Under the Social Security Act of 1935 was created principally as a result of the Great Depression to gave the country an old-age benefit system. Originally Social Security provided benefits only for workers, but later provided benefits for the workers’ family also, and it was then known as Old-Age and Survivors Insurance. Several amendments were added that expended the benefits, and in 1956, disability income because part of the benefits offered under this plan, whereupon the name was changed to Old-Age, Survivors, and Disability Insurance (OASDI).
With the further expansion of this Act in 1965, under Title VIII, Medicare was introduced, and the name was changed to its present title, Old-Age, Survivors, Disability and Health Insurance (OASDHI).
Because the Social Security program attracts changes because it has been so politicized and since the fastest growing area of voters are senior citizens, there are changes in Social Security almost continually, and plans are afoot to privatize portions of it. Whether this will change or alter the disability income part of Social Security has not been determined, but any change in Social Security has always been to liberalize the benefits, so it can be expected that there will be changes in the disability income part also.
Benefits under OASDHI is based upon the individual being part of the labor market, which is different than most of the rest of the world as plans in other countries are based on some sort of universal coverage for all nationals. All occupations are covered but certain occupations have special eligibility rules because of legal or administrative reasons. All of the states have entered into agreements with the Federal Health and Human Services. Groups that are not under a state or local retirement system may be required to be covered. Approximately 95% of the employed persons in the U.S. are covered under OASDHI and must pay Social Security taxes.
Benefits are divided into three categories: (1) fully insured, (2) currently insured, and (3) disability insured. Determination as to category depends upon number of quarters of coverage of an individual and when they were earned.
A quarter of coverage is allowed for each $750 (adjusted annually depending upon the national average of wage level) unit of annual earnings on which Social Security taxes are paid, up to a maximum of 4 quarters per year.
An individual worker is eligible for cash disability benefits, if he
Another way of looking at this (as published in information pieces by the Social Security Administration) is that there are two programs. One is the Social Security Disability Insurance program which pays benefits to the individual and certain members of his family if the individual is “insured,” meaning that they have worked long enough and paid Social Security taxes.
The other is Supplemental Security Income that pays benefits based on financial need.
For persons disabled before age 31, these requirements are reduced. For blind persons, the second requirement (above) does not need to be met.
The disabled individual must be willing to participate in state vocational rehabilitation services.
Disability Income benefits under Social Security is equal to 100% of the Primary Insurance Amount and continues during disability or until the normal retirement age is reached, at which time it them becomes a retirement benefit.
The Primary Insurance Amount is the monthly amount paid to a retired worker at the normal retirement age (65) or to a disabled worker. This primary insurance amount is based on the worker’s average indexed monthly earnings (AIME). The AIME is designed to make sure that monthly cash benefits reflects any changes in the individual’s level of wages over the working lifetime of the individual so that the benefits will have a relatively constant relationship to the earnings of the worker before retirement.
The method of determining the actual amount is rather complex and involves a formula involving the actual earnings in a certain year, the average annual wages at the time of retirement or disability, and the average annual wages for the year in which the “actual earnings” used in this formula, is used. The maximum family benefit is a percentage of the AIME. As a note of interest, if the AIME at time of retirement is $5,000, the maximum benefit would be 54.6%; for $3,500, benefit would be 66.7%; and for $2,000, the amount is 87%.
After the worker’s AIME is determined, another formula is applied to determine the primary insurance amount. The PIA is simpler to determine than the AIME: The PIA is 90% of the first $505 of AIME; plus 32%$ of the next $2,538, and plus 15% of the AIME in excess of $3,043. (These figures also vary from year to year, and those given were those used in 1999 as an example.)
If this appears to be a redistribution of income, just remember that the major goal of the Social Security program is just that, the redistribution of income to provide a floor of security for lower paid workers. Seldom discussed, but one of the results of this philosophy is that there is a lower income replacement rate and “rate of return” for higher earners. Until quite recently, Social Security paid more in benefits per individual than the amount collected from the individual in Social Security taxes (using time-value of money). This is not now the case; hence the continued discussions on Social Security reform in Washington.
Automatic Cost-of-Living Adjustment (COLA) creates an automatic income in benefits every December and is based upon the Consumer Price Index (CPI). If the CPI should fall during a year, the benefits remain stable and future COLA increases are based upon the CPI level before the decline.
There is a limit on the maximum monthly benefits that can be paid to a family based upon the earnings of one person, and if the person was disabled in 1981 or later the maximum family benefit is the lower of 85% of the worker’s AIME or 150% of the PIA.
