¿Está usted incapacitado? Conozca los hechos.

Hay muchas confusión sobre la incapacidad de la seguridad social prestaciones del seguro. Pero una cosa es segura: obtener prestaciones de incapacidad de la Seguridad Social es no es un camino fácil.

Todos tenemos una idea de lo que creemos que significa ser "discapacitado": generalmente creemos que lo sabemos cuando lo vemos. Sin embargo, no siempre es así.

Consider world-renowned astrophysicist and cosmetology Stephen Hawking, who died in 2018.  Hawking was wheelchair bound early in life due to a motor neuron disease related to amyotrophic lateral sclerosis (ALS).  As he lost more and more motor function, Hawking eventually could only communicate via small cheek movements translated into speech by a sophisticated machine.

Americans unfamiliar with Stephen Hawking  would  doubtless view his iconic pictures – frail, unable to hold his head up and looking like a rag doll tossed in his wheelchair – and consider him “disabled”.

Por otro lado, muchos de nosotros conocemos a una persona que recibe prestaciones por incapacidad de la Seguridad Social que a nosotros nos parece de todo menos incapacitada. Si bien es cierto que hay muchos que reciben prestaciones por incapacidad de la Seguridad Social que no deberían haber sido aprobadas, lo más probable es que la apariencia externa de estos beneficiarios de la incapacidad no refleje sus limitaciones reales y que, de hecho, no puedan trabajar.

Entitlement to social security disability insurance benefits is not based on a claimant’s appearance.  Rather “disability” is a precise legal definition under the Social Security Act.  But before we consider that definition of what it means to be “disabled”, let’s consider some prerequisites to social security disability insurance entitlement.

Legal Status in US

Para tener derecho a las prestaciones del seguro de incapacidad de la Seguridad Social, el solicitante debe ser ciudadano o nacional de Estados Unidos, o pertenecer a la categoría de "extranjero" (término jurídico que designa a los no ciudadanos).

Insured Status

Social security disability insurance (SSDI)  is just what it says:  insurance.  It is insurance coverage for disability that you pay for via your FICA taxes.  Insurance requires that you pay your premiums  Therefore, you must have “condición de asegurado" para el SSDI mediante el pago de impuestos FICA ..

La condición de asegurado es una prueba que consta de dos partes.

1. ha obtenido al menos 20 QC en los últimos 10 años ("cobertura reciente"), y
2. está totalmente asegurado.

For most Americans who have worked all their lives there is no problem with insured status – particularly the “fully insured” test.  But the “recent coverage” can be problematic for those who have not worked for a long time.  That is, those who have not worked at least 5 of the last 10 years may have a problem with meeting the “recent coverage” leg of the insured status test.   Those who file, fail to appeal, and refile repeatedly for social security disability insurance are in particular danger of losing their insured status.

Definition of “Disabled” under the Social Security Act

In most cases, insured status for social security disability insurance benefits is not a concern.  The main issue in a disability case is whether the person meets the legal definition for disability under the Social Security Act.  Here is that definition:

En incapacidad para ejercer una actividad remunerada sustancial (AGS) debido a una enfermedad física o mental médicamente determinable. deficiencia mental(s) que pueda preverse que provoque la muerte o que haya durado o pueda preverse que dure un periodo continuado no inferior a 12 meses".

Pero he aquí un resumen más comprensible de lo que la Ley de Seguridad Social entiende por "discapacitado".

Who decides if I am “Disabled”?

As you have already guessed, the social security administration determines whether your medical condition imposes such significant restrictions on your ability to perform work-related activity that your condition fits the definition of “disabled” under the Social Security Act. Folks here in Texas are often confused if not angry when they file a claim for social security disability benefits at the suggestion of their physician and still get turned down.  “My doctor says that I am disabled – how can they say that I am not”!

Other sources and decision determining disability do not necessarily mean that social security will find someone disabled under the social security act.  Those sources include:

• Dictamen favorable de invalidez en virtud de una póliza de invalidez de corta o larga duración;
• Favorable disability rating from the Veteran’s Administration;
• Alto índice de indemnización por accidente laboral;

It should be noted, however, that these other favorable disability finding, and the supportive opinions of treating physician’s is very important evidence for social security.  Social security regulations provide that they must consider these types of evidence and get good reasons if they disregard them.

Key Social Security Disability Regulations: How the Social Security Act definition of “Disabled” is  Really Determined

Those not familiar with administrative law might assume  that the language from the Social Security Act defining “disability” that I cite in quotes above would be what social security decision-makers and Administrative Law Judges refer to day-in, day-out in deciding disability cases. That assumption would be wrong.  Social security has created pages and pages of regulations designed to implement the Social Security Act.  In determining disability, social security uses the regulation at CFR § 404.1520. “Evaluation of disability in general” referred to as the 5-step  Sequential Evaluation Process. This graphic illustrates how the Sequential Evaluation Process.    The Kaiser Permanente Foundation also has a good graphic on the steps social security follows in determining qualification for social security disability insurance or supplemental secure income benefits.  Also, take a look at our Frequently Asked Questions about social security disability.