Who is Eligible for SSDI?

Social Security Disability Insurance (SSDI) is a federal benefit that is available to persons who have suffered a disability after years of paying into the Social Security system via previous taxable income.

At Jeffrey Glassman Injury Lawyers, our Boston SSDI attorneys are committed to helping people navigate the complex labyrinth of bureaucracy and secure benefits to which they are entitled.

Although determination of eligibility can be a convoluted process, it essentially comes down to two points. Qualified applicants will have:

• Worked long enough to accrue sufficient work credits;
• Been diagnosed with a condition that adheres to the Social Security Administration’s definition of disability.

Unlike workers’ compensation, SSDI does not require the disabling condition be connected in any way to one’s work. The focus is on long-term ailments that are either terminal or affect a person for a year or longer.

And unlike Supplemental Security Income (SSI), one’s “deemed income” – or income of a spouse, parents or others with whom the applicant lives – is not factored into the decision. However, the government will take into account one’s own income. Generally speaking, it’s difficult for anyone who is working to obtain SSDI benefits. But the measure is technically whether a person is prevented by way of his or her condition from engaging in “Substantial Gainful Activity.”

The Social Security Administration (SSA) holds that if a person is not blind, is working and earns more than $1,130 monthly (as of 2016), he or she is considered engaged in Substantial Gainful Activity. For a person who is blind, the cut-off is $1,820 a month.

Approximately 8.8 million workers with disabilities were receiving SSDI as of 2015, with the average disabled worker receiving about $1,146 monthly. The most one can receive (as of 2015) is $2,663.

First thing necessary in assessing whether an individual is qualified for benefits is to ascertain whether he or she is disabled per the SSA’s standards. Just because you can’t work in your current job due to your condition, you aren’t automatically entitled to benefits.

Generally, the standard is that claimant suffers from a debilitating condition that is terminal or long-term (12 months or more) that completely prevents the performance of any type of work activity.

The rules assume members of working families have access to resources in the short-term. That’s why they adhere to a strict definition of disability in which:

• Worker cannot do work he or she did before.
• SSA determines worker cannot adjust to other work because of medical condition AND
• Disability has lasted or is expected to last at least a year or result in death.

The agency will be focused on determining severity of the condition and whether ailment interferes with basic work-related functions. Assuming this is the case, the agency will also look to see if the condition is listed on the agency’s list of medical conditions. If the condition is found on that list to the specifications detailed, applicant will be considered disabled. If it is not, the agency will next look at whether worker can reasonably be expected to do their work or other types of work. If not, the person will be deemed disabled.

The second critical element in determining SSDI eligibility is tallying his or her “work credits.”

According to the SSA, these credits are the “building blocks” the agency uses in order to figure out whether an individual has the baseline amount of covered work necessary to qualify for SSDI. No one is getting SSDI benefits who hasn’t earned enough credits.

Credits are earned as an individual works and pays Social Security taxes. Although the process for earning credits has changed over the years, it now stands that a maximum of four credits can be earned in any given year.

• To earn one credit in 2015, one must make $1,220 in covered earnings.
• To earn four credits in 2015, one has to make $4,880 in covered earnings.
• No credits are given for interest on dividends, investments or savings or for pension payments because no tax for Social Security is paid from those earnings.

A person’s age is a key factor in determining the number of work credits necessary to qualify for SSDI. In general, you need 40 total credits, with 20 of those accrued in the last decade, ending in the year the claimant became unable to work.

However, workers who are younger at the time of disability won’t need as many credits.

• Younger Than 24: 6 credits in the last 3 years.
• 24 – 31: Credits need to reflect at least half-time work from age 21 to time of disability. so if you become disabled at age 29, you would need credit for four years of work (16 credits) out of the past eight years (ages 21 to 29).
• Older than 31: At least 20 credits in the decade immediately prior to the disability. A person who is between 21 and 42 needs at least 20. A person who is 52 needs at least 30. A person who is 58 needs at least 36. A person who is 62 or older needs at least 40 credits.

The rules are different if claimant is blind.

The good news is most people who have worked fairly steadily over the years will earn more credits than they need to reach minimum eligibility. Unfortunately, workers don’t get “extra points” for extra credits. However, monthly benefits will be determined based on average earnings over the course of the working years.

Dependents of eligible beneficiaries may also qualify for benefits. Children (biological, adopted, stepchild or dependent grandchild) may also receive benefits if they are unmarried and:

• Are under the age of 18;
• Are a full-time student (no higher than grade 12) who is 18-19;
• Are 18 or older and have a disability that started before age 22.

Spouses also may receive benefits if:

• He or she is caring for a child who is under 16 or disabled;
• Is 62 or older (unless he or she receives a higher Social Security benefit based on his or her earnings record).

A spouse who is already receiving benefits may be eligible to receive more benefits, but those benefits won’t be “stacked” beyond the maximum allowable.