disABILITY Consultants 5473 S. Buckskin Pass Dr. Colorado Springs, CO 80917 email: geriley@adelphia.net Phone: 719-596-5898 Fax: 719-597-0193 Helpful Hints and General Information when Applying for Social Security Disability Insurance Benefits and Supplemental Security Income Benefits Introduction: If you are applying for social security benefits for the first time or have already applied this may be some helpful information for you. If you need more specific answers then please email me at my address or call me at 719-596-5898. In order to insure my availability then please leave a time you would like to call. I am in Colorado and I am in the Rocky Mountain Time Zone. Definition of Disability as Defined by Social Security: The definition of disability used by social security does not mean you are permanently disabled. In order to be considered disabled you have to meet the following definition: Your mental and/or physical condition is such that you will be unable to perform substantial gainful activity (employment or employment like activities) for a period of 12 continuous months. Your mental and/or physical condition is such that you will be unable to perform substantial gainful activity (employment or employment like activities) and it can be expected to result in death within 12 months. Substantial Gainful Activity: Now what is meant by substantial gainful activity? Basically, this refers to basic work skills and money earned from a job. Generally speaking, if you are employed at the time of your application and earning more than $780.00 (as of January 1, 2002) or more per month in gross wages then this will generally be regarded as substantial gainful activity. If you are earning between $500.00 and $780.00 per month in gross wages then generally this will be regarded as substantial gainful activity. If you are earning below $500.00 per month this may not be viewed as substantial gainful activity. However, regardless of the income, if it is below $700.00 per month, then social security will pay close examination to how much bending, walking, standing, lifting, pushing, pulling et cetera you will be doing. These decisions are based on medical records submitted to them. The "Disability Report Form": Now, when you file you complete a form called a "Disability Report." How you complete this form is critical. Take your time and be detailed when completing this form. If your disability interferes with this then get assistance from someone. The form will ask when your condition caused you to stop working and will ask you how your condition interferes with you working. Be detailed about this. For example, difficulty with sleep which causes fatigue, pain and where it is located and when it occurs and for how long, restrictions in walking, standing, lifting, pushing, pulling, bending, reaching, sitting et cetera. Also restrictions from your disability which interfere with environmental conditions such as having to avoid dust, fumes, and odors or cold and hot temperatures. It will ask you information about past doctors, hospitalizations, surgeries and treatment. It will also ask you the addresses of any treating providers so they can get the medical information. Another portion of the form asks you to provide your work history for the last 15 years if you have worked as skilled or semi skilled jobs. If not then it may want your entire work history if you have all you have worked is unskilled labor. Another portion of the form deals with your social contacts, household maintenance duties, recreational hobbies and so forth. Do not put in these areas, for example in social contacts, that you have "none." If you have very limited social contacts by phone or in person then give them the frequency and duration of these contacts. For example, 10 minutes with friends by phone each day. If you have difficulty sustaining contacts with phone or visiting or having others visit then explain why as it relates to your disability. These questions must be completed by you from the viewpoint that if your are claiming you are too disabled to work then you must also be to disabled to carry on extensive household choirs, social contacts, recreational activities and so forth. Think about it, if someone is sick with the flu then they generally will not be doing a lot of reading or household choirs or visiting others. If you are to disabled to work then you should have constraints in your personal life as well. Also, be sure to include difficulties, on a separate sheet, if necessary, concerning these activities. If your disability cause you problems in bathing, washing hair, grooming, dressing, actually eating (use of utensils), and so forth be sure to include these. What you report on this form will be cross referenced by medical data obtained or submitted to the social security administration. If it can not be supported then a limitation will not be acknowledged to exist. You may receive additional forms in the mail from social security asking more details about your work history, activities, and/or pain. Be sure you are detailed and fill them out with the thought being you are disabled and you are limited in doing what activities because of what disability related problems. Social Security Disability Insurance and Supplemental Security Income-The Difference: When you actually apply for social security you are automatically assessed for two programs. One is Supplemental Security Income and the other is Social Security Disability Insurance. The medical requirements are identical for both programs but the amount they pay is determined differently. People who have historically had difficulty working because of a disability or have not worked in five of the last 10 years prior to the onset of their disability are generally going to be viewed as potential applicants for Supplemental Security Income (hereafter referred to as SSI). The amount paid each month is fixed to a maximum. As of