The Social Security Administration administers two types of disability programs: Social Security Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI). While the medical requirements for these programs are the same, there are important differences in the non-medical requirements. It is possible to be eligible for both programs.
DIB, or Title II Benefits
In order to receive these benefits, the claimant must be “fully insured” and show that they became disabled and unable to work between their date first ensured and their “date last insured” (DLI). A claimant is fully Insured once they have worked and paid Social Security taxes for a period for a period of time. Generally speaking, if the claimant has worked five (5) of the last ten (10) years, he/she will be fully insured; the DLI typically expires five years after the claimant stops working.
SSI, or Title XVI Benefits
In order to receive SSI benefits, the claimant must meet certain financial requirements. Those who have a limited work history (or their DLI has expired) and they currently have low household income and minimal assets may qualify for SSI.
The medical requirements for these programs are identical. The claimant must show that they have a severe impairment that prevents them from performing work for a period of at least twelve (12) consecutive months. Due to this durational requirement, it is advisable to wait until an individual has been out of work for at least six to eight months before applying.
Once an application is received, the Social Security Administration performs a five-step evaluation to determine the issue of disability.
1) Earnings Test
The first step is an earnings test. If the claimant is engaging in “substantial gainful activity,” they are found not disabled. If they are not performing substantial gainful activity, the process goes to the next step.
2) Severity Test
The second step is a medical severity test. The claimant must show that they have a “severe” impairment. If they do not, they are found not disabled. This is intended to weed out groundless claims. If a claimant does have a severe impairment, the claim proceeds to the third step.
3) Listing of Impairments Test
The third step is a presumptive disability test. The Social Security Administration maintains a list of impairments that are judged to be automatically disabling if certain criteria are met. If a claimant can show that their impairment meets the criteria found in this list, they are found to be disabled. If they do not meet the criteria in this list, the claim proceeds to the fourth step.
4) Residual Functional Capacity and Ability to Perform Past Work Test
Before the fourth step, the claimant’s “residual functional capacity” (RFC) must be assessed. This is an assessment of the claimant’s ability to perform work-related functions, such as standing, walking, sitting, lifting, and carrying. Following this assessment, the claim proceeds to the fourth step, which is a test to determine if the claimant can perform their past relevant work. The claimant’s RFC is compared to the demands of his past work. If they are able to perform their past work, they are found to be “not disabled.” However, if they are unable to perform their past work, the claim proceeds to the fifth and final step.
5) Ability to Perform Other Work Test
The fifth step is a test to determine if the claimant can perform any other work on a full-time basis. If the claimant is found to be capable of performing any other work on a full-time basis, they are found “not disabled.” For example, an individual no longer able to perform construction work is insufficient — they must show that they are unable to perform even a desk job before being found “disabled” by the Social Security Administration. When the claimant is over 50, the criteria is generally easier as their age, education, and past work are considered to their benefit.