File 05-10029.TXT Uploaded from F.L.I.C.net on 16-NOV-93 1-(607)-272-1549 (7 days-24 hours, 8-N-1) F.L.I.C.net operated by the: Finger Lakes Independence Center 607 W. Clinton Street Suite 112 Ithaca NY, 14850 Voice/TTY 1-(607) 272-2433 SYSOP: Jon W. Merritt Virus Scanned, McAfee Associates 9.12 V100 Booklet title: "Disability" U.S. Department of Health And Human Services Social Securtiy Administration SSA Publication No. 05-10029 January 1992 ICN 456000 Who Should Read This Booklet? You should, if you want to know more about the various kinds of disability benefits available from Social Security. This booklet will tell you who is eligible, how to apply, and what you need to know once benefits start. We pay disability benefits under two programs: the Social Security disability insurance program and the Supplemental Security Income (SSI) program. The medical requirements for disability payments are the same under both programs and a person's disability is determined by the same process. While eligibility for Social Security disability is based on prior work under Social Security, SSI disability payments are made on the basis of financial need. And there are other differences in the eligibility rules for the two programs. This booklet deals primarily with the Social Security disability program. For information on SSI disability payments, refer to the section, "A Word About Supplemental Security Income," at the back of this book, or ask for the booklets, SSI (Publication No. 05-11000) and Working While Disabled ... How Social Security Can Help (Publication No. 05-10095). Please Note: This booklet provides a general overview of the disability program. The information it contains is not intended to cover all provisions of the law. For specific information about your case, contact Social Security. What's Inside Part 1--Introduction To Disability And Social Security What We Mean By "Disability" Who Can Get Social Security Disability Benefits Disability Benefits For People With HIV Infection Disability Benefits For Children How Much Work You Need For Social Security Benefits Part 2--Signing Up For Disability How To Apply Who Decides If You Are Disabled How We Determine Disability Rules For Blind Persons If Your Claim Is Denied Part 3--When Your Claim Is Approved Your First Check How Much You Will Get From Social Security How Other Payments Affect Benefits Benefits May Be Taxed You Can Get Medicare If You're Disabled Reviewing Your Disability What Can Cause Benefits To Stop Part 4--Going Back To Work Benefits While You Work A Word About Supplemental Security Income For More Information Other Booklets Available Part 1 Introduction To Disability And Social Security Disability is something most people don't like to think about. But the chances of your becoming disabled are probably greater than you realize. In fact, studies show that one out of four young workers will become disabled some time during their lifetime. It's a fact that, while most people spend time working to succeed in their jobs and careers, few think about ensuring that they have a safety net to fall back on should the unthinkable happen. This is where Social Security comes in. We pay cash benefits to people who are unable to work for a year or more because of a disability. Benefits continue until a person is able to work again on a regular basis and a number of work incentives are available to ease the transition back to work. What We Mean By "Disability" It's important that you understand how Social Security defines "disability." That's because different programs have different bases for determining disability. Some programs may pay for partial disability or for short-term disability. Social Security does not. Disability under Social Security is based on your inability to work. You will be considered disabled if you are unable to do any kind of work for which you are suited, and only if your inability to work is also expected to last for at least a year or to result in death. Some consider this a strict definition of disability, and it is. The program assumes that working families have access to other resources to provide support during periods of short-term disabilities, including workers compensation, insurance, savings, and investments. It is designed to provide a continuing income to you and your family when you are unable to do so. Benefits continue as long as you remain disabled. Who Can Get Social Security Disability Benefits You can receive Social Security disability benefits at any age. If you are receiving disability benefits at age 65, they become retirement benefits, although the amount remains the same. Certain members of your family may also qualify for benefits on your record. They include: * Your unmarried son or daughter, 18 or older, if he or she has a disability that started before 22. (If a disabled child under 18 is receiving benefits as a dependent of a retired, deceased, or disabled worker, someone should contact Social Security to have his or her checks continued at 18 on the basis of disability.) * Your spouse at any age if he or she is caring for a child of yours who is under 16 or disabled and also receiving checks. Certain family members may qualify for disability benefits if you should die. They include: * Your disabled widow or widower 50 or older. The disability must have started before your death or