The definition of disability can vary widely. Someone with no arms and no legs might not feel disabled at all, while someone who has lost a finger may feel permanently disabled. For purposes of offering disability benefits, supplemental security income (SSI) and Social Security disability standards have been created to help define when someone is disabled.
You also need to have a physical or mental condition that falls under Social Security’s definition of disability.
The Social Security Administration (SSA) will pay monthly benefits to people unable to work for at least 12 months or longer because of their disability. Social Security does not pay part-time or temporary disability benefits. If your disability falls under these categories, your first step should be to investigate workers’ compensation benefits.
Also, to qualify for Social Security Disability Insurance (SSDI) benefits, you need to have worked in a job where you paid Social Security taxes. You need to have garnered a specific number of Social Security “credits” to be eligible for SSDI benefits.
- You can earn as many as four credits per year.
- In 2018, every $1,320 you earned from self-employment or in wages counted as one credit.
- When you earn $5,280 in a calendar year, you have earned your four credits.
- Your age affects the total number of credits needed to qualify for SSDI benefits. In most cases you will need 40 credits, included 20 earned in the past 10 years up until you became disabled. Younger workers can qualify by earning fewer credits.
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Understanding the Current Disability Definition
You may be disabled under current Social Security disability standards and eligible for Social Security Disability Insurance (SSDI) benefits if you:
- Have a mental, medical or physical impairment.
- Your impairment keeps you from substantial gainful activity (SGA). In 2019, this will be defined as activity earning you more than $1,220 per month.
- Your impairment has either kept you from SGA for 12 months at a minimum or is forecast to prevent you from substantial gainful activity for at least 12 months in the future.
By these Social Security disability standards, therefore, you may qualify for disability if you have a serious enough condition to prevent you from earning more than $1,220 per month for at least a year. Of course, to receive disability, you need to be able to prove your disability as well — with medical records, loss of earnings proof and more.
What Does Substantial Gainful Activity Mean?
Substantial gainful activity, a term used by the SSA, is connected to a specific monetary amount. To put it another way, it is a monthly earning limit.
- When a person applies for SSDI benefits, the SSA will evaluate their earnings. They will also do this if they conduct any future reviews of an individual’s benefits claim. This is called a continuing disability review.
- If you apply for SSDI benefits, but you are earning more than the SGA amount of $1,220 a month, SSA will deny your claim as a technical denial. This means that the SSA believes that if you are earning more than the SGA amount, you are not severely disabled, and you are ineligible for SSDI benefits.
- A technical denial takes place at the local SSA office where you submitted your claim. This means that it is never forwarded to the Disability Determination Services or assigned to an examiner to review.
- The SSA adjusts the SGA limit according to inflation. This means it could change year to year. Also, the SGA limit is based on your gross, not your net income. That means the SSA looks at your total pay before taxes. It makes sense for you or your attorney to check at least once a year to see if there have been any changes in the SGA limit.
- It is difficult to receive SSDI benefits if you are earning more than the SGA limit of $1,220 a month. However, if your disability worsens and you must stop working, or your wages fall below this limit, you should talk to a lawyer familiar with Social Security benefits about filing a claim.
How Will I Know If My Impairment Will Keep Me From SGA in the Future?
When you apply for SSDI benefits, the most important information you can provide are documents that detail your medical condition. As part of the application process, SSA examiners will look at several factors to determine if you are eligible for benefits.
One of the critical medical documents is known as a Residual Functional Capability (RFC) rating. Your doctor prepares this document for the SSA examiners or an Administrative Law Judge (ALJ) if you have appealed a denial. It describes in detail your disability and how it impairs or severely limits your ability to do your work.
Once you have decided to file a claim for SSDI benefits, it is essential that you notify your doctor immediately. Your doctor can then begin to prepare the documentation and paperwork that details all the medical conditions concerning your impairment.
If you do not have a doctor, or cannot afford one, the SSA will provide you a Social Security doctor who will do what is known as a consultative exam. Unfortunately, unless your disability is exceptionally severe and limiting, the chances are that a doctor who gives you a consultative exam will recommend that you not receive SSDI benefits.
