to well over a year to get a hearing, depending on caseloads.[7]

In an attempt to speed up the application process, beginning in August 2006, the SSA implemented changes to the application process in the six-state New England region, on a trial basis. On December 1, 2007, the SSA implemented the program nationwide.[8]

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Timetable

The SSA provided a table of average wait times which were current through the end of fiscal year 2006.[4] These times include awards and denials.

Level Name Wait time
1 Initial application 88
2 Reconsideration never without an attorney
3 Hearing 483
4 Appeals Council 203
5 Federal district court no data

Likelihood of receiving benefits

Nationwide statistics provided by the SSA in 2005 stated that 34 percent of all SSDI applications are ultimately approved.[9]

In these statistics, the breakdown of approvals and denials at each level were:

Level Approval % Denial %  % of denials appealed
Initial application 10 75 12
Reconsideration 12 86 2
Hearing 2 12 98
Appeals Council 33 07 no further appeals, goes to Federal district court

While legal representation is not required by law, the percentages above may tend to favor those with representation, especially when medical evidence is less compelling, and especially at the more advanced stages. As a result, specialized law firms focused on representing SSDI and SSI claimants and have formed a substantial private industry around the Social Security Administration. The AARP is the largest.

Differences between SSDI and Long Term Disability Insurance

  • Social Security provides a regular monthly payment that supplements any current disability benefits already received. It also provides annual cost of living increases. A portion of these benefits may be tax free.
  • Regardless of a person's age, after receiving SSDI benefits for 24 months, they are eligible for Medicare, including Part A (hospital benefits), Part B (medical benefits), and Part D (drug benefits).
  • If a person receives Social Security disability benefits, any COBRA benefits may also be extended from 18 to 29 months.
  • Social Security disability entitlement "freezes" Social Security earnings records during a person's period of disability. Because those years will not be counted when computing future benefits, their Social Security retirement benefits may be lower.
  • If a person receiving Social Security disability benefits has a dependent under age 18, the dependent may also be eligible for benefits.
  • Social Security will provide a person opportunities to return to work while still paying them disability benefits.

References

  1. ^ Barbara C. Wallace. Toward Equity in Health. Springer Publishing Company. http://books.google.com/books?id=x6UPRV73gEwC&pg=PT478&lpg=PT478&dq=. Retrieved 2008-09-11.  
  2. ^ "Listing of Impairments - Adult Listings". Social Security Administration. http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm. Retrieved 2008-02-07.  
  3. ^ "20 CFR § 404.1545, Your Residual Functional Capacity". Social Security Administration. http://edocket.access.gpo.gov/cfr_2006/aprqtr/20cfr404.1545.htm. Retrieved 2008-12-19.  
  4. ^ a b "Performance Section" (PDF). Social Security Administration. http://www.ssa.gov/finance/2006/Performance_Section.pdf. Retrieved 2008-02-07.  
  5. ^ Sylvester J. Schieber, Chairman, Social Security Advisory Board (February 14, 2007). "Testimony Before the Subcommittee on Social Security of the House Committee on Ways and Means". http://waysandmeans.house.gov/hearings.asp?formmode=view&id=5438. Retrieved 2008-02-07.  
  6. ^ prweb.com "AAPD and Allsup Release State Rankings for Disability Backlogs". PRWeb. http://www.prweb.com/releases/2007/7/prweb543829.htm prweb.com. Retrieved 2008-02-07.  
  7. ^ "Navigating Statement of Sylvester J. Schieber, Chairman, Social Security Advisory Board". Committee on Ways and Means, U.S. House of Representatives. 2008-04-23. http://www.ssab.gov/documents/SchieberWaysandMeans042308.pdf. Retrieved 2008-09-11.  
  8. ^ "Commissioner Astrue Extends Social Security’s Quick Disability Determination Nationwide: Final Rule Will Accelerate Benefits to Those Deemed Clearly Disabled". Press release. Social Security Administration. September 5, 2007. http://www.ssa.gov/pressoffice/pr/qdd-process-pr.htm. Retrieved 2008-02-07.  
  9. ^ "Flow of Cases Through The Disability Process: Fiscal Year 2005". Social Security Administration. http://www.ssa.gov/disability/disability_process_welcome_2005.htm. Retrieved 2008-02-07.  

Further reading

External links


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