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Booklet title: "Disability"

U.S. Department of Health And Human Services
Social Securtiy Administration
SSA Publication No. 05-10029
January 1992
ICN 456000

Who Should Read This Booklet?

You should, if you want to know more about the various kinds of
disability benefits available from Social Security.
This booklet will tell you who is eligible, how to apply, and what you
need to know once benefits start.

We pay disability benefits under two programs: the Social Security
disability insurance program and the Supplemental Security Income (SSI)
program. The medical requirements for disability payments are the same
under both programs and a person's disability is determined by the same
process. While eligibility for Social Security disability is based on
prior work under Social Security, SSI disability payments are made on
the basis of financial need. And there are other differences in the
eligibility rules for the two programs. This booklet deals primarily
with the Social Security disability program. For information on SSI
disability payments, refer to the section, "A Word About Supplemental
Security Income," at the back of this book, or ask for the booklets,
SSI (Publication No. 05-11000) and Working While Disabled ... How
Social Security Can Help (Publication No. 05-10095).

Please Note: This booklet provides a general overview of the disability
program. The information it contains is not intended to cover all
provisions of the law. For specific information about your case,
contact Social Security.

What's Inside


Part 1--Introduction To Disability And Social Security
What We Mean By "Disability"
Who Can Get Social Security Disability Benefits
Disability Benefits For People With HIV Infection
Disability Benefits For Children
How Much Work You Need For Social Security Benefits

Part 2--Signing Up For Disability
How To Apply
Who Decides If You Are Disabled
How We Determine Disability
Rules For Blind Persons
If Your Claim Is Denied

Part 3--When Your Claim Is Approved
Your First Check
How Much You Will Get From Social Security
How Other Payments Affect Benefits
Benefits May Be Taxed
You Can Get Medicare If You're Disabled
Reviewing Your Disability
What Can Cause Benefits To Stop

Part 4--Going Back To Work
Benefits While You Work

A Word About Supplemental Security Income

For More Information

Other Booklets Available

Part 1 Introduction To Disability And Social Security

Disability is something most people don't like to think about. But the
chances of your becoming disabled are probably greater than you
realize. In fact, studies show that one out of four young workers will
become disabled some time during their lifetime.

It's a fact that, while most people spend time working to succeed in
their jobs and careers, few think about ensuring that they have a
safety net to fall back on should the unthinkable happen. This is where
Social Security comes in. We pay cash benefits to people who are unable
to work for a year or more because of a disability. Benefits continue
until a person is able to work again on a regular basis and a number of
work incentives are available to ease the transition back to work.

What We Mean By "Disability"

It's important that you understand how Social Security defines
"disability." That's because different programs have different bases
for determining disability. Some programs may pay for partial
disability or for short-term disability. Social Security does not.

Disability under Social Security is based on your inability to work.
You will be considered disabled if you are unable to do any kind of
work for which you are suited, and only if your inability to work is
also expected to last for at least a year or to result in death.

Some consider this a strict definition of disability, and it is. The
program assumes that working families have access to other resources to
provide support during periods of short-term disabilities, including
workers compensation, insurance, savings, and investments. It is
designed to provide a continuing income to you and your family
when you are unable to do so. Benefits continue as long as you remain
disabled.

Who Can Get Social Security Disability Benefits

You can receive Social Security disability benefits at any age. If you
are receiving disability benefits at age 65, they become retirement
benefits, although the amount remains the same. Certain members of your
family may also qualify for benefits on your record. They include:

* Your unmarried son or daughter, 18 or older, if he or she has a
disability that started before 22. (If a disabled child under 18 is
receiving benefits as a dependent of a retired, deceased, or disabled
worker, someone should contact Social Security to have his or her
checks continued at 18 on the basis of disability.)

* Your spouse at any age if he or she is caring for a child of yours
who is under 16 or disabled and also receiving checks.

Certain family members may qualify for disability
benefits if you should die. They include:

* Your disabled widow or widower 50 or older. The disability must have
started before your death or within 7 years after your death. (If your
widow or widower caring for children receives Social Security checks,
she or he is eligible if she or he becomes disabled before those
payments end or within 7 years after they end.)

* Your disabled ex-wife or husband who is 50 or older if the marriage
lasted 10 years or longer.

