How Are Social Security Disability Benefits Calculated?

How Are Social Security Disability Benefits Calculated?

To be eligible for Social Security Disability Insurance (“SSDI”) benefits, you must have (1) a disabling condition that meets the Social Security Administration’s (“SSA”) definition of a disability and (2) paid a certain amount of Social Security taxes throughout your working career. The amount of disability benefits you can receive will be based on the amount of Social Security taxes you paid before becoming disabled.[1]

Applying for SSDI can be a stressful and complicated. At the Law Offices of Mark T. Hurt, we are experienced in successfully helping disabled clients secure disability income benefits.

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If you are disabled and would like to learn about SSDI or SSI benefits, call our office to schedule a free consultation. We will evaluate your case and explain the various benefits to which you may be entitled. We are only entitled to a fee if you receive a benefit award.

How Are My SSDI Benefits Calculated?

SSDI benefits are based on the amount of income on which you paid Social Security taxes. Using your Average Indexed Monthly Earnings (“AIME”), also referred to as average earnings, the SSA will calculate your Primary Insurance Amount (“PIA”), which is the amount of benefits you are entitled to receive.

As you can likely imagine, the formula used by the SSA to determine the PIA is complicated, making it difficult for most individuals to compute. In 2020, the average SSDI benefit amount is $1,259 per month, but it can be substantially more if you had a high income before disabled. As a social security benefits lawyer, I can assess your work history and tax payments and provide you with an estimate of the amount of benefits to which you may be entitled.

How Long Does It Take to Receive Social Security Benefits?

Generally, it takes three to five months for an SSDI application to be processed; however, if your claim is denied, you may have to appeal and wait longer. Statistically, initial claims have a denial rate of approximately 65%, meaning that, more likely than not, the claims process will take months to over a year to complete.

However, the chance of a wrongful denial can be significantly reduced by seeking the help of an experienced social security benefits lawyer. At our firm, we understand the claims process and the specific types of information required for benefit claim approval, which helps decrease the chance that a claim will be denied due to insufficient documentation.

What are the Factors that Can Lead to Social Security Payment Delay?

The following are some additional factors that can delay an SSDI decision:

• The nature of your condition. The SSA maintains a list of medical conditions that are so severe that they are automatically considered to be disabilities. If an injury or condition is not on the list, an individual determination will need to be made to assess whether the injury or ailment can be considered disabling.
• The responsiveness of a physician to requests for medical records and documentation. All SSDI applications must be supported by facts and documentation, and it may be necessary for a doctor to provide statements and medical records to substantiate a disability claim. If a physician does not respond to SSA requests for information or fails to submit proof of a patient’s diagnosis, the claim approval or denial can be delayed.
• Whether a medical examination is needed to support a disability claim. The SSA requires that some applicants have special medical examinations or tests before they can decide whether the applicants qualify for benefits. In these cases, waiting for an appointment or test results can push back a determination.
• If an application has been randomly selected for a quality assurance review. A Disability Quality Branch review is a process the SSA uses to ensure that examiners are following policies and procedures when making decisions on whether to approve or deny SSDI claims. The SSA occasionally and randomly inspects cases that have undergone processing or are engaged in being reviewed and performs a secondary evaluation that can take anywhere from a couple of weeks to several months.

How is Backpay Calculated?

Because it can take months to process an SSDI application and receive an approval letter, most disability applicants are eligible for back payments of benefits. The number of months of back payments depends on the SSDI application submission date and the date that an individual became disabled as determined by the SSA (known as the “established onset date” or “EOD.”)

In addition to receiving back pay from the application date forward, it is possible to receive up to 12 months of retroactive payments for the year before the application date, if the disabling condition existed at that time. However, benefits are not available for any months before the EOD.

How Long Do I Have to Wait to Collect Benefits?

Once an individual is approved for SSDI, there is a five-month waiting period beginning on the EOD.

What is the Maximum Amount of Back Pay that Can Be Received?

The maximum back pay benefit amount to which an individual may be eligible is equal to (i) the five month period after disability has been determined, plus (ii) the number of months beginning on the EOD to the date of the disability determination (up to 12 months). So, the maximum number of months of back pay is 17 months total).

Will I Receive Less SSDI If I Am Currently Collecting Other Benefits?

Disability payments, such as worker’s compensation, can offset SSDI benefits. However, other disability payments, such as veterans’ benefits or those made by private insurance, do not result in a reduction.

Will My Disability Benefit Amount Change?

As long as you remain disabled and are unable to work, you will be entitled to SSDI benefits. If your condition improves and you return to work, you must notify the SSA, and your will benefits will likely be reduced or discontinued.

Benefits can be discontinued if the SSA determines:

• You work and earn over $1,260 per month (non-blind disabled SSDI or SSI applicants) or $2,110 (blind SSDI applicants); or
• Your medical condition improves, and you are no longer disabled.[2]

The SSA conducts periodic case reviews to evaluate if there has been a change in circumstance. Many times, examiners determine that a person is no longer eligible for benefits, even when they are still disabled and unable to work. Under these circumstances, the individual is entitled to challenge the decision.

If your continuing benefits have been wrongfully denied, we would like to help. We can evaluate your claim and help compile evidence to make a strong argument to reverse the determination.

Call our Offices to Schedule a Free Consultation to Learn How We Can Help With Your SSDI or SSI Claim.

[1] Benefits for People with Disabilities, SSA, https://www.ssa.gov/disability/.

[2] These amounts are accurate as of March, 2020, but are subject to change.