Disability Benefits & Your Legal Options
People with disabilities often cannot earn enough money to support themselves, and they may not be able to rely on family members or friends for all of their needs. To help them make ends meet, the Social Security Administration of the federal government provides two benefits programs: Social Security Disability Insurance and Supplemental Security Income. However, these programs require an applicant or recipient to meet strict criteria.
Private insurance companies also offer long-term disability benefits policies if a person suffers from an injury or illness that prevents them from working or restricts their earning capacity. These may be critical for people with disabilities who do not meet the requirements of government benefits programs. In addition, several states have created short-term disability benefits programs for injuries or illnesses from which an employee recovers sooner.
Social Security Disability Insurance
To get SSDI benefits, a claimant must have accumulated a sufficient number of work credits and must have a qualifying disability. A claimant must not be engaging in substantial gainful activity. Also, their condition must significantly limit their ability to perform basic work tasks, and it must have lasted or be expected to last for at least 12 months, or to result in death.
A claimant who meets the requirements above usually will be eligible for benefits if their condition satisfies or equals the criteria of an entry in the Listing of Impairments, which is a manual of disabling conditions. Otherwise, the SSA will conduct a residual functional capacity assessment to determine what work the claimant can still perform despite their limitations. They will be eligible for benefits if they cannot perform their past relevant work (as the SSA defines this term) and cannot adjust to other work.
Supplemental Security Income
In contrast to an SSDI claimant, a person seeking SSI benefits does not need to have accumulated a certain number of work credits. However, the process of establishing medical eligibility parallels the SSDI process. Although the SSA provides for a basic SSI payment, this amount may increase if the state where the claimant lives provides supplemental benefits.
Only people who have limited income and resources can get these benefits. The SSA counts only certain types of income and resources, while excluding others. A recipient who earns income, for example, will not have the first $65 of their monthly earned income counted, and only half of any earned income beyond that amount will be counted. Resources that are not counted include the home where the SSI recipient lives, a vehicle that they use for transportation, and household goods and personal effects, among others.
Long-Term Disability Benefits
In exchange for paying premiums to an insurer, a consumer can get long-term disability benefits if they need to miss work for a long time or become permanently unable to work. Benefits usually will account for a percentage of the policyholder’s pre-disability income, and they may last for a certain time or until the policyholder reaches a certain age. Some policyholders may want to purchase riders, which are add-on features that improve benefits for an extra cost. For example, a residual disability rider might provide benefits based on a partial disability.
The definition of a disability in a long-term disability policy may determine when it takes effect. Some policies use an “own occupation” definition of disability, which means that a policyholder may be entitled to benefits if they cannot do their pre-disability job. Other policies use an “any occupation” definition of disability, which means that a policyholder is entitled to benefits only if they cannot work in any job, or often any job for which they are suited based on their education, training, and experience. Still other policies may use more nuanced definitions.
Short-Term Disability Benefits
California, New York, New Jersey, Rhode Island, and Hawaii have established short-term disability benefits programs operated through government agencies. The rules for these programs vary by state, but generally benefits are based on the pre-disability wages of the claimant within a specified period. Limits on the amount and duration of benefits typically apply, and a person with a disability must file their claim within a relatively short time after the onset of the disability. An employee also may get short-term disability coverage as part of their employment benefits. Insurers usually do not offer these policies on an individual basis.
