When President Franklin D. Roosevelt signed the Social Security Act into law on August 14, 1935, the original program was designed to pay benefits only to retired workers aged 65 or older. The 1939 amendments added two new categories of benefits: payments to the spouse and minor children of a retired worker (known as dependents benefits) and survivors benefits paid to the family of a deceased worker. That change transformed Social Security from a retirement program for individuals into a family-based economic security program.
The Social Security Amendments of 1954 initiated the Disability Insurance (DI) program that provided the public with additional coverage against economic insecurity. Effective as of 1955, there was a disability "freeze" of workers' Social Security records during years when they were unable to work. While that measure offered no cash benefits, it did prevent such periods of disability from reducing or wiping out retirement and survivors benefits. This legislation outlined the work requirements, the definition of disability, the nature of the disability determinations, and the emphasis on rehabilitation that are still fundamental to the disability program.
On August 1, 1956, as he signed new disability legislation, President Eisenhower was quoted as saying, "We will . . . endeavor to administer the disability [program] efficiently and effectively, [and] . . . to help rehabilitate the disabled so that they may return to useful employment . . . . I am hopeful that the new law . . . will advance the economic security of the American people." These amendments provided cash benefits to disabled workers aged 50-64 (after a 6-month waiting period) and to adult children of retired, disabled, or deceased workers, if the children had been disabled before age 18.
Over the next 4 years, Congress broadened the scope of the program, providing benefits to disabled workers' dependents in 1958 and permitting disabled workers under age 50 to qualify for benefits in 1960. In 1967, the act was further amended to provide benefits for disabled widows and widowers aged 50-64 at a reduced rate.
The Social Security Amendments of 1972 further enhanced the disability program by:
Throughout the 1970s, growth in the disability rolls was higher than expected as a result of increased applications. In addition, relatively few beneficiaries were being rehabilitated and returning to work. As a result, Congress enacted legislation in 1980 that:
In response to concerns arising from the implementation of the 1980 provision regarding the continuing disability review process, Congress legislated in 1982 that persons who appeal decisions that their disability has ceased:
Two provisions of the Social Security Amendments of 1983 affected the disability program:
In 1984, the Congress enacted a number of changes affecting the interpretation of disability such as instituting a "medical improvement standard" in the continuing disability review process, revising the mental impairment listings, and considering the combined effect of all impairments when determining eligibility for benefits.
From 1984 through 1998, many relatively minor legislative changes were made in the Social Security disability program. Those changes provided additional Medicare protection for the disabled, made the definition of disability for disabled widow(er)s the same as that for disabled workers, prohibited eligibility for individuals whose drug addiction or alcoholism was a contributing factor to their impairment, and modified the provisions for a trial work period.
On December 17, 1999, President Clinton signed into law the Ticket to Work and Work Incentives Improvement Act. The purpose of that legislation is to improve the disability program's work incentives by giving beneficiaries greater choice in seeking rehabilitation and employment services. The provisions of the act:
The definition of disability under Social Security is different from that used by other disability programs. Social Security pays benefits only for total disability; it does not pay benefits for partial disability or for short-term disability.
To be eligible for benefits a person must:
Meeting the insured requirement means that a person must have worked long enough--and recently enough--under Social Security. The number of work credits (quarters of coverage) a person needs to qualify for benefits depends on the individual's age when he or she becomes disabled.
Section 223(d)(1) of the Social Security Act defines "disability" as an--
In most cases, a dollar amount is used to indicate whether a person is engaging in substantial gainful activity. For 2000, the SGA amount was $700 per month for a nonblind individual and $1,170 per month for a blind person. Beginning with January 2001, the SGA level will be adjusted annually based upon the national average wage index.
A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. An impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings.
