Disability Benefits
If you unable to work on a full-time sustained basis, you may be eligible for Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits.
Under the law, “disability” means the inability to engage in substantial gainful activity because of a medically determinable impairment, either physical or mental, which can be expected to last for a continuous period of at least 12 months or result in death.
In other words, you may qualify if:
* You cannot do the type of work that you did before
* You have worked and paid into Social Security, earning sufficient work credits or you have limited income and resources
* You cannot adjust to other work because of your medical condition(s)
* Your disability has lasted or is expected to last for at least 12 months or to result in death
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SOCIAL SECURITY DISABILITY BENEFITS (SSD)
Social Security Disability Benefits (SSD, also called SSDI or DIB) are paid to disabled people who have worked for at least 5 of the last 10 years. SSD is wage replacement income for individuals who have worked and paid FICA (payroll) taxes. SSD also provides a variety of benefits to family members when a primary wage earner becomes disabled or dies. You can find more information about SSD benefits in this booklet entitled Disability Benefits published by SSA.
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SUPPLEMENTAL SECURITY INCOME BENEFITS (SSI)
Supplemental Security Income Benefits (SSI) benefits are paid to people who are both poor and disabled. It is a welfare type benefit that generally requires that you have less than $2,000.00 in assets if you are single or less than $3,000.00 in assets if you are married. For more information about the SSI disability program for adults, see the Supplemental Security Income (SSI) publication from SSA. There are many exceptions and work-arounds for SSI so if you think you have a possible SSI claim you should contact an attorney or SSA.
In addition, SSI children’s disability benefits are paid to children 18 years old and younger who are disabled and whose parents or guardians are poor. For information about disability programs for children, refer to Benefits For Children With Disabilities published by SSI.
General Instructions on Filing a Disability Claim
1. Carefully decide the date you want your claim to begin as this will determine your weekly benefit amount. Disability Insurance Claim Form
2. Complete ALL items on the “Claim Statement of Employee“ and sign it. Make certain that all information is complete and accurate since errors or omissions may cause your claim to be returned and may delay payment. Disability Insurance Claim Form
3. Doctor’s Certification: Ask your doctor to complete and sign the “Doctor’s Certificate” (page 3)
The following licensed health care providers are authorized to sign the Doctor’s Certificate portion of the DE 2501, for patients under their care and for conditions within their scope of practice:
* Physician and Surgeon holding a M.D. or D.O. degree
* Chiropractor
* Dentist
* Optometrist
* Podiatrist
* Psychologist
* Nurse midwife or licensed midwife (For normal pregnancy and childbirth only)
* Nurse Practitioner (For all conditions within scope of practice. In order to certify disabilities other than normal pregnancy and childbirth, the nurse practitioner must perform a physical examination and collaborate with a physician and/or surgeon.)
Other individuals who can certify to a disability include:
* Accredited religious practitioner
* Registrar of a county hospital in California
* Medical officer of a United States government medical facility
* State or local health officer
Note: If a nurse practitioner is certifying a Claim for Disability Benefits for a disability other than a normal pregnancy or childbirth, he/she must complete, print and sign the “Nurse Practitioner Certification for Disability Insurance Benefits, DE 2509A” and attach it to the Claim for Disability Benefits, DE 2501. Disability Insurance Claim Form
Nurse Practitioner Certification For Disability Insurance Benefits, DE 2509A
4. Cannot Complete Form: If you cannot complete the claim form because of your disability, or if you are an authorized agent filing for benefits on behalf of a physically incapacitated, mentally incapacitated, or deceased claimant, you will need to request the appropriate form(s) for your situation. Call 1-800-480-3287 for further instructions.
5. Religious Practitioner: If you are under the care of an accredited religious practitioner, you must include with your claim form a “Practitioner’s Certificate, “DE 2502. Ask your practitioner to complete and sign it. (Rubber stamped signature facsimiles are not accepted.) Call 1-800-480-3287 to get a Practitioner’s Certificate, “DE 2502”
6. Temporary Workers’ Compensation: If you are receiving temporary Workers’ Compensation benefits and are filing for reduced DI benefits for the same days, the Doctor’s Certificate is not required. None
7. Mail your claim to the DI office nearest to your residence no earlier than 9 days–but no later than 49 days–after the first day you became disabled. Mail your completed, signed “Claim Statement of Employee” together with the completed, signed “Doctor’s Certificate“ and any other supporting documents.
Tips and Advice For Claims
1. Regardless of what anyone tells you, it’s good advice, if you are disabled and unable to work, to pursue a claim for Social Security disability, or ssi based on disability, and get it filed immediately. Reason: disability claims can take a very long time to process. This isn’t true in all cases, but it is in most. Unfortunately, many claimants for disability benefits have experienced severe problems and hardship simply because they had no idea how long the process would be, and only realized when it was too late that they should have filed an application much much sooner.
2. If you are denied on your Initial Claim, it’s good advice to get an attorney or non attorney Representative to provide representation and help you with your claim for continuing and past due benefits (back pay). Reason: the way the disability system works, a claimant will, typically, either be approved on an initial application…or will be forced to follow the appeal route, at least to the point where their case is brought before an Administrative Law Judge at a social security disability hearing. This is not always the case, but it is generally a predictable rule of thumb (*reconsiderations usually have a much higher rate of denial than initial claims–and initial claims are denied 60 to 70 percent of the time, depending on the state in which you filed. For this reason, most claimants will have to go to a hearing if they hope to be approved–and going to a hearing unrepresented is foolish).
3. If you think you may have problems doing the paperwork for your social security disability Claim, take some advice and find qualified assistance immmediately. An extraordinary number of persons who apply for benefits, or file an appeal following a denial, fail to properly complete their paperwork, or fail to submit their forms in a timely manner (*all appeals for disability must be filed within 60 days of the date of the last denial).
