By Matthew DeGioia, (301) 563-6685
In the past few months, we have received an influx of calls from people who have suffered from COVID-19 asking if they qualify for disability benefits. In such unprecedented times as these, it is important to know what options are available should you, or one of your family members, become disabled to work.
If you are covered under a short-term or long-term disability policy as a benefit of employment, you should review the terms of your policy to determine whether you are eligible for disability insurance benefits. For more information on filing a claim for short-term or long-term disability benefits, click here.
However, if you are not covered under a disability insurance plan, and are not a federal or state employee, then your main recourse is to file a claim for Social Security Disability Insurance benefits.
The Social Security Disability Insurance program provides disability annuities for claimants who have worked and paid FICA taxes for a certain number of years, and who are found disabled according to the Social Security Administration’s rules and regulations. Generally, a claimant is eligible to apply for Social Security Disability Insurance benefits if the claimant has worked and earned credits in 20 of their last 40 quarters, or five of their last 10 years. In 2021, a worker earns a credit for every $1,470 in gross earnings that they make in the year.
Further, to be eligible to file an application for Social Security Disability Insurance benefits, a claimant must allege disability no later than their Date Last Insured. The Date Last Insured can be found on a claimant’s Social Security earnings record, or by contacting the Social Security Administration by phone at 1-800-772-1213 (TTY Number 1-800-325-0778).
The 5 Steps to Determining SSDI Eligibility
However, just because a claimant is eligible to apply for Social Security Disability Insurance benefits, it does not mean that the claimant is entitled to disability benefits. The Social Security Administration establishes a claimant’s entitlement to disability benefits only after it determines whether a claimant’s impairments meet their medical criteria for disability. The Administration follows a five-step sequential evaluation process.
- First, the Administration must determine whether the claimant is engaging in substantial gainful activity. Substantial gainful activity is defined as work activity that involves doing significant physical or mental activities that are usually done for pay or profit. Generally, if a claimant has earnings from employment or self-employment above an amount defined in the regulations, it is presumed that the claimant has demonstrated the ability to engage in substantial gainful activity. For 2021, the monthly substantial gainful activity amount for statutorily blind individuals is $2,190, and the amount for non-blind individuals is $1,310.
- Second, the Administration must determine whether the claimant has a medically determinable impairment, or a combination of impairments, that are severe and prevent an individual from engaging in any gainful activity for at least 12 continuous months. An impairment is “severe” if it significantly limits an individual’s ability to perform basic work activities. By contrast, an impairment is not deemed “severe” if it has no more than a minimal effect on an individual’s ability to work. Therefore, if a claimant’s symptoms from COVID-19 do not prevent a claimant from working for at least a 12-month period, the claimant is not entitled to receive Social Security Disability Insurance benefits. However, if a claimant’s symptoms from COVID-19 are debilitating to the point where they prevent a claimant from working for at least one year, the claim remains viable.
- Third, the Administration must determine whether the claimant’s impairment is of a severity to meet or medically equal the criteria of an impairment listed in the Social Security Listing of Impairments. For claimants who are alleging disability due to symptoms from COVID-19, it is likely that their claims would be evaluated under Section 3.00-Respiratory-Adult of the Listing. If you are alleging disability due to COVID-19, it is recommended that you discuss with your medical provider, preferably a pulmonologist, whether they would be willing to provide a medical opinion in writing as to whether you meet any of the requirements of the Listing of Impairments.
In the event that a claimant’s impairment is found not to meet or medically equal a listed impairment, the Administration can still find a claimant disabled if the medical evidence of record demonstrates that a claimant is unable to perform any job in the national economy. This determination is made at the fourth and fifth steps of the disability evaluation process.
- The fourth step requires the Administration to determine whether the claimant has the residual functional capacity to perform the requirements of the claimant’s past relevant work. The term “past relevant work” means work performed by the claimant within the last 15 years or 15 years prior to the date that disability must be established. Moreover, the work must have lasted long enough for the claimant to learn to do the job and perform substantial gainful activity. If the claimant has the residual functional capacity to perform any of his or her past relevant work, the claimant is not disabled. Therefore, even if a claimant’s symptoms from COVID-19 prevent the claimant from performing their last job, the claimant must still further prove that they are precluded from performing any of their past relevant work in order for their claim to remain viable.
- Finally, in the fifth step, the Administration considers whether the claimant is able to do any other work considering their residual functional capacity, age, education, and work experience. If the Administration determines that a claimant is able to perform any other work despite their background, work history, and impairments, the claimant is not disabled under the Administration’s rules. It is important to note, however, that the Administration’s Medical-Vocational Guidelines provide exceptions for claimants who are aged 55 and over who have a history of performing light, medium, or heavy work. In these cases, if a claimant has limited education and limited skills, or limited transferability of their skills due to their impairments, the claimant can still be found disabled even if they are found capable of performing sedentary work.
When applying for Social Security Disability Insurance benefits, it is important for any claimant, especially those alleging disability due to COVID-19, to consider the complexity of the Social Security application process. We recommend that you ask your medical providers whether they are willing to provide their written professional opinion of whether you are medically unable to perform any job in the national economy for at least a 12-month period due to the symptoms and limitations of your medical conditions.
Please be careful and consider contacting me if you have questions about your Social Security Disability Insurance claim.
Contact Matthew DeGioia at (301) 563-6685.
About Andalman & Flynn, P.C.: Founded in 1998 in downtown Silver Spring, Maryland, Andalman & Flynn has forged a distinguished reputation for legal excellence. The firm represents individuals seeking disability benefits throughout the country and practices family law throughout Maryland and the District of Columbia. The firm focuses on cases that impact the rights of everyone, and are there for clients when responsive legal help is most critical. The firm has provided legal analysis on national and local television and radio, and their attorneys often testify before legislative bodies and are routinely invited to contribute to prominent legal publications. For more information about Andalman & Flynn, please visit the website at andalmanflynn.com or call 301.563.6685