Disability Benefits For People With HIV Infection

People with HIV infection or AIDS may also qualify for disability
benefits when they are no longer able to work or when they must
severely limit the amount of work they do because of the disease. A
person diagnosed with AIDS who is not working generally qualifies for
disability benefits. Some people with HIV infection that has not
progressed to AIDS may be just as severely disabled as a person with
AIDS, and therefore just as likely to qualify for disability. For more
information, ask for the booklet, A Guide to Social Security And SSI
Disability Benefits For People With HIV Infection (Publication No.
05-10020).

Disability Benefits For Children

In recent years, there has been a growing concern about whether parents
are aware of the disability benefits that are available for their
disabled children. More than 475,000 children under 18 who have
disabilities currently receive such benefits; many suffer some form of
mental retardation, others from various childhood conditions.
We recently changed the way we decide if a child is disabled, generally
making it easier for children to qualify.

SSI disability benefits are payable to people of any age with a
disability, including children. For more information, ask Social
Security for the booklets, SSI (Publication No. 05-11000) and Social
Security and SSI Benefits For Children With Disabilities (Publication
No. 05-10026).

Social Security dependents benefits are payable to children under 18 if
a parent is recieving retirement or disability benefits or is deceased.
These benefits may also be paid to children 18 or older who were
disabled before age 22. Benefits will continue into their adult years
as long as they remain disabled.

How Much Work You Need For Social Security Benifits

To qualify for Social Security disability benefits, you must have
worked long enough and recently enough under Social Security. You earn
up to a maximum of 4 credits per year. The amount of earnings required
for a credit increases each year as general wage levels rise. Family
members who qualify for benefits on your work record do not need work
credits.

The number of work credits needed for disability benefits depends on
your age when you become disabled.

* Before age 24--You need 6 credits in the 3-year period ending when
your disability starts.

* Age 24 to 31--You need credit for having worked half the time between
21 and the time you become disabled. For example, if you became
disabled at age 27, you would need credit for three years of work (out
of 6 years).

Age 31 or older--You need to have the same number of work credits as
you would need for retirement, as shown in the following chart. Also,
you generally must have earned at least 20 of the credits in the 10
years immediately before you became disabled.

Born After               Born Before
1929, Become             1930, Become                  Credits
Disabled At Age          Disabled Before 62            You Need
----------------------------------------------------------------------
31 through 42                                            20
     44                                                  22
     46                                                  24
     48                                                  26
     50                                                  28
     52                                                  30
     53                                                  31
     54                                                  32
     55                                                  33
     56                                                  34
     57                       1986                       35
     58                       1987                       36
     59                       1988                       37
     60                       1989                       38
62 or older                   1991 or later              40
----------------------------------------------------------------------

Part 2--Signing Up For Disability

How To Apply

You should apply at any SOcial Security office as soon as you become
disabled. (You may file by phone, mail or by visiting the nearest
office.) However, Social Securtiy disability benefits will not begin
until the 6th full month of disability. This "waiting period" begins
with the first full month after the onset of your disability.

The claims process for disability benefits is generally longer than for
other types of Social Security benefits--from 60 to 90 days. It takes
longer to obtain medical information and to assess the nature of the
disability in terms of your ability to work. However, you can help
shorten the process by bringing certain documents with you when you
apply. These include:

* The Social Security number and proof of age for each person applying
for payments.  This includes your spouse and children, if they are
applying for benefits.

* Names, addresses, and phone numbers of doctors,
hospitals, clinics, and institutions that treated you and
dates of treatment.

* A summary of where you worked in the past 15 years and the kind of
work you did.

* A copy of your W-2 Form (Wage and Tax Statement),
or if you are self-employed, your Federal tax return
for the past year.

* Dates of any prior marriages is your spouse in applying.

Do not delay filing for benefits just because you do not have all the
information you need. The Social Security office will be glad to help
you.

Who Decides If you Are Disabled

After helping you complete your application, the Social Security office
will review it to see if you meet the nondisablity requirements of the
law. These include such factors as weather you have worked long enough
and recently enough to qualify for disability benefits, your age, and
if you are applying for benefits as a family member, your relationship
to the worker. The office will then send your application to the
Disability Determination Services (DDS) office in your State. There, a
decision will be made as to whether you are disabled under the Social
Security law.

