3. Cash Disability Benefits and Related Disability Protection

What are the types of disability protection under Social Security?

There are seven types of disability protection included under Social Security:

1. Monthly cash benefits for a disabled worker and family. The benefits for the disabled worker are usually called “disability insurance benefits.” However, in this Chapter they are called “disabled worker’s benefits.” This is to distinguish them from other benefits for disabled persons.
2. Monthly cash benefits for the needy, blind, or disabled individuals. This includes blind or disabled children (under the Supplemental Security Income (SSI) program.
3. The establishment of a period of disability for a disabled worker. This protects against the loss of, or the reduction in, the disability amount or retirement insurance benefits for the worker or the worker’s survivors. The establishment of a period of disability excludes the time that the worker is disabled when determining either insured status or the amount of benefits. This protects the worker since it is likely that the worker does not have substantial earnings when disabled.
   The requirements for disabled worker’s benefits and for establishing a period of disability are nearly the same. A worker entitled to either one is usually entitled to both.
4. Monthly cash benefits for a disabled widow(er) or disabled surviving divorced spouse. These benefits apply to disabled widow(er)s (or disabled surviving divorced spouses) age 50-59 who meet the other requirements for entitlement to widow(er)’s insurance benefits.
5. Monthly cash benefits for a disabled child of a worker entitled to disabled worker’s or retirement benefits or of an insured worker who died. These benefits are payable as early as age 18 and there is no upper age limit. They are referred to as childhood disability benefits because the child must have become disabled before reaching age 22.
6. Vocational rehabilitation services, employment services, or other support services for a Social Security disability beneficiary or a SSI disabled or blind recipient. These services help beneficiaries obtain the services and assistance they need to go to work. A State vocational rehabilitation agency or an employment network provides these services.
7. Hospital and supplementary medical insurance protection to:
   1. A person under age 65 who has been entitled to either of the following:
      1. Disability benefits as a disabled worker, widow(er), or adult child; or
      2. Disabled widow(er) benefits for at least 24 months.
      Note: The person must be entitled to benefits on the basis of insured status established under the Social Security Act. This does not include credits earned under the program of any other country.
   2. A person who:
      1. Has chronic kidney failure requiring a regular course of dialysis or a kidney transplant; and
      2. Is fully insured, currently insured, or entitled to monthly insurance payments because of work covered by the Social Security Act or the Railroad Retirement Act. This includes the spouse or dependent child of a person who is insured or entitled to monthly benefits payable under these Acts.
      3. A person whose disability did not end prior to December 1, 1980. The beneficiary may have his or her medical coverage continued for a maxi mum of 24 months after entitlement ends based on disability, provided medical recovery has not occurred.
         Note: After this period, a person may elect to purchase premium Medicare coverage. This is provided he or she continues to have a disabling impairment, files during an enrollment period, and his or her premium-free Medicare coverage ended because of substantial gainful activity .

When are you entitled to disabled worker’s benefits?

If you are a disabled worker, you are entitled to monthly cash benefits if you meet the following conditions:

1. Are under a disability;
2. Have filed an application for disabled worker’s benefits ;
3. Have disability insured status;
4. Have completed a five-month waiting period, unless you are exempt from this requirement; and
5. Have not reached full retirement age. Your benefits begin with the first month that you meet all of the conditions above.

What are “auxiliary benefits?”

“Auxiliary benefits” are additional monthly benefits. These benefits may be payable to other family members on your earnings record if you are entitled to disabled worker’s benefits. They are payable to your family members even when you are not receiving benefits because of imprisonment.

What is the “waiting period?”

The waiting period consists of five (5) full calendar months in a row. It begins with the earliest full calendar month (but not more than 17 months before the month you filed the application) that you:

1. Are disabled; and
2. Meet the disability insured status requirements for benefit purposes. You are not entitled to benefits for any month in the waiting period.

W hen is the waiting period NOT required?

No waiting period is required if any of the following conditions are met:

1. You were previously entitled to disabled worker’s benefits. The period of disability must have ended within five years before the month you again became disabled; or
2. You were previously entitled to a period of disability. The period of disability must have ended within five years before the month you again became disabled.
   Note: The waiting period requirement does not apply to SSI benefits.

How is the amount of your disabled worker’s benefit computed?

Your disabled worker’s benefit rate is generally equal to the primary insurance amount.

When is your benefit rate less?

Your actual disabled worker’s benefit rate may be less than the primary insurance amount if any of the conditions below are met:

1. A reduction becomes necessary because you receive workers’ compensation and/or a public disability benefit based on your work relationship paid under a Federal, State, or local public law or plan; or
2. You become entitled to disabled worker’s benefits after a reduced widow(er)’s or retirement insurance benefit.

W hen are you consider ed “disabled”?

You are considered “disabled” and entitled to disabled worker’s benefits if you meet the following conditions:

1. You cannot engage in any substantial gainful activity because of a physical or mental impairment. You must not only be unable to do your previous work, but also any other type of work considering your age, education, and work experience;
   Note: It does not matter whether such work exists in your immediate area, whether a specific job vacancy exists, or whether you would be hired if you applied for work.
2. Your impairment(s) must be established by objective medical evidence;
3. It is expected that your impairment(s) will either result in death or last for at least 12 months in a row; and
4. Your impairment(s) must be the primary reason for your inability to engage in substantial gainful activity.
   Note: The definition of disability above also applies to adults (persons age 18 or over) for determining eligibility on the basis of disability under the SSI program.

Are impairments relating to your commission of a felony covered by disability cash benefits?

Under title II, if you committed a felony after October 19, 1980, you are not entitled to disability cash benefits if:

1. Your impairments (or the aggravation of preexisting impairments) are related to your commission of the felony; or
2. Your impairments (or the aggravation of preexisting impairments) are related to your confinement in a correctional facility for the conviction of the felony.