The Social Security program pays benefits to disabled individuals and to certain dependents. Those benefits include the following:
The disability decisionmaking process begins when an individual files an application for benefits at a Social Security office. An employee in the office determines if the applicant meets the nonmedical requirements for benefits such as age, work credits, performance of SGA, and relationship to the insured worker. If those requirements are met, the application is sent to the Disability Determination Services (DDS) office in the state where the applicant resides. The DDS then decides whether an individual is disabled under Social Security law.
Disability examiners and medical staff in the DDS office use medical evidence from the applicant's doctors, hospitals, clinics, or institutions where the individual received treatment. Those medical sources are also asked for information about a person's ability to do work-related activities, such as walking, sitting, lifting, carrying, and remembering instructions.
The DDS may need more medical information before they can decide a person's case. If it is not available from the individual's current medical sources, they may ask the applicant to go to a special examination, called a "consultative examination," that is paid for by the Social Security Administration (SSA).
A five-step sequential evaluation process is used to decide if a person is disabled. Those steps are as follows:
A person is considered blind if his or her vision cannot be corrected to better than 20/200 in the better eye or if his or her visual field is 20 degrees or less, even with a corrective lens. A number of special rules apply to persons who are blind. Those rules recognize the impact of blindness on a person's ability to work. For example, the dollar amount used to determine if a blind individual is engaging in SGA is higher than the limit for a sighted person.
If an applicant's claim for disability benefits is denied, he or she has the right to appeal that decision. There are four levels of appeals: (1) reconsideration by the state DDS; (2) hearing by an administrative law judge (ALJ); (3) review by the Appeals Council; and (4) federal court review. At each level of appeal, claimants or their representative must file the request for appeal in writing within 60 days from the date of the notice of denial.
Generally, the reconsideration is the first step in the appeals process. The reconsideration is a case review and is similar to the initial determination except that the case is assigned to a different disability examiner and medical team at the DDS. Claimants are given the opportunity to present additional evidence, which is considered along with the evidence that was submitted during the initial determination.
If the claim is again denied, the individual may request a hearing before an ALJ. Usually the ALJ will hold a hearing, although the claimant may ask that his or her case be decided on the basis of the written record without a hearing. At the hearing, the claimant and witnesses testify under oath or affirmation, and the testimony is recorded verbatim. The ALJ is responsible for looking into all the issues; he or she receives documentary evidence as well as the testimony of witnesses. The ALJ will allow the claimant, the claimant's representative, or both to present arguments and examine witnesses.
The final step in the administrative appeals process is at the Appeals Council. If the claimant is dissatisfied with the hearing decision, he or she may request that the Appeals Council review the case. The Council, made up of administrative appeals judges, may also, on its own motion, review a decision within 60 days of the ALJ's decision.
The Appeals Council considers the evidence of record, any additional evidence submitted by the claimant, and the ALJ's findings and conclusions. The Council may grant, deny, or dismiss a request for review. If it agrees to review the case, the Council may uphold, modify, or reverse the ALJ's action, or it may remand it to the ALJ so that he or she may hold another hearing and issue a new decision.
Claimants may file an action in a federal district court within 60 days after the date they receive notice of the Appeals Council's action. If the U.S. District Court reviews the case record and does not find in favor of the claimant, the claimant can continue with the appellate process to the U.S. Circuit Court of Appeals.
In addition to meeting the strict medical definition of disability, an individual must also meet an insured-status requirement. To be eligible for disabled-worker benefits, a person must have worked long enough and recently enough under Social Security. A person can earn up to four work credits per year. The amount of earnings required for a credit increases each year as general wage levels rise.
The number of work credits a person needs for disability benefits depends on the individual's age when he or she becomes disabled. To be fully insured, the maximum number of credits needed is 40. To be currently insured, a person generally needs 20 credits earned in the last 10 years ending with the year he or she becomes disabled. However, younger workers may qualify with fewer credits.
Dependents of a disabled worker are eligible for benefits if the worker meets both the medical and insured-status requirements. Disabled widow(er)s and disabled adult children do not need to meet a work requirement themselves, but the worker on whose record they are filing must be insured.
