The Social Security Administration (SSA) decides who is eligible for disability payments under rules established in the Social Security Act by the US Congress.  In order to be eligible for payments, one must be considered disabled according to Social Security’s definition of “disabled”. Once you are defined as disabled under the Social Security Act, the SSA makes disability payments under one of the two programs:

· Social Security Disability Insurance (SSDI), for workers who have paid into the Social Security trust fund (and their dependents), and

· Supplemental Security Income (SSI), for disabled individuals with limited incomes and assets (and their dependents).

SSDI and SSI are commonly referred to as Title 2 and Title 16 because they are authorized under Titles 2 and 16 of the Social Security Act.  A person applying for disability benefits or claiming a disability is considered a claimant. Claimants may apply under both Title 2 and 16; these are known as concurrent claims. Concurrent claims take place each time a claimant applies for Social Security disability benefits.  When SSA receives your application, it will determine whether you are eligible for disability benefits under SSDI or SSI, even if you have not specifically requested both. This means that if you apply for SSDI benefits, SSA will automatically process your claim for any SSI benefits that you may be entitled to. If your SSDI claim is turned down, you do not have to file another claim for possible SSI benefits.

1.       Social Security Disability Insurance (SSDI) provides payments to workers who have made contributions to the Social Security trust fund through the Social Security tax on their earnings.  SSDI is also available to certain dependents of workers. If you are found eligible for SSDI, you might be entitled to retroactive (past) benefits if you can show that you were disabled before the date of your application.

Retroactive benefits are typically paid one lump sum and are calculated as follows:

Example: If John Smith applied for Social Security disability benefits in January and was approved monthly benefits of $1,000 in July, he would be entitled to six months of retroactive benefits from January to July.  ($1,000 x 6 = $6,000)

A.      Who qualifies? To qualify for SSDI, you must fall into one of the following categories:

i.                    You are a disabled insured worker under the age of 65

You must have worked both long enough and recently enough to qualify (in most cases, this means that you must have worked 5 out of the last 10 years). Unfortunately, it may not be sufficient that you worked for many years and paid Social Security taxes. When you worked is also very important. The law requires that you earn a certain number of credits in a specified time before you are eligible for benefits. You can earn up to four credits per year, each credit representing three months. The amount of earnings required for a credit increases each year as general wage levels raise.  

In effect, you count backwards from the year that you became disabled to see whether you have the appropriate number of credits.  That means that credits from many years before you became disabled are automatically wiped out, or expire. This leads to a troublesome situation for individuals who haven’t worked for many years before becoming disabled. Their credits may dip below the required amount, and they can lose eligibility for SSDI.

The date on which an individual can lose eligibility is called the “date last insured,” or DLI—often a subject of dispute in Social Security cases. If you think your DLI is too far in the past to qualify you for SSDI, talk to your local SSA Field Office to make sure—in certain rare circumstances, you may still qualify.

The rules are as follows:

· Before age 24. You’ll need at least six credits earned in the three-year period ending when your disability started.

· Age 24 to 31. Credit for having worked half the time between age 21 and the age you became disabled. For example, if you become disabled at age 27, you would need credit for three years of work (12 credits) during the six years between ages 21 and 27.

· Age 31 or older.  In general, you will need the number of work credits shown in the chart below.  Unless you are blind, at least 20 of the credits must have been earned in the ten years immediately before you became disabled.

Note: You can find out how many credits you have by contacting your local SSA office or, by filling out this form by clicking here.

ii.                  You are the family member of an eligible worker

The SSA pays auxiliary benefits to people who qualify based on certain family members’ entitlement to retirement or disability payments. Benefits are paid based on the earnings records of the insured worker who paid enough Social Security taxes. If you qualify for auxiliary benefits, you do not necessarily have to be disabled; nor do you need the work credits described above. A person who qualifies for auxiliary benefits is referred to as an auxiliary beneficiary. These individuals are typically any children, widows, spouses, and parents who receive Old-Age, Survivors and Disability Insurance (OASDI) benefits based on other wage earners Social Security record.