Can a period of disability be established for impairments relating to your commission of a felony?

Although you may not be eligible for cash benefits, your confinement-related impairments and impairments aggravated by your confinement may be used to establish a period of disability. You can apply to have your Social Security records show how long you are disabled.

If a period of disability is established, the months in that period of time are not counted in computing your average earnings for any future benefits.

Is blindness considered a disability?

For title II, there is a special blindness condition if you are a blind worker who is at least 55. You are considered disabled if the following conditions are met:

1. You cannot engage in substantial gainful activity because of your blindness; and
2. Your blindness keeps you from doing work that you previously could do with some regularity and over a substantial period of time.

No benefits are payable for any month that you engage in substantial gainful activity.

What is the definition of “blindness”?

For Social Security purposes, “blindness” is either of the following:

1. Central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; or
2. A limitation in the field of vision so that the widest diameter of the visual field is an angle of 20 degrees or less (tunnel vision).
   Note: The same definition of blindness applies to all applicants for purposes of determining eligibility on the basis of blindness under the SSI program.

Are impairments relating to drug or alcohol abuse covered by disability benefits?

For both title II and title XVI, you can not be considered disabled if drug or alcohol abuse is a contributing factor of disability. This is true regardless of age.

What is a “period of disability?”

For title II, a “period of disability” is a continuous period of time when you are disabled. This period of disability is not counted when determining your insured status and the monthly benefit amount payable to you and your family . The period of disability can also preserve your family’s rights to benefits in another way: the beginning date of the period of disability is a point for determining dependency of a child and a parent.

When may you establish a period of disability?

For title II, you may establish a period of disability if you meet the conditions below:

1. You file an application either while you are disabled or no later than 12 months after the month in which your period of disability ends;
   Note: A valid application on behalf of a deceased worker may be filed within three months following the month of the worker’s death. It is filed by a person who would be qualified for unpaid monthly benefits.
2. You have disability insured status;
3. You were disabled before a final decision was made on your application; and
4. You were disabled for a period of at least five months in a row before you reached full retirement age (or you are exempt from serving a waiting period ) .

When does your period of disability begin?

For title II, your period of disability begins:

1. On the date your disability began, if you meet the requirements for disability insured status as of that day; or
2. On the first day of the first calendar quarter after your disability began and you attain disability insured status.

When does your period of disability end?

For title II, your period of disability generally ends with the last day of the month that the earliest of these events occurs:

1. The second month after the month your disability ends;
2. The month before the month you reach full retirement age; or
3. The month you die.

When can you receive widow(er)’s benefits based on disability?

You can receive disabled widow(er)’s benefits as a disabled widow(er) or surviving divorced spouse age 50-59 if, effective for benefits payable January 1991 or later, you meet the conditions below:

1. You meet the definition of disability for disabled workers;
2. You became disabled no later than seven years after the latest of the following months:
   1. The month the disabled worker died;
   2. The last month you were previously entitled to mother’s or father’s insurance benefits on the disabled worker’s earnings record; or
   3. The month your entitlement to widow(er) insurance benefits ended because the disability ended;
3. You have been disabled throughout a waiting period of five full calendar months in a row; and
   Note: No waiting period is required if you were previously entitled to disabled widow(er)’s benefits.
4. You meet the non-disability requirements for a surviving spouse or a surviving divorced spouse.
   Note: A widow(er) age 60-64 and under a disability is entitled to disabled widow(er)’s benefits for Medicare purposes.

When do disabled widow(er)’s benefits begin?

The first month of your entitlement to disabled widow(er)’s benefits is the latest of the following months:

1. If a waiting period is required, the sixth consecutive full calendar month of disability; or
2. If a waiting period is not required, the first full calendar month of disability;
3. The month your insured spouse died;
4. The twelfth month before the month you applied for benefits; or
5. The month you turn 50.

How is “disability” defined for determining entitlement for disabled widow(er)’s benefits?

For title II, the definition of “disability” for determining your entitlement to disabled widow(er)’s benefits is the same as that shown for disabled workers. This definition applies to disabled widow(er)’s benefits payable January 1991 or later.

Note: The following may not be used to establish disabled widow(er)’s benefits:

1. Impairments or the aggravation of preexisting impairments related to the commission of a felony after October 19, 1980, for which you are convicted; or
2. Impairments or the aggravation of preexisting impairments related to your confinement for committing such a crime.

What benefits may a child receive based on disability?

A child under the age of 18 who is found to be disabled may be eligible for Supplemental Security Income (SSI) under title XVI.

An adult child may be entitled to Childhood Disability Benefits (CDB) under title II if he/ she became disabled before age 22.

Definition of disability for Supplemental Security Income (SSI) children’s benefits

A child under age 18 is eligible to receive SSI based on disability if he or she:

1. Has very little income and resources;
2. Is not engaging in substantial gainful activity ;
3. Has a physical or mental condition(s) that very seriously limits his or her activities; and
4. The condition(s) has lasted, or is expected to last, at least 1 year, or is expected to result in death.
   Note: The SSI definition of disability for children is different from the definition of disability for adults under SSI and Social Security disability. A child’s condition(s) must result in “marked and severe functional limitations,” which is a level of severity that meets, medically equals, or functionally equals the listings.

When may a child receive Childhood Disability Benefits (CDB)?

Your adult son or daughter, age 18 or over, is entitled to receive CDB if he or she:

1. Meets the definition of disability;
2. Became disabled before age 22;
3. Meets the other requirements for child’s insurance benefits; and
4. Is not imprisoned within the U.S. for conviction of a felony.
   Note: There is no upper age limit for childhood disability benefits. Disabled adult sons or daughters can qualify on the record of a stepparent or grandparent in some cases.