within 7 years after your death. (If your widow or widower caring for children receives Social Security checks, she or he is eligible if she or he becomes disabled before those payments end or within 7 years after they end.) * Your disabled ex-wife or husband who is 50 or older if the marriage lasted 10 years or longer. Disability Benefits For People With HIV Infection People with HIV infection or AIDS may also qualify for disability benefits when they are no longer able to work or when they must severely limit the amount of work they do because of the disease. A person diagnosed with AIDS who is not working generally qualifies for disability benefits. Some people with HIV infection that has not progressed to AIDS may be just as severely disabled as a person with AIDS, and therefore just as likely to qualify for disability. For more information, ask for the booklet, A Guide to Social Security And SSI Disability Benefits For People With HIV Infection (Publication No. 05-10020). Disability Benefits For Children In recent years, there has been a growing concern about whether parents are aware of the disability benefits that are available for their disabled children. More than 475,000 children under 18 who have disabilities currently receive such benefits; many suffer some form of mental retardation, others from various childhood conditions. We recently changed the way we decide if a child is disabled, generally making it easier for children to qualify. SSI disability benefits are payable to people of any age with a disability, including children. For more information, ask Social Security for the booklets, SSI (Publication No. 05-11000) and Social Security and SSI Benefits For Children With Disabilities (Publication No. 05-10026). Social Security dependents benefits are payable to children under 18 if a parent is recieving retirement or disability benefits or is deceased. These benefits may also be paid to children 18 or older who were disabled before age 22. Benefits will continue into their adult years as long as they remain disabled. How Much Work You Need For Social Security Benifits To qualify for Social Security disability benefits, you must have worked long enough and recently enough under Social Security. You earn up to a maximum of 4 credits per year. The amount of earnings required for a credit increases each year as general wage levels rise. Family members who qualify for benefits on your work record do not need work credits. The number of work credits needed for disability benefits depends on your age when you become disabled. * Before age 24--You need 6 credits in the 3-year period ending when your disability starts. * Age 24 to 31--You need credit for having worked half the time between 21 and the time you become disabled. For example, if you became disabled at age 27, you would need credit for three years of work (out of 6 years). Age 31 or older--You need to have the same number of work credits as you would need for retirement, as shown in the following chart. Also, you generally must have earned at least 20 of the credits in the 10 years immediately before you became disabled. Born After Born Before 1929, Become 1930, Become Credits Disabled At Age Disabled Before 62 You Need ---------------------------------------------------------------------- 31 through 42 20 44 22 46 24 48 26 50 28 52 30 53 31 54 32 55 33 56 34 57 1986 35 58 1987 36 59 1988 37 60 1989 38 62 or older 1991 or later 40 ---------------------------------------------------------------------- Part 2--Signing Up For Disability How To Apply You should apply at any SOcial Security office as soon as you become disabled. (You may file by phone, mail or by visiting the nearest office.) However, Social Securtiy disability benefits will not begin until the 6th full month of disability. This "waiting period" begins with the first full month after the onset of your disability. The claims process for disability benefits is generally longer than for other types of Social Security benefits--from 60 to 90 days. It takes longer to obtain medical information and to assess the nature of the disability in terms of your ability to work. However, you can help shorten the process by bringing certain documents with you when you apply. These include: * The Social Security number and proof of age for each person applying for payments. This includes your spouse and children, if they are applying for benefits. * Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment. * A summary of where you worked in the past 15 years and the kind of work you did. * A copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your Federal tax return for the past year. * Dates of any prior marriages is your spouse in applying. Do not delay filing for benefits just because you do not have all the information you need. The Social Security office will be glad to help you. Who Decides If you Are Disabled After helping you complete your application, the Social Security office will review it to see if you meet the nondisablity requirements of the law. These include such factors as weather you have worked long enough and recently enough to qualify for disability benefits, your age, and if you are applying for benefits as a family member, your relationship to the worker. The office will then send your application to the Disability Determination Services (DDS) office