Click Here To ViewSocial Security Disability: YOUR RIGHTS AND BENEFITS IN THE SOCIAL SECURITY SYSTEM
By Rudberg Law Offices, LLC | November 17, 2008
Social Security Disability
Social Security Disability is designed to assist individuals who have become unable to work. Social Security Disability benefits are intended to be a safety net for a worker who unexpectedly becomes disabled. Benefits continue until the person is able to work again on a regular basis, or have substantial earnings from part-time work.
Definition of Disabled
Social Security Disability eligibility is based on an inability to work. It is not designed to be a short term or partial disability program. Under the Social Security Act, you must be unable to perform your job and any other job due to your condition. Benefits are designed for people who are expected to be unable to perform work for a period of twelve (12) months or longer, or who have a terminal illness. Social Security is clearly a safety net, and resources other than Social Security are usually the first resources used to assist the disabled person.
You can receive disability benefits until you reach full retirement age, at which time the benefits automatically convert to retirement benefits. Your family members may also be eligible for benefits based on your disability status.
In order to qualify for benefits you must have enough work credits, which is also referred to as an earnings record. How long you have worked and how recently you have worked are relevant in determining if you are entitled to benefits. The amount of earnings required for a credit increases each year as wage levels rise among the population. Generally, you need 20 credits earned in the last 10 years ending with the year you become disabled. If you do not have enough work credits, or if your monthly Social Security Disability benefit amount would be low, you may still qualify for Supplemental Security Income benefits on the basis of your disability. However, strict income and resource requirements apply, and this benefit is generally less than what your Social Security Disability benefit would be.
Applying for Benefits
It is advisable to apply at any Social Security office as soon as you become disabled. Sometimes you can apply by phone or by mail. If you qualify your benefits will be payable dating back to the time you are disabled up to one year before the date you filed for benefits.
The application process for disability can be slow and it is advisable to provide detailed information such as your Social Security number, proof of age, information on all doctors that you have treated with for your condition along with the dates of treatment, medications you are taking, and a complete work history. If you do not have certain information the Social Security Administration will try to obtain the information necessary to process your claim. Your ability to provide basic information will speed-up the processing of your claim. It usually takes several months for a claim to be decided at the initial level.
There are some basic requirements, which Social Security uses to determine eligibility. Your application is sent to the Disability Determination Services in Pennsylvania to consider the facts of your case. In addition to reviewing your medical condition, they also evaluate your ability to do work-related activities. They may ask you to go to a consultative examination in order to obtain updated information on your medical condition. Social Security pays for the exam and any travel related expenses to attend the exam. You may request that your own doctor conduct this examination, provided your doctor is willing to complete all of the required examination forms.
Claim Investigation
Social Security reviews certain aspects of your situation in order to determine if your claim will be paid. If you are working and your earnings are over $940 per month, then you will normally not be found disabled if you earned this amount within the first twelve (12) months of your claimed period of disability. Your condition must interfere with basic work related activities for your claim to be considered. Social Security then looks at a variety of other factors to determine whether you are disabled. The Social Security Administration uses a Listing of disabling conditions, and if your condition is not on the list or does not equal a condition on the list, they have to decide if it is of equal severity to a listed impairment. Most disabled people do not meet these listings, but that is not a problem, as there are other ways to be found disabled.
If the Social Security Administration determines you do not meet a Listing condition, it will then examine your ability to perform certain work-related tasks. This is called your “residual functional capacity.” If it finds you can perform the demands of your prior job, it will find you not disabled. On the other hand, if it finds you cannot perform your past work (for example, a job that required heavy lifting), then it must consider whether you can do any other type of work. In doing so, the Social Security Administration considers your residual functional capacity, as well as your age, education, past work experience, including any transferable skills you may have. If you can adjust to other forms of work your claim is denied. However, your age plays a major role in this last step in determining disability.
The Social Security Administration uses four age categories together with your exertional limitations. Exertional limitations are limitations in things like how much you can lift, sit, walk, and stand. If you are between 18 and 44 years of age, you are considered a younger individual who would adjust to new work fairly easily. If you are between 45 and 49, adjustment to new work is considered more difficult, and for those between 50 and 54, even more so. For those 55 years of age or older, even if the Social Security Administration finds you have the capability to do “light work,” such as lifting 10 pounds on a regular basis, you will usually be found disabled if you cannot perform your old job, and your job skills would not readily transfer to a new job.
