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Disability Benefits Guide for NY Residents

Friday, April 3, 2020

Approximately 37.5% of the world’s population has a disability, but some disabilities don’t impair a person’s ability to do work. For disabled individuals who aren’t able to work or pay for private disability insurance, Social Security benefits offer an important source of income.  Benefits are paid monthly through this program which allows disabled individuals to continue on with their lives, but qualifying for Social Security disability benefits is notoriously difficult. Further, the payout is calculated off the number of years the beneficiary worked before becoming disabled. So that means that younger disabled individuals are likely to receive lower benefits than people who are older when they become disabled. 

Understanding the challenges ahead in applying for and receiving Social Security disability benefits can help applicants prepare for the steps involved to ensure that the process goes smoothly.

Before we delve into disability benefits, let’s take a look at disabilities in general. 

What are the top 10 disabilities?

Between 2006 and 2015, only about one-third of Social Security Disability Insurance applicants were approved for disability benefits. During the initial application stage, only about one-fourth of applicants were approved. The remainder had to go through a reconsideration or appeals process in order to receive benefits.

 

The top 10 most common disabilities that were approved for coverage include:

 

  1. Disabilities caused by pregnancy
  2. Musculoskeletal disorders that affect the spine, back, knees, hips, shoulders, or other parts of the body.
  3. Hernias, gastritis and other digestive disorders
  4. Depression, anxiety, and other mental health issues
  5. Injuries including sprains, strains, and fractures
  6. Cancer
  7. Cardiovascular issues such as coronary artery disease
  8. Joint disorders such as arthritis
  9. Digestive issues
  10. Respiratory problems such as asthma and COPD

What conditions are considered for disability?

 

To qualify for Social Security Disability Insurance, an applicant must have a medical condition that is expected to last for at least one year (12 months) or longer. The disability may, in some cases, be life-threatening. Many of the conditions that would qualify the applicant for disability are listed in the Social Security disability blue book. Conditions in the listing manual for 2020 include:

 

●       Back injuries and musculoskeletal conditions

●       Heart failure, coronary artery disease and other cardiovascular conditions

●       COPD, asthma, or other respiratory illnesses

●       Sensory or speech issues including blindness or hearing loss

●       IBD or liver disease and other digestive tract problems.

●       Multiple Sclerosis, cerebral palsy, Parkinson’s Disease, Epilepsy or other neurological disorders.

●       Sjogren’s Syndrome or Marfan Syndrome and other various syndromes.

●       Depression, anxiety, autism, intellectual disorders, or other mental disorders.

●       Dermatitis and other skin disorders.

●       Cancer

●       HIV/AIDs, lupus, rheumatoid arthritis and other immune system disorders.

●       Genitourinary problems including kidney disease.

●       Hemolytic anemias, disorders of bone marrow failure and other hematological disorders

 

To qualify for Social Security disability, applicants don’t have to satisfy the exact listing for a particular condition or illness. Rather, Social Security must regard the beneficiary’s condition as medically equivalent to specified criteria in the blue book listing or a related listing. When your physical symptoms are medically equivalent to a listing this is called “equaling a disability listing”.

 

In some cases, applicants don’t meet the criteria and their condition also doesn’t equal the criteria listed in the blue book. The impairment doesn’t have to be listed in the Social Security blue book in order for the applicant to qualify for benefits, but to qualify for benefits the applicant still can’t work because their condition limits their functioning to such a degree that it simply isn’t possible. The Social Security Administration carefully considers these situations. The applicant’s inability to do work and routine activities are used to determine whether or not the applicant could safely do another kind of job if they aren’t able to do the job they initially performed. In order to receive benefits, the condition must be medically determinable and it must reduce the person’s Residual Functional Capacity to a degree that makes it impossible for them to do their prior job or any job. 

Who qualifies for disability in NY?

To qualify for disability in New York, the applicant must fulfill certain conditions:

 

●       The employer and one or more employees becomes “covered” four weeks after the 30th day of their employment.

●       An employer decides to provide benefits by filing an Application for Voluntary coverage. Employees are then covered for disability.

●       Recent or current employees who work for an employer who is “covered” and who have worked for at least 4 consecutive weeks qualify for disability.

●       Employees who have changed from one job where they were “covered” to another job where they are “covered”, receive disability benefits protection starting on the first day of their new job. Eligible employees don’t lose protection during the first 26 weeks of unemployment as long as the employee is eligible to claim unemployment insurance benefits.

●       Personal or domestic employees who work for 40 or more hours weekly for one employer qualify for disability benefits.

 

To qualify for disability, applicants must have a condition listed in the most current Social Security blue book or they must have a medically equivalent condition. If they don’t have a condition that’s medically equivalent to one that’s listed in the blue book, the applicant may still qualify for disability under a medical-vocational allowance. A medical-vocational allowance considers the applicant’s functional impairment to determine if he or she is able to do work or not. The medical-vocational impairment test considers not only the diagnosis or symptoms that could impair the applicant’s ability to work, but also the applicant’s education and skills.

Who is exempt from NYS disability?

 

The following individuals are not covered by NYS disability insurance:

 

●       The minor child of an employer

●       Members of religious orders such as ministers, priests, rabbis, sextons, or Christian Science readers

●       Government, maritime, or railroad laborers

●       Volunteers who work for non-profit organizations and receive no compensation for their work. Compensation includes the following: stipends, room and board, and other incentives that have a monetary value. (Stipends that are provided solely to offset an applicant’s expenses that are incurred while they’re performing an activity for a non-profit do not count as stipends)

●       Executive officers or teachers who work for religious, charitable, or educational institutions and people receiving rehab services in a sheltered workshop operated by such an institution

●       People who are receiving aid from a charitable or religious institution

●       A corporation that consists of corporate officers who singly or jointly own all stock or hold all of the offices and employ no other employees

●       Golf caddies

●       Students at elementary or secondary school who go to classes during the daytime and work part-time either during their school year or during their regular vacation period

●       Employees who change from one job that qualifies for disability to another that is exempt or “non-covered” and work for more than 4 weeks

●       The spouse of an employer that filed a spousal exclusion form

 

NOTE: Non-covered employers may choose at any time to provide disability benefits by filing an Application for Voluntary Coverage with the Chair of the Worker’s Compensation Board.