To illustrate, based upon 1999 benefits and subject to later COLA adjustments, the maximum family benefits would be 150% of the fist $645 of the PIA; plus 272% of the next $286; plus 134% of the next $283, plus 175% of the PIA in excess of $1,214.
The original determination of disability is under the purview of the state agencies, with the Social Security Administration having the right to review.
Disability is defined as the inability to engaged in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to last or has lasted for a period of not less than 12 months, or result in death.
F NOTE: No benefits are payable for partial disability or for short-term disability.
Monthly benefits are made to family members of individuals who are receiving disability insurance benefits – and are the same as ones that would qualify for family benefits for those who are receiving retirement benefits. A lower family maximum benefit applied in disability cases than in retirement and survivor cases.
Rehabilitation is part of the disability program, as mentioned earlier. Therefore, a beneficiary who is disabled but who still performs services despite the disability or severe handicaps, can continue receiving disability benefits for a period of nine months. The law also provides a three month adjustment period for beneficiaries who medically recover from their disabilities.
An unmarried child of a deceased, disabled or retired worker covered under the Social Security program who (the worker) has been disabled since before age 22, is eligible for a cash disability benefit at age 18 or later. The child’s benefits are payable for as long as the disability continues, and are the same as the benefit received by a dependent child who is not disabled, of a disabled, retired or deceased worker. Another benefit may be paid to a mother or father who is taking care of a disabled child that is receiving benefits, and also applies if he/she is a spouse of a disabled, retired or deceased worker. The rehabilitation requirement also applies to a disabled child.
California, Hawaii, New Jersey, New York, Rhode Island and Puerto Rico have temporary disability plans. With these state laws, disabled employees may collect disability income benefits regardless if the disability started while they were working, but are not paid if the disability is covered under Worker’s Compensation. In most states (except – New York) the disability program could be considered as an extension of state unemployment insurance laws.
The programs vary in some degree from state to state although employees contribute to the plan in all of these 6 jurisdictions. In California and Rhode Island, only the employees contribute, and (except R.I.) an employee may obtain coverage from either a state fund or from private insurers who are required by law to provide benefits at least as liberal as those provided under the state fund. Self-insurance generally is permitted.
The following information is derived directly from IRS Section 1611, which pertains to the Social Security Administration, Office of Disability. Please do not be concerned with all of the format used by the Internal Revenue Service, but since many Disability Income policies coordinate benefits with the SSA Disability program, at the very least it must be taken into consideration when discussing a Disability Income insurance program.
Also, ignore the dates of effectiveness in the Section of the IRS Code as this is the original Section and updates are continual.
Emphasis on certain sections is defined by underlining or in bold print in order to assist in reading and understanding this IRS Section. Specific notes by the author of this text and not part of the IRS Code 1611 will be in “curly braces” { } and italicized to differentiate it from the code text.
SEC. 1611. [42 U.S.C. 1382] (a)(1) Each aged, blind, or disabled individual who does not have an eligible spouse and--
(A) whose income, other than income excluded pursuant to section 1612(b), is at a rate of not more than $1,752 (or, if greater, the amount determined under section 1617) for the calendar year 1974 or any calendar year thereafter, and
(B) whose resources, other than resources excluded pursuant to section 1613(a), are not more than (I) in case such individual has a spouse with whom he is living, the applicable amount determined under paragraph (3)(A), or (ii) in case such individual has no spouse with whom he is living, the applicable amount determined under paragraph (3)(B),
shall be an eligible individual for purposes of this title.
(2) Each aged, blind, or disabled individual who has an eligible spouse and--
(A) whose income (together with the income of such spouse), other than income excluded pursuant to section 1612(b), is at a rate of not more than $2,628 (or, if greater, the amount determined under section 1617) for the calendar year 1974, or any calendar year thereafter, and (B) whose resources (together with the resources of such spouse), other than resources excluded pursuant to section 1613(a), are not more than the applicable amount determined under paragraph (3)(A), {see 3A and 3B below for amounts}
shall be an eligible individual for purposes of this title.
(3)(A) The dollar amount referred to in clause (I) of paragraph (1)(B), and in paragraph (2)(B), shall be $2,250 prior to January 1, 1985, and shall be increased to $2,400 on January 1, 1985, to $2,550 on January 1, 1986, to $2,700 on January l, 1987, to $2,850 on January 1, 1988, and to $3,000 on January 1, 1989.
(B) The dollar amount referred to in clause (ii) of paragraph (1)(B), shall be $1,500 prior to January 1, 1985, and shall be increased to $1,600 on January 1, 1985, to $1,700 on January l, 1986, to $1,800 on January 1, 1987, to $1,900 on January 1, 1988, and to $2,000 on January 1, 1989.