4. Advice: Since your Social Security Disability or ssi claim will be evaluated completely on the basis of your medical records, the best advice is to get regular, ongoing medical treatment. Reason no. 1: even if your past medical records indicate that you are disabled, an examiner or judge will not be able to approve your claim for continuing benefits if current medical records are not available to substantiate your claim. Reason no. 2: if you attempt to get a supporting statement from your doctor (an RFC is much better–see the definitions page), you may have difficulty getting your physician to cooperate if he/she has not seen you recently. If you lose your medical coverage before your claim for benefits is approved, as is usually the case, try to be seen at a free clinic, county health department, or emergency room. While these treatment sources are not the best, they are, simply put, better than nothing. Another avenue to pursue may be with your state’s Vocational Rehab department. Very often, VR can assist claimants in getting certain testing and examinations paid for. Though this is always for the purpose of developing a VR claim, vr counselors are usually willing to supply these records to a claimant’s representative as well. Just remember this advice: as a general rule you cannot be approved for social security disability or ssi based on disability if you are not seen by a medical provider at least once every two months.
FREQUENTLY ASKED QUESTIONS
Do I have to be poor to obtain Social Security benefits?
No, you do not, and such benefits are not part of any federal or state welfare program. You should not feel ashamed in applying for benefits, since you in essence paid an insurance premium out of your salary each month to protect you and your family in the event you were to become unemployable. You paid the premium and you are entitled to collect if you cannot work. It is not now and never has been a charitable venture. You paid for it, and if you can’t work, you are legitimately entitled to receive it during your time of need. That’s what you paid for, and it is available for you when you need it.
My disability claim has been denied so what should I do now?
At this point, you should hire an experienced Social Security attorney to represent you from this point forward since all further dealings will be with an Administrative Law Judge. Dabney & Barnes should be contacted as soon as you receive you denial of benefits since you only have 60 within which to appeal. We can help you with regard to the paperwork that needs to be completed, signed and filed in order to protect your claim.
Do I have to be permanently, totally disabled in order to obtain Social Security disability benefits?
No, you do not. Social Security benefits are given to many individuals who are off work for at least one year, but who reach a point when they can and in fact do return to work. At that time, their benefits can be discontinued, subject to being reinstated again if they are, once again, unable to work. The important thing to remember here is when in doubt as to how long you may be off work, go down and file anyway. If it turns out to be a year or more, you will be glad you did.
Do I really need a lawyer to handle my case in a hearing before an Administrative Law Judge?
Absolutely! Matters such as objections to evidence, preparing briefs with citations to rules, regulations and cases, and direct and cross examinations of expert witnesses such as doctors and vocational Experts is not something that can be left to non-lawyers. There are some non-attorney representatives who do represent disability claimants, but their lack of legal training is a definite disadvantage to hiring them. The fees paid are the same as they are regulated by federal law, so if you are going to pay for legal representation, you might as well have an experienced Social Security attorney working for you, not some non-lawyer who can’t appeal on your behalf all the way to Federal Court.
How much do I have to pay a lawyer to represent me before Social Security?
The standard fee set by federal law is 25% of back benefits with a current maximum cap of $5,300.00 which from time to time is adjusted by the Social Security Administration. Your attorney and you must sign a fee agreement in conformity with federal law which must also be approved by the Administrative Law Judge. All attorneys are paid the same, with the exception that some will occasionally charge on an hourly basis which is very complex and which many attorneys feel is actually disadvantageous to claimants because it can result in someone paying an attorneys fee which is greater than the 25% contingency and $5,300.00 cap. If you don’t win, you do not have to pay us. Dabney & Barnes represents all of our clients on a contingent fee basis for 25% of back benefits. We do not charge an hourly rate for our legal services.
Disability Benefit Myths
You do NOT have to be out of work for at least one year before you are able to apply for disability insurance benefits.
You can and should file for benefits as soon as you are unable to work. Don’t let anyone at your local Social Security District Office talk you out of applying until you have been off work for at least one year. You need only show either that you have in fact been off work for a year or more, or that your medical condition is such that it is likely that you will be off work for least one year. If you can’t work anymore, file!
You do NOT absolutely need a favorable report from your doctor that you are unable to work to win your claim.
However, the existence of such a report is certainly helpful to your claim, and frequently means the difference between a win or a loss. If your doctor is willing to prepare such a report, have him or her do it and submit it to Social Security. Also, it is very important for you to personally obtain copies of as many of your medical records as possible, make a copy for your own file and hand-deliver them to your local Social Security District Office – preferably when you file, but if you can’t do it that quickly, then hand-deliver a copy of your medical records after you have filed. Don’t delay your filing, however, in order to get copies of your records. File first without the records if you have to, and deliver the medical records later when you can get them. And, keep in touch with Social Security to make sure your case moves along.
You should NOT give up when Social Security turns you down.
If you are truly unable to work, appeal each and every adverse decision timely. Don’t give up simply because the agency tells you that it doesn’t believe you are totally disabled. Almost everyone gets turned down at least once, and frequently at the reconsideration stage as well, particularly if you are under 50 years of age or have a High School Diploma or GED. If your claim is denied a second time on reconsideration, immediately contact us so we may assist you with regard to your appeal. This time the appeal will be on a form entitled “Request for Hearing before an Administrative Law Judge.” From this point on, you should seriously consider hiring an attorney who specializes in Social Security law. There are not that many in Utah because the area is rather highly specialized; but, you should not settle for anything less than an attorney who knows what the law is and has handled a lot of cases before the Social Security Administration.
If you have a Workers Compensation claim, you can also file for Social Security benefits; and the same is true if you have a personal injury claim.