In the DDS office, a team consisting of a physican (or psychologist)
and a disability evaluation specialist will consider all the facts in
your case and decide if you are disabled. They will first make every
reasonable effort to get medical evidence from your doctors and from
hospitals, clinics, or institutions wehre you have been treated. The
Government pays a reasonable charge for any medical reports that it
needs and requests. If the DDS team has difficulty getting a medical
report, you may be asked to help obtain it. You do not need to ask your
doctor for a report before you apply for disability benefits. But, if
you have copies of your medical reports available, it may take us less
time to process your claim.

On the medical report forms, your doctors or other sources are asked
for a medical history of your condition: What is wrong with you and
when it began; how the condition limits activities; what the medical
test have shown; and what treatment has been provided. They are also
asked for information about your ability to do work related activities,
such as walking, sitting, lifting, and carrying. They are not asked to
decide whether you are disabled.

Additional medical information may be needed before the DDS team can
decide your case. If it is not available from your current medical
sources, you may be asked to take a special examination called a
"consultative examination." Your doctor or the medical facility where
you have been treated is the preferred source to perform this
examination. Social Securtiy will pay for the examination or any other
additional medical tests you may need, and for certain travel expenses
related to it.

The rules in the Social Security law for determining disability differ
from those in other Government and private programs. However, a
decision made by another agency and the medical reports it obtains may
be considered in determining whether you are disabled under Social
Security rules.

Once a decision on your claim is reached, you will receive a written
notice from the Social Security Administration. If your claim is
approved, the notice will show the amount of your benefit and when
payments start. If it is not approved, the notice will explain why.

How We Determine Disability

You should be familiar with the process we use to determine if you are
disabled. It's a step-by-step process involving five questions. They
are:

1 Are you working?
If you are and your earnings average more than $500 a month, you
generally cannot be considered disabled.

2 Is your condition "severe"?
Your impairments must interfere with basic work-related activities for
your claim to be considered further.

3 Is your condition found in the list of disabling impairments?
We maintain a list of impairments for each of the major body systems
that are so severe they automatically mean you are disabled. If your
condition is not on the list, we have to determine if it is of equal
severity to an impairment on the list. If it is, your claim is
approved. If it is not, we go to the next step.

4 Can you do the work you did previously?
If your condition is severe, but not at the same or equal severity as
an impairment on the list, then we must determine if it interferes with
your ability to do the work you did in the last 15 years. If it does
not, your claim will be denied. If it does, your claim will be
considered further.

5 Can you do any other type of work?
If you cannot do the work you did in the last 15 years, we then look to
see if you can do any other type of work. We consider your age,
education, past work experience, and transferable skills, and we review
the job demands of occupations as determined by the Department of
Labor. If you cannot do any other kind of work, your claim will be
approved. If you can, your claim will be denied.

Rules For Blind Persons

The Social Security disability program has special rules for blind
persons. If you qualify, you may receive benefits either on the basis
of blindness or on the basis of disability.

You are considered blind under Social Security rules if your vision
cannot be corrected to better than 20/200 in your better eye, or if
your visual field is 20 degrees or less, even with a corrective lens.

If you are blind, you can earn up to the current monthly amount of the
annual earnings limit that applies to non-disabled beneficiaries. This
is generally higher than the "substantial gainful activity" level of
$500 that applies to non-blind disabled workers. (See page 16.)

If you are blind, you should file for disability even if you are
working regularly and your earnings are too high to receive disability
benefits. That's because you might be eligible for a disability
"freeze." This means that your future benefits, which are figured on
your average earnings over your working life, will not be reduced
because of relatively lower earnings in those years when you are blind.


You should also note that, as a blind beneficiary, you may request to
receive your Social Security notices by telephone or certified mail
rather than regular mail. Just let your local Social Security office
know.

If Your Claim Is Denied

If your claim is denied, or if you disagree with any other decision we
make, you may appeal the decision. The Social Security office will help
you complete the paperwork.

There are four levels of appeal. If you disagree with the decision at
one level, you may appeal to the next level. You have 60 days from the
time you receive the decision to file an appeal to the next level. We
assume that you receive the decision 5 days after the date on it,
unless you can show us that you received it later.

Reconsideration

Your file is reviewed by persons other than those who made the original
decision.

