How is “disability” defined for adults by the Social Security Administration (SSA)?
The law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months…” CFR § 404.1505(a)
What meets this definition?
To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work or any other substantial gainful work that exists in the national economy.” CFR § 404.1505(a)
What is substantial gainful work (also referred to as substantial gainful activity or SGA)?
“Substantial gainful activity is work activity that is both substantial and gainful:
(a) Substantial work activity. Substantial work activity is work activity that involves doing significant physical or mental activities. Your work may be substantial even if it is done on a part-time basis or if you do less, get paid less, or have less responsibility than when you worked before.
(b) Gainful work activity. Gainful work activity is work activity that you do for pay or profit. Work activity is gainful if it is the kind of work usually done for pay or profit, whether or not a profit is realized.
(c) Some other activities. Generally, we do not consider activities like taking care of yourself, household tasks, hobbies, therapy, school attendance, club activities, or social programs to be substantial gainful activity.” CFR § 404.1572.
Note: Several additional factors affect the applicability of the above definition (ie. blindness, unsuccessful work attempts, etc.)
What is past relevant work (PRW)?
Definition of past relevant work. Past relevant work is work that you have done within the past 15 years, that was substantial gainful activity, and that lasted long enough for you to learn to do it.” CFR § 404.1560(b)(1)
What kinds of benefits are there?
Upon approval, the types of benefits one can receive are Social Security Disability Insurance (SSDI) benefits, and Supplemental Security Income (SSI) benefits, spousal benefits (current spouse, widow(ers), divorcees), & children’s benefits.
Is it hard to apply for Social Security disability benefits?
It’s very doable. At the initial level, your local Social Security office will guide you through the process step-by-step. If you have been approved, you will receive a notice and will begin receiving benefits. If not, you will have 60 days to appeal the decision (plus an additional 5 days for mailing). During those 60 days you can decide to appeal on your own or to seek representation. If you decide to seek representation through our firm, our staff members will guide you through the process and seek to make it as stress-free as possible.
When can I file for Social Security Benefits?
o SSI-If you are applying for Supplemental Security Income (commonly referred to as “SSI”) you can do so at any time given that you meet the income and asset requirements.
o SSDI- If you are applying for Social Security Disability Insurance (“SSDI”) benefits, you may file a claim once you have satisfied one of the four methods used for determining eligibility according to CFR § 404.130 (excerpts listed below).
• Rule I—You must meet the 20/40 requirement. You are insured in a quarter for purposes of establishing a period of disability or becoming entitled to disability insurance benefits if in that quarter—
o You are fully insured; and
o You have at least 20 QCs in the 40-quarter period ending with that quarter.
• Rule II—You become disabled before age 31. You are insured in a quarter for purposes of establishing a period of disability or becoming entitled to disability insurance benefits if in that quarter—
o You have not become (or would not become) age 31;
o You are fully insured; and
o You have QCs in at least one-half of the quarters during the period ending with that quarter and beginning with the quarter after the quarter you became age 21; however—
If the number of quarters during this period is an odd number, we reduce the number by one; and
(ii) If the period has less than 12 quarters, you must have at least 6 QCs in the 12-quarter period ending with that quarter.
• Rule III—You had a period of disability before age 31. You are insured in a quarter for purposes of establishing a period of disability or becoming entitled to disability insurance benefits if in that quarter—
o You are disabled again at age 31 or later after having had a prior period of disability established which began before age 31 and for which you were only insured under paragraph (c) of this section; and
o You are fully insured and have QCs in at least one-half the calendar quarters in the period beginning with the quarter after the quarter you became age 21 and through the quarter in which the later period of disability begins, up to a maximum of 20 QCs out of 40 calendar quarters; however—
If the number of quarters during this period is an odd number, we reduce the number by one;
If the period has less than 12 quarters, you must have at least 6 QCs in the 12-quarter period ending with that quarter; and
No monthly benefits may be paid or increased under Rule III before May 1983.
• Rule IV—You are statutorily blind. You are insured in a quarter for purposes of establishing a period of disability or becoming entitled to disability insurance benefits if in that quarter—
o You are disabled by blindness as defined in § 404.1581; and
o You are fully insured.
• How we determine the 40-quarter or other period. In determining the 40-quarter period or other period in paragraph (b), (c), or (d) of this section, we do not count any quarter all or part of which is in a prior period of disability established for you, unless the quarter is the first or last quarter of this period and the quarter is a QC. However, we will count all the quarters in the prior period of disability established for you if by doing so you would be entitled to benefits or the amount of the benefit would be larger.