If the reason you are unable to work is because your medical problems arose out of a serious work-related event, you do NOT have to wait to file for disability benefits until your workers compensation benefits cease. You may concurrently receive a check for both disability insurance benefits and workers compensation benefits. There may be some reduction in the amount due to the Social Security offset rule, but in 95%-plus of the cases, most claimants receive checks which exceed the total from either source. Many injured workers are not aware of the fact that they can receive lifetime awards both from Social Security as well as from the Utah Workers Compensation system.
Receipt of a personal injury award by settlement or Court decision does not mean that you do not have a valid Social Security claim, either, for the same reasons. If you are disabled, you can file, and the fact that you are receiving or may receive benefits from another source will not prevent you from filing.
Useful Social Security Internet Sites
There are several important Internet sites which you can use to obtain information about your own Social Security benefits, get answers to your questions and to research various areas of Social Security law that may not be readily available to most people seeking disability insurance or supplemental security income benefits. We have identified some of the best ones below.
Applying for Social Security Disability Benefits Online
http://ssa.gov/d&s1.htm
Here is probably the most useful site on our Useful Internet Site page which is the web site for applying for Social Security Disability Benefits and Supplemental Security Income. For our clients who are home-bound, who cannot drive a car or who don’t have transportation to visit a Social Security District Office, this is the best way to initiate a claim without having to schedule a personal appointment with a Social Security representative. If you have not yet filed for benefits, this is a fast and accurate way to do it – but do it right now! If you get denied, give us a call to help with your appeal.
Personal Earnings and Benefit Estimate Statement
https://s044a90.ssa.gov/apps6z/isss/main.html
One of the most valuable exercises you can perform before you reach retirement age, or before you file a disability claim with the Social Security Administration, is to request information about your past lifetime income and your future retirement calculations. You may now do this by utilizing the Internet. Specifically, you may obtain a copy of your “PEBES” which contains a breakdown of your annual income during your work life as well as a great deal of other financial information concerning benefits that you are entitled to as a result of your employment history. Everyone should request one of these.
Social Security Administration
http://www.ssa.gov
This web site provides a wealth of information on disability as well as retirement benefits, and attempts to answer many common questions which Social Security personnel are frequently called upon to answer. It also addresses a lot of technical information which comes up from time to time. It is an invaluable resource for getting information which is not readily available anywhere else.
Social Security Handbook
http://www.ssa.gov/OP_Home/handbook/ssa-hbk.htm
This handbook has been widely regarded as the Bible of Social Security law. While it has in past years been almost impossible to order by mail, it has now been made available on the Internet for free. It contains a lot of practical, helpful information.
American Association of Retired Persons
http://www.aarp.org
The American Association of Retired Persons, better known by its acronym, AARP, has a web site that can bring you up-to-date on the latest developments in Washington on the major issues of the day concerning Social Security. The web site also contains information about membership, lobbying activities and identifies various ways in which you can help to preserve your own benefits as well as contribute time and resources to making the system safe for all of us. This is where your efforts can impact political decisions.
Glossary
Activities of Daily Living (ADL)
Include adaptive activities such as cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring appropriately for grooming and hygiene, using telephones and directories, and using a post office
Administrative Appeals Judge (AAJ)
An Appeals Council judge who reviews ALJ decisions
Administrative Law Judge (ALJ)
A neutral fact finder employed by the Office of Disability Adjudication & Review (ODAR) to determine if a person is entitled to benefits under the law
Age
Age refers to person’s chronological age and the extent to which age affects ability to adapt to a new work situation and to work in competition with others. A person reaches a particular age the day before his or her birthday.
Categories of Age:
1. Younger Person–if an individual is under age 50, the regulations provide that generally SSA does not consider that the individual’s age will seriously affect the ability to adapt to new work situations. It is only when an individual is illiterate and age 45 through 49 that age affects the ability to adapt to new work situations for those under age 50.
2. Person Approaching Advanced Age–if an individual is closely approaching advanced age (50-54), SSA will consider age along with a severe impairment and limited work experience as possibly seriously affecting an individual’s ability to adapt to a significant number of jobs in the national economy.
3. Person of Advanced Age–SSA considers advanced age (55-59) to be the point at which age significantly affects a person’s ability to engage in substantial gainful activity. If an individual is severely impaired, of advanced age, and cannot do at least medium work, he/she may be found disabled unless the individual has skills that can be used in (transferred to) less demanding jobs that exist in significant numbers in the national economy.
4. Person Close to Retirement Age–if an individual is close to retirement age (60 or older) and has a severe impairment, he or she will be considered not able to adjust to sedentary or light work unless the individual has skills that are highly marketable.