Amounts of Benefits [4]
(b)(1) The benefit under this title for an individual who does not have an eligible spouse shall be payable at the rate of $1,752 (or, if greater, the amount determined under section 1617) for the calendar year 1974 and any calendar year thereafter, reduced by the amount of income, not excluded pursuant to section 1612(b), of such individual.
(2) The benefit under this title for an individual who has an eligible spouse shall be payable at the rate of $2,628 (or, if greater, the amount determined under section 1617) for the calendar year 1974 and any calendar year thereafter, reduced by the amount of income, not excluded pursuant to section 1612(b), of such individual and spouse.
{Note: These figures have changed every year, but this is the original IRS Section 1611. Generally, if you are working in 2002 and your earnings average more than $780 a month, ($9,360 annually)you cannot be considered as disabled. If you are working in 2003, the limit is $800 a month ($9,600 annually).}
(c)(1) An individual's eligibility for a benefit under this title for a month shall be determined on the basis of the individual's (and eligible spouse's, if any) income, resources, and other relevant characteristics in such month, and, except as provided in paragraphs (2), (3), (4), (5), and (6), the amount of such benefit shall be determined for such month on the basis of income and other characteristics in the first or, if the Commissioner of Social Security so determines, second month preceding such month. Eligibility for and the amount of such benefits shall be redetermined at such time or times as may be provided by the Commissioner of Social Security.
(2) The amount of such benefit for the month in which an application for benefits becomes effective (or, if the Commissioner of Social Security so determines, for such month and the following month) and for any month immediately following a month of ineligibility for such benefits (or, if the Commissioner of Social Security so determines, for such month and the following month) shall-
(A) be determined on the basis of the income of the individual and the eligible spouse, if any, of such individual and other relevant circumstances in such month; and
(B) in the case of the month in which an application becomes effective or the first month following a period of ineligibility, if such application becomes effective, or eligibility is restored, after the first day of such month, bear the same ratio to the amount of the benefit which would have been payable to such individual if such application had become effective, or eligibility had been restored, on the first day of such month as the number of days in such month including and following the effective date of such application or restoration of eligibility bears to the total number of days in such month.
(3) For purposes of this subsection, an increase in the benefit amount payable under title 11 (over the amount payable in the preceding month, or, at the election of the Commissioner of Social Security, the second preceding month) to an individual receiving benefits under this title shall be included in the income used to determine the benefit under this title of such individual for any month which is—
(A) the first month in which the benefit amount payable to such individual under this title is increased pursuant to section 1617, or
(B) at the election of the Commissioner of Social Security, the month immediately following such month.
{Simply put, benefits start on the month of disability, or at a later date if so determined by Social Security. The same holds true of any increase in benefits.)
(4)(A) Notwithstanding paragraph (3), if the Commissioner of Social Security determines that reliable information is currently available with respect to the income and other circumstances of an individual for a month (including information with respect to a class of which such individual is a member and information with respect to scheduled cost-of-living adjustments under other benefit programs), the benefit amount of such individual under this title for such month may be determined on the basis of such information.
(B) The Commissioner of Social Security shall prescribe by regulation the circumstances in which information with respect to an event may be taken into account pursuant to subparagraph (A) in determining benefit amounts under this title.
(5) Notwithstanding paragraphs (1) and (2), any income which is paid to or on behalf of an individual in any month pursuant to (A) a State program funded under part A of title IV, (B) section 472 of this Act (relating to foster care assistance), (C) section 412(e) of the Immigration and Nationality Act (relating to assistance for refugees), (D) section 501 (a) of Public Law 96-422 (relating to assistance for Cuban and Haitian entrants), or (E) the Act of November 2, 1921 (42 Stat. 208), as amended (relating to assistance furnished by the Bureau of Indian Affairs), shall be taken into account in determining the amount of the benefit under this title of such individual (and his eligible spouse, if any) only for that month, and shall
not be taken into account in determining the amount of the benefit for any other month. [5]
{Any amounts paid under these programs as stated above, will be subtracted from any disability due under the Social Security disability program.}
(6) The dollar amount in effect under subsection (b) as a result of any increase in benefits under this title by reason of section 1617 shall be used to determine the value of any in-kind support and maintenance required to be taken into account in determining the benefit payable under this title to an individual (and the eligible spouse, if any, of the individual) for the 1st 2 months for which the increase in benefits applies.
(7) For purposes of this subsection, an application of an individual for benefits under this title shall be effective on the later of--
(A) the first day of the month following the date such application is filed, or
(B) the first day of the month following the date such individual becomes eligible for such benefits with respect to such application.
