Guest author: Jeff Rabin, JD
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.
Here are two 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”?
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 preclude 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.
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 Rabin is an attorney leading a law firm representing people nationwide seeking Social Security disability benefits. You can learn more about Jeff and his team at https://www.rabinsslaw.com/.
This article was edited for length and originally published (and republished here, with permission, by the Empower Network on substack.