Social Security Disability Law
Certain individuals who are no longer able to work because of an injury are entitled to disability benefits. To qualify for disability benefits, an individual must be so severely injured that he or she cannot work any more. Temporary injuries that occur at work are covered under workers' compensation benefits.
There are two sources of disability benefits. The first is through disability insurance, which can be purchased individually, but is more often provided to an employee by the employer. The other source of disability benefits is through two government programs, Supplemental Security Income (SSI) and Social Security Disability Benefits (SSD).
The two Social Security programs are the subjects of this discussion. They are provided through the federal government, although Illinois provides supplemental benefits. Anyone who believes that he or she may be entitled to benefits should discuss his or her options with a lawyer who is knowledgeable about Social Security disability law.
Supplemental Security Income. SSI pays monthly benefits to individuals who can prove that they have a financial need for the benefits and who are 65 years old or older, blind, or disabled. Note that the law imposes two requirements on eligibility: (1) financial need, plus (2) one of the following: age, blindness, or disability. Thus, a disabled person is entitled to the benefits, regardless of age, if he or she can prove financial need.
The definition for being disabled is an "inability to engage in any substantial gainful activity by reason of any medically determined physical or mental impairment which can be expected to last for a continuous period of not less than 12 months or result in death." Note again that the definition includes the phrase "any substantial gainful activity," which means that a person who cannot perform his or her current job is not necessarily disabled if they can perform some other job. Thus, a manual laborer who can no longer perform manual labor isn't disabled for SSI purposes if he or she is able, for example, to do clerical work.
Note also that the definition requires that the disability be "medically determined," which means that an individual will not be eligible under SSI until a medical doctor concludes that the individual is disabled within the meaning of the law.
The definition for determining whether a child is disabled is that the child must have a physical or mental condition that can be medically proven and that results in "marked and severe functional limitations" of substantial duration. Thus, an autistic child, for example, may qualify for benefits if the financial need requirement is met. A child is defined as someone who is under 18 (under 22 if still in school) and unmarried.
In either case, the disability need not be physical; it can be emotional and still qualify for benefits.
SSI is administered through the Social Security Administration. Applications are made to the SSA, which requires filling out forms and signing documents.
Decisions that are "initial determinations" can be appealed. Examples of an initial determination are a denial of SSI benefits or an award of benefits at a lower rate than the applicant thought he or she was entitled to. Any applicant who is not using an attorney should consult one if the applicant wants to appeal an initial decision. In some cases, special rules apply if the appeal is made within 10 days, so applicants should act fast once the unfavorable initial determination is made.
SSD. The other program is the Social Security disability benefits, which is also administered through the Social Security Administration. It pays monthly benefits to individuals who are no longer able to work. To qualify, a person needs to have worked long enough to be eligible for the program and must be disabled for at least a year. The length of time a person needs to have worked depends on his or her wages. The Social Security Administration uses a system of work credits in which a worker can earn a maximum of four work credits per year.
To qualify for payments, a person needs 40 work credits, at least 20 of which must have been earned in the previous 10 years, which means in effect that a person would need to have worked in five of the previous 10 years. Younger workers (those under 31) who are disabled have less strict requirements. For 2003, a worker would need to earn at least $3,560 in order to qualify for all four work credits.
The definition of disability is that the person must be totally disabled and unable to work for at least one year. To be considered disabled, a person must be (1) not working or working but earning below a certain level ($800 per month in 2003), (2) suffering a condition that interferes with basic work-related activities, (3) suffering a condition either on a list that the SSA maintains or of an equal severity to a condition on the list, (4) unable to do the work the person did before the injury, and (5) unable to adjust to other work.
Special disability eligibility rules apply to the blind, widows/widowers, and children. If benefits are awarded, they begin on the sixth full month after the disability began and are actually paid in the following month (the seventh month after the disability began).
To determine how much a person is entitled to receive, the SSA computes lifetime average earnings. The amount received may be reduced by the amount received by the person under workers' compensation or a public pension fund.
Once a person is disabled for two years, he or she is automatically enrolled in Medicare and is entitled to receive health insurance coverage through those programs.
Family members may also be eligible for SSD benefits. They can usually get about half the rate that the disabled individual receives, and there is a total limit that one family can get that is based on the disabled person's lifetime earnings. Both spouses and children are eligible for benefits, if certain conditions are met.
Applications are made at the nearest Social Security office. If the SSA denies benefits, the person has the right to ask the office to review the application again.
State aid. The Illinois Department of Human Services administers a program called the Aid to the Aged, Blind, and Disabled Grant Program. It provides small monthly supplements to low-income, disabled Illinois residents whose needs are not being by the federal programs.