Hearing

If the reconsideration decision is still unfavorable, you may apply for
a hearing before a judge. If you are appealing a decision that you are
no longer medically disabled, you may also request that we continue
your benefits while you wait for a decision.

Appeals Council

The Appeals Council will review your case if it feels that there is an
issue that the judge did not address. If it denies your review, or you
otherwise disagree with its decision, you may appeal to a Federal Civil
Court.

United States District Court

Again, you have 60 days from the day you received the notice of the
decision to appeal to a Federal Court.

Part 3 When Your Claim Is Approved

Your First Check

Once a decision is made that you are disabled, you will receive your
first Social Security disability check dating back to the 6th full
month from the onset of your disability. You also will receive a
booklet describing your responsibilities as a Social Security
beneficiary: When You Get Social Security Disability Benefits--What You
Need To Know (Publication No. 05-10153). You should read this booklet
carefully and keep it in a safe place with your other valuable papers
in order to refer to it whenever questions arise.

How Much You Will Get From Social Security

The amount of your monthly disability benefits is based on your
lifetime average earnings covered by Social Security. If you would like
an estimate of your disability benefit, all you have to do is call or
visit Social Security and ask for it. We'll send you a form you can use
to get a Personal Earnings and Benefit Estimate Statement.

How Other Payments Affect Benefits

Eligibility for other government benefits can affect the amount of your
Social Security disability benefits.

Other Disability Benefits

Social Security benefits may be affected if you are also eligible for
workers' compensation (including black lung) or for disability benefits
from certain Federal, State, local government, Civil Service, or
military disability programs. Total combined payments to you and your
family from Social Security and any of these other programs generally
cannot exceed 80 percent of your average current earnings before
becoming disabled.

Government Pension Offset

If you are a disabled widow or widower or the spouse of a disabled
worker, a "government pension offset" may reduce your Social Security
payment. The offset applies if you become eligible for a Federal State,
or local government pension based on your own work not covered by
Social Security. The amount of your Social Security spouse's benefit
may be reduced by two-thirds of the amount of your government pension.


There are some exceptions when the offset would not
apply. For more information, call or visit Social Security to ask for a
free copy of the fact sheet, Government Pension Offset (Publication No.
05-10007).

Pension From Work Not Covered By Social Security

If you become disabled and entitled to a Social Security disability
benefit and you also receive a monthly pension based on work not
covered by Social Security, your disability payment will be smaller
than normal. That's because we use a different formula to figure the
Social Security benefit of people who get other public pensions.

For more information, call or visit Social Security to ask for a free
copy of the fact sheet, A Pension From Work Not Covered By Social
Security (Publication No. 05-10045).

Benefits May Be Taxed

A relatively small number of people may have to pay Federal income
taxes on their Social Security benefits. This usually happens only if
your total income is high. At the end of the year, you will receive a
Social Security Benefit Statement (Form SPA-1099) showing the amount
of benefits you received. The statement is to be used for completing
your Federal income tax return if any of your benefits are subject to
tax. You may use the Internal Revenue Service Publication 915 for
additional information on the tax.

You Can Get Medicare If You're Disabled

You will be automatically enrolled in Medicare after you have been
getting disability benefits for 2 years.

There are two parts to Medic arc hospital insurance and medical
insurance. Hospital insurance helps pay hospital bills and some
follow-up care. The taxes you paid while you were working financed this
coverage, so it's premium free if you're eligible. The other part of
Medicare, medical insurance, helps pay doctors' bills and other
services. You pay a monthly premium for this coverage if you want it.
Almost everybody has both parts of Medicare.

If you get Medicare, and have little income or resources, you should
know about a program that can save you money on out-of-pocket medical
costs. The program is called the "Qualified Medicare Beneficiary"
program, or QMB. For more information, call a Social Security office to
ask for the factsheet, You Should Know About QMB (Publication No.
05-10079).

Reviewing Your Disability

Your benefits will continue as long as you are disabled. However, your
case will be reviewed periodically to see if you are still disabled.
The frequency of the reviews depends on the expectation of recovery.

* If medical improvement is "expected" your case will normally be
reviewed within 6 to 18 months.

* If medical improvement is "possible," your case will normally be
reviewed no sooner than 3 years.

* If medical improvement is "not expected" your case will be reviewed
no sooner than 7 years.