Alleged Onset Date (AOD)
The date on which a person became disabled due to a physical or mental impairment
Americans With Disabilities Act (ADA)
Federal law, 42 U.S.C. § 12101, that provides remedies for discrimination against disabled people
Appeals Council (AC)
The highest level of administrative appeal, the Appeals Council reviews decisions made by ALJs. Appeals Counsel members decide if a request for review of an ALJ decision will be granted, denied, or dismissed. The Appeals Council is located in Falls Church, VA
Arduous Work
Physical work requiring a high level of strength or endurance. May be arduous if it demands a great deal of stamina such as repetitive bending or lifting at a very fast pace. Generally, physical demands are classified as heavy
Auxiliary (AUX)
Other family members, usually children or spouse, to whom additional monthly benefits may be payable on the earnings record of a person entitled to Social Security benefits
Average Current Earnings (ACE)
A reduction in the disabled worker’s, and dependents’ benefits may be made for any month the worker’s total Social Security benefits, workers compensation, and, where applicable, other public disability benefits exceed 80 percent of his or her “average current earnings.” Multiple formulas are used to calculate average current earnings, then the highest number is used
Average Indexed Monthly Earnings (AIME)
The dollar amount used to calculate Social Security benefits for people who attained age 62 or became disabled (or died) after 1978. To arrive at AIME, SSA adjusts actual past earnings using an “average wage index,” so persons won’t lose the value of past earnings (when money was worth more) in relation to more recent earnings. If a person attained age 62 or became disabled (or died) before 1978, SSA uses Average Monthly Earnings (AME)
Central Office (CO)
Administrative headquarters for the Social Security Administration, located in Woodlawn, Md., a suburb of Baltimore
Chief Administrative Law Judge (CALJ)
Located in Falls Church, Va., the CALJ has supervisory authority over Regional Chief Administrative Law Judges, Hearing Office Chief ALJs, and ALJs
Childhood Disability Benefits (CDB)
This program provides benefits for disabled adult children (DAC) who may obtain benefits on the work record of a retired, disabled, or deceased parent. These persons must be over age 18 and unmarried, and must become disabled before age 22. Disability is determined using the rules for the regular Social Security disability program
Claims Representatives (CR)
Federal employees of the Social Security Administration who assist individuals in applying for Social Security and SSI benefits. They determine if the person meets entitlement requirements. They make many of the required inputs to a nationwide database that processes claims
Code of Federal Regulations (CFR)
The Code of Federal Regulations is a codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the federal government.
Constantly
Use of this term in the RFC or SCO means that the activity or condition occurs two-thirds or more of an eight-hour day
Consultative Examination (CE)
Medical examination at government expense. Exams may be from the individual’s treating physician or independent consultative physician hired by SSA. Its Purpose is to obtain more detailed medical findings about the impairment; or obtain technical or specialized medical information; or to resolve conflicts or differences in findings already in the file
Continuing Disability Review (CDR)
Periodic reviews conducted to determine if disability continues. They may be scheduled where medical improvement was expected or unscheduled if the beneficiary or state vocational rehabilitation agency reports improvement
Controlling Date (CD)
The latest date a widow(er) can be found disabled. It functions like the Date Last Insured in a regular Social Security disability case
Cost of Living Adjustment (COLA)
Automatic periodic (usually yearly) increases in SSA and SSI benefits based on a formula tied to cost of living increases
Date of Entitlement (DOE) to Disability (DOED)
Date of entitlement establishes the date from which past due benefits will be paid:
1. Title II (SSD)–Five full months after date of onset.
2. Title XVI (SSI)–Date of application or the first of the month after all requirements are met.
Date of Filing (DOF)
The date that is used to determine when an application for benefits is received. This may be the actual date received or a date in the past in certain “protective filing date” cases
Date First Insured (DFI)
The earliest date the person first meets the coverage requirements for Social Security disability
Date Last Insured (DLI)
The date on which a person’s coverage for disability protection expires. It applies in Title II (SSD) claims only
Date of Onset (DOO)
The date the person became disabled
Dictionary of Occupational Titles (DOT)
Last updated in 1991, the DOT provides a brief description of more than 12,000 occupations that exist in the economy. Prepared by the Department of Labor, DOL
Disability
The inability to perform any substantial gainful activity by reason of any medically determinable physical and/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
Disability Determination Service (DDS)
State agency that makes disability determinations at initial and reconsideration levels. Usually called the “state agency”
Disability Insurance (DI)
Social Security Disability Insurance program
Disability Insurance Benefits (DIB)
Monthly Social Security disability payments
Disabled Individual, Worker or Child (DIWC)
Disability claim under Title II of the Social Security Act
Disabled Widow/Widower Benefits (DWB or DIWW)
The disability benefits available to disabled widows and widowers of insured workers, with benefits first payable to the widow(er) at age 50
Drug Addiction or Alcoholism (DAA)
Also referred to as alcoholism or other drug abuse (AODA)
Earnings Record (ER)
A history of earnings reported to SSA. The earnings are used to determine insured status for entitlement to retirement, survivors, disability and health insurance benefits and to calculate cash benefit rates
Earnings Requirement
Applies only in Title II DIB cases. A DIB person must have worked and earned at least 20 quarters of coverage in the last 40 quarters before “onset” (equivalent to 5 of the last 10 years) and be “fully insured” to be entitled to disability benefits. SSA gives special consideration to blind persons and persons under the age of 31. In these situations, persons with fewer than 20 quarters of covered work may be entitled to disability benefits
Education
Education is primarily used to mean formal schooling or other training which contributes to ability to meet vocational requirements, for example, reasoning ability, communication skills, and arithmetical ability. However, if an individual does not have formal schooling, this does not necessarily mean that he or she is uneducated or lacks these abilities. The term “education” also includes how well the individual is able to communicate in English.
Categories of Education:
1. Illiteracy–Illiteracy means the inability to read or write. SSA considers someone illiterate if the person cannot read or write a simple message such as instructions or inventory lists, even though the person can sign his or her name. Generally, an illiterate person has had little or no formal schooling.
2. Marginal Education–Marginal education means ability in reasoning, arithmetic, and language skills which are needed to do simple, unskilled types of jobs. SSA generally considers that formal schooling at a 6th grade level or less is a marginal education.
3. Limited Education–Limited education means ability in reasoning, arithmetic, and language skills, but not enough to allow a person with these educational qualifications to do most of the more complex job duties needed in semi-skilled or skilled jobs. SSA generally considers that a 7th grade through the 11th grade level of formal education is a limited education.
4. High School Education and Above–High school education and above means abilities in reasoning, arithmetic, and language skills acquired in formal schooling at a 12th grade level or above. SSA generally considers that someone with these educational abilities can do semi-skilled through skilled work. High school education includes a General Equivalency Diploma (GED).
