Disability is defined differently depending upon the type of program or insurance that covers your situation. The type of programs or insurance that define disability include: Social Security, Workers’ Compensation; and private disability insurance. The Social Security Administration’s criteria for disability is different between SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income). The Workers’ Compensation criteria for disability is different from both of the Social Security programs. A private disability insurance policy’s criteria is different from that of either Social Security or Workers’ Compensation.
If you believe you have a disability, you should consult our experienced Delaware County disability lawyer in Pennsylvania for a thorough assessment of your particular situation.
Social Security Disability
Social Security defines disability as:
- you can no longer do the work you did beforehand
- Social Security determines that you can not adjust to other work because of a medical condition
- your disability has lasted or will last at least one year or result in death
SSDI pays benefits to disabled or blind individuals who are ‘insured’ by that individual’s contributions to the Social Security Trust fund (your FICA payroll deductions). In order to receive benefits under this program a worker must have worked and payed taxes for a certain number of years. Generally, these ‘work credits’ are reached if you worked 2 1/2 years out of the last 10 years. Once the worker has reached retirement age, these SSDI benefits will convert to the Social Security Administration’s regular retirement benefits.
SSDI benefits are not paid for the first five months following the worker’s disability. The amount of the monthly benefit is determined by the worker’s earnings history.
SSI provides a monthly cash payment to certain people in need. This program is funded through the Federal Government’s general tax revenues. A person in need is anyone aged 65 or older, or blind, or disabled, and who has limited income and resources. A person in need may also be a disabled child under 18 if he or she has a medically determined physical and/or mental impairment (including emotional or learning problems) that result in severe functional limitations, have or will last one year, or result in death.
For SSI purposes, limited income includes: money earned from work; money received from other sources (such as social security benefits, workers’ comp benefits, unemployment benefits; family and friends; and free food or shelter. Limited resources include: cash on hand; checking or savings accounts; stocks and/or bonds; life insurance; and personal property. Generally, an individual’s limited resouce amounts to $2,000 and a couple’s limited resource amounts to $3,000.
Workers’ Compensation Disability
Workers’ Compensation disability is different from each of the Social Security disability programs. First, the workers’ comp. disability must have occurred on the job, or in the course and scope of the worker’s employment. Second, there is no age requirement as long as the worker was injured during work. Third, workers’ comp. disability may be either total or partial. Generally, the social security programs provide benefits only for total disability. Fourth, worker comp benefits are based on the worker’s weekly wage and are not determined or reduced by the worker’s other financial assets. Fifth, worker comp benefits are not based on the need of the injured worker.
Private Disability Insurance
Private disability insurance is different from both Social Security and Workers’ Compensation. Private disability insurance pays out benefits to an individual who, because of illness or injury, is unable to earn income. Private disability insurance is not based on work credits as is SSDI. Private disability insurance is not based on need as is SSI. Private disability insurance is not based on a work related injury as is workers’ compensation.
An individual, or that individual’s employer, purchases private disability insurance and pays a premium for the coverage. Private disability insurance can be a Short Term Disability Policy. Generally, a Short Term Disability policy has a 7-14 day waiting period; and, pays out benefits for a defined time such as 2 years. Private disability insurance can also be a Long Term Disability Policy. Generally, a Long Term Disability policy has a longer waiting period (such as 3-6 months) and a longer pay out of benefits (such as up to retirement age).
The calculation of private disability insurance benefits is similar to the workers’ comp calculation. Generally private disability insurance benefits, whether Short Term Disability or Long Term Disability, amount to 60-70% of the individual policyholder’s gross income.
Disability Claim Denial
If you have filed an initial claim for disability benefits through either Social Security, Workers’ Compensation, or a private disability policy; and, your disability claim was denied or refused, you should consult an experienced disability lawyer as soon as possible in order to start the reconsideration process of your initial claim.
If you believe you have a disability; whether work related or not; whether needs based or not; you should consult an experienced disability attorney for a confidential evaluation of your specific situation.
Other Practice Areas
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