Disability Benefits Guide for Workers Employed Throughout Long Island and NYC
The Social Security Disability Insurance (SSD or SSDI) program, administered by the Social Security Administration (SSA), is a payroll tax-funded insurance program that pays monetary benefits to individuals who cannot work due to a disability. While the SSA defines “disability” very strictly and there are several hurdles applicants must clear before obtaining benefits, the SSD program is a lifeline for over nine million people in the United States. If you are considering seeking SSD benefits, you have come to the right place; here, a disability attorney provides an overview of the program.
What Qualifies as a “Disability” for Disability Benefits Purposes?
The SSA defines “disability” very narrowly and pays benefits only to individuals who suffer full disability; no benefits are payable for partial disability or short-term disability.
An individual is considered disabled if:
- The individual cannot do the work they did before
- The individual cannot transition to other types of work due to their medical condition(s), and
- The disability has lasted or is expected to last for at least 12 months or to result in death
When determining whether an applicant meets the above criteria, the SSA considers several factors, including whether they are working when they apply, whether the condition is “severe,” and whether the condition is found in the list of disabling conditions, among others.
Disability Benefits for Mental Health Conditions
Individuals who suffer from mental health conditions are also eligible to receive SSD benefits. Generally, the SSA evaluates the applicant’s medical evidence and assesses several criteria to determine whether the applicant displays “extreme” or “marked” limitations of certain areas of mental functioning. For “serious and persistent” mental health disorders (those with a documented history of at least two years), the applicant may qualify if he or she can show evidence of:
- Ongoing medical treatment or mental therapy in a highly structured setting
- Minimal capacity to adapt to changes in environment or to demands that are not already part of the applicant’s daily life
Mental health conditions that may qualify the applicant for SSD benefits include: neurocognitive disorders, schizophrenia spectrum and psychotic disorders, depressive and bipolar disorders, intellectual disorders, anxiety and obsessive-compulsive disorders, personality and impulse-control disorders, autism spectrum disorders, neurodevelopmental disorders, eating disorders, and trauma- and stressor-related disorders.
The Most Common Disabilities
According to the SSA’s 2019 Annual Statistical Report (the latest report available), benefits were awarded to a total of 679,449 individuals. The breakdown of disabilities by diagnostic group was as follows:
- Musculoskeletal system and connective tissue: 37.7%
- Mental disorders: 13.3%
- Mood disorders: 5.2%
- Organic mental disorders: 2.2%
- Schizophrenic and other psychotic disorders: 1.8%
- Intellectual disability: 1.0%
- Autistic disorders: 0.4%
- Childhood and adolescent disorders not elsewhere classified: 0.1%
- Developmental disorders: 0.1%
- Other: 2.6%
- Cancers: 11.6%
- Circulatory system: 10.6%
- Nervous system and sense organs: 9.1%
- All other impairments: 17.7%
This breakdown varies little year to year — musculoskeletal system disorders consistently account for a plurality of disabilities, followed by mental disorders, followed by cancer.
In a profile of all beneficiaries in the year 2019, the SSA found that:
- Workers accounted for the largest share of disabled beneficiaries (86%)
- The average age of beneficiaries was 55
- Men and women were represented almost equally, with men accounting for less than 51% of beneficiaries
- The average monthly benefit received was $1,258
Are All New York Workers Covered under the Program?
Not all workers are automatically covered under the program. Instead, workers qualify for coverage by building up a certain amount of “work credits” that they earn by paying Social Security taxes. Workers can earn up to a maximum of four credits per year. To qualify, applicants must meet both a recent work test and a duration of work test.
The number of credits an applicant needs to meet the recent work test generally are as follows:
- Before age 24: An applicant may qualify if they have earned 6 credits in the 3-year period before their disability starts.
- Ages 24 to 31: An applicant may qualify if they have credit for working half the time between age 21 and the time they become disabled. For example, if an applicant becomes disabled at age 27, they would need 3 years of work (12 credits) out of the past 6 years (between ages 21 and 27).
