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SOME THINGS SOCIAL SECURITY DISABILITY DOES NOT COVER

 Social Security disability (SSDI) is a complicated program which covers certain insured workers or past workers against long-term disability.  SSDI does not cover everyone or everything.

Here are some common things that SSDI will not cover.  

1.  A short-term impairment which is not expected to end in death or last for a continuous period of at least 12 months is not covered.

2.  Any impairment for an individual who is not insured under the Social Security Act.  A claimant must have earned a minimum number of work credits (also called "quarters of coverage") to be insured.  An adult age 31 or over needs to have worked at least 5 years out of the most recent 10 years and paid FICA (the Social Security tax).

3.  No benefit is payable to a claimant while he/she is incarcerated for a period of 30 days or more.

4.  No benefit is payment to an individual who is able to work at Substantial Gainful Activity (SGA).  SGA is defined in 2024 as earning at least $1,550 per month (gross) from employment or self-employment. If an individual files a disability claim while working at SGA the claim is given an automatic Step 1 denial, no matter how severe an impairment might be.

5.  There may not be a benefit for an impairment that is materially connected to drug or alcohol abuse (DAA).  There are complicated rules about this and just because a claimant has an addiction or abuse issue does not necessarily mean that benefits are not available.  The question is whether the substance abuse or addiction is MATERIAL to the disabling impairment.  

Under Social Security Rule 13-a(p)

a. DAA is not material to the determination that the claimant is under a disability if the claimant would still meet our definition of disability if he or she were not using drugs or alcohol. If DAA is not material, we find that the claimant is disabled.

b. DAA is material to the determination of disability if the claimant would not meet our definition of disability if he or she were not using drugs or alcohol. If DAA is material, we find that the claimant is not disabled.

We strongly urge claimants considering an SSDI claim to speak with a disability attorney before filing a claim.  There is usually no cost just for a consultation.

 

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