I. ENTITLEMENT TO DISABILITY INSURANCE BENEFITS

After onset of a severe physical or mental impairment, a worker may become entitled to monthly disability insurance benefits under the Social Security Old-Age, Survivors, and Disability Insurance (OASDI) program, provided he or she:

• Meets the definition of disability set forth in the Social Security Act;

• Has filed a claim for disability insurance benefits;

• Satisfies the disability insured requirements of the Act;

• Has completed a 5-month waiting period; and

• Has not attained normal retirement age ¹.

A worker's cash benefit is classified as an award at the time of initial payment. Additional auxiliary benefits may also be payable to other family members based on the earnings record of the entitled worker. This study analyzes the activity of disabled workers of the Social Security Disability Insurance (DI) program as described under title II of the Social Security Act.

A. Definition of Disability

For purposes of entitlement to DI benefits, disability is defined as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment. The impairment must be expected to result in death or to last for a continuous period of at least 12 months. In addition, the disability must prevent the claimant from performing previous work, or engaging in any other kind of work in which a significant number of jobs exist. It is immaterial whether such work exists in the claimant's immediate area, or whether a specific job vacancy exists, or whether the claimant would be hired if he or she applied for work.

Several additional points are worth mentioning:

• The worker's impairment must be the primary reason for the inability to engage in SGA.

• The formal determination of disability is based on a sequential process defined in regulations. The first step compares actual earnings to a specified level to determine ability to engage in SGA. Absent such actual earnings evidence, the sequential process continues with an evaluation of the nature and severity of the alleged impairment, followed by consideration of age, education, and work experience.

• Under the Social Security Act as amended in 1996 by Public Law 104-121, drug-addiction or alcoholism may not be used as a contributing material factor in the disability determination process.

• Special provisions exist for the evaluation of insured status and disability in cases of statutory blindness.

• The same definition of disability applies when determining eligibility of adults under the Supplemental Security Income (SSI) program as described under title XVI of the Social Security Act. This means-tested cash benefits program is also administered by the Social Security Administration (SSA).

B. Disability Insured Status and Waiting Period

To be insured for disability benefits, a worker must earn a requisite number of quarters of coverage (QCs) in employment covered by Social Security. ² The worker must accrue a sufficient number of QCs to be deemed fully insured ³ and, in addition, must have worked recently in covered employment. The number of required recent QCs varies by age, and ranges from 6 out of the last 12 quarters immediately preceding the onset of disability, to 20 out of the last 40.

The waiting period for DI benefits consists of 5 consecutive full calendar months beginning with the earliest full calendar month throughout which the worker satisfied both the definition of disability and the disability insured requirements. Benefits are not payable during the waiting period. However, the waiting period is waived for individuals who had a prior period of disability, which ended within 5 years of the current period of disability. In contrast, there is no waiting period for disability benefits under the SSI program.

July 30, 1999