in your State. There, a decision will be made as to whether you are disabled under the Social Security law. In the DDS office, a team consisting of a physican (or psychologist) and a disability evaluation specialist will consider all the facts in your case and decide if you are disabled. They will first make every reasonable effort to get medical evidence from your doctors and from hospitals, clinics, or institutions wehre you have been treated. The Government pays a reasonable charge for any medical reports that it needs and requests. If the DDS team has difficulty getting a medical report, you may be asked to help obtain it. You do not need to ask your doctor for a report before you apply for disability benefits. But, if you have copies of your medical reports available, it may take us less time to process your claim. On the medical report forms, your doctors or other sources are asked for a medical history of your condition: What is wrong with you and when it began; how the condition limits activities; what the medical test have shown; and what treatment has been provided. They are also asked for information about your ability to do work related activities, such as walking, sitting, lifting, and carrying. They are not asked to decide whether you are disabled. Additional medical information may be needed before the DDS team can decide your case. If it is not available from your current medical sources, you may be asked to take a special examination called a "consultative examination." Your doctor or the medical facility where you have been treated is the preferred source to perform this examination. Social Securtiy will pay for the examination or any other additional medical tests you may need, and for certain travel expenses related to it. The rules in the Social Security law for determining disability differ from those in other Government and private programs. However, a decision made by another agency and the medical reports it obtains may be considered in determining whether you are disabled under Social Security rules. Once a decision on your claim is reached, you will receive a written notice from the Social Security Administration. If your claim is approved, the notice will show the amount of your benefit and when payments start. If it is not approved, the notice will explain why. How We Determine Disability You should be familiar with the process we use to determine if you are disabled. It's a step-by-step process involving five questions. They are: 1 Are you working? If you are and your earnings average more than $500 a month, you generally cannot be considered disabled. 2 Is your condition "severe"? Your impairments must interfere with basic work-related activities for your claim to be considered further. 3 Is your condition found in the list of disabling impairments? We maintain a list of impairments for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on the list, we have to determine if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step. 4 Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then we must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further. 5 Can you do any other type of work? If you cannot do the work you did in the last 15 years, we then look to see if you can do any other type of work. We consider your age, education, past work experience, and transferable skills, and we review the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied. Rules For Blind Persons The Social Security disability program has special rules for blind persons. If you qualify, you may receive benefits either on the basis of blindness or on the basis of disability. You are considered blind under Social Security rules if your vision cannot be corrected to better than 20/200 in your better eye, or if your visual field is 20 degrees or less, even with a corrective lens. If you are blind, you can earn up to the current monthly amount of the annual earnings limit that applies to non-disabled beneficiaries. This is generally higher than the "substantial gainful activity" level of $500 that applies to non-blind disabled workers. (See page 16.) If you are blind, you should file for disability even if you are working regularly and your earnings are too high to receive disability benefits. That's because you might be eligible for a disability "freeze." This means that your future benefits, which are figured on your average earnings over your working life, will not be reduced because of relatively lower earnings in those years when you are blind. You should also note that, as a blind beneficiary, you may request to receive your Social Security notices by telephone or certified mail rather than regular mail. Just let your local Social Security office know. If Your Claim Is Denied If your claim is denied, or if you disagree with any other decision we make, you may appeal the decision. The Social Security office will help you complete the paperwork. There are four levels of appeal. If you disagree with the decision at one level, you may appeal to the next level. You have 60 days from the time you receive the decision to file an appeal to the next level. We assume that you receive the decision 5 days after the date on it, unless you can show us that you received it later. Reconsideration Your file is reviewed by persons other than those who made the original decision. Hearing If