(8) The Commissioner of Social Security may waive the limitations specified in subparagraphs (A) and (B) of subsection (e)(1) on an individual's eligibility and benefit amount for a month (to the extent either such limitation is applicable by reason of such individual's presence throughout such month in a hospital, extended care facility, nursing home, or intermediate care facility) if such waiver would promote the individual's removal from such institution or facility. Upon waiver of such limitations, the Commissioner of Social Security shall apply, to the month preceding the month of removal, or, if the Commissioner of Social Security so determines, the two months preceding the month of removal, the benefit rate that is appropriate to such individual's living arrangement subsequent to his removal from such institution or facility.
(d) The Commissioner of Social Security may prescribe the circumstances under which, consistently with the purposes of this title, the gross income from a trade or business (including farming) will be considered sufficiently large to make an individual ineligible for benefits under this title. For purposes this subsection, the term "gross income" has the same meaning as when used in chapter 1 of the Internal Revenue Code of 1954 [6] . {This gives the SS Administration the right to determine what gross income of a self employed or farmer would make them eligible for benefits.)
(e)(1)(A) Except as provided in subparagraphs (B), (C), (D), (E), and (G), no person shall be an eligible individual or eligible spouse for purposes of this title with respect to any month if throughout such month he is an inmate of a public institution. {A prisoner is not eligible for benefits under this act. Eligibility of other criminals are discussed later.}
(B) In any case where an eligible individual or his eligible spouse (if any) is, throughout any month (subject to subparagraph (G)), in a medical treatment facility receiving payments (with respect to such individual or spouse) under a State plan approved under title XIX, or an eligible individual is a child described in section 1614(f)(2)(B), or, in the case of an eligible individual who is a child under the age of 18, receiving payments (with respect to such individual) under any health insurance policy issued by a private provider of such insurance the benefit under this title for such individual for such month shall be payable (subject to subparagraph (E))—
(I) at a rate not in excess of $360 per year (reduced by the amount of any income not excluded pursuant to section 16.12(b)) in the case of an individual who does not have an eligible spouse; (ii) in the case of an individual who has an eligible spouse, if only one of them is in such a facility throughout such month, at a rate not in excess of the sum of--
(I) the rate of $360 per year (reduced by the amount of any income, not excluded pursuant to section 1612(b), of the one who is in such facility), and
(II) the applicable rate specified in subsection (b)(1) (reduced by the amount of any income, not excluded pursuant to section 1612(b), of the other); and
(III) at a rate not in excess of $720 per year (reduced by the amount of any income not excluded pursuant to section 1612(b)) in the case of an individual who has an eligible spouse, if both of them are in such a facility throughout such month.
For purposes of this subsection, a medical treatment facility that provides services described in section 1917(c)(1)(C) shall be considered to be receiving payments with respect to an individual under a State plan approved under title XIX during any period of ineligibility of such individual provided for under the State plan pursuant to section 1917(c).
(C) As used in subparagraph (A), the term "public institution" does not include a publicly operated community residence, which serves no more than 16 residents. [7]
(D) A person may be an eligible individual or eligible spouse for purposes of this title with respect to any month throughout which he is a resident of a public emergency shelter for the homeless (as defined in regulations which shall be prescribed by the Commissioner of Social Security); except that no person shall be an eligible individual or eligible spouse by reason of this subparagraph more than 6 months in any 9-month period.
(E) Notwithstanding subparagraphs (A) and (B), any individual who-
(I)(1) is an inmate of a public institution, the primary purpose of which is the provision of medical or psychiatric care, through-out any month as described in subparagraph (A), or
(II) is in a medical treatment facility throughout any month as described in subparagraph (B), (ii) was eligible under section 1619( a) or (b) for the month preceding such month, and
(iii) under an agreement of the public institution or the medical treatment facility is permitted to retain any benefit payable by reason of this subparagraph,
may be an eligible individual or eligible spouse for purposes of this title (and entitled to a benefit determined on the basis of the rate applicable under subsection (b)) for the month referred to in subclause (I) or (II) of clause (I) and, if such subclause still applies, for the succeeding month.
(F) An individual who is an eligible individual or an eligible spouse for a month by reason of subparagraph (E) shall not be treated as being eligible under section 1.619(a) or (b) for such month for purposes of clause (ii) of such subparagraph.