5. Inability to Communicate in English–Since the ability to speak, read and understand English is generally learned or increased at school, SSA may consider this an educational factor. Because English is the dominant language of the country, it may be difficult for someone who doesn’t speak and understand English to do a job, regardless of the amount of education the person may have in another language. Therefore, SSA considers a person’s ability to communicate in English when it evaluates what work, if any, he or she can do. It generally doesn’t matter in what other language a person may be fluent.
Electronic Disability Folder (eDIB)
SSA’s online collection of documents related to a person’s case. It is designed to replace the paper files used by SSA in the past
Employee (EE)
Under the Social Security Act there are three classes of workers who are considered employees:
1. Officers of corporations.
2. Those who are employees under the common-law test.
3. Those in four specific occupations who if they are not employees under 1 or 2 above may still be employees if certain conditions are met. Agent drivers, full-time life insurance salespersons, full-time traveling or city salespersons and home workers may be considered employees.
Employer/Employee (ER/EE)
The employer/employee relationship is a term used to describe who is the employer and has the final authority to control the worker in performing his or her services, or which reserves the right to do so–the person or entity which has the sole power to hire, fire, and supervise the worker. There are a number of rules or guidelines used to determine who the employer is or if the worker is in fact not an employee but self-employed
Environmental Conditions
Temperature, humidity, noise, vibration, fumes, odors, toxic conditions, dust, poor ventilation, hazards, etc.
Equal Access to Justice Act (EAJA)
The Act, 28 U.S.C. § 2412(d), provides for awards of attorney fees against the federal government under certain circumstances
Established Onset Date (EOD)
The date on which medical and work information substantiates that the person became disabled (Title II)
Exertional Activity
One of the primary strength activities (walk, stand, sit, lift, carry, push, pull) which defines a level of work
Exertional Capability
A capability required to perform an exertional activity
Exertional Level
A work classification defining the functional requirements of work in terms of the range of the primary strength activities required. The categories are sedentary, light, medium, heavy, and very heavy
Expedited Reinstatement (EXR)
If a beneficiary, whose benefits were terminated because of the performance of SGA, stops working after the end of the 36-month re-entitlement period, that beneficiary can request “expedited reinstatement,” referred to as EXR, for 60 months after entitlement is terminated because the person returned to work at the SGA level
Extended Period of Eligibility (EPE)
A 36-month period where T-2 disability benefits can begin again without filing a new application for benefits where disability ceased due to work activity (substantial gainful activity–SGA) and the earnings subsequently fall below the SGA amount
Family Maximum (FMAX)
The maximum amount of Social Security benefits payable on a Social Security record
Federal Benefit Rate (FBR)
The federal monthly SSI payment due an individual. The amounts are set by statute and are subject to annual increases as determined by the cost-of-living adjustments. If the individual’s monthly countable income exceeds the FBR, the SSI payment may be decreased or eliminated
FICA Tax
FICA stands for “Federal Insurance Contributions Act.” It’s the tax withheld from salary or self-employment income that funds the Social Security and Medicare programs
Field Office (FO)
The Social Security Administration has about 1300 local offices, most of which are field offices, located throughout the country. A field office may have a branch office, that is, a secondary site that is administratively managed by the field office. At local offices, individuals can apply for a Social Security number, check on an earnings record, apply for benefits, and get information about individual and family rights and obligations under the law
Fingering
Picking, pinching, or otherwise working with the fingers primarily (rather than with the whole hand or arm as in “Handling”)
Frequently
Use of this term in the SCO or RFC means occurs one-third to two-thirds of an eight-hour workday
Full Range of Work
All or substantially all of the unskilled occupations existing at an exertional level
Fully Insured
One of two requirements for insured status to qualify to receive Social Security disability benefits. A person must have one QC for every year of age after age 21 up to the calendar year before becoming disabled, but never more than 40 QCs are required
Grid
A common term used for the tables in the Medical-Vocational Guidelines found in Code of Federal Regulations that provides an age and education based framework for decision making
HALLEX
The SSA manual used by the Office of Disability Adjudication and Review. A copy may be found on SSA’s website, www.socialsecurity.gov
Handling
Seizing, holding, grasping, turning, or otherwise working with the hand or hands. Fingers are involved only to the extent that they are an extension of the hand
Hearing Office Chief Administrative Law Judge (HOCALJ)
Supervises the work of all the ALJ’s in a particular ODAR. The HOCALJ reports to the Regional Chief ALJ
Impairment Related Work Expenses (IRWE)
The cost of certain impairment-related services and items that a disabled (but not blind) person needs in order to work can be deducted from earnings for the purposes of determining SSI payment amount and whether work is SGA, even if these items and services are also needed for non-work activities
In-Kind Support and Maintenance (ISM)
In the SSI program, unearned income in the form of food or shelter that an individual receives from someone else
Insured Status (I/S)
When a person has the requisite number of quarters of coverage for entitlement to a Social Security (Title II) benefit. The number of quarters required for insured status is dependent upon the type of benefits sought and the age of the person. (See Earnings Requirement)
Interim Assistance Agreement (IAA)
Agreement by which a person for SSI agrees to repay the state for assistance provided while the SSI claim is pending
Master Beneficiary Record (MBR)
SSA’s computerized record containing a history of benefits paid on an individual’s record including all auxiliaries as well as current benefits being paid
Maximum Sustained Work Capability
The highest functional level a person can perform on a regular and continuing basis–sedentary, light, medium, heavy, or very heavy
Medicaid
The state health insurance program for poor and otherwise uninsured people
Medically Determinable Impairment (MDI)
An impairment that is shown to exist by generally accepted medical diagnostic techniques
Medical Evidence of Record (MER)
A person’s medical records that have been provided to SSA
Medical Expert (ME)
A medical doctor or psychologist who at an ALJ’s request provides a medical opinion about a person’s case either in testimony or by answering interrogatories
Medical Improvement Expected (MIE)
When a person’s disability is expected to improve, SSA will document the file to show MIE and diary the case for future reexamination
Medical Improvement Not Expected (MINE)
If a person’s disability is not expected to improve, the case will be coded MINE
Medical Improvement Possible (MIP)
The vast majority of disability cases, which are supposed to be reviewed every three years
Medical Re-Exam Date (MRED)
If medical improvement is expected, the case will be diaried for a reexamination in the future for a CDR
Medical-Vocational Guidelines
Also known as the “grids,” the Medical-Vocational Guidelines are tables contained in 20 C.F.R., Appendix 2, Subpart P of Regulation No. 4. They feature vocational rules that consider a person’s age, education, prior work experience, and remaining RFC to direct or guide the decision maker to a conclusion of “disabled” or “not disabled”
Medicare
The federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with permanent kidney failure with dialysis or a transplant, sometimes called ESRD (End-Stage Renal Disease).
