Social Security Disability (SSD) Glossary
If you're too injured or too ill to work, it's a really scary thing and you may need help. Are you wondering whether you qualify for disability benefits or whether you should consult with a qualified Social Security Disability attorney? This article - keyword glossary will help.
Social Security Disability - Keyword Glossary
If you haven't yet dealt with the Social Security system, either SSD or SSI, the language may seem foreign to you. Some folks find it challenging to understand the program qualifications, benefits, and application process.
While a Social Security Disability attorney is always the best person to give you advice regarding your individual situation, this article - the Social Security Disability keyword glossary - will list, define, and provide examples of the most commonly used SSD and SSI terminology.
If you run across other confusing terms, jot them down and ask your SSD lawyer to help you to understand. You are welcome to use www.attorneys.org to find an SSD attorney or you could ask a loved one for a referral or the local bar association for a list of attorneys.
Administrative Law Judge (ALJ)
Administrative law judges are not part of the traditional civil or criminal court systems. Instead, they are a neutral trier of fact (aka "judge") in a dispute between a governmental agency such as the Social Security Administration and an individual.
If you exhaust your SSA reconsiderations (i.e. appeals) and are still not approved for disability, you have the right to have your case heard by an administrative law judge.
There is no jury, but the proceeding is like any other bench trial where the judge is the trier of both fact and law. A bench trial means that there is no jury.
- The ALJ decides what facts are true and which are not true.
- The ALJ also decides how the law applies to your specific case.
- The ALJ administers oaths, listens to testimony, accepts properly presented evidence and makes both factual and legal decisions.
The Chief Administrative Law Judge (CALJ), based in Falls Church, Virginia - oversees all other Administrative Law Judges.
Alleged Onset Date (AOD)
Don't let the term "alleged" get to you. The "alleged onset date" is simply the date you became too ill or too injured to work, aka that date you became disabled.
Americans with Disabilities Act (ADA)
You've likely heard of the Americans with Disabilities Act. It's a federal law, which means it was passed by Congress and is the law in all 50 states.
The ADA outlaws discrimination against disabled people and provides remedies for those who do suffer discrimination.
If your Social Security Disability (SSD) claim is denied, you will receive instructions on how to appeal so your case is reviewed.
- When you appeal, your claim is reconsidered or reexamined.
- You absolutely must appeal or ask for reconsideration (same thing) within the requisite time period - 60 days.
- If you fail to appeal within the 60 days appeal period, your claim will be dismissed and you'll have to start the entire application process all over.
- Because cases are long and arduous, taking up to 2 years, starting over is not in your best interests.
Appeals Council (AC)
If your case reaches the administrative law judge, who also denies your claim, you can appeal to the "Appeals Council", which may grant your appeal or not.
Application for Benefits
As you might guess, you must fill out forms to let the Social Security Administration (SSA) know why you are eligible to receive to receive benefits.
For SSD, it is imperative that you fully document your disability claims by providing medical documentation from your doctors or psychologist with the initial application.
You absolutely can apply for benefits on your own or you can retain a Social Security Disability lawyer who knows how to fill out the application and provide supporting documentation so your application has the highest chance of being approved.
- You can apply for SSD online.
- You can apply for SSD at a Social Security office.
- Or, you can apply for SSD via the telephone by calling 1.800.772.1213. The TTY phone number is 1.800.325.0778.
- You can find a SSD lawyer online at www.attorneys.org, by asking a loved one for a referral, or by calling the local bar association and asking for a list of SSD lawyers who practice in your area.
When you are approved for disability benefits, your children or spouse may be entitled to benefits as well. These family members are referred to as "auxiliary".
Keep in mind that the SSA offers 5 kinds of benefits. Though this glossary has been designed specifically for those in need of SSD (disability) benefits, the SSA also provides retirement, family (dependents), survivors, and Medicare benefits.
SSD benefits include monthly payments and Medicare coverage. Oddly, Medicare coverage doesn't start until 2 years after your disability claim has been approved.
Your benefits will continue so long as you remain disabled up to retirement age, when retirement Social Security benefits are available.
There are back to work plans that allow you to try to work and maintain your benefits.
- If you are able to work, great. The benefits continue for a transition period.
- If you are not able to work or not able to work much, your SSD benefits will continue and you'll know you tried.
- You are able to work and earn some income, just not a lot. If you can earn a lot, the SSA says you're not disabled enough to receive disability benefits.