Can you go on disability for depression?

It is possible to go on disability for depression, but an individual with this disorder must meet certain criteria to be eligible to receive benefits. The specific criteria are listed in Social Security’s listing manual. In some cases, applicants may be granted disability on the basis of a medical-vocational allowance if the depressive symptoms are severe and other factors are present in the applicant’s work history, age, and level of education.

 

Depression is listed as Social Security’s impairment listing 12.04, Depressive, Bipolar, and Related. To qualify for Social Security disability benefits for depression, you must demonstrate that you have a severe form of the disease by manifesting at least five of the following symptoms:

 

●       Depressed mood

●       Diminished interest in all or almost all activities

●       Poor appetite or overeating that results in a demonstrable change in weight

●       Sleep disturbances (oversleeping or insomnia)

●       Inability to concentrate or think clearly

●       Feelings of guilt or worthlessness

●       Thoughts of suicide or death

●       Slow physical movement or reaction time

●       Slowed speech and physical agitation such as hand wringing or pacing

 

Additionally, you must meet certain functional criteria that show that your ability to work has been impaired as a result of the depressive disorder. An extreme or “marked” limitation in two of the following areas is necessary to receive disability benefits for depression:

 

●       Social interaction and the use of socially appropriate behaviors

●       Concentration, persistence, and maintaining an acceptable pace to complete tasks on schedule and/or

●       Adaptation and the management of one’s self (bill-paying, cooking, shopping, dressing, and practicing good hygiene).

●       Judgment, application, remembering, and understanding information such that instructions can be followed, new things learned, and the knowledge applied to tasks.

How long does it take to get approved for disability in NY?

As a general rule, it takes between 30 days and six months to get approved for disability in New York, but there are edge cases where the approval is granted prior to 30 days and of course, there are times when the decision takes longer than 6 months. Many experts recommend that applicants prepare to wait between 3 to 5 months from the time of application to receive an initial decision about SSDI benefits. Appeals cases get backlogged and in 2017, for example, there were more than one million cases waiting to be reconsidered. Applicants wait an average of 18 months to receive either approval or denial of benefits after an appeal.

How much does disability pay in NY?

For an individual, the federal monthly benefit amount is $771. For a couple, the benefit amount is $1,157 per month. The actual amount that a beneficiary receives, however, depends on the income they received prior to leaving their job and the amount of taxes they paid during the time they were working.

 

Beneficiaries can’t collect disability benefits at the same time that they receive paid family leave benefits. A beneficiary may only collect benefits for 26 or fewer weeks from either disability leave or paid family leave during any 52 week time period.

 

While on disability in New York, beneficiaries are responsible for their medical care expenses.  Neither the employer nor their insurance carrier is responsible for any medical expenses the beneficiary incurs.

 

Prior to receiving disability, the beneficiary’s employer is allowed to take a contribution from employees to offset their disability insurance benefits costs, but this isn’t required. The contribution that an employer can take is 0.5 percent of the employees wages, but no more than 60 cents per week. Employees with two jobs that yield more than $120 per week can ask for an adjustment in the contribution from two employers such that the combined contributions don’t exceed 60 cents weekly.

 

Under some Disability Benefits Plans, it is possible for an employee to contribute more than 60 cents weekly, but these situations are atypical and must be related in a reasonable way to the value of the benefits. Under such an arrangement where the employee is required to contribute, employers must also contribute to make up the balance of the insurance cost.

Do you pay taxes on NYS disability?

In New York state, you must pay Social Security and Medicare taxes on the disability benefits that are paid by an employer or their insurance carrier.

How do you apply for disability in NY?

There are two ways to apply for disability benefits in New York. You can either apply online at https://www.ssa.gov/benefits/disability/ or you can apply in person at a local Social Security office. Schedule an appointment by calling 1-800-772-1213 (TTY 1-800-325-0778) between 7:00 AM and 7:00 PM Monday through Friday or show up at the office without an appointment. To apply for disability online, you have to meet the conditions listed below:

 

●       The applicant must be 18 years of age or older.

●       The applicant must not be able to work due to an unexpected medical condition that will likely last for at least 12 months or result in death.

●       The applicant must not be currently receiving benefits through their own Social Security record.

●       The applicant must not have been denied benefits for a disability within the preceding 60 days.

 

If the application was denied recently, there is an Internet Appeal application that the applicant can use to request a review of the denial determination that was made.

 

Once an applicant has applied for disability, they can then apply for Supplemental Security Income (SSI) online if certain requirements are met. An applicant is eligible to file for SSI if they meet the following requirements:

 

●       The applicant must be between the ages of 18 and 65 years.

●       The applicant should not have ever been married.

●       The applicant must not be blind.

●       The applicant must be a U.S. citizen residing either in the District of Columbia, the Northern Mariana Islands, or the contiguous 50 states.

●       The applicant should not have applied for benefits or received benefits in the past.

●       The applicant should be applying for Social Security Disability Insurance at the same time that they are filing a SSI claim.

 

When the online application process has been completed, a Social Security representative will contact the applicant by telephone or via mail to gather any additional information that might be needed for the application.

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