the reconsideration decision is still unfavorable, you may apply for a hearing before a judge. If you are appealing a decision that you are no longer medically disabled, you may also request that we continue your benefits while you wait for a decision. Appeals Council The Appeals Council will review your case if it feels that there is an issue that the judge did not address. If it denies your review, or you otherwise disagree with its decision, you may appeal to a Federal Civil Court. United States District Court Again, you have 60 days from the day you received the notice of the decision to appeal to a Federal Court. Part 3 When Your Claim Is Approved Your First Check Once a decision is made that you are disabled, you will receive your first Social Security disability check dating back to the 6th full month from the onset of your disability. You also will receive a booklet describing your responsibilities as a Social Security beneficiary: When You Get Social Security Disability Benefits--What You Need To Know (Publication No. 05-10153). You should read this booklet carefully and keep it in a safe place with your other valuable papers in order to refer to it whenever questions arise. How Much You Will Get From Social Security The amount of your monthly disability benefits is based on your lifetime average earnings covered by Social Security. If you would like an estimate of your disability benefit, all you have to do is call or visit Social Security and ask for it. We'll send you a form you can use to get a Personal Earnings and Benefit Estimate Statement. How Other Payments Affect Benefits Eligibility for other government benefits can affect the amount of your Social Security disability benefits. Other Disability Benefits Social Security benefits may be affected if you are also eligible for workers' compensation (including black lung) or for disability benefits from certain Federal, State, local government, Civil Service, or military disability programs. Total combined payments to you and your family from Social Security and any of these other programs generally cannot exceed 80 percent of your average current earnings before becoming disabled. Government Pension Offset If you are a disabled widow or widower or the spouse of a disabled worker, a "government pension offset" may reduce your Social Security payment. The offset applies if you become eligible for a Federal State, or local government pension based on your own work not covered by Social Security. The amount of your Social Security spouse's benefit may be reduced by two-thirds of the amount of your government pension. There are some exceptions when the offset would not apply. For more information, call or visit Social Security to ask for a free copy of the fact sheet, Government Pension Offset (Publication No. 05-10007). Pension From Work Not Covered By Social Security If you become disabled and entitled to a Social Security disability benefit and you also receive a monthly pension based on work not covered by Social Security, your disability payment will be smaller than normal. That's because we use a different formula to figure the Social Security benefit of people who get other public pensions. For more information, call or visit Social Security to ask for a free copy of the fact sheet, A Pension From Work Not Covered By Social Security (Publication No. 05-10045). Benefits May Be Taxed A relatively small number of people may have to pay Federal income taxes on their Social Security benefits. This usually happens only if your total income is high. At the end of the year, you will receive a Social Security Benefit Statement (Form SPA-1099) showing the amount of benefits you received. The statement is to be used for completing your Federal income tax return if any of your benefits are subject to tax. You may use the Internal Revenue Service Publication 915 for additional information on the tax. You Can Get Medicare If You're Disabled You will be automatically enrolled in Medicare after you have been getting disability benefits for 2 years. There are two parts to Medic arc hospital insurance and medical insurance. Hospital insurance helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this coverage, so it's premium free if you're eligible. The other part of Medicare, medical insurance, helps pay doctors' bills and other services. You pay a monthly premium for this coverage if you want it. Almost everybody has both parts of Medicare. If you get Medicare, and have little income or resources, you should know about a program that can save you money on out-of-pocket medical costs. The program is called the "Qualified Medicare Beneficiary" program, or QMB. For more information, call a Social Security office to ask for the factsheet, You Should Know About QMB (Publication No. 05-10079). Reviewing Your Disability Your benefits will continue as long as you are disabled. However, your case will be reviewed periodically to see if you are still disabled. The frequency of the reviews depends on the expectation of recovery. * If medical improvement is "expected" your case will normally be reviewed within 6 to 18 months. * If medical improvement is "possible," your case will normally be reviewed no sooner than 3 years. * If medical improvement is "not expected" your case will be reviewed no sooner than 7 years. What Can Cause Benefits To Stop