Is it necessary to hire a representative to represent me in my Social Security disability hearing?
No. You are not required to hire a representative. However, often hiring a representative is recommended due how easy it is to become overwhelmed with the large volume of medical records, Social Security documents, regulations, etc. that are required to prepare a successful appeal. In addition, as a potential claimant, it can get a bit stressful juggling the day-to-day rigors of life in addition to seeking benefits. As such, it helps to have a group of experienced professionals on your side.
How do representatives who help Social Security disability claimants get paid?
Representatives who help Social Security disability claimants are paid through a fee agreement signed by both the claimant and his or her appointed representative. The representative and the claimant must agree, in writing, to a fee that does not exceed the lesser of 25% of past due benefits or a prescribed dollar amount.
Can I get Social Security disability benefits if I expect to get better and return to work?
In order to receive Social Security disability benefits one must be “disabled” by Social Security’s definition. In other words, they must have an “inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
I got hurt on the job. I am drawing worker’s compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the worker’s compensation ends?
It depends. Worker’s compensation, unlike private pension or private insurance benefits, may affect your Social Security benefits. The general rule is “If you receive workers’ compensation or other public disability benefits and Social Security disability benefits, the total amount of these benefits cannot exceed 80 percent of your average current earnings before you became disabled.” -SSA Publication No. 05-10018 ICN 454500
I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security benefits?
“If you have a combination of impairments, no one of which meets a listing, [Social Security] will compare your findings with those for closely analogous listed impairments. If the findings related to your impairments are at least of equal medical significance to those of a listed impairment, [they] will find that your combination of impairments is medically equivalent to that listing.” –CFR § 404.1526(b)(3)
In other words, the findings from your combination of impairments will be taken into account holistically and compared to the findings of listed impairments when making your disability determination.
My doctor says I’m disabled so why is Social Security denying my Social Security disability claim?
Although medical records and physician recommendations carry a great deal of weight when determining a claimant’s disability status, such recommendations are not binding. Disability Determination Services (DDS), comprised of SSA field offices and State agencies, actually make the decision after considering a number of factors. If you feel that your decision has been reached in error, you are encouraged to appeal within 60 days of the date listed on your denial letter. If you are interested in our assistance in this process, please feel free to contact us via in the information listed on this site.
If I am approved for Social Security disability benefits, how much will I get?
SSI- The monthly “maximum” Federal amounts for 2014 are $721 for an eligible individual, $1,082 for an eligible individual with an eligible spouse, and $361 for an essential person. These amounts are determined by the SSA and vary yearly based on cost of living.
SSDI- There are several factors that contribute to the amount of SSDI benefits that a claimant may be eligible to receive (ie. earnings record, contribution amount, etc.). In order to find out your individual status visit: http://www.ssa.gov/myaccount/.
VA says I am disabled, so why is Social Security denying my Social Security disability claim?
The SSA and VA have differing definitions of the term “disability”. As such, the burdens of proof necessary to qualify for benefits are not the same. According to the United States Department of Veterans Affairs, in order to be disabled by VA standards veterans must be “at least 10% disabled because of injuries or diseases that were incurred in or aggravated during active duty, active duty for training, or inactive duty training.” The same is not the case for Social Security disability benefits. Instead, disability under the SSA requires a claimant to possess an “inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months…”
If I am found disabled how far back will Social Security pay benefits?
It depends. If you qualify for disability under SSI, you may be entitled to back payments for the dates between when you applied for disability benefits and the time you were approved. As for SSDI benefits, you may qualify for back payments from the established onset date (EOD) to the approval date minus the required five-month waiting period.
What is the difference between Medicare and Medicaid?
Medicaid is funded, in combination, by both the federal government and state governments and extends to low-income individuals who are not covered under Medicare. In certain instances, people who are covered by Medicare may also be eligible for limited Medicaid benefits to fill in gaps in their Medicare coverage.
Medicare is administered by the federal government and funded through monthly deductions from the income of working individuals. Medicare benefits are split into four parts (A,B, C, and D) and may be administered in a number of ways based on various factors.
If Social Security tried to cut off my disability benefits, what can I do?
Once you have received a notice stating that your benefits will be, or have been discontinued, you are given 60 days to appeal the decision (plus 5 days for mailing). You may appeal individually or seek legal counsel to do so on your behalf. If you decide to seek legal counsel, you should do so immediately in order to ensure that there is adequate time to prepare your claim.