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EDPNA - technical
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Exam of 23 pages for the course EDB. ESL . EDPNA at EDB. ESL . EDPNA (EDPNA - technical)
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EDPNA - technicalSSDI (Social Security Disability Insurance)
Section 404 of 20 CFR specifically outlines the regulations regarding Social
Security Disability Insurance aka Title II aka Disability Insurance Benefits - all of
these are synonymous and are used interchangeably to describe this program.
It's a good idea to read the table of contents to 20 CFR 404 so you can get a
better understanding of which subparts discuss which topic regarding Social
Security Disability Insurance.
Unlike SSI eligibility, SSDI eligibility is based on the work history of the applicant,
not resource based. After an applicant applies, SSA must make sure they meet
the following technical requirements:
1. Is the applicant under full retirement age (66)?
2. Is the applicant fully insured?
3. Is the applicant insured for disability?
Also, unlike SSI, SSDI benefits can be paid to the disabled worker's family in
some cases. This is called auxiliary benefits and can be paid to dependent
children under the age of 18 or spouse (or divorced spouse if married for 10
years) under the age of 62 who has joint care of the children.
SSI
The medical definition of disability for adults is exactly the same for both SSDI
and SSI. You'll see mirror images of many of these provisions under 20 CFR 404
for SSDI 20 CFR 416 for SSI. In many places the regulations read word for word,
exactly the same.
One major difference is that under SSI, there is no work requirement; therefore,
children can qualify as disabled. This is described in 20 CFR 416.906. Also,
there's no retroactivity for an SSI claimant, meaning the claimant cannot be
eligible for benefits any earlier than the date the claim is filed. Another difference
between the two programs is that for SSI there are very strict income and
resource provision, whereas under SSDI there are insured status provisions.
,The definition of disability is exactly the same under Title II and Title XVI.
The law defines disability as the inability to do any substantial gainful activity
(SGA) by reason of any medically determinable physical or mental impairment(s)
which can be expected to result in death, or which has lasted or can be expected
to last for a continuous period of not less than 12 months.
Rule 3: You had a period of disability before age 31
You are insured in a quarter for purposes of establishing a period of disability or
becoming entitled to disability insurance benefits if in that quarter-
(1) You are disabled again at age 31 or later after having had a prior period of
disability established which began before age 31 and for which you were only
insured under paragraph (c) of this section; and
(2) You are fully insured and have QCs in at least one-half the calendar quarters
in the period beginning with the quarter after the quarter you became age 21 and
through the quarter in which the later period of disability begins, up to a
maximum of 20 QCs out of 40 calendar quarters; however-
(i) If the number of quarters during this period is an odd number, we reduce the
number by one;
(ii) If the period has less than 12 quarters, you must have at least 6 QCs in the
12-quarter period ending with that quarter; and
(iii) No monthly benefits may be paid or increased under Rule Ill before May
1983.
Rule 1 - 20/40:
You have to have 20 quarters of coverage in the 40-quarter period ending with
the quarter that you became disabled. This is called the 20/40 rule. Or
essentially, you have worked five years out of the last ten years, before you
became disabled.
Rule 4: You are statutorily blind.
, (1) You are disabled by blindness as defined in § 404.1581; and
(2) You are fully insured.
What if you become disabled prior to age 31?
20 CFR 404.130: You are insured in a quarter for purposes of establishing a
period of disability or becoming entitled to disability insurance benefits if in that
quarter-
(1) You have not become (or would not become) age 31;
(2) You are fully insured (next chapter); and
(3) You have Quarters of Coverage (QCs) in at least one-half of the quarters
during the period ending with that quarter after the quarter you became age 21;
however-
(i) If the number of quarters during this period is an odd number, we reduce the
number by one; and
(ii) If the period has less than 12 quarters, you must have at least 6 QCs in the
12- quarter period ending with that quarter.
Insured Status for Statutorily Blind Individuals
Statutorily blind individuals must only meet the fully disability insured status.
Definition of statutorily blindness for Social Security purposes:
We will consider you blind under the law for a period of disability and for payment
of disability insurance benefits if we determine that you are statutorily blind
(404.130(e)).
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