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Do I Qualify For Disability Benefits?
And, Who is Eligible for Social Security Benefits?
You could qualify for Social Security Disability (SSI or SSDI) if you have a physical or mental condition that limits your ability to perform substantial gainful activity. The disability must have lasted, or be expected to last, for at least twelve months or result in death. You must also be under the age of 65 and have worked five out of the last ten years. (If you have not worked 5 of the last 10 years, you may still qualify for Supplemental Security Income or SSI). A qualifed social security advocate or attorney can help you determine exactly what you qualify for.
The Main Factors of Eligibility
#1 - Have you worked five of the last ten years?
The first factor in determining eligibility for disability benefits (SSDI) is whether you are considered insured. To be insured you typically must have worked five of the last ten years, although this time requirement is less for younger applicants who have not had as much time to work. Most applicants for disability benefits who have been employed will be insured. However, those who don't qualify for SSDI may for Supplemental Security Income (SSI), whether they have been employed, if their income is low enough.
#2 - Have you been (or expect to be) disabled for at least 12 months?
To be eligible you must also meet the durational requirement. The durational requirement means you must have been or expected to be disabled for at least twelve months, or the disability is expected to result in death.
#3 - Are you under the age of 65?
#4 - Can you perform "substantial gainful activity"?
It is important for you to understand what the Social Security Administration (SSA) means by substantial gainful activity. Substantial gainful activity is the ability to perform any regular job or work-like activity. Even volunteer work or school attendance will be considered. The test for disability is not about whether you can or cannot perform your current or previous job. Neither is the test about whether you can or cannot find employment. The test is about whether you can do any job or work-like activity that is generally available. Work-like activity can mean working for wages, attending school, or any other work-like activity (such as volunteer work), even if you are not getting paid. In plain English, you are not eligible if you can perform any work, including sedentary (unskilled) labor.
If you apply for benefits and your claim is initially denied you should appeal the decision. If your appeal advances to an administrative hearing, a judge will consider your "residual functional capacity.." Residual functional capacity is the key to proving your disability. The SSA defines residual functional capacity as your ability to perform work-like activities given your physical and mental limitations. In other words, the judge will decide what is the most activity you can do on a regular and continuing basis. Regular and continuing basis means a full 40-hour per week or equivalent work schedule.
#5 - Has a doctor provided a diagnosis and medical evidence that support your disability claim?
Finally, your disability must be supported by medical evidence. There is no simple explanation for what medical evidence is needed. The SSA requirements only state that you must provide a diagnosis of a medically determinable physical or mental condition that result from anatomical, physiological or psychological abnormalities, which can be demonstrated through medically acceptable clinical and laboratory diagnostic techniques. Essentially, your physical or mental disability must be established through medical evidence consisting of signs, symptoms, and laboratory findings, supported by adequate doctors' reports. A qualifed social security advocate or attorney will know exactly what you should provide.
If your condition appears on the SSA's Listing of Impairments, your condition will likely receive a favorable finding if you meet the specific criterion for the listed impairment. However, this is usually very difficult to accomplish. Otherwise, you must provide enough evidence to convince the judge your condition is serious enough to significantly limit your ability to perform work-like activities.
Substantial Gainful Activity
The SSA defines "substantial gainful activity" as "work activity that involves doing significant physical or mental activities. 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." This definition may leave you with the impression that only some work-like activities are considered substantial gainful activity. This is not the case. Most activities that you might do for pay are considered substantial gainful activity and even some activities that you do not do for pay might be classified as a "work-like activity" that could be done for profit and therefore it is a substantial gainful activity.
Substantial Gainful Activity is the minimum level of work that a person can perform to be considered productive. It is important to keep in mind that if the SSA determines you are capable of performing any task that is considered substantial gainful activity the SSA will find you ineligible for disability benefits. Even if you are working on a part-time basis, the amount of wages earned from this activity may disqualify you from receiving disability benefits.
It is important for a disabled person to clearly demonstrate they have met the criteria to be considered disabled by the SSA. Do not assume that because you cannot perform your previous jobs due to your disability that you will be considered eligible for benefits. You must be classified as disabled from performing any work-like activity that might result in substantial gainful activity. Every year the SSA redefines the amount of money an individual can earn and remain below the level considered to be substantial gainful activity. Due to the difficulties of meeting the standard of disability and staying below the level of substantial gainful activity as defined by the SSA, many applicants secure the representation of a legal professional that handles Social Security law.
Impairment Related Work Expenses
Impairment related work expenses are out-of-pocket expenditures that are made as a result of your disability so that you are able to work. Examples of these expenses are medical devices, service animals, medicine, medical supplies and items such as syringes or bandages. For the expenses to be considered an "impairment related work expense" it must not be reimbursed by your employer or medical insurance, it must be related to your disability, and it must be required for you to successfully complete the tasks required of you at your job. Doctor visits and attendant care paid for out of pocket can also be considered an impairment related work expense if it is required to prepare you for work, transport you to work, or attend to needs related to your disability while you are at work. Transportation to work, vehicle modifications, or modifications to your home may also be calculated as impairment related work expenses. A qualified representative can assist you with all work related questions. .
Residual Functional Capacity
The SSA defines "residual functional capacity" as "Your impairment(s), and any related symptoms, such as pain, may cause physical and mental limitations that affect what you can do in a work setting. Your residual functional capacity is the most you can still do despite your limitations." The residual functional capacity standard is used when your disability does not meet the standard of an SSA disability category. Typically, a claim is evaluated based upon the residual functional capacity criteria when it reaches the third tier of the evaluation process - the administrative hearing.