What Can Cause Benefits To Stop

There are two things that can cause us to decide that you are no longer
disabled and to stop your benefits.

Your benefits will stop if you work at a level we consider
"substantial." Usually, average earnings of $500 or more a month are
considered substantial.

Your disability benefits would also stop if we decide that your medical
condition has improved to the point that you are no longer disabled.

You Must promptly report any improvement in your condition, your return
to work, and certain other events as long as you are receiving
benefits. These responsibilities are explained in the booklet you will
receive when benefits start.

Part--4 Going Back To Work

If you're like most people, you would rather work than try to live on
disability benefits. There are a number of special rules that provide
cash benefits and Medicare while you attempt to work. We call these
rules "work incentives." You should be familiar with these disability
work incentives so that you can use them to your advantage.

If you are receiving Social Security disability benefits, the following
rules are among the work incentives that apply:

* Trial Work Period--For 9 months (not necessarily consecutive), you
may earn as much as you can without affecting your benefits. (The 9
months of work must fall within a 5-year period before your trial
work period can end.) A trial work month is any month in which you earn
more than $200. After your trial work period ends, your work is
evaluated to see if it is "substantial." If your earnings do not
average more than $500 a month, benefits will generally continue. If
earnings do average more than $500 a month, benefits will continue for
a 3-month grace period before they stop.

* Deductions for Impairment-Related Expense--Work expense related to
your disability will be discounted in figuring whether your earnings
constitute substantial work.

* Medicare Continuation--Your Medicare coverage will continue for 39
months beyond the trial work period. If your Medicare coverage stops
because of your work, you may purchase it for a monthly premium.

For more information about Social Security's work incentives, ask for a
copy of the booklet, Working While Disabled...How Social Security can
Help (Publication No. 05-10095).

As we stated earlier, the medical requirements for disability payments
are the same for Social Securtiy and SSI, and a person's disability is
determined by the same process for both programs. But there are some
differences between Social Securtiy and SSI that you should know about.
These include:

*  No disability waiting period is required under SSI. Because SSI
payments are based on financial need, the presumption that a person has
resources to handle short-term health problems does not exist.

* Under SSI, you may qualify for an immediate disability payment if
your condition is obviously disabling and you meet the SSI income and
resource limits.

* Different work incentive rules apply to SSI recipients. The major
difference ti that cash benefits and Medicaid continue as long as the
SSI income limits are not exceeded (the "substantial" income level
discussed on page 17 does not apply). Another important rule permits
money to be set aside for uop to 48 months for a work goal. Other
special rules apply to blind persons, disabled students, and people
with disabilities who work in sheltered workshops.

Some work incentive rules are the same for SOcial Securtiy disability
and SSI. These include the work expenses exclusion and the continuation
of benefits while in vocational rehabilitation program.

For more information about SSI disability payments, ask for the
publications, SSI (Publication No. 05-11000) and Working While
Disabled...How Social Security Can Help (Publication No. 05-10095).

For More Information

For more information or to apply for benefits, call or visit Social
Security. It's easiest to call Social Security's toll-free telephone
number. The number is 1-800-772-1213. You can speak to a representative
7 a.m. to 7 p.m. on business days.

The Social Security Administration treats all calls confidentially--
whether they're made to our toll-free number or to one of our local
offices. We also want to ensure that you receive accurate and courteous
service. That is why we have a second Social Security representative
listen to some incoming and outgoing telephone calls.

Other Booklets Available

Social Security has a number of publications that contain
information about other Social Security programs. Con-
tact Social Security to get a free copy of any of these publi-
cations. They include:

Understanding Social Security (Publication No. 05-10024)--A
comprehensive explanation of all the Social Security programs.

Retirement (Publication No. 05-10035)--Explains Social Security
retirement benefits.

Survivors (Publication No. 05-10084)--Explains Social Security
survivors benefits.

Medicare (Publication No. 05-10043)--Explains Medicare hospital
insurance and medical insurance.

SSI (Publication No. 05-11000)--Explains this program, which provides a
basic income to people who are 65 or older, disabled, or blind and have
limited income and resources.

Social Security And SSI Benefits For Children With Disabilities
(Publication No. 05-10026)--Explains benefits available to children
with disabilities.

All these publications are available in Spanish.

U.S.  GOVERNMENT PRINTING OFFICE: 1991--312-168/660003