This article by appears in Expert Insights, our section for expert tips, tricks, and perspective into work, disability, and chronic illness.
We all work for paychecks promised by a boss. But we never get the amount promised. Why? Because every paycheck has a stub and that stub has lines which take away our pay. American workers understand that they are paying for retirement benefits but few understand the disability insurance benefits they are purchasing. Millions of Americans pay into Social Security’s disability system with their paychecks and have little idea of what they have purchased. Lack of knowledge can be devastating when illness or injury occurs.
American workers pay for Social Security’s Old Age, Survivors and Disability Insurance programs, and for Medicare with each paycheck deduction. Every employer matches those deductions dollar for dollar. About $1.308 trillion was paid into the Social Security trust funds in fiscal year 2025 and more than 70 million American received monthly support. Of that number, about 15 million are receiving Social Security disability benefits.
This article will discuss three important facts people need to know about the disability insurance programs administered by Social Security:
What are the basic requirements of Social Security’s two primary disability programs?
How does Social Security decide whether someone is totally disabled?
Isn’t there significant fraud in this program causing a waste of tax dollars?
1. Social Security Disability programs’ basic requirements: SSDI and SSI
The Social Security Administration administers two primary disability programs. There are some subsets which may be the subject of future discussions. The first program is Title II of the Social Security Act known as Social Security Disability Insurance benefits also called “SSDI.” The second program is Title XVI of the Social Security Act and is called Supplemental Security Income or “SSI.” The differences are important.
A. SSDI requires tax payments.
Your payroll deductions for “OASDI” are your payment of insurance premiums for coverage under Social Security’s programs. To qualify for SSDI you must have paid into the Social Security system for at least 40 quarters in your lifetime, and for 20 quarters of the 40 quarters preceding the onset of becoming totally disabled. You can, and should, check your own quarters of coverage periodically by opening a My Social Security account at www.ssa.gov. This should be a basic financial planning step for every person who has paid into the Social Security System. Since this SSDI coverage is purchased with payroll taxes there are no limits on assets or unearned income.
B. SSI is “means tested.”
SSI requires that the Claimant have minimal financial resources. First, the Claimant must have less than $2,000 in any type of financial asset other than a home if living in it, and one car. Bank accounts, U.S. savings bonds, IRAs, 401ks and cash value life insurance are all examples of possible disqualifying assets. The second requirement is that the Claimant have no income. Money coming in from work, savings or family gifts will all count against SSI benefits. This program is for people who are totally disabled and have very limited financial resources.
C. The medical test is identical.
Both programs have the same medical test for benefits. In legal language, both require proof of the inability to engage in substantial gainful activity because of a medically determinable physical or mental impairment (or combination of impairments) that is either expected to result in death, or that has lasted or expected to last at least 12 consecutive months.
Stripped of the legal mumbo jumbo, this means that a Claimant must prove medical symptoms which are so severe that they prevent the ability to perform any type of full-time work, considering age, education and work experience, for a period that has lasted or is expected to last at least 12 months or result in death.
The key point here is that the focus is NOT on diagnosis – the focus is upon proof of symptoms and their impact on the Claimant’s ability to function in a work setting.
Summary: SSDI – totally disabled, worked and paid FICA taxes; SSI – totally disabled and indigent. For both, must prove medical symptoms preclude ability to work.
2. Social Security will focus on medical charts – that is the main evidence.
A common misunderstanding is Social Security’s definition of “proof” for total disability. First, other than in Compassionate Allowance situations, a “diagnosis” does not mean total disability. People work with fibromyalgia and cancer and multiple sclerosis and with bipolar disease and with any other type of diagnosis. The focus in any Social Security disability application is on the evidence of the “symptoms” from the diagnoses and how those symptoms impact a person’s ability to do basic work activity on a full time basis.
However, Social Security has a restrictive view of proof of symptoms and their impact on function. A Claimant’s description of pain, fatigue, weakness, frustration, anger alone will NOT be sufficient to prove total disability. Nor will the testimony of spouses, family members, friends and past employers alone be sufficient to prove total disability. These are “medical cases” that focus on the clinical medical charts of the treating medical specialists.
Medical records are the core evidence in any Social Security analysis. Reports from doctors are nice, and are considered, but are rejected if they are inconsistent with the medical charts. It is critical that anyone seeking this help understand what symptoms SSA will be expecting given their medical issues, and what type of doctors SSA will expect you to be seeing for treatment. It will be what those doctors write down while examining and treating their patient that will be the evidence in a disability case.
Summary: the focus of SSA is on your medical charts, not your diagnoses.
3. In this program “waste, fraud and abuse” are myths.
There is much street talk about fraud in the SSA disability program. However this is not supported by any studies. It is false. There are no credible, acceptable studies that support widespread fraud in these programs. There are administrative errors, especially after government efficiency programs led to a decimation of the Social Security staff and many people with experience left the agency.
More work is being done by fewer staff so more administrative errors do occur. However, the Center for Budget and Policy Priorities estimate that the true fraud rate in these programs is between 0.006 and 0.5%. People in the United States illegally do not get disability benefits. With few exceptions even people who are in the USA legally, but not citizens, cannot receive SSI unless they are here as refugees, under grant of asylum or have served in the armed forces. SSA has an amazing record of cost-efficient (if very slow) administration. When measured against incoming tax dollars or total benefits paid, the SSA’s SSDI administrative expenses generally range from 0.7% to 1.6%. Because of the highly complex asset and income calculations, SSI administrative expenses are about 7-8% of its expenses.
However, this should be contrasted with the vaunted “private sector” and the purported efficiencies of the private insurance disability industry. The administrative expense ratio of the private disability insurance carriers in the US are reported by numerous sites to be between 20% and 30% - far in excess of SSA’s costs for operation.
Summary: SSA’s disability programs are not rife with fraud and operate with exceptional cost-efficiency.
Conclusion:
Social Security’s disability programs are an incredibly critical safety net for US citizens suffering from serious medical conditions and symptoms. Understanding the programs and the law are important for people suffering from medical issues, for family members, for medical providers and for counselors and advisors.
These programs serve Americans with disabilities well and with efficient, albeit very slow, performance.
Jeffrey A. Rabin
Jeffrey Rabin is an attorney representing people nationwide needing Social Security disability benefits. A lawyer since 1980, Mr. Rabin found his firm in 1988 and has represented people at all levels of the administrative process and in the federal courts.
The views expressed in this article are those of the contributor and do not necessarily reflect the views of The Empower Network. Content is provided for informational purposes only.
