96.001: Social Security: Disability Insurance

Objectives: To replace part of the earnings lost because of a physical or mental impairment severe enough to prevent a person from working.

MAIN TOPICS:

96.001 ELIGIBILITY REQUIREMENTS:

Applicant Eligibility: A disabled worker under age 65 is eligible for Social Security disability benefits if he or she has worked for a sufficient period of time under Social Security to be insured. The insured status requirements depend upon the age of the applicant and the date he or she became disabled. Coverage credits under the social security systems of certain foreign countries with which the U.S. has reciprocal agreements may be taken into account to meet the requirements.

Certain family members of disabled workers also are eligible for benefits:

  1. Unmarried children under age 18, or under age 19 for students in elementary or secondary school;
  2. Unmarried adult offspring at any age if disabled before age 22;
  3. Wife or husband at any age if child in his or her care is receiving benefits on worker's Social Security record and is under age 16 or disabled;
  4. Spouse age 62 or over; and
  5. Divorced wives or husbands age 62 or over who were married to the worker for at least 10 years.

For workers who are first eligible after 1985 for both (a) a pension based on non-covered employment and (b) Social Security disability (or retirement) benefits, a less generous benefit formula applies. In addition, Social Security disability benefits are reduced (offset) by the amount that the sum of all disability benefits payable under Social Security and certain Federal, State, or local public disability and workers' compensation laws or plans exceeds the higher of 80% of the worker's average current earnings or the total Social Security benefit that would otherwise be payable on the disabled worker's record.

The Social Security benefit for a spouse of a disabled worker is subject to a pension offset if the spouse receives a governmental pension based on his or her own work in non-covered employment. However, the offset does not apply if: (i) the person received or became eligible to receive the pension before December 1, 1982, and can meet eligibility requirements for Social Security auxiliaries' benefit as they existed in January 1977; or (ii) if the person received, or was eligible to receive, the pension before July 1, 1983, and the person was dependent on his or her spouse for at least one-half support at the time the spouse died, became disabled or became entitled to Social Security benefits. The amount of the public pension used for purposes of the offset against Social Security spouse's benefits is equal to two-thirds of the public pension. The Social Security benefit for the spouse of a disabled worker is also offset dollar for dollar by the amount of any Social Security benefit the spouse receives based on his or her own work. All benefits to spouses and children of disabled workers are subject to an earnings test unless those beneficiaries are age 70 or older. In 1996, benefits are reduced $1 for each $2 of earnings over $8,280 for those under age 65 and $1 for each $3 of earnings over $12,500 for those ages 65 through 69.

Beneficiary Eligibility: Qualified disabled workers under age 65. Under the definition of disability in the Social Security law, disability benefits are provided to a person who is unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment that has lasted or is expected to last at least 12 months, or to result in death.

Disabled widow(er)s' benefits are covered under survivors insurance.

Felony-related impairments and confinement-related impairments cannot be considered in determining whether an individual is under a disability if the individual has been convicted of a felony which was committed after October 19, 1980. Effective in February 1995, new restrictions were placed on disability insurance benefits for those impairments that are based on drug addiction or alcoholism. The restrictions include time limiting benefits to 36 months during which treatment is available, and requiring that the benefit be paid to a representative payee. Public Law 103-296. Effective for claims finally adjudicated on March 29, 1996, (or for claims approved before then, with benefits payable beginning January 1, 1997) eligibility can no longer be based on drug addiction or alcoholism. Public Law 104-121.

Credentials/Documentation: Proof of disability and possibly proof of age. If applying for benefits for family members, additional proofs of age, relationship to disabled worker, or school attendance may be required.

96.001 APPLICATION & AWARD PROCESS:

Preapplication Coordination: None. This program is excluded from coverage under E.O. 12372.

Application Procedure: Phone or visit the local Social Security Office.

Award Procedure: After review of the application is completed, the applicant (or representative payee) will be notified by mail.

Deadlines: An individual should apply for disability benefits when he or she feels the eligibility requirements are met. Retroactivity of benefit payments is limited to 1 year before filing.

Range of Approval/Disapproval Time: Not applicable.