Mental Residual Functional Capacity (MRFC)
What a person can do in a work setting on a regular and continuing basis in spite of the person’s mental limitations and restrictions. Mental RFC focuses on a person’s ability to understand, carry out, and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting
Medical Source Statement (MSS)
A statement from a person’s treating source about what the person can still do despite the person’s impairments. The statement should be based on the medical source’s findings concerning the person’s medical history, clinical findings, laboratory findings, diagnosis and treatment
Monthly Benefit Amount (MBA)
The regular monthly benefit check an individual receives from SSA
Never
An RFC rating that means not even once during an eight-hour day
Nonexertional Impairment
An impairment that does not directly affect the ability to sit, stand, walk, lift, carry, push, or pull; rather, this type of impairment affects the mind, vision, hearing, speech, and use of the body to climb, balance, stoop, kneel, crouch, crawl, reach, or handle, and use of the fingers for fine activities
Not Present
Use of this rating in the SCO means that the activity or condition does not exist
Occasionally
Use of this term in the SCO or RFC means that the activity occurs at least once up to one-third of an eight-hour workday
Occupational Base
The occupational base is the number of occupations, as represented by RFC, that an individual is capable of performing. These “base” occupations are unskilled in terms of complexity. The regulations take notice of approximately 2,500 medium, light, and sedentary occupations; 1,600 light and sedentary occupations; and 200 sedentary occupations. Each occupation represents numerous jobs in the national economy
Office of Central Operations (OCO)
The payment center for processing disability claims located in SSA headquarters in Baltimore, MD
Office of Disability Adjudication and Review (ODAR)
The part of SSA that conducts hearings on Social Security claims that have been denied. This is not the same agency that denied the initial application and the reconsideration
Office of General Counsel (OGC)
The part of SSA that, among other things, accepts service of process on the Commissioner of Social Security and handles litigation against the Social Security Administration
Office of the Inspector General (OIG)
Investigative department of SSA that handles all SSA investigations. OIG investigates allegations of fraud by beneficiaries and SSA employees. It also investigates and evaluates SSA programs
Old-Age, Survivor and Disability Insurance (OASDI)
The Social Security programs that provide monthly cash benefits to wage earners and dependents when the wage earner retires, to surviving dependents, and to disabled worker beneficiaries and their dependents
Overpayment (OP)
An overpayment is an excess payment. It is the total amount an individual received for any period which exceeds the total amount that should have been paid for that period
Past Relevant Work (PRW)
Work a person performed within the last 15 years which lasted long enough for him or her to learn the job and which was substantial gainful activity
Physical Demands
Jobs classified in terms of sedentary, light, medium, heavy, and very heavy exertion as both the regulations and the Dictionary of Occupational Titles (DOT) define those terms:
1. Sedentary Work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although sedentary jobs involve sitting, they also require a certain amount of walking and standing to carry out job duties. Jobs are sedentary if they require occasional walking and standing, provided other sedentary criteria are met. Because sedentary occupations may require occasional standing and walking, the actual periods of standing or walking should generally total no more than about 2 hours of an 8-hour workday. Work processes in specific occupations will dictate how often and how long a person needs to be on his or her feet to obtain or return small articles. By its very nature, work performed primarily in a seated position entails no significant stooping. Most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions.
2. Light Work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Since frequent lifting or carrying requires a person to be on his or her feet up to two-thirds of a workday, the full range of light work requires standing or walking for a total of approximately 6 hours of an 8-hour workday. Even though the weight a person lifts in a particular light job may be minimal, the regulations classify a job as light work when it requires a significant amount of walking or standing–the primary difference between sedentary and most light jobs.
A job is also in this category when it involves sitting most of the time with some pushing and pulling of arm-hand or leg-foot controls requiring greater exertion than in sedentary work; e.g., mattress sewing machine operator, motor-grader operator, and road-roller operator (skilled and semi-skilled jobs in these particular instances). Relatively few unskilled light jobs are performed in a seated position. The lifting requirements for the majority of light jobs can be accomplished with occasional, rather than frequent, stooping. Many unskilled light jobs are performed in one location–in which case the ability to stand is more critical than the ability to walk. Light jobs require the use of arms and hands to grasp, hold, and turn objects. They generally do not involve the use of the fingers for fine activities to the extent required in most sedentary jobs.
3. Medium Work involves lifting no more than 50 pounds at a time with frequent lifting of objects weighing up to 25 pounds. A full range of medium work requires standing or walking for a total of approximately 6 hours in an 8-hour workday in order to meet the requirements of frequent lifting or carrying of objects up to 25 pounds. As with the requirements of light work, sitting may occur intermittently during the remaining time. In contrast to the fine precision activities of the fingers and hands required by sedentary work, medium work generally requires only use of the arms and hands to grasp, hold, or turn objects.
