It can be difficult for a recently injured worker to understand that he or she has become disabled. Disability may not be something you have often thought about before. Hard workers take pride in their work ethic, and because of this pride it may be difficult for them to admit they are disabled. If the worker does not know how to define disability, he or she will have a difficult time determining the nature of their disability. On the other hand, the Social Security Administration (SSA) has a very clear concept of what constitutes a disability. Because the SSA is responsible for managing the Social Security Disability (SSD) and Supplemental Security Income (SSI) programs, all decisions regarding the determination of an individual's eligibility for disability benefits are made according to their definition of disability. Below is an explanation of how the SSA defines disability and the policies they use to make their determinations.
What is the Social Security Disability Program?
If you have ever been a wage earner, you have paid into the Social Security program. The Federal Insurance Contributions Act (FICA) requires that wage earners contribute to a federal fund that supports Social Security and Medicare. The Social Security Disability Program is designed to insure workers who become unable to work, their disabled surviving spouses, and their children. This program is not welfare! It works much like the insurance you pay for your home or your car. The money withheld from your paycheck is the FICA tax and it creates the fund used to pay out disability claims. Should you become disabled, having contributed to this fund you are eligible to collect benefits as a substitute for the wages you would be earning at work.
Determining Disability
Even if you have paid into the Social Security fund, disability benefits are not guaranteed. This is where the definition of disability becomes extremely important. The SSA has outlined specific requirements that a disability applicant must meet in order to receive benefits. Some of these requirements include: the length of time in which a worker has earned wages before becoming disabled and the duration of the disability. Furthermore, the criteria for what constitutes a disability specify that a wage earner must be mentally or physically impaired in such a manner that limits his or her ability to perform "substantial gainful activity." This disability must be expected to last for a minimum duration of 12 months or ultimately result in death. Finally, an applicant for disability benefits must have worked for 5 of the last 10 years and must be younger than 65.
The Amount of Payment and Health Care
The amount of your disability benefit is calculated using your past earnings. This means that workers receive a different payment amount based upon their income level previous to becoming disabled. Should the disability persist longer than 24 months, you will automatically be enrolled in Medicare. The disability benefit will continue until you are no longer disabled or until you reach the age of 65 at which point you will begin to receive retirement benefits. Should you have children that are dependent upon your income, they may also receive disability benefits. However, only the disabled worker is eligible for Medicare.
Supplemental Benefits
The supplemental benefit program is known as the Supplemental Security Income program or SSI. It is often confused with Social Security Disability (SSD), but is actually a separate program entirely. Both programs pay benefits based upon an established disability. However, there are distinct differences between these two programs that all disability applicants should be aware of.
The SSI program
Supplemental Security Income is an entitlement program that assists the elderly, blind and disabled persons with money for necessities such as food, clothing, and shelter. The SSI program is funded by the general fund of federal tax revenues rather than the FICA tax (which funds the SSD program). There is no minimum time period an individual must have worked to qualify for SSI. There are strict guidelines regarding income level and necessity that an applicant must meet in order to receive SSI benefits. Regardless of your disability, if an applicant exceeds these limits they will be disqualified from receiving SSI. Generally, the SSA will calculate the income of entire household rather than just the individual applying for benefits.
SSI is determined from the date of application not the initial date of the disabling condition. Applicants approved for SSI are automatically entered into the Medicare and Medicaid programs from the date benefits are awarded. Dependents of an SSI recipient are not eligible to receive monetary benefits.
Children
A child that is disabled may qualify for SSI. Benefits paid through the SSI program are awarded to children under eighteen years old, meet the disability standards, and whose parents or guardians meet the financial requirements. A child's disability is determined using a different set of standards than those used for adults. If a child is not working and has a severe impairment the child will be considered disabled. The condition must limit a child's ability to function in a similar manner as healthy children of the same age. The impairment must be such that the disability created is comparable to that of an adult. Once a child receiving SSI benefits reaches the age of eighteen, the parents income and assets are no longer calculated when evaluating eligibility for the SSI program.