Appeals: Phone or visit any Social Security Office. The appeal process ranges from a reconsideration to a review by the Federal courts.

Renewals: Not applicable.

Criteria for Selecting Proposals: Not applicable.

Examples of Funded Projects: Not applicable.

Range & Average of Financial Assistance: Monthly cash benefits for a worker disabled in 1996 range up to a maximum of $1,462 based on the level of the worker's earnings and the age at which a worker becomes disabled. The corresponding maximum for such a worker with a family is $2,193.90. As of December 31, 1995, the average benefit paid to a disabled worker alone was $667 and the average amount payable to a disabled worker with eligible dependents was $1,147. This takes into account stipulations set forth in Public Law 96-265 and Public Law 97-35. Under Public Law 97-123, the minimum amount is no longer applicable for workers who either become disabled or first met the insured status requirements after December 1981, and a lesser amount can be paid, depending on the worker's average earnings.

96.001 RELATED PROGRAMS:

96.001 PROGRAM ACCOMPLISHMENTS: In fiscal year 1995, an average of 5,656,000 disabled workers and their dependents received monthly cash benefits. It is estimated that for fiscal year 1996, an average of 5,915,000 disabled workers and their dependents received monthly cash benefits, and during fiscal year 1997, the number receiving benefits will increase to 6,277,000.

96.001 FINANCIAL & ADMINISTRATIVE INFO:

Federal Agency: SOCIAL SECURITY ADMINISTRATION

Type of Assistance: Direct Payments with Unrestricted Use; Direct Payments for Specified Use.

Obligations: (Benefit Payments) FY 95 $40,201,000,000; FY 96 est $43,297,000,000; and FY 97 est $47,094,000,000.

Budget Account Number: 20-8007-0-7-651.

Authorization: Social Security Act of 1935, Title II, as amended; Public Laws 74-271, 86-778, 92-603, 93-66, 93-112, 95-216, 96-265, 96-473, 97-35, 97-123, 97-455, 98-4, 98-21, 98-76, 98-168, 98-369; Public Laws 98-460, 99-272, 99-335, 99-509, 99-514, 100-203, 100-360, 100-647, 101-234, 101-239, 101-649, 101-508, 103-296, 103-387, and 103-432; 42 U.S.C. 401; 42 U.S.C. 420-425.

Regulations, Guidelines, & Literature: Code of Federal Regulations, Title 20, Parts 401, 404 and 422. "If You Become Disabled," SSI-29, and other publications are available from any Social Security Office without charge.

96.001 INFO CONTACTS:

Regional or Local Office: Consult Appendix IV of the Catalog.

Headquarters Office: Office of Public Inquiries, Room 4100, Annex, Social Security Administration, Baltimore, MD 21235. Phone: (410) 965-2736. Use the same number for FTS.

96.001 ASSISTANCE CONSIDERATIONS:

Formula & Matching Requirements: This program has no statutory formula or matching requirements.

Length & Time Phasing of Assistance: Not applicable.

Uses & Use Restrictions: Monthly cash benefits are paid to eligible disabled persons and to eligible auxiliary beneficiaries throughout the period of disability after a 5-month waiting period. Costs of vocational rehabilitation also are paid for certain beneficiaries.

There are no restrictions on the use of benefits received by beneficiaries, although the right to future benefits is not transferrable or assignable. The Federal Government gives the States funds, in advance or by way of reimbursement, for necessary costs in making disability determinations under 20 CFR part 404 subparts P and Q and part 416 subparts I and J. Necessary costs are direct as well as indirect costs as defined in 41 CFR part 1-15, subpart 1-15.7 of the Federal Procurement Regulations System for costs incurred before April 1, 1984; and 48 CFR part 31, subpart 31.6 of the Federal Acquisition Regulations System and Federal Management Circular A-74-4 as amended or superseded for costs incurred after March 31, 1984.

96.001 POST ASSISTANCE REQUIREMENTS:

Reports: Any change in address or eligibility requirement (such as improvement of disabling condition or work activity) must be reported to the local Social Security Office when it occurs.

Audits: Persons are contacted periodically to see if they continue to qualify for benefits.

Records: Not applicable.

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