- Age 31 and older: An applicant must have earned at least 20 credits in the 10-year period immediately before becoming disabled.
The number of credits an applicant needs to meet the duration of work test generally are as follows:
- Before age 28: 1.5 years of work
- Age 30: 2 years
- Age 34: 3 years
- Age 38: 4 years
- Age 42: 5 years
- Age 44: 5.5 years
- Age 46: 6 years
- Age 48: 6.5 years
- Age 50: 7 years
- Age 52: 7.5 years
- Age 54: 8 years
- Age 56: 8.5 years
- Age 58: 9 years
- Age 60: 9.5 years
Please note that these numbers are merely estimates and do not cover all situations.
Can You Qualify for Benefits if You Are Still Working?
Generally, yes, you can qualify for disability benefits if you are working, although there are limits to the income you may make. The SSA does not require that beneficiaries be completely unable to work. Instead, they must be unable to engage in Substantial Gainful Activity (SGA), which is defined as the type of work that requires significant mental or physical activities for which people are usually entitled to be paid for. When evaluating whether an applicant is engaged in SGA, the SSA looks to several factors, including:
- The nature of the work
- How well the applicant performs the work
- Whether the work is done under special conditions that take the applicant’s disability into account
- Whether the applicant is self-employed
- How much time the applicant spends engaged in work
Activities not typically considered to be SGA include taking care of oneself, household tasks, hobbies, therapy, school attendance, club activities, and social programs.
The SSA also places an annual cap on the amount of money an individual may make before his or her work is considered to be SGA.
How Much Does Disability Pay?
The amount of benefits a beneficiary receives depends upon how much money he or she made before becoming disabled. This amount is based on a complex mathematical formula that takes into account the applicant’s average earnings (the Average Indexed Monthly Earnings or AIME), which is then used to calculate the Primary Insurance Amount (PIA). At the end of 2020, the average monthly benefit amount was $1,277.05.
The SSA Evaluation Process
At the first phase of the evaluation process, the SSA determines whether the applicant meets the nonmedical requirements for benefits, such as age, work credits, whether the applicant can engage in SGA, etc. If the applicant meets those requirements, the SSA sends the application to the Disability Determination Services (DDS) office in the state where the applicant resides.
In the second phase, the DDS uses a five-step sequential evaluation process to determine whether a person is disabled:
- Is the applicant working? If the applicant is working and earning more than the SGA limit, he or she generally will not qualify for benefits.
- Is the condition “severe”? A condition is “severe” if it interferes with necessary work-related activities
- Does the applicant have an impairment that meets or equals one that is described in the SSA’s listing of impairments? The SSA keeps a list of impairments for 14 major body systems that it considers to be so severe that they automatically mean that a person is disabled. If the condition is not on the list, DDS will decide whether it is of equal severity to a listed impairment.
- Can the applicant do the work he or she previously did? If the applicant’s condition is severe but not of equal severity as an impairment on the list, DDS must determine whether it interferes with a person’s ability to do the work he or she previously did
- Can the applicant do any other type of work? To determine the applicant’s ability to do other work, DDS considers the applicant’s medical conditions, age, education, work experience, and transferable skills. If DDS determines that the person cannot do other work, their claim will be approved. If it determines that the applicant can do other work, their claim will be denied.
In some cases, DDS may need additional medical information before they can make a determination, in which case the applicant will be asked to undergo a consultative examination at the SSA’s expense.
Contact a Long Island Disability Attorney for More Information
If you have suffered a disability that prevents you from working, you should speak to an attorney who can help you evaluate the strength of your potential claim. To get started, please contact a Long Island disability attorney at Turley Redmond & Rosasco by using our online form or calling us at 516-745-5666 (Garden City), 631-582-3700 (Ronkonkoma), or 631-399-0400 (Shirley).