Most claims do not meet the SSA's standard definition of a disability. Usually, the disability of an individual requires a more subjective evaluation. When assessing residual functional capacity, the SSA will consider your ability to meet the physical, mental, sensory, and other requirements of your past relevant work. Furthermore, the SSA will also assess whether or not your disability limits your capacity to make adjustments that might allow you to perform any other work that exists in the national economy. If the SSA finds that you are able to perform any work you have performed in the past 15 years or that you are able to perform other work that is available in the national economy your claim will be denied.
Physical and Mental Considerations
Clearly, your residual functional capacity is determined on the basis of the physical and mental limitations you experience as a result of your disability. But how does this factor into determining your ability to work? A physical disability that limits your ability to walk or stand would prevent you from performing work that requires walking or standing for more than hour at a time while on the job. A mental disability that limits your ability to focus for extended periods of time would prevent you from performing work that requires extended periods of concentration or involves complex procedures. Whether you suffer from physical and/or mental impairments, the SSA will consider the combined effect of these conditions when making a determination regarding your application. This is helpful to the applicant, because assessed separately their conditions may not qualify them for disability benefits. However, the total effect of these conditions may limit an individual in such a way that they are unable to fulfill any type of sustained gainful activity.
Making a Determination
The SSA bases its determination of your residual functional capacity upon your medical records, statements in your applications, the statements of others (such as your employer), and the diagnosis of your treating physician. Using these sources, the SSA will assess both your physical and mental capabilities. Physical capabilities are categorized as sedentary, light, medium, heavy, or very heavy. Mental capabilities are categorized as less than unskilled, unskilled, semiskilled, or skilled. The top categories for both mental and physical disabilities indicate that you do not have a disability and therefore will not receive benefits. At the opposite end "sedentary" and "less than unskilled" indicate that your disabled and therefore qualify for benefits.
These categories are used to compare your capabilities with those of certain jobs as assigned by the SSA. The lower you rank within these categories, the more likely you are to qualify as disabled and receive benefits. Understanding the many factors that are considered in making this determination can be very confusing. The success of your application is totally dependent upon accurate evidence supporting your disability claim.
Returning To Work
If you have a disability claim pending, returning to work will likely jeopardize approval of your application. When a claim has reached the level of administrative hearing the judge may find that you are capable of work-like activities if you are employed even part time. On the other hand, should you attempt to return to full-time work but are unable to meet the demands of your position, the judge evaluating your case may reward your effort be approving your claim. Regardless of the unique factors of any claim, if the applicant is working during the approval process a finding of ineligibility is likely.
The Trial Work Period
If you are receiving Social Security Disability benefits and wish to try to return to work, you should not fear that your benefits will immediately be revoked. After a recipient of SSD has been disabled for one year, the SSA allows an individual to participate in the trial work period (SSI recipients are not eligible for this program). This is a nine-month period of time where you may attempt to return to the workforce while you continue to receive benefits. The months do not need to be consecutive. However after nine months of work within a period of 60 months the Trial Work Period ends. It is also important to note that if you attempt to perform work that the SSA considers substantial gainful activity during the first 12 months following the initial date of your disability you will not be eligible for a Trial Work Period and may have your benefits revoked if you have been approved.
How the SSA defines "services"
"Services" is the word used by the SSA to define work performed for which you have been compensated during the Trial Work Period. As an employee working for another individual or business, a month will count toward your Trial Work Period if the wages earned for your "services" exceed $700 (2009 figure). If you are self-employed, a month of "services" is any month in which you earn more than $700 or work 80 hours. There is no limit to the amount of income you can make in a month during the Trial Work Period.
The Extended Period of Eligibility
Once you have completed your Trial Work Period you will enter the Extended Period of Eligibility. This period will begin even if you do not continue to work. The Extended Period of Eligibility is a 36-month period in which you will continue to receive your disability benefits. However, during the Extended Period of Eligibility if you work in any month and earn more than the amount the SSA considers substantial gainful activity ($980/month for 2009), you will not receive your disability benefits. Nonetheless your disability eligibility remains protected. If during this period you work but earn less than what the SSA considers substantial gainful activity you will receive your benefit check for that month. The SSA presumes that you remain disabled during this period, therefore, should you be unable to continue to work, you will be able to continue receiving your SSD benefits without the need to reapply.
The Ticket to Work Program and Work Incentives
The Ticket to Work and Work Incentives Improvement Act of 1999 expanded the opportunities available to those recipients of SSD benefits who have a desire to work but are unable due to their disability. The Ticket to Work Program connects SSD/SSI recipients with employment service providers (known as Employment Networks) to achieve individual work goals. The SSA will provide you with an actual ticket that will enable you to obtain services from Employment Networks such as vocational rehabilitation and employment. The Ticket to Work Program provides you with real choices in obtaining the services and resources you need to find and maintain employment, while providing a safety net during this transition. With the help of Employment Networks, if you receive SSD or SSI you can take work while receiving your benefits.
Work incentives are special rules that make it possible for people with disabilities receiving SSD or SSI to explore work options and still receive benefits until they are able to support themselves. If you have a disability Social Security Work Incentives help remove the barriers to work by offering support services and providing a safety net to assist you in finding the right job and succeed in the workplace.