Understanding Social Security Disability

Two Different ProgramsTitle 2 SSDIRequires work: 5 years out of last 105 month waiting period24 month Medicare waiting period12 months retroMay pay family benefits

Title 16 SSIDINo work requiredIncome: < $710/$1066Resources: < $2K/$3KLiving arrangements1 month waiting periodNo retroactivityMedicaidNo family benefits

Definition Of Disability

Inability to engage in Substantial Gainful Activity

(work) (2013 - $1,040 month) by reason of a

physical or

mental impairment that has lasted or is expected

to

last at a severe level for a period of at least 12

continuous months.

Substantial Gainful Activity2013 – Generally SGA if over $1040 month

Impairment related work expenses (Rx co-

pays, doctor co-pays, special equipment,

transportation, etc.) can reduce earnings

Subsidy/special considerations can reduce earnings

Office Processes

Local SSA Office

Paperwork processing centerApplication/appeal intakeDetermination of non-medical factors

Disability Unit

Located in RaleighNever sees the clientObtains medical recordsMakes medical decision

Work Requirements – T2

Credits earned by working

2013 - $1,160 per credit up to 4

10 years minimum work (40 credits)

5 of the years (20 credits) must be within the

10 years prior to onset of disability (current

connection)

Onset Date

Not always equivalent to diagnosis date

2 different factors:

1. Not engaging in SGA (2013 - $1,040

month)

2. Have a severe condition (12 months

duration)

Onset/Entitlement ExampleDiagnosis date: 03/15/2012

Stop work date: 09/30/2012

Correct onset date would be 09/30/2012

Waiting period: 10/12 – 02/13

Entitlement date: 03/2013

First payment: 04/2013

Medicare: 03/2015

Onset/Entitlement Example 2Diagnosis date: 03/15/2012

Stop work date: 03/15/2012

Correct onset date would be 03/15/2012

Waiting period: 04/12-08/12

Entitlement date: 09/12

First payment date 10/12

Medicare: 09/2014

Retroactivity: dependent on application

Onset vs EntitlementUnder T2 SSDI, can delay as long as 17 months from

onset to file application with no loss in benefits

Allows up to 12 months retro benefits from date of

application (subject to onset/waiting period

restrictions)

Onset 10/15/2011, Waiting Period Nov., Dec., Jan.,

Feb., Mar

Application Date 04/15/13 = Potential Retro benefits

to 04/2012

Offset 1Workers Compensation – WC + SSA cannot exceed

80% of monthly average current earnings. Excess is

offset against SSA benefit.

Example, average earnings = $3,000 month, ACE =

$2400

Workers Comp = $500 week, or $2,165 month

SSA = $2000

Total of $4,165 in benefits, $1,765 offset

Net SSA = $235.00

Offset 1 (cont)

WC lump sum payments are also offset

Lump sum pro-rated based on weekly wage

will result in offset

Lump sum pro-rated on life expectancy will

usually avoid offset

WC offset is removed at age 65

Offset 2Employer long term disability is usually offset

by Social Security (even if paid for by

employee)

LTD: $2500 per month

T2 SSDI: $2000 per month

Insurance offsets the $2000, paying only $500

per month under the LTD

Varies from policy to policy

Application ProcessCan apply through local office appointment

(telephone) or via internet

Application takes about 1 ½ hours

See green worksheet

Client can have consultant or representative

if desired

Decision takes from 3-5 months

AppealsReconsideration (SSA-561) 2-3 months

Paper review, DDS in Raleigh

Hearing (HA-501) 18-24 months

Administrative Law Judge in Greensboro

Need representative

Appeals Council Review 6-12 months

Council is in Arlington VA

Benefit RatesT2 benefits are based on average earnings over an

“elapsed period” from age 22 to date of disability

onset, less 5 drop out years

Example:

Disabled at age 45. From age 22, there are 23

“elapsed years”, less 5 drop out years = 18 used in

the computation

Disability rate is equivalent to age 66 retirement rate

Benefit Rates

Family benefits are payable, usually 50% of

the worker’s primary rate.

Worker’s benefit $1500, family = $750.00

Divided pro-rata share for multiple children

in family