Understanding Social Security Disability Insurance (SSDI)

Published:  November 2020

By:  Bob Braunstein, Federal Benefits Specialist

 

The Relationship Between OPM Disability Retirement and SSDI

 

Most Federal employees are able retire from Federal service around 56 or 57 years of age after completing 30 or more years of creditable service. These retirements are immediate and include important benefits such as health insurance, life insurance, dental and vision coverage, and other benefits for the rest of their lives.  Similar retirement and benefit options could be available earlier to employees who become disabled for their work and qualify for the Office of Personnel Management’s Disability Retirement benefit. Disability retirement is available to any Federal employee who has completed at least 18 months of creditable civilian service with a medical condition that renders them incapable of performing the duties of their current position (or those of any job at the same grade and pay in their organization and general commuting area). Disability retirements come with the similar pensions and insurance benefits and continue as long as the retiree remains disabled.  Those approved for Disability Retirement must also apply for Social Security Disability Insurance (SSDI) when they separate.    

 

Applying and Qualifying for SSDI

 

Unlike OPM’s Disability Retirement requirements, to qualify for SSDI, you must have a physical or mental impairment severe enough to prevent you from working in virtually any capacity. The disabling condition must be expected to last for at least 12 months, or to otherwise result in death. Prospective SSDI beneficiaries must also meet two different earnings tests: 1) a recent work test, based on age at the time of disability; and 2) duration of work test to show that they worked long enough under Social Security. For example, if one became disabled at age 38, they would need to have completed at least 4 years of Social Security-covered work as one of the qualifications for SSDI. If the disabling condition occurred later, say at 55 years of age, they would need to have worked for 8 years. Along with meeting these conditions, the disabling medical condition would have to meet Social Security’s disability benefit criteria.  

 

The process begins by filing an application for SSDI. Applications require basic information including Social Security numbers, birth certificates, names, addresses, and phone numbers of the doctors, caseworkers, hospitals, and clinics that took care of the medical condition, and dates of actual visits to these facilities. Information is also required on prescribed and over the counter medications, laboratory and test results, and summaries/proof of recent work activities.

 

SSDI Application Review Process

 

Social Security performs an initial review of SSDI applications to check the number of years an applicant worked, if they are still working, whether the work would preclude receipt of SSDI benefits, and other general qualifications criteria. They then forward cases to Disability Determination Services Office (DDSO) in applicants’ states where most of the in-depth medical qualifications analysis for SSDI is performed.

 

While SSDI qualifying medical criteria vary somewhat from state to state, the process for making the disability determination is relatively uniform. Essentially, state doctors request information from applicants’ doctors about their conditions including medical evidence from hospitals, clinics, and other institutions where they have been treated. In some cases, separate special examinations may be required to validate a specific medical condition to ensure it qualifies for SSDI. The following 5-step evaluation process is used in determining SSDI eligibility:

 

Step 1. Are you working?
If working, average earnings must fall within the amount allowed by Social Security to still be considered eligible for SSDI. This is a maximum of $1,260 per month in 2020 ($2,110 for those who are blind).

 

Step 2. Does your medical condition significantly limit your ability to do basic work activities?
Basic work activities include lifting, standing, walking, sitting, and remembering. Also, is the medical condition expected to last for at least 12 months, or otherwise result in death?

 

Step 3. Is your medical condition included on your state’s listing of qualified conditions?
State listings of impairments describe medical conditions considered so severe they prevent gainful employment. Most state listings are relatively similar, but there may be differences. In all cases, the lists are specific with respect to qualifying disabling conditions and applicants must usually have one of them (or a disability similar in severity and nature) to qualify for SSDI. 

 

Step 4. Can you do the work you did before?
If an applicant cannot do their immediate previous work and is currently not working, the process moves immediately to step 5. If an applicant is still working, that work is reviewed to determine whether it either disqualifying or otherwise allowable when receiving SSDI benefits.

 

Step 5. Can you do other work?
If not working, the state considers any work an applicant might be able to do taking into consideration their age, education, past work experience, and skills. (Social Security has special rules called work incentives that allow you to test your ability to work and still receive monthly Social Security disability benefits. You can also get help with education, rehabilitation, and training you may need to work. If you do take a job or become self-employed, tell SS immediately and read their publication “Working While Disabled—How We Can Help” – Publication No. 05-10095 on the ssa.gov website.)

 

The SSDI Decision

 

Once a decision is made, the state sends a letter notifying applicants of the approval or disapproval of their claim. If approved for SSDI benefits, information is sent to the beneficiary on the amount of the monthly payment and when it will begin. The first SSDI monthly payment is deposited in the sixth full month after the date the disability began. For example, if the disability began on June 15th, the first disability payment will be deposited in the month of December. The payment would post to the beneficiary’s bank account in January (as SS pays benefits one month in arrears). The approval process generally takes three to five months. In cases where decisions take longer, beneficiary payments can be retroactive to the sixth full month after the disabling condition began. For more information, see the Social Security publication, “What You Need to Know When You Get Disability Benefits” – Publication No. 05-10153 available at www.ssa.gov.

 

When an application for SSDI is not approved, the decision letter contains an explanation as to why and provides information on the appeals process. Generally, either the disapproval of an application, or the amount of an SSDI award may be appealed as explained in the Social Security publication entitled, “The Appeals Process” – Publication No. 05-10041, also available at www.ssa.gov.

 

Other Benefits

 

If you are approved for SSDI, your family members may also be entitled to benefits based on your award. This could include a spouse who is 62 years of age or older; children under 16 (including adopted children and grandchildren living with you in a parent/child relationship); and totally disabled children at any age if their disability is permanent and began prior to reaching 22 years of age. For more information, see the Social Security Disability Benefits Family Benefits section at www.ssa.gov.

 

Bob Braunstein is a retired Federal employee who was last employed as a Senior Human Resources Consultant with the Office of the Comptroller of the Currency (OCC) at the Department of the Treasury. During his Federal career, he served in a full range of HR positions spanning recruitment, staffing, employee relations, retirement and benefits, and position classification/management disciplines.  He is a retirement and benefits presenter for NITP.