There are two things that can cause us to decide that you are no longer disabled and to stop your benefits. Your benefits will stop if you work at a level we consider "substantial." Usually, average earnings of $500 or more a month are considered substantial. Your disability benefits would also stop if we decide that your medical condition has improved to the point that you are no longer disabled. You Must promptly report any improvement in your condition, your return to work, and certain other events as long as you are receiving benefits. These responsibilities are explained in the booklet you will receive when benefits start. Part--4 Going Back To Work If you're like most people, you would rather work than try to live on disability benefits. There are a number of special rules that provide cash benefits and Medicare while you attempt to work. We call these rules "work incentives." You should be familiar with these disability work incentives so that you can use them to your advantage. If you are receiving Social Security disability benefits, the following rules are among the work incentives that apply: * Trial Work Period--For 9 months (not necessarily consecutive), you may earn as much as you can without affecting your benefits. (The 9 months of work must fall within a 5-year period before your trial work period can end.) A trial work month is any month in which you earn more than $200. After your trial work period ends, your work is evaluated to see if it is "substantial." If your earnings do not average more than $500 a month, benefits will generally continue. If earnings do average more than $500 a month, benefits will continue for a 3-month grace period before they stop. * Deductions for Impairment-Related Expense--Work expense related to your disability will be discounted in figuring whether your earnings constitute substantial work. * Medicare Continuation--Your Medicare coverage will continue for 39 months beyond the trial work period. If your Medicare coverage stops because of your work, you may purchase it for a monthly premium. For more information about Social Security's work incentives, ask for a copy of the booklet, Working While Disabled...How Social Security can Help (Publication No. 05-10095). As we stated earlier, the medical requirements for disability payments are the same for Social Securtiy and SSI, and a person's disability is determined by the same process for both programs. But there are some differences between Social Securtiy and SSI that you should know about. These include: * No disability waiting period is required under SSI. Because SSI payments are based on financial need, the presumption that a person has resources to handle short-term health problems does not exist. * Under SSI, you may qualify for an immediate disability payment if your condition is obviously disabling and you meet the SSI income and resource limits. * Different work incentive rules apply to SSI recipients. The major difference ti that cash benefits and Medicaid continue as long as the SSI income limits are not exceeded (the "substantial" income level discussed on page 17 does not apply). Another important rule permits money to be set aside for uop to 48 months for a work goal. Other special rules apply to blind persons, disabled students, and people with disabilities who work in sheltered workshops. Some work incentive rules are the same for SOcial Securtiy disability and SSI. These include the work expenses exclusion and the continuation of benefits while in vocational rehabilitation program. For more information about SSI disability payments, ask for the publications, SSI (Publication No. 05-11000) and Working While Disabled...How Social Security Can Help (Publication No. 05-10095). For More Information For more information or to apply for benefits, call or visit Social Security. It's easiest to call Social Security's toll-free telephone number. The number is 1-800-772-1213. You can speak to a representative 7 a.m. to 7 p.m. on business days. The Social Security Administration treats all calls confidentially-- whether they're made to our toll-free number or to one of our local offices. We also want to ensure that you receive accurate and courteous service. That is why we have a second Social Security representative listen to some incoming and outgoing telephone calls. Other Booklets Available Social Security has a number of publications that contain information about other Social Security programs. Con- tact Social Security to get a free copy of any of these publi- cations. They include: Understanding Social Security (Publication No. 05-10024)--A comprehensive explanation of all the Social Security programs. Retirement (Publication No. 05-10035)--Explains Social Security retirement benefits. Survivors (Publication No. 05-10084)--Explains Social Security survivors benefits. Medicare (Publication No. 05-10043)--Explains Medicare hospital insurance and medical insurance. SSI (Publication No. 05-11000)--Explains this program, which provides a basic income to people who are 65 or older, disabled, or blind and have limited income and resources. Social Security And SSI Benefits For Children With Disabilities (Publication No. 05-10026)--Explains benefits available to children with disabilities. All these publications are available in Spanish. 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