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Social Security Disability Requirements

March 8, 2016

How do you qualify for Social Security Disability Insurance benefits (“SSD”)?

In order to apply for SSD benefits, you must have worked in the past and have earned a sufficient amount to become insured for SSD benefits. As an individual works and pays Social Security taxes they are able to earn one quarter of coverage for every $1,260 they earn in 2016, up to a maximum of four quarters of coverage per year for a total of $5,040 per year. Normally, you need to have worked five years out of the last ten to be currently insured and have accumulated a total of forty quarters of coverage. There are exceptions for younger individuals that have not had enough time to accumulate forty quarters of coverage, which allows them to become insured with less.

Proving Disability

You do not remain insured forever and eventually your insured status “expires.” If you have been working full-time and cease work activity, you will usually remain insured for another five years. This is an extremely important point and is why you should not hesitate to obtain appropriate medical treatment to document your disabilities and to apply as soon as you think you are no longer able to remain employed full-time in any capacity, in order to increase your chances of proving disability while still insured. Why is this important? Because you must prove disability while still insured for benefits. If you are found disabled after your insured status expired, you cannot be entitled to SSD benefits.

Available Monthly Benefits

In regard to what monthly benefits are available, if found disabled you are entitled to a monthly check that is based on how much you have earned over your working years. Your monthly amount is called your Primary Insurance Amount (“PIA”). This amount can vary and we have personally represented clients with PIAs as low a few hundred dollars to well over $2,000 per month. You will also be entitled to Medicare health coverage. However, you are not eligible for coverage until 24 months have elapsed from your first month of entitlement. At that time, you can then subscribe to different parts of Medicare for the offered premiums.

Determination of Disability

social security administration logo

To determine whether you are disabled, the Social Security Administration (“SSA”) follows a five-step sequential evaluation:

1. At the first step, SSA determines whether you are engaging in substantial gainful activity (“SGA”). If you are earning more than a certain monthly amount SSA considers you to be engaging in SGA. SSA has set the monthly threshold of gross (before any taxes are taken out) earnings that disqualify you at $1,130 in 2016. It is possible to have your gross earnings reduced to below the SGA threshold if you have impairment-related work expenses or to have the work excused if one of the work incentive rules apply.

2. At the second step, SSA determines whether you have a “severe” impairment which is defined as an impairment or combination of impairments that significantly limit your physical or mental abilities to do basic work activities. This is a low threshold and most individuals are able to satisfy this requirement and move on to the other steps of the analysis. If SSA finds that you do not have a “severe” impairment, the analysis stops and you are denied benefits.

3. At the third step, SSA determines whether your condition meets or equals one of those set forth in the Listing of Impairments. The Listing of Impairments is exactly that – a long list of impairments found in the Federal Regulations with certain findings required for each that SSA deems to automatically be disabling. This is a high threshold and it is difficult to satisfy the requirements of any of the Listings. If you do, the analysis stops there and you are found to be disabled.

4 & 5. If you are not found disabled, the analysis continues to the fourth and fifth steps at which SSA determines your residual functional capacity (“RFC”) – what you retain the ability to do both physically and mentally – and whether or not it allows for you to return to your past relevant work (full-time work you performed in the last fifteen years) and if not, if you could perform any other job in the national economy. If you can do either, your claim will be denied. If you cannot perform your past relevant work or any other job due to your limitations, SSA will find that you are disabled.

What does all of this mean?

Overall, it has gotten much more difficult to obtain disability benefits and it is important that you keep current with your medical treatment and that your symptoms, exacerbations, etc. are appropriately documented. Navigating the turbulent waters of applying for disability benefits can be an arduous journey and the attorneys and staff at Balin Law are here to assist you at every turn. Do not hesitate to contact us by phone or email for a free consultation at one of our eight conveniently located offices in northern Ohio.