(G) A person may be an eligible individual or eligible spouse for purposes of this title, and subparagraphs (A) and (B) shall not apply, with respect to any particular month throughout which he or she is an inmate of a public institution the primary purpose of which is the provision of medical or psychiatric care, or is in a medical treatment facility receiving payments (with respect to such individual or spouse) under a State plan approved under title XIX or, in the case of an individual who is a child under the age of 18, under any health insurance policy issued by a private provider of such insurance, if it is determined in accordance with subparagraph (H) or (J)[8] that--
(I) such person's stay in that institution or facility (or in that institution or facility and one or more other such institutions or facilities during a continuous period of institutionalization) is likely (as certified by a physician) not to exceed 3 months, and the particular month involved is one of the first 3 months throughout which such person is in such an institution or facility during a continuous period of institutionalization; and
(ii) such person needs to continue to maintain and provide for the expenses of the home or living arrangement to which he or she may return upon leaving the institution or facility.
The benefit of any person under this title (including State supplementation if any) for each month to which this subparagraph applies shall be payable, without interruption of benefit payments and on the date the benefit involved is regularly due, at the rate that was applicable to such person in the month prior to the first month throughout which he or she is in the institution or facility.
(H) The Commissioner of Social Security shall establish procedures for the determinations required by clauses (I) and (ii) of subparagraph (G), and may enter into agreements for making such determinations (or for providing information or assistance in connection with the making of such determinations) with appropriate State and local public and private agencies and organizations. Such procedures and agreements shall include the provision of appropriate assistance to individuals who, because of their physical or mental condition, are limited in their ability to furnish the information needed in connection with the making of such determinations. {If these situations ever arise, direct contact with the Social Security Administration would be necessary as these procedures are constantly changing.}
(I)(I) The Commissioner shall enter into an agreement, with any interested State or local institution comprising a jail, prison, penal institution, or correctional facility, or with any other interested State or local institution a purpose of which is to confine individuals as described in section 202(x)(1)(A)(ii),[9] under which--
(I) the institution shall provide to the Commissioner, on a monthly basis and in a manner specified by the Commissioner, the names, social security account numbers, dates of birth, confinement commencement dates, and, to the extent available to the institution, such other identifying information concerning the inmates of the institution as the Commissioner may require for the purpose of carrying out this paragraph and the other provisions of this title; and [10]
(II) the Commissioner shall pay to any such institution, with respect to each individual who receives in the month preceding the first month throughout which such individual is an inmate of the jail, prison, penal institution, or correctional facility that furnishes information respecting such individual pursuant to subclause (1), or is confined in the institution (that so furnishes such information) as described in section 202(x)(1)(A)(ii), a benefit under this title for such preceding month, and who is determined by the Commissioner to be ineligible for benefits under this title by reason of confinement based on the information provided by such institution, $400 (subject to reduction under clause (ii)) [11] if the institution furnishes the information described in subclause (1) to the Commissioner within 30 days after the date such individual becomes an inmate of such institution, or $200 (subject to reduction under clause (ii))[12] if the institution furnishes such information after 30 days after such date but within 90 days after such date.
(ii) The dollar amounts specified in clause (I)(II) shall be reduced by 50 percent if the Commissioner is also required to make a payment to the institution with respect to the same individual under an agreement entered into under section 202(x)(3)(B).[13]
{The preceding paragraphs and subparagraphs relate to the Soc. Sec. payment to the state if the individual is receiving benefit under Soc. Sec. Disability and becomes confined as an inmate.}
(iii) [14] The Commissioner shall maintain, and shall provide on a reimbursable basis, [15]- information obtained pursuant to agreements entered into under clause (I) to any Federal or federally-assisted cash, food, or medical assistance program for eligibility and other administrative purposes under such program. [16].
(iv) [17] Payments to institutions required by clause (I)(1I) shall be made from funds otherwise available for the payment of benefits under this title and shall be treated as direct spending for purposes of the Balanced Budget and Emergency Deficit Control Act of 1985.