The full range of medium work requires both considerable lifting and frequent bending-stooping (“stooping” is a type of bending in which a person bends his or her body downward and forward by bending the spine at the waist; “crouching” is bending both the legs and spine in order to bend the body downward and forward). This activity requires flexibility of the knees as well as of the torso. However, relatively few occupations in the national economy require lifting, pushing or pulling activities from primarily a sitting position; e.g., taxi driver, bus driver, a tank-truck driver (semi-skilled jobs). In most medium jobs, the critical requirement is being on one’s feet for most of the workday. An individual’s ability to perform frequent lifting or carrying of objects weighing up to 25 pounds is often more critical than being able to lift up to 50 pounds at a time.
4. Heavy Work involves lifting objects weighing more than 100 pounds. If a person can do very heavy work, he or she can also engage in heavy, medium, light, and sedentary work.
Presumptive Disability (PD)
Presumptive Disability payments are made to a person who is initially applying for SSI based on an allegation of disability or blindness, and whose medical condition is such that it presents a strong likelihood that the person will be found disabled under SSA rules. The person must meet all nonmedical factors of eligibility. The payments continue for up to 6 months pending a formal determination of disability. If the claim is ultimately denied, SSA does not claim an overpayment
Primary Insurance Amount (PIA)
The PIA is the figure from which almost all cash benefit amounts are derived, including monthly benefits for workers, their dependents, and their survivors. The PIA is based on an individual’s taxable earnings averaged over the working lifetime to yield a monthly benefit that partly replaces the earned income lost because of retirement, disability, or death
Privacy Act of 1974 (PA)
The Privacy Act requires federal agencies to publish in the Federal Register notices of systems of records they maintain which contain personal information about individuals. Under the Privacy Act, information about an individual is generally not disclosed without the individual’s consent, except as provided by that law
Program Operations Manual System (POMS)
The largest system of internal instructions used by SSA employees and by the employees of the state agencies who make disability determinations. A public version is available from SSA’s website, www.socialsecurity.gov
Program Service Center (PSC)
Program service centers are located in Birmingham, Alabama; Chicago, Illinois; Kansas City, Missouri; Jamaica, New York; Philadelphia, Pennsylvania; and Richmond, California. These offices, along with the Office of Central Operations in Baltimore, Maryland, house and service the records of individuals who are receiving Social Security benefits
Protective filing date
The effective filing date of an application for benefits which is before the actual filing date pursuant to SSA regulations
Quarters of Coverage (QCs)
Social Security credits are earned for a certain amount of work under Social Security
Reaching
Extending the hands and arms in any direction
Reconsideration (RECON)
If a person is not satisfied with the determination on a claim, he or she may request a reconsideration and submit new evidence if available
Regional Chief Administrative Law Judge (RCALJ)
The head administrative law judge in one of SSA’s ten regions
Regional Office (RO)
Regional SSA headquarters in one of SSA’s ten regions
Residual Functional Capacity (RFC)
What a person can do in a work setting in spite of the functional limitations and environmental restrictions imposed by his or her medically determinable impairment(s). RFC is the maximum degree to which the person retains the capacity for sustained performance of the physical and mental requirements of jobs
Restriction
A restriction is what a person should not do because of an impairment-related risk to self or others or because it would be medically inadvisable. A restriction can be exertional or non-exertional
Retirement, Survivors, Disability Insurance (RSDI)
The Social Security program that pays benefits to persons who are retired, eligible dependents of deceased workers, or disabled workers
Sequential Evaluation
A multi-step process that decision makers use to determine whether a person is or continues to be disabled
Severe Impairment
An impairment or combination of impairments that significantly limits one’s physical or mental ability to do basic work activities, the abilities and aptitudes necessary to do most jobs. Examples of basic work activities include: walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, and handling; seeing, hearing, and speaking; understanding, carrying out, and remembering simple instructions; use of judgment; responding appropriately to supervision, co-workers, and usual work situations; and dealing with changes in a routine work setting
Skill
Knowledge of a work activity which requires the exercise of significant judgment that goes beyond the carrying out of simple job duties and is acquired through performance of an occupation which is above the unskilled level (requires more than 30 days to learn). It is practical and familiar knowledge of the principles and processes of an art, science, or trade, combined with the ability to apply them in practice in a proper and approved manner. This includes activities like making precise measurements, reading blueprints, and setting up and operating complex machinery. A skill gives a person a special advantage over unskilled workers in the labor market
Skill Level
A work classification whereby work is defined according to skill requirements.
1. Unskilled Work—Unskilled work is work which needs little or no judgment to do simple duties that can be learned on the job in a short period of time. The job may or may not require considerable strength. For example, SSA considers jobs unskilled if the primary work duties are handling, feeding, and offbearing (that is, placing or removing materials from machines which are automatic or operated by others), or machine tending, a person can usually learn to do the job in 30 days, and little specific vocational preparation and judgment are needed. A person does not gain work skills by doing unskilled work.
2. Semi-Skilled Work—Semi-skilled work is work which needs some skills but does not require doing the more complex work duties. Semi-skilled jobs may require alertness and close attention to watching machine processes; or inspecting, testing or otherwise looking for irregularities; or tending or guarding equipment, property, material, or persons against loss, damage or injury; or other types of activities which are similarly less complex than skilled work, but more complex than unskilled work. A job may be classified as semi-skilled where coordination and dexterity are necessary, as when hands or feet must be moved quickly to do repetitive tasks.