· Spouse’s and divorced spouse’s benefits. To qualify for auxiliary benefits as a spouse or divorced spouse, one of the following must apply:

Ø  You are the divorced spouse of a retired or disabled worker who is entitled to benefits, you are 62 years old or older, and you were married to the worker for at least ten years.

Ø  You are the divorced spouse of a worker insured under SSDI who has not filed a claim for benefits, you are age 62 or older, your former spouse is age 62 or older, you were married for at least ten years, and you have been divorced for at least two years.

Ø  You are a disabled widow or widower, at least 50 years of age but less than 60 years old, and you are the surviving spouse of a worker who received Social Security disability or retirement benefits.

Ø  You are the surviving spouse (including a surviving divorced spouse) of a deceased insured worker, and you are age 60 or older.

Ø  You are the surviving spouse (including a surviving divorced spouse) of a deceased insured worker, and you are for a child of the deceased entitled to benefits who is either under the age of 16 or has been disabled since before age 22. (These benefits are known as “mother’s or father’s benefits.”)

· Child’s benefits.  A dependent, unmarried child is entitled to child’s insurance benefits on the Social Security record of an insured parent, or deceased parent who was insured at death, if any of the following apply:

Ø  The child is under the age 18.

Ø  The child is age 18 or 19 and a full-time student.

Ø  The child is an adult and has been disabled since or before age 22.

· Parent’s benefits. You may qualify for parent’s benefits if all of the following are true:

Ø  Your child was an insured worker who died.

Ø  You are at least 62 years old.

Ø  You are divorced, widowed, or unmarried and have not married since your child’s death.

Ø  You were receiving at least one-half of your support from your child at the time of death.

Ø  You can provide evidence of this support within two years of the death (you may be exempt from providing evidence if unusual circumstances, such as extended illness, mental or physical incapacity, or language barrier, show that you could not have reasonably known of the two-year rule).

· Lump-sum death benefits.  A lump-sum death payment of several hundred dollars may be paid to the surviving spouse of an insured worker if the survivor was living in the same household as the deceased at the time of death. You must apply for this benefit within two years of the insured worker’s death.

B.      Citizenship or Residency Requirements:

If you qualify based on the criteria listed above, you may receive SSDI payments if you are a U.S. citizen or permanent resident, living in the United States or abroad. If you are neither a citizen nor a permanent resident, you still may be entitled to receive SSDI if you can show that you are lawfully present in the United States and meet certain other criteria.

If you are a citizen when you apply for SSDI benefits, you will have to show proof of your residency. Acceptable forms of proof include a birth certificate showing birth within the United States or any of the following:

Ø  Certificate of Naturalization issued by U.S. Citizenship and Immigration Services (USCIS) or the Immigration and Naturalization Service (INS)

Ø  U.S. Passport

Ø  U.S. Citizen Identification Card

Ø  Report of Birth Abroad of a Citizen of the U.S. (issued by the State Department)

Ø  Certificate of Birth issued by a foreign service post

Ø  Certificate of Citizenship issued by USCIS or the INS, or

Ø  Certification of Report of Birth issued by the U.S. State Department

If you are a permanent resident or resident alien, you will have to show that you are lawfully in the United States under one of the following conditions:

Ø  Lawful admission for permanent residence

Ø  Admission as  a refugee or conditional entrance as a refugee

Ø  Asylum status or pending application for political asylum

Ø  Parole status

Ø  Deportation withheld or pending application for withholding of deportation

Ø  Member of a class of aliens permitted to remain in the United States for humanitarian or other public policy reasons, or

Ø  You have been battered or subjected to cruelty by a family member while in the United States.

Ø   

Most foreign workers in the United States are covered under the U.S. Social Security program and can potentially qualify for disability benefits. If however, you are neither a citizen nor a permanent resident, you still may be covered under Social Security Disability.

2.       Supplemental Security Income (SSI) provides payments to an adult or child who is disabled and has limited income and resources. If your income and resources are too high, you will be turned down for benefits no matter how severe your medical disorders. You will be turned down even if you have not paid enough in Social Security taxes to qualify for SSDI.

The SSI limits on income and resources is one of the most complicated areas handled by the SSA. Only SSA representatives can accurately determine your income and resources for purposes of qualifying for SSI.