Childhood Disability Benefits (CDB)
If a child becomes disabled before the age of 22, he or she can receive disability benefits based on a parent's work record.
- The parent must be retired, disabled, or deceased.
- The claimant must be age 18 or older and unmarried.
These claimants are referred to as "Disabled Adult Children" or "DAC".
Claims Representatives (CR)
A claims representative is assigned the task of helping individuals apply for Social Security benefits, including disability benefits. In addition, it's the claims representative who determines whether you qualify for benefits or not.While claims representatives supposedly represent both your interest as well as the Government's interest, that's likely impossible:
- Claim representatives are federal employees. They are paid by the Government.
- On the other hand, if you hire a Social Security Disability attorney, that attorney owes his or her full allegiance to you, not the Government.
Credits - Social Security CreditsThere are two Social Security Disability requirements:
- First, you must be disabled through illness or injury and unable to work. The disability must be thought to last for a year or more or your result in death.
Second, you must have worked the prerequisite number of quarters to earn enough credits.
- You may see some articles that use the term, "quarters of coverage".
- Credits, Social Security credits, and quarters of coverage all basically mean the same thing, that you've worked enough, and - paid into the system via your payroll taxes) to qualify for benefits.
- In 2012, Social Security credits are based on earnings. You receive 1 credit for each $1,130 of earnings, up to 4 credits per calendar year.
If you work under that table and don't pay taxes, you will not qualify for SSD even though you're medically qualified and have worked.
This makes sense because SSD benefits are really insurance proceeds. You have to have paid your insurance premiums to qualify for proceeds. It's like you've had to pay your homeowner's insurance to have the insurance company pay if your house burns down.
- If you become disabled before you are 24 years of age, you have to have paid into the system and earned 6 credits during the last 3 years. 6 credits are equal to 1.5 years of working.
- If you're between the ages of 24 to 30, you'd need to work about half of your eligible working time between age 21 and whatever age you become disabled.
For example, if you become disabled at age 27, you'd need to have worked 3 years to be eligible.
- If you become disabled at age 31 or older, there is a minimum of 20 credits (5 years) required. The older you are, the more credits that are required.
WARNING: It is likely in your best interests to consult with a qualified SSD attorney who can best determine both whether you are medically eligible and have the requisite work credits. It's not as straight forward as you might think and if you make a mistake, you may not receive the disability benefits you've earned and need.
Decision Notice , Award Letter, Denial Letter
The SSA will send you a letter letting you know whether you are qualified for benefits - or not. If you are eligible, the payment amount will be included.
- An award letter means that benefits have been granted.
A denial letter means that your claim has been denied.
- Appeal rights will be included in any denial letter.
- You MUST appeal within the allotted time frame - 60 days or your claim will be dismissed and you'll have to start all over.
- WARNING: Many many many claims are denied on the first, second, and third levels. SSD process is archaically arduous and long because of inefficiency and an effort to weed people out. DO NOT GIVE UP.
Instead of receiving a monthly check, your disability benefits can be deposited into your bank account. This saves administrative dollars, reduces theft and misuse, and makes getting your benefits more convenient for you.
You will receive monthly financial payments as well as health care coverage (Medicare) if you qualify for disability benefits.To qualify:
- First, you must be disabled through illness and injury and unable to work for a year or more - or your result in death.
- Second, you must have worked and earned enough "credits".
- There are attorneys who focus their practice on Social Security Disability claims. They are called "Social Security lawyers", "Social Security Disability attorneys", "SSD attorneys", or "disability lawyers".
Your attorney is paid with 25% of your back benefits - 0% of your future benefits.
- This means that if it takes two years for your claim to be approved, you'll get a big check for 24 months of benefits (minus the mandatory waiting period) - 25% for SSD attorney fees.
- All future monthly payments are 100% your own.
- There are no out-of-pocket or upfront fees and if your case is not approved, you pay absolutely nothing.
Disability Insurance (DI) - Social Security Disability Insurance Program
When you pay FICA (payroll) taxes, you're paying into the Social Security and Medicare systems - they are insurance programs.
This means that when you receive disability benefits - including monthly payments and Medicare benefits, you are receiving insurance proceeds, which you earned by working and paying FICA taxes.
Disability Insurance Benefits (DIB)
Monthly Social Security Disability payments and Medicare to pay for health care needs.
Documentation - Proof - Evidence
Documentation is simply written proof. In SSD cases, documentation usually refers to medical records.