3. Skilled Work—Skilled work requires qualifications in which a person uses judgment to determine the machine and manual operations to be performed in order to obtain the proper form, quality, or quantity of material to be produced. Skilled work may require laying out work, estimating quality, determining the suitability and needed quantities or materials, making precise measurements, reading blueprints or other specifications, or making necessary computations or mechanical adjustments to control or regulate the work. Other skilled jobs may require dealing with people, facts, or figures or abstract ideas at a high level of complexity.
Social Security Disability Insurance (SSDI)
The official name of the Social Security disability program
Social Security Ruling (SSR)
Precedential decisions of the Social Security Administration, including program policy statements, Appeals Council decisions, opinions of the Office of General Counsel, etc. When SSA finds a court decision to be an accurate statement of SSA policy, SSA may also issue that decision as a Social Security Ruling
SSI Windfall Offset
The overpayment of SSI benefits which is deducted from Title II benefits as a result of full SSI benefits being paid for a month in which a beneficiary will later receive a Social Security disability benefit payment
Substantial Gainful Activity (SGA)
Involves significant physical or mental activities in a work setting and is usually done for pay or profit, regardless of whether a profit is realized. A chart of the SGA amounts is found on SSA’s website at http://www.socialsecurity.gov/OACT/COLA/sga.html. Following is a more detailed explanation:
1. Substantial work activity. Substantial work activity is work activity that involves doing significant physical or mental activities. Work may be substantial even if it is done on a part-time basis or if an individual does less, gets paid less, or has less responsibility than he or she had before.
2. Gainful work activity. Gainful work activity is work activity that an individual does 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.
3. Some other activities. Generally, SSA does not consider activities like self-care household tasks, hobbies, therapy, school attendance, club activities, or social programs to be substantial gainful activity.
Supplemental Security Income (SSI)
A cash assistance program funded and administered by the federal government for low-income individuals who are aged, blind, or disabled. Authorized by Title XVI of the Social Security Act
Temporary Assistance to Needy Families (TANF)
Cash assistance program serving needy families with children that is funded jointly by federal and state governments and administered by state and county departments. This program replaced AFDC in 1996
Ticket to Work
The Ticket to Work Program provides most people receiving Social Security benefits choices for receiving employment services. Under this program SSA issues a ticket to an eligible beneficiary who, in turn, may choose to assign the ticket to an Employment Network (EN) of the beneficiary’s choice to obtain employment services, vocational rehabilitation services, or other support services necessary to achieve a vocational (work) goal. The EN, if it accepts the ticket, will coordinate and provide appropriate services to help the beneficiary find and maintain employment
Title II (T II, T-2)
Social Security benefits; retirement, survivors and disability benefits are authorized under Title II of the Social Security Act
Title XVI (T XVI, T-16)
Supplemental Security Income benefits are authorized under Title XVI of the Social Security Act
Title XVIII (T XVIII, T-18)
Medicare program. Benefits for hospital insurance and supplementary medical insurance are authorized under Title XVIII of the Social Security Act
Title XIX (T XIX, T-19)
See Medicaid
Trial Work Period (TWP)
A trial work period is provided as an incentive for personal rehabilitation efforts for disabled workers receiving Social Security disability benefits who are still disabled but return to work. It allows them to perform services in as many as nine months without affecting their right to benefits during the trial work period if their impairment does not improve during this period
Trait
A vocationally relevant attribute or characteristic which permits a person to properly perform a work activity. Traits are relevant whether learned or innate. Traits are not skills. A musician requires both a good sense of pitch and fine finger dexterity (traits) to play a piece of music by ear without error (skill); a lab researcher may require acute vision (trait) to identify a particular bacteria found in a culture (skill); a machinist must rely on perception of size and shape (trait) to cut material within certain tolerances (skill)
Transferability of skills
An individual is considered to have skills that can be used in other jobs when the skilled or semi-skilled work activities done in past work can be used to meet the requirement of other skilled or unskilled work activities.
Transferability is most probable and meaningful among jobs in which:
1. The same or a lesser degree of skill is required;
2. The same or similar tools and machines are used; and
3. The same or similar raw materials, products, processes, or services are involved.
Underpayment (UP)
An amount due a person that has not been paid. Underpayments usually result from unpaid accrued benefits or unnegotiated checks
Unskilled Work
Work that requires little or no judgment to do simple duties that can be learned on the job in a short period of time (i.e., 30 days or less). Generally SVP of 1 or 2 as rated in the SCO
Unsuccessful Work Attempt (UWA)
Work lasting up to six months that the person is forced to stop or reduce below the SGA level because of the person’s disability. Such work is disregarded when evaluating the person’s disability under the sequential evaluation process
Veterans Affairs (VA)
A federal agency that administers programs for US veterans. This agency was previously named and is often referred to as the “Veteran’s Administration”
Vocational Expert (VE)
An expert witness who provides an opinion about vocational issues for use at a disability hearing, either in person or in answer to interrogatories
Vocational Factors
An individual’s RFC, age, education, and work experience
Wage Earner (WE)
An individual working under and paying wages covered under the Social Security system
Waiting Period (WP)
Five consecutive full calendar months beginning with the earliest full calendar month throughout which the worker was under a disability and had disability insured status for benefit purposes. No Title II benefits are paid during the waiting period
Widow or Widowers Insurance Benefits (WIB)
Social Security benefits paid to a surviving spouse of a deceased worker who was insured under the Social Security program
Windfall Offset
The reduction in retroactive Title II benefits equal to the amount of SSI payments a recipient would not have received had Title II been paid on time
Workers Compensation (WC)
State laws that ensure medical care and cash benefits to a worker injured in connection with a job, or cash benefits to dependents if the worker is killed. There is a limit on the amount of Social Security disability benefits plus worker’s compensation benefits a recipient may receive