(J) For the purpose of carrying out this paragraph, the Commissioner of Social Security shall conduct periodic computer matches with data maintained by the Secretary of Health and Human Services under title XVIII or XIX. The Secretary shall furnish to the Commissioner, in such form and manner and under such terms as the Commissioner and the Secretary shall mutually agree, such information as the Commissioner may request for this purpose. Information obtained pursuant to such a match may be substituted for the physician's certification otherwise required under subparagraph (G)(I).[18]
(2) No person shall be an eligible individual or eligible spouse for purposes of this title if, after notice to such person by the Commissioner of Social Security that it is likely that such person is eligible for any payments of the type enumerated in section 1612(a)(2)(B), such person fails within 30 days to take all appropriate steps to apply for and (if eligible) obtain any such payments. {If a person is notified that they are eligible for Soc. Sec. disability benefits, they must still take the necessary steps to formally apply for benefits.}
(3) Notwithstanding anything to the contrary in the criteria being used by the Commissioner of Social Security in determining when a husband and wife are to be considered two eligible individuals for purposes of this title and when they are to be considered an eligible individual with an eligible spouse, the State agency administering or supervising the administration of a State plan under any other program under this Act may (in the administration of such plan) treat a husband and wife living in the same medical treatment facility described in paragraph (1)(B) as though they were an eligible individual with his or her eligible spouse for purposes of this title (rather than two eligible individuals), after they have continuously lived in the same such facility for 6 months, if treating such husband and wife as two eligible individuals would prevent either of them from receiving benefits or assistance under such plan or reduce the amount thereof. {The meaning of this very long sentence is to determine if a married couple is considered as two eligible persons or eligible person with a spouse when they are living in a medical treatment facility.}
(4)[19] No person shall be considered an eligible individual or eligible spouse for purposes of this title with respect to any month if during such month the person is--
(A) fleeing to avoid prosecution, or custody or confinement after conviction, under the laws of the place from which the person flees, for a crime, or an attempt to commit a crime, which is a felony under the laws of the place from which the person flees, or which, in the case of the State of New Jersey, is a high misdemeanor under the laws of such State; or
(B) violating a condition of probation or parole imposed under Federal or State law.
{Benefits are not payable to a criminal or probable criminal.}
(5) [20] Notwithstanding any other provision of law (other than section 6103 of the Internal Revenue Code of 198612 .1 and section 1106(c) of this Act), the Commissioner shall furnish any Federal, State, or local law enforcement officer, upon the written request of the officer, with the current address, Social Security number, and photograph (if applicable) of any recipient of benefits under this title, if the officer furnishes the Commissioner with the name of the recipient, and other identifying information as reasonably required by the Commissioner to establish the unique identity of the recipient, and notifies the Commissioner that--
(A) the recipient
(I) is described in subparagraph (A) or (B) of paragraph (4)[21; and
(ii) has information that is necessary for the officer to conduct the officer's official duties; and
(B) the location or apprehension of the recipient is within the officer's official duties.
{Soc. Sec. must cooperate with law enforcement officials if it is within their jurisdiction and authority}
(f)(1) Notwithstanding any other provision of this title, no individual (other than a child described in section 1_614(a)(1)(B)(ii)) shall be considered an eligible individual for purposes of this title for any month during all of which such individual is outside the United States (and no person shall be considered the eligible spouse of an individual for purposes of this title with respect to any month during all of which such person is outside the United States). For purposes of the preceding sentence, after an individual has been outside the United States for any period of 30 consecutive days, he shall be treated as remaining outside the United States until he has been in the United States for a period of 30 consecutive days. {Just no way to spend the summer on the Riviera if you are drawing Soc. Sec. disability!}
(2) For a period of not more than 1 year, the first sentence of paragraph (1) shall not apply to any individual who-
(A) was eligible to receive a benefit under this title for the month immediately preceding the first month during all of which the individual was outside the United States; and
(B) demonstrates to the satisfaction of the Commissioner of Social Security that the absence of the individual from the United States will be--
(I) for not more than 1 year; and
(ii) for the purposes of conducting studies as part of an educational program that is-
(I) designed to substantially enhance the ability of the individual to engage in gainful employment;
(II) sponsored by a school, college, or university in the United States; and
(III) not available to the individual in the United States.
{ - unless, of course, the disabled person is a student and just has to study art in Paris…}
(g) In the case of any individual or any individual and his spouse (as the case may be) who--
(1) received aid or assistance for December 1973 under a plan of a State approved under title 1, X, XIV, or XVI,
(2) has, since December 31, 1973, continuously resided in the State under the plan of which he or they received such aid or assistance for December 1973, and
(3) has, since December 31, 1973, continuously been (except for periods not in excess of six consecutive months) an eligible individual or eligible spouse with respect to whom supplemental security income benefits are payable
the resources of such individual or such individual and his spouse (as the case may be) shall be deemed not to exceed the amount specified in sections 1611(a)(1)(B) and 1611(a)(2)(B) during any period that the resources of such individual or such individual and his spouse (as the case may be) does not exceed the maximum amount of resources specified in the State plan, as in effect for October 1972, under which he or they received such aid or assistance for December 1973. {Again, obviously, this would be updated in practice to 2003.}
(h) In determining eligibility for, and the amount of, benefits payable under this section in the case of any individual or any individual and his spouse (as the case may be) who-
(1) received aid or assistance for December 1973 under a plan of a State approved under title X or XVI,
(2) is blind under the definition of that term in the plan, as in effect for October 1972, under which he or they received such aid or assistance for December 1973,
(3) has, since December 31, 1973, continuously resided in the State under the plan of which he or they received such aid or assistance for December 1973, {December of previous year} and
(4) has, since December 31, 1973, continuously been (except for periods not in excess of six consecutive months) an eligible individual or an eligible spouse with respect to whom supplemental security income benefits are payable.