The SSA will request medical records from your doctors.
- Ask your Social Security Disability attorney if any documentation should be included with your initial application or appeals.
- A letter of explanation or summary of medical records may help.
- The SSA will access your payroll tax history directly.
FICA Tax - Payroll Tax - Social Security and Medicare Taxes
If you are employed, you'll see FICA taxes subtracted from each paycheck. If you're self-employed, you still pay these taxes - through quarterly payments or paycheck taxes.
- FICA is the acronym for "Federal Insurance Contributions Act".
- Notice the word, "insurance," in the name. Disability benefits are insurance proceeds. You pay the insurance premiums through FICA taxes. Disability benefits are NOT welfare.
- FICA taxes fund Social Security and Medicare.
Health Insurance - Medicare
Two years after you start to receive disability payments, you will be entitled to Medicare to pay for health care expenses.
As a side note, if you qualify for SSI - support for low-income folks - you also qualify for Medicaid, immediately.
- There is no health insurance waiting period for those who qualify for SSI (Supplemental Security Income).
- There is a two-year health insurance wait for those who qualify for SSD (Social Security Disability). Odd and unfortunate, we know.
If you are work eligible for Social Security benefits because you have the requisite work credits, you are insured - thus, you have "insured status".The number of credits you need to qualify for Social Security Disability, depends on how old you are:
- If you become disabled before you are 24 years of age, you have to have paid into the system and earned 6 credits during the previous 3 years. 6 credits are equal to 1.5 years of working.
- If you're age 24 to 30, you'd need to work about half of your eligible working time between age 21 and whatever age you become disabled. For example, if you become disabled at age 27, you'd need to have worked 3 years to be eligible.
- If you become disabled at age 31 or older, there is a minimum of 20 credits (5 years) required. The older you are, the more credits that are required.
List of Impairments
The Social Security Administration has published a list of impairments, that are so severe, disability benefits are appropriate.
No worries if your medical situation isn't listed. This simply means that you and your Social Security Disability lawyer must show SSA that your condition - illness or injury - is so severe that it prevents you from working.
NOTE: Mental disabilities such as depression, anxiety, and the like are recognized impairments.
Medicaid is health insurance for those with very low incomes and very limited resources - and are aged, disabled, or blind.
If you qualify for SSI, you qualify for Medicaid.
Because Medicaid is administered by the states, it has varying names from state to state such as "MediCal" in California and "Medical Assistance" in Pennsylvania.
"Medical-vocational guidelines are tables or grids that list your age, educational level, work experience, and remaining functional capability to help the SSA determine whether you meet their definition of "disability".
Social Security Disability attorneys will show you how to present your case so the tables are turned to your greatest benefit.
Medicare is health insurance for those age 65 and older, those who qualify for SSD, and those with certain serious kidney conditions.
You'll receive Medicare benefits 2 years after you start receiving your SSD benefits.
Nutrition Assistance Program - Food Stamps - SNAP
SNAP helps low income - low resource families pay for groceries.
- If you qualify for SNAP, your children qualify for free meals at school.
- If you don't qualify for SNAP, but are lower income, your child may still qualify for free or reduced fee school meals.
- Many schools serve both breakfast and lunches - even during school breaks.
- Because everything is computerized, your child's friends and cafeteria workers won't know that your child is receiving subsidized meals. It's private.
Program Operations Manual System (POMS)
The POMS is a big instruction book for Social Security Administration employees - as well as state agency employees - who make disability determinations.
Here's a link to POMS. Fortunately, it's not a secret handbook and you can see how employees make decisions and handle your claim.
Protective Filing Date
The first date you contact the Social Security Administration is your "protective" filing date - this date may be used to give you an earlier application date - instead of the date you submit your full and signed application.
Reconsideration (RECON) - Appeal
If your disability claim is denied, you can ask for reconsideration, like an appeal, to have your case heard again and you will have the opportunity to submit new evidence (e.g. medical records).
- A few states are experimenting with eliminating the reconsideration step, which would get claimants to the Administrative Judge level much more quickly than under the current system.
- Those states are Alabama, Alaska, Colorado, Louisiana, Michigan, Missouri, New Hampshire, and Pennsylvania as well as areas of California and New York.
Your reconsideration or appeal options will be included in any denial letter. Be sure that you follow the instructions and ask for a reconsideration or appeal as appropriate within the appeal period.