January 1, 2000 it will be $515.00. Also, they generally receive Medicaid as opposed to Medicare. SSI is a program that is based on resources. For example, if you are single and have more than $2000.00 in cash assets then even if you medically qualify for this program you still would not be eligible for benefits. They count the direct and indirect support you receive from someone else such as family or a small pension plan or a 401(k) plan (even though you it is supposedly not accessible to you until you reach 59 years 6 months of age. They exempt you house and car but if you have a titled interest in a second car then they count the value of that titled interest. If you have a life insurance policy you have paid into which has a cash value then they count that as well. If you are receiving workers compensation benefits then they count the monthly payments. If you have settled a claim then they count the amount you actually received. Finally, as December 1996, if you have had a claim pending for sometime and are approved at the hearing level (2-3 years after you initially filed) and your back pay equal more than 12 months of SSI benefits then they will pay you the entire back pay of 18 months. The first payment will be approximately 1/3 of the back pay, then six months later and 1/3, and then six months later the final amount. Social Security Disability Insurance (here after referred to as SSDI) is entirely different. They do not generally care about your resources. This is program for people who have been working steadily until the onset of some disease or health condition which has caused them to stop working. Eligibility is based on your age and how much you have "paid in" to the social security trust fund. For example, a person who are 40 will need to have paid in for 40 quarters (4 quarters to the year or a total of 10 years) to be determined eligible. On the other hand, a person who is 27 will need to have paid in perhaps only 12, pending special rules. The amount you received is based on the amount of wages taxed by social security. The more that was taxed the hirer the monthly payment. Also, if approved for this program you may also be entitled to a check for dependant children. If you have a workers compensation payment each month then generally social security will reduce the benefit check by that payment but certain rules apply. In some cases the opposite happens and the workers compensation check is reduced and not the social security check. If you have settled certain rules apply here as well which may affect you monthly check. However, discussion of this is beyond the scope of this article. Unlike SSI, back pay exists with SSDI. Specifically, back pay could go back to six months after you stopped working. Also unlike SSI, SSDI has a waiting period. The waiting period is generally five months after you request to apply for benefits. For example, let us say you contact social security on March 1 and request an appointment. They give you an appointment for March 22. The counting starts from March 1. Now suppose your case is approved on May 1 for SSDI benefits and they determine you were disabled as of March 1. After five full months of disability pass you then receive your first check which would be on August 1. If you have met the resource limit they will pay you SSI benefits for the five month waiting period. Currently, the law requires any SSI payments to be made prior to SSDI payments being made. What Social Security Does When Assessing Your Application? Social Security has a five step process in assessing your application. Step One is to determine if you are performing substantial gainful activity. Refer to the beginning of this for that information. If you are performing substantial gainful activity then you will be found not disabled. If you are not performing substantial gainful activity then we go to step 2. The disability or disabilities, are they severe? The disability is determined to be severe by how restrictive it is of your ability to carry out physical activities such as lifting, standing and so forth as well as your ability to deal with environmental conditions (dust, fumes, dangerous machinery et cetera). If you are not very limited then you disability is determined to be not severe and you are therefore ineligible. Otherwise, step 3 is moved to. Social Security publishes a listing of what they refer to as a Category of Impairments. One for Adults and one for children. If you fit these impairments then you are presumed to be disabled and eligible for benefits without regard to your work experience, age, and education. If not then you move to step 4. Social Security not examines your functional limitations (walking, standing, bending reaching etc. and any other limitations such as comprehension, attention) and asks the question: Can this person do work they have previously done? If they determine you can then you are not eligible. If they determine you can not do prior work then they move to the final step, step 5. Can you perform any work which exists in ample numbers in the national economy? That is, do you have the functional limitations to perform other jobs which exist even though you may not have the training for them? The assumption is made that you can always get the training if you have the ability. If the answer is yes then you are not disabled, if the answer is no then you are eligible. Closing: The attempt here was to give you some basic information concerning social security. Hopefully this information will assist you and assist you in determining if you should attempt social security benefits or not. If you have questions you may contact me at the above address and phone or, preferably, email me at geriley@adelphia.net or contact my web site at http://home.adelphia.net/~geriley/ This material may be reproduced as long as credit is given to disability Consultants. copyright-1996, 2000, 2002 disABILITY Consultants