There shall be disregarded an amount equal to the greater of (A) the maximum amount of any earned or unearned income which could have been disregarded under the State plan, as in effect for October 1972, under which he or they received such aid or assistance for December 1973, and (B) the amount which would be required to be disregarded under section 1612 without application of this subsection.
{The following list of references just illustrates the fact that these laws change and change and change and this list can otherwise be ignored for purposes of this discussion.)
(I) For application and review requirements affecting the eligibility of certain individuals, see section 1631(j).
[='] See Vol. II, P.L. 93-66, §211, with respect to supplemental security income benefits for essential persons.
[4] Changes have been made by publication in the Federal Register: See. Vol. 11, Appendix A and B, for 1998 through 2000 Cost-of-Living Increase Information.
[5] See Vol. 11 for P.L. 82-414, §412(e), P.L. 96-422, §501(a), and P.L. 67-85, the Act of November 2, 1921.
[6] P.L. 83-591.
P.L. 99-514, §2, provides, except when inappropriate, any reference to the Internal Revenue Code of 1954 shall include a reference to the Internal Revenue Code of 1986.
[7] See Vol. II, P.L. 96-598, §4, with respect to the Boundary County Restorium, Bonner's Ferry, Idaho.
[8] P.L. 106-169, §212(b), struck "subparagraph (H)" and substituted "subparagraph (H) or (J)".
[9] P.L. 106-170, §402(c)(2), struck out "institution described in clause (I) or (ii) of section 202(x)f 1)(A) the primary purpose of which is to confine individuals as described in section 202(x)(1)(A)," and substituted "institution comprising a jail, prison, penal institution, or correctional facility, or with any other interested State or local institution a purpose of which is to confine individuals as described in section 202(x)(1.)(effective as if included in P.L. 104-193, §203(a).
The reference to §202(x)(1)(A)(ii) shall be deemed a reference to such §202(x)(1)(A)(ii) as amended by P.L. 106-170, §402(b)(1)(C).
[10] P.L. 106-170, §402(a)(3)(A), struck out "; and" and substituted "and the other provisions of this title; and", applicable to individuals whose period of confinement in an institution commences on or after April 1, 2000.
[11] P.L. 106-170, §402(c)(1)(A), inserted "(subject to reduction under clause (ii))", effective as if included in P.L. 106-170, §203(a).
[12] P.L. 106-170, §402(c)(1)(A), inserted "(subject to reduction under clause (ii))", effective as if included in P.L. 106-170, §203(a).
[13] P.L. 106-170, §402(c)(1)(C), added this clause (ii), effective as if included in P.L. 106-170, §203(a).
[14] P.L. 106-170, §402(c)(1)(B), redesignated the former clause (ii) as clause (iii).
P.L. 106-170, §402(c)(3)(A), struck out subclause I and "II", effective as if included in P.L. 104-193, §203(a). For subclause I as it formerly read, see Vol. 11, Superseded Provisions, P.L. 106-170.
[15] P.L. 106-169, §204, struck out "is authorized to" *and substituted "shall" effective December 14, 1999.
* P.L. 106-170, §402(a)(3)(B), struck out "is authorized to provide, on a reimbursable basis," and substituted "shall maintain, and shall provide on a reimbursable basis," applicable to individuals whose period of confinement in an institution commences on or after April 1, 2000.
[16] P.L. 106-170, §402(c)(3)(B), struck out "eligibility purposes" and substituted "eligibility and other administrative purposes under such program", effective as if included in P.L. 104-193, §203(a).
[17] P.L. 106-170, §402(c)(1)(B), redesignated the former clause (iii) as clause (iv).
[18] P.L. 106-169, §212(a), added subparagraph (J), effective December 14, 1999.
[19] P.L. 106-169, §207(c)(1), struck out paragraph (4), applicable to statements and representations made on or after December 14, 1999. For paragraph (4) as it formerly read, see Vol. II, Superseded Provisions, P.L. 106-169.
P.L. 106-169, §207(c)(3), redesignated the former paragraph (5) as paragraph (4).
[20] P.L. 106-169, §207(c)(3), redesignated the former paragraph (6) as paragraph (5).