To determine the amount of a person's monthly cash benefit, SSA uses the following four-step process:
Disabled-worker and dependents benefits may be offset if the disabled worker receives workers' compensation (WC) or other public disability benefits (PDB). The 1965 Social Security Amendments require that benefits be reduced when the worker is also eligible for periodic or lump-sum WC/PDB payments, so that the combined amount of the disabled worker's and family's Social Security benefit plus the WC/PDB does not exceed 80 percent of the worker's average current earnings. The combined payments after reduction are never less than the total Social Security benefits were before reduction. The reduction continues until the month the worker reaches age 65 or the month the WC/PDB payment stops, whichever comes first.
If a spouse or disabled widow(er) worked for a federal, state, or local government to which he or she did not pay Social Security taxes, the pension he or she receives from that agency may reduce his or her Social Security benefits. That provision is known as the government pension offset. The offset will reduce the amount of the Social Security benefit by two-thirds of the amount of the government pension.
The annual earnings test applies to non-disabled beneficiaries under the FRA. Benefits for those beneficiaries are withheld $1 for every $2 they earn above the annual earnings limit. In the calendar year a beneficiary attains the FRA, for months before the FRA, $1 is withheld for every $3 earned over the annual earnings limit for that age group. A retired worker's earnings will also affect his or her dependents' benefits, including those of disabled adult children. In addition, a spouse's earnings may affect benefits for his or her children. How a disabled beneficiary's work affects his or her benefit is discussed in the next section.
Other reasons for withholding benefits include spouses who no longer have an entitled child in their care, beneficiaries who are incarcerated, or beneficiaries whose whereabouts are unknown.
Special rules make it possible for disabled beneficiaries to work and still receive monthly benefits and Medicare or Medicaid. Those rules are known as work incentives.
Disabled beneficiaries are encouraged to return to work by providing a trial work period (TWP) and an extended period of eligibility (EPE). During the TWP, earnings are allowed to exceed the SGA dollar amount for 9 months. During the
3-year EPE that follows the TWP, benefits are withheld only for those months in which earnings exceed the SGA amount. After the end of the EPE, monthly benefits are terminated only after the earnings exceed the SGA amount. Certain impairment-related expenses that a person needs to make in order to work may be deducted when counting earnings to determine if the work is substantial. Even if cash benefits are withheld, Medicare and Medicaid coverage can continue.
The Ticket to Work and Work Incentives Improvement Act has further improved work incentives. That law substantially expands work opportunities for people with disabilities. The provisions of the law become effective at different times in different parts of the country. The provisions below apply to both Social Security and SSI.
More information about work incentives can be found at www.ssa.gov/work.
In general, benefits continue as long as a person remains disabled. However, under Social Security law, all disability cases must be reviewed from time to time to make sure that people receiving benefits continue to meet the disability requirements. Benefits continue unless there is strong proof that a person's impairment has medically improved and that he or she is able to return to work. Benefits continue unless there is strong proof that a person's impairment has medically improved and that he or she is able to return to work.
How often a case is reviewed depends on the severity of the impairment and the likelihood of improvement. The frequency can range from 6 months to 7 years. Here are general guidelines for reviews.
During a review, the disabled beneficiary is asked to provide information about any medical treatment he or she has received and any work he or she might have done. An evaluation team that includes a disability examiner and a doctor then requests the individual's medical records and carefully reviews his or her file. If the team decides a person is still disabled, benefits will continue. If they decide that the person is no longer disabled, the individual can file an appeal if he or she disagrees with the determination. Otherwise, benefits stop 3 months after the beneficiary is notified that his or her disability ended.
Benefits for dependents continue as long as the disabled worker continues to be entitled to benefits. However, a person's benefits may be terminated for other reasons. Here are the most common reasons to terminate benefits:
Benefits usually stop effective with the month the terminating event occurred.