WARNING: If you have not received a response from the SSA within a reasonable period of time, which can be months, be sure to follow up.
Occasionally, notices are not sent or get lost - if you miss your appeal or reconsideration date because of lack of notice, the SSA does not care. You'll have to reapply and start all over, which may delay your benefits by another 2 years.
You can have a trusted helper receive and manage your disability payments or SSI payments on your behalf.
Sometimes folks appoint a friend, relative, or interested party such as an attorney to handle interactions with the SSA.
Although representative payees must keep good records and report to the SSA, only select someone you trust completely.
Residual Functional Capacity (RFC)
"Residual functional capacity" refers to the work you still can do, despite being ill or injured.
The SSA will determine whether you can sustain some kind of physical and mental performance.
- If you cannot perform any job because you don't have the physical or mental capacity to do so, you'll be deemed disabled.
- If you still have the capacity to perform the physical and mental tasks of some job, you may be denied benefits.
Residual functional capacity is considered along with your work history, education, and the like.
Retroactive Benefits - Back Benefits
Happily, retroactive benefits are paid in a big check!
When you are approved for disability payments, you'll receive monthly benefits back to the time of your original application.
- Disability claims can take up to 2 years to get approved, so you'll receive a handsome payment upon approval.
- There is a 5-month waiting period for benefits. This means that you won't receive payments for those first 5 calendar months of your disability.
- Your Social Security Disability attorney will be paid from your retroactive benefits only. The fee is 25% of back benefits.
If you work for yourself and earn more than $400 per year, you have self-employment income and need to pay self-employment taxes. Self-employment income is derived from individual participation or from being a partner in a trade, business, or profession.
- Those who are self-employed pay both the employee and employer share of both the Social Security and Medicare taxes.
- You can qualify for Social Security Disability payments and medical benefits even if you are self-employed so long as you meet the normal requirements of disability and requisite work credits.
If your illness or injury significantly limits your ability to do basic work activities, you are deemed to have a "severe" impairment.
- Those who are severely impaired don't have the physical and or mental capability to carry out most jobs.
- For example, if you can't walk, stand, sit, lift, push, pull, reach, carry, or handle tools or equipment, you are severely impaired.
- In addition, most jobs require seeing, hearing, speaking, carrying out instructions, and using judgment. If you can't do these things, you are severely impaired.
Social Security is a government run insurance plan. So long as you pay into the system, e.g. pay your insurance premiums, you (or your family) will receive benefits when you retire, become disabled, or die.
Social Security Administration (SSA)
The Social Security Administration is part of the federal Government.
It is the part of the administration that handles benefits for retirees, disabled folks, family members (who have lost a loved one), and the poor. If you're into the history of the SSA, feel free to click on the link.
The SSA is funded by tax dollars; specifically, those dollars taken out of your paycheck in FICA taxes aka "payroll taxes".
- FICA taxes fund Social Security and Medicare.
- If you are employed, your employer pays half of the FICA tax and you pay half of the FICA tax.
- If you are self-employed, you pay both the employer and the employee sides of the FICA tax.
- If you work "under the table", those wages won't help you to qualify for Social Security benefits.
Social Security Laws - Social Security Act
If you want to go straight to the source, there's no better way to do so than to review the Social Security laws - they are all compiled in one place called the "Social Security Act".
- The instruction manual for Social Security Administration employees is called the Program Operations Manual (POM).
- You can also review Social Security rulings.
- The Social Security Administration publishes a general SSA guidebook as well.
Substantial Gainful Activity (SGA)
The SSA will deem you disabled and therefore qualified for benefits if you are unable to participate in substantial gainful activity.
- "Substantial gainful employment" is work that people usually do to get paid, involving significant physical and/or mental activities.
- Clubs, school, self-care, housework, social programs, and hobbies don't count as substantial gainful employment.
Trial Work Period (TWP)
Most folks want to work and a trial work period is a way to test the waters - determine whether you are well enough to work - without risking your disability benefits.
The trial work period allows you to work for up to 9 months while keeping your benefits.
- If you realize during the trial work period that you haven't improved and can't work, that's okay. Your benefits are there.
- If you have improved, you have a safety cushion, which will help to transition you back into the work force with less fear.
Waiting Period (WP)
There is a 5-month waiting period before disability benefits kick in. Even if you've met the disability and work requirements, there are no benefits for the first 5 full calendar months of disability.
If your claim is approved and you get a big payment for back payments, the 5 months will be subtracted.