Social Security disability

Definition of Disability

Assuming that one qualifies for Social Security disability benefits by being fully insured or partially insured, one must then meet Social Security’s definition of disability. Disability, under Social Security, is defined as the inability to engage in any substantially gainful activity by reason of a medically determinable physical or mental impairment that has lasted or is expected to last 12 months or result in an early death. This definition is not as liberal as most definitions of disability found in policies marketed through insurance companies.
Anyone working in jobs covered by Social Security or operating his/her own business may earn up to a maximum of 4 credits for each year of work.

The term fully insured refers to someone who has earned 40 quarters of coverage (the equivalent of 10 years of work), and is therefore entitled to receive Social Security retirement, Medicare, and survivor benefits.

An individual can attain a currently insured status (or partially insured), and by that qualify for certain benefits if he or she has earned 6 credits (or quarters of coverage) during the 13-quarter period ending with the quarter in which the insured:

• Dies;
• Becomes entitled to disability insurance benefits; or
• Becomes entitled to old-age insurance benefits.

For younger workers, the number of quarters required to qualify for the benefits differs by age according to a table established by Social Security.

2. Definitions

Employer — A person, partnership, association, corporation, or legal representative of a deceased employer, who has persons in employment as previously defined.

Employee — A person engaged in the services of an employer in any employment as previously defined, except a minor child of the employer, except a domestic or personal worker in a private home who is employed for less than 40 hours per week by any one employer, and except a duly ordained, commissioned, or licensed minister, priest or rabbi, a sexton, a Christian Science reader, or member of a religious order, or an executive officer of a corporation who owns all the outstanding stocks, and holds all the offices of the corporation.

Disability — During employment, means the inability of an employee, as a result of injury or sickness not arising out of and in the course of an employment, to perform the regular duties of his/her employment or the duties of any other employment which the employer may offer at the employee’s regular wages and which injury or sickness prevent him/her from performing. (Disability also includes disability caused by or in connection with a pregnancy.)

3. Waiting Period

The waiting, or elimination period for Social Security disability benefits is 5 months. Benefits begin at the beginning of the 6th month and are not retroactive to the beginning of the disability.

4. Disability Income Benefits

The amount of Social Security disability benefits is based upon the worker’s Primary Insurance Amount (PIA), which is calculated from their Average Indexed Monthly Earnings over their highest 35 years. The lowest 5 years of income may be deleted from calculation.

Social Security disability benefits will continue for 3 months when a person returns to work making more than $850 per month. This is an incentive to get people back to work.

Employees are NOT entitled to benefits for:

• More than 26 weeks during 52 consecutive calendar weeks or during any one period of disability;
• Any period of disability during which an employee is not under the care of a licensed physician;
• Any disability occasioned by willful intention of the employee to bring about injury or sickness to him/herself;
• Any day of disability during which the employee performed work for remuneration or profit;
• Any day of disability for which the employee is entitled to receive remuneration in an amount greater than that to which he/she would be entitled;
• Any period for which the employee is subject to disqualification or suspension of unemployment benefit rights;
• Any disability due to any act of war; or
• Any disability commencing before the employee becomes eligible for benefits.

The New York Disability Benefit Law provides income benefits for nonoccupational injuries or diseases which prevent employees from earning a living, but does not provide medical or other benefits.

The New York Disability Benefits Law is administered by the Chairman of the Workers CompensationBoard.

3. Employment Covered

Employees eligible for coverage include those employed in any trade, business or occupation carried on by an employer. The following types of employment, however, would not be considered eligible:

• Services performed for the state, and other governmental agencies, as specified;
• Services subject to the federal Railroad and Unemployment Insurance Act;
• Maritime employment;
• Services performed as a real estate broker or sales associate; and
• Casual employment, and the first 45 days of extra employment not regularly in employment as otherwise defined.

4. Benefits

New York State Disability Benefits are only paid when the individual cannot collect unemployment because of disability.

Employed Individuals — For an employed individual, disability benefits will be payable after a 7-day waiting period. The weekly benefit that the disabled employee is entitled to receive is one-half of the employee’s weekly wage; however, the benefit cannot exceed $170. If the employee’s weekly average wage is less than $20, the benefit is such average weekly wage.

Unemployed Individuals — An unemployed individual whose employment has been terminated and who, during a period of unemployment within 26 weeks immediately following such termination of employment, becomes ineligible for unemployment benefits, then becomes eligible for disability income coverage.

Exclusions and Exemptions - Employees are NOT entitled to benefits for:

• More than 26 weeks during 52 consecutive calendar weeks or during any one period of disability;
• Any period of disability during which an employee is not under the care of a licensed physician;
• Any disability occasioned by willful intention of the employee to bring about injury or sickness to him/herself;
• Any day of disability during which the employee performed work for remuneration or profit;
• Any day of disability for which the employee is entitled to receive remuneration in an amount greater than that to which he/she would be entitled;
• Any period for which the employee is subject to disqualification or suspension of unemployment benefit rights;
• Any disability due to any act of war; or
• Any disability commencing before the employee becomes eligible for benefits.