[21] See Vol. 11, P.L. 83-591.
[22] P.L. 106-169, §207(c)(2), struck out "(5)" and substituted "(4)".
There are certain practical applications of these benefits of which one should be aware. The stark fact is that it is not easy to receive these benefits in many cases. Keep in mind that in order to receive these benefits the individual must not be able to perform any substantial gainful employment, and further, the disability must be expected to last at least 12 months or longer (or result in early death).
Does the Social Security Administration always approve disability benefits? Absolutely not. According to the most recent statistics available, which only studied workers, approximately 70% of the claims are denied.
To put it another way, (these percentages are approximations and may actually vary a point or two in either direction) while 30% of the claims are initially approved, 70% are not. Only 42% are appealed, of which reconsideration by the state agency allows only 15%, denying 85%. 53% of those denied are appealed to the next level – the administrative law judges – which allows 65% of those appealed, denying 35%.
The claim can continue to be appealed to the Appeals Council. Statistically, 65% of those denied by the administrative law judge, are appealed to the Appeals Council, which allows 5% of those denied. Of the 95% denied 16% are appealed to the U.S. District Court, which allows 20% those appealed from the Appeals Council.
All of this means that of Social Security disability claims involving workers, 46% are eventually allowed (and 54% denied). One could safely say that more than half of these claims are denied.
Worker’s Compensation must be mentioned if for no other reason than to clarify misperceptions as many feel that if they are injured on the job, there is no further need for protection against loss by disability.
All states require that employers provide Workers’ Compensation for employees who are injured on the job or who develop an occupational disease. While it is true that these benefits cover medical care and loss of income, these benefits are not nearly adequate to maintain a person’s lifestyle. For instance, in some areas the weekly income is slightly more than $250 a week.
Those who have “white collar” jobs are not usually at risk for job-related injuries or diseases, therefore it is apparent that this coverage is not of vital interest to these people.
STUDY QUESTIONS
1. Old-Age, Survivors, and Disability Insurance (OASDHI) differs from disability programs in the most of the rest of the world because
A. other countries have universal programs covering all nationals, while OASDHI covers individuals who are part of the labor market.
B. the other countries only cover pregnant women and children.
C. other countries pay for their programs through individual premiums collected.
D. disability programs are not allowed in most of the other countries.
2. Benefits for OASDHI are divided into three categories, which does NOT include
A. fully insured.
B. privately insured.
C. currently insured.
D. disability insured.
3. Actually, there are two programs, one of which is the Social Security Disability insurance program, the other is
A. an HMO program.
B. Long Term and Nursing Home Care.
C. Medicaid.
D. Supplemental Security Income.
4. Disability Income benefits under Social Security are equal to
A. 100% of the Primary Insurance Amount.
B. 50% of the Social Security Retirement benefit.
C. the longevity of the disabled person times (last reported income times .78)
D. benefits otherwise received from Medicaid.
5. The original determination of disability for OASDHI benefits is
A. solely under the jurisdiction of the Social Security Administration.
B. under the purview of the state agencies, with Social Security Admin. having the right to review.
C. a function of the federal Department of Health and Human Services.
D. performed by the state Surgeon General.
6. Benefits are NOT payable for
A. disabilities caused by a mental condition.
B. disability because of an accident.
C. partial disability or Short-term disability.
D. those with incomes less than $4,000 per year.
7. In relation to OASDHI benefits, rehabilitation
A. is never offered.
B. is at the option of the disabled person.
C. is a part of the disability program.
D. is only offered to those disabled persons who have dependents.
8. Eligibility rules for OASDHI benefits are lengthy and detailed, but
A. the Commissioner of Social Security is the final authority in determining benefits.
B. local and state laws can supercede any decision by the Social Security administration.
C. close to 100% of those that apply, receive benefits.
D. they are deliberately confusing so they can come in under budget every year.
9. Nathan was on OASDHI disability when he held up a 7-11 and was sentenced to prison.
A. His benefits cease upon his conviction.
B. His full benefits continue while he is in prison and is sent to him each month.
C. His full benefits will be paid to his beneficiary every month he is in prison.
D. His benefits will be reduced by 5% for each year of confinement.
10. When OASDHI benefits are applied for, approximately 30% are approved, and 70% are not. How many of the appealed claims are eventually approved (approximately).
A. All of them.
B. Less than half (46%) are eventually approved.
C. None are approved as the system discourages appeal of a decision.
D. About 10%
ANSWERS TO STUDY QUESTIONS
1A 2B 3D 4A 5B 6C 7C 8A 9A 10B