A.      Income Limits

To qualify for SSI, your monthly income (as counted by the SSA) cannot exceed something called the federal benefit rate (FBR). The FBR for a married couple is approximately 33% more than for an individual. If only one member of a couple is eligible, both spouse’s income is still considered. If a child under age 18 is living with parents, then the parents’ income is considered.  The federal benefit rate sets both the SSI income limit and the maximum federal SSI payment.

B.      Resource Limits

To qualify for SSI, your resources must also not exceed certain limits. A “resource” is cash or another asset that can be converted to cash and used for support. If you or your spouse has the right, authority, or power to sell property and keep the proceeds, it will be considered a resource. Resources are categorized as either liquid or non-liquid. Liquid resources include cash and other assets that could be converted to cash within 20 working days.

The most common types of liquid resources are savings and checking accounts, stocks, bonds, mutual funds, promissory notes, and certain types of life insurance. Non-liquid resources cannot be converted to cash within 20working days. They include both real property (land) and personal property. The SSA may consider some resources to be both liquid and non-liquid (such as an automobile or life insurance policy). The resource limits are set by law and are not subject to regular cost-of-living adjustments, but they have increased slowly over the years.

C.      Citizenship and Residency Requirements

SSI disability payments are usually available only to U.S. citizens. There are several exceptions, however, under which non-citizens might be eligible, including the following:

Ø  You were lawfully living in the United

Ø  States on August 22, 1996, and you are blind or disabled;

Ø  You were receiving SSI on August 22, 1996, and you are lawfully living in the United States; or

Ø  You were lawfully admitted for permanent residence under the Immigration and Nationality Act (INA) and have a total of 40 credits of work in the United States. (Your spouse’s or parent’s work also may count.)

Important:  If you entered the United States on or after August 22, 1996, then you may not be eligible for SSI for the first five years as a lawfully admitted permanent resident even if you have 40 qualifying credits of earnings.

Some other non-citizens who may be eligible for SSI payments are:

Ø  Active duty members of the U.S. armed forces;

Ø  Noncitizen members of federally recognized Indian tribes;

Ø  Certain noncitizens admitted as Amerasian immigrants; and

Ø  Cuban/Haitian entrants under the Refugee Education Assistance Act

D.      Receiving Benefits When Outside the U.S.  

SSI payments are generally only available to people residing in the 50 states, District of Columbia, or Northern Mariana Islands. If you receive disability benefits and move, for example, to Mexico or Puerto Rico, you will lose those benefits. There are a few exceptions for some U.S. citizen children and students:

Ø  A blind or disabled child may be eligible for SSI benefits while outside the United States if the child is a U.S. citizen, lives with a parent who is a member of the U.S. armed forces assigned to permanent duty outside the United States, and was eligible to receive SSI benefits in the month before the parent reported for duty abroad.

Ø  A student of any age may be eligible for SSI benefits while temporarily outside the United States for the purpose of engaging in studies not available in the United States sponsored by an educational institution in the United States and designed to enhance the student’s ability to engage in gainful employment. The student must have been eligible to receive SSI benefits in the month proceeding the first full month abroad.

It’s possible that you don’t qualify for SSI benefits, but might be entitled to conditional payments—in essence, a loan. This happens when your resources are above the resource limits, but include non-liquid assets that may take months for you to convert into cash in order to use as support. In that situation, the SSA will make conditional payments until you sell your assets and can support yourself. You will not receive SSI—and you must refund to the SSA the amount you received at the end of the conditional payment period.

Presumptive disability (PD) payments are made to a person who is initially applying for SSI benefits, and whose medical condition is such that there’s a strong likelihood the person will be found eligible for disabled payments. The person must meet all non-medical factors of eligibility – such as having low income and few assets. If you are an SSDI claimant—a worker who has paid Social Security taxes—you are not entitled to presumptive disability.

If the SSA agrees that you are presumptively disabled, you may receive payments for up to six (6) months while your application for disability benefits is pending. If after six (6) months of presumptive disability payments, the SSA has not made a formal determination on your disability application, the presumptive disability payments end until this formal determination is made. Regardless of your case determination, these payments do not need to be paid back.