Even if you do not fall under a category that tells the Social Security Administration to find you disabled, it will still examine whether given all of your health conditions (including non-exertional limitations such as headaches and hearing loss) there is any work available for you.
Claim Approval
When the Social Security Administration makes a determination on your claim for benefits, it will send you a letter explaining its decision. If approved, your letter will state the amount of benefits you will receive, and when your payments will start. If you have been denied benefits, the letter will explain why, and give you information on appealing. You will have only 60 days in which to file an appeal.
Benefits will start the sixth full month after the date your disability began. Benefits for the preceding month are paid one month after they are due. The amount that you will receive is based on your lifetime average earnings. You can request a benefit estimate any time from Social Security. You should also receive a letter each year that states what your benefit amount would be if you were found disabled.
Social Security benefits are taxed if your household income is above a certain amount. Other benefits that you may receive, such as workers’ compensation benefits, can reduce the amount of Social Security benefits you receive each month. This is called an offset.
Once you begin to receive benefits your case may be reviewed periodically based on your medical condition and whether you are expected to recover. If you are expected to recover, your case will sometimes be reviewed within the year, and if you are unlikely to recover, your case may be reviewed as late as seven (7) years from when you were found disabled.
Claim Denial and Appealing Your Decision
If you receive a letter of denial, or if you disagree with any aspect of the decision from the Social Security Administration, you may appeal the decision. You have 60 days to file an appeal. Recent statistics show that about 65% of cases are denied at the initial level. In Pennsylvania, when you receive an initial denial, you may appeal by filing a Request for Hearing by an Administrative Law Judge. Many people who are initially denied benefits are approved at this level. Therefore, under certain circumstances it is certainly a good idea to take an appeal. If you receive a denial letter, please contact Rudberg Law Offices, LLC immediately, as strict time limits apply.
Once you appeal, the Social Security Administration will occasionally review your claim again and see if a decision can be made without a hearing. Normally, you will have to have a hearing, and your claim will eventually be assigned to a Judge who will review your case. Sometimes, individuals wait over one (1) year from when they appeal before a hearing is scheduled. This is, unfortunately, a normal occurrence. During the period in which you are waiting for a hearing, you can submit additional medical information about your medical conditions. At a hearing, you will have an opportunity to tell the Judge about your condition(s) and how it affects your ability to work. Often, a vocational expert will be at the hearing in order to address questions from the Judge about whether there are available jobs with the limitations the Judge believes you have. The Judge uses this information to make his or her determination on your appeal.
Healthcare Coverage
You are eligible to receive Medicare healthcare benefits two years from the date you became eligible to receive Social Security Disability benefits. Sometimes the date you became eligible to receive benefits can go back a year from the date you initially filed a claim for these benefits, and you can get past-due benefits from this date. Social Security automatically enrolls you in a basic Medicare plan. You should contact your local Social Security office for information about additional Medicare health coverage. Medicare entitles you to medical insurance to pay for the doctors’ bills and other services, but there is usually a monthly fee for certain coverage depending on your income level.
Return to Work
Many recipients of Social Security Disability Benefits have questions regarding how benefits will be affected if they return to work. Social Security provides work incentives and employment support programs.
Usually you are permitted to return to work for a trial period of nine (9) months (not necessarily consecutive) during which time your benefits will not be affected by your earnings. Each month that you earn more than $670.00 (before deductions) within a rolling 60-month period is counted toward the nine (9) month total. If, after this trial period, and upon review by Social Security, your earnings are deemed substantial, or greater than $940 a month, your benefits will stop for the months in which you earned over that amount. Your benefits can be reinstated for up to 36 months after your trial work period if you make less than this amount, and your monthly benefit amount will often be reduced by your monthly income, so it is important to report your monthly work earnings to the Social Security Administration. The Social Security Administration can recover benefits it paid to you during the period of time you did not report your monthly income. This is called an overpayment. Please keep in mind that your ability to work may be considered by the Social Security Administration when it reviews whether you are still disabled.
Conclusion
Social Security Disability Benefits provide a safety net for those who are injured and disabled and often have no other means to pay their bills. Remember to apply early, provide as much detailed information as possible, appeal if you do not prevail on your initial application, and keep the Social Security Administration advised of your progress both medically, and in any work that you do.
Rudberg Law Offices, LLC is available to answer any questions you, your family, and your friends may have about this process. Please be advised that the information contained in this document is subject to change, especially the earnings limits figures.
If you have any questions about earnings and eligibility, you should contact your local Social Security office or seek legal advice.
Topics: Social Security | Back to Top
Comments are closed.