If you cannot afford a doctor, see if there are any free clinics in your area. While free clinics sometimes have long waiting periods, an examination by an independent doctor about your disability can go a long way toward your SSDI benefits claim being approved.
To determine if you are eligible for SSDI benefits, the Social Security examiners will take this medical information and use it to determine if you can do your last job or any of the other jobs you have had in the previous 15 years. The SSA will then determine if there is any other kind of job that you could do. Normally this determination is made based on your limitations, age, level of education and any skills you have acquired on previous jobs in the past.
Once the SSA examiners have completed this process, they will determine whether or not your impairment kept you from reaching the SGA level the past 12 months or will keep you from reaching it in the next 12 months.
You will continue to receive benefits as long as you are unable to work or reach the SGA limit. As we noted above, however, the SSA will conduct regular reviews of your situation to see if your disability has improved or if you have returned to work even part-time and are now making above the SGA level.
Why Is the Medical Information so Important?
Up-to-date medical information is one of the most important ways that Social Security examiners or ALJs determine the level of your impairment. A lack of current and useful medical information is one of the main reasons, along with earning above the SGA limit, that the SSA uses to deny initial applications for SSDI benefits.
If this happens to you, don’t be frustrated or think that the best thing you can do is to apply again. If your initial application is denied, your next best step is to appeal your denial. At this point, you should hire an experienced Social Security benefits attorney if you haven’t done so already to help you with your claim.
Noted that the denial rate for initial claims is around 65 percent. This claim rate can vary from state to state and even from city to city. On the other hand, however, the success rate for applicants who appeal their initial denial before an ALJ is around 62% and in some cases even higher.
How Does the SSA Determine If My Disability Will Prevent Me From Earning the SGA?
If you are not working or you are earning below the $1,220 a month SGA limit, the SSA office will send your application through to the Disability Determination Services (DDS) office. That office uses several steps to determine your eligibility:
1. How Severe Is Your Medical Condition?
Your disability should be severe enough that it significantly affects your ability to do basic tasks like standing, walking, lifting, sitting or remembering for at least 12 months. If the DDS office finds that your disability is not severe enough to limit you in these ways, they will deny your application.
If, however, they do determine that your limitations interfere with your ability to do these basic job-related functions, you move on to the next step.
2. Is Your Condition on the SSA’s List of Disabling Conditions?
The SSA keeps a list of medical conditions for all the major systems in your body that it considers severe enough to prevent you from having any SGA. If your condition, however, cannot be found in the list, the SSA examiners will need to decide if your disability is severe enough. This is where having complete medical records and a list of every visit to the doctor, every visit to an emergency room and every specialist you have seen will play a huge role in the success or failure of your application.
3. Can You Do Any Previous Job?
SSA examiners will take a look at any job you’ve held in the last 15 years. Looking at the medical evidence, they will consider whether you could still hold any of these jobs. If they think you can, they will deny your application. If they believe that your disability is severe enough that it will prevent you from working at any previous job, they will then proceed to the next step.
4. Is There Any Kind of Work That You Can Do?
When the SSA examiners look into this question, they will take several different factors under consideration such as a medical condition, education, age, previous jobs and if you have learned any transferable skills at an earlier job. If you cannot do any other kind of work, the SSA will likely determine that you are disabled.
The SSA has also implemented two initiatives in the hopes that it will speed up the processing of new SSDI claims:
- Compassionate allowances: Some cases will qualify for SSDI benefits as soon as a diagnosis is confirmed. These cases include people with Lou Gehrig’s disease (ALS), pancreatic cancer or leukemia.
- Quick disability determinations: Advanced computer screening is used to locate applications that have a very high probability of being granted.
What Is A Closed Period Benefit, How Do I Qualify for It and Is It Affected by My SGA?
A closed period benefit is a benefit that only lasts from the start of your disability until the time when you can return to work at an SGA level again. This means that the period begins on the day when you were unable to work and closes on the day you return to a job where you have substantial gainful activity. Your disability has a beginning and an end.
- To qualify for these benefits, you need to have a disability that has lasted or will last for at least 12 months. Also, you need to file a disability claim within 14 months after your disability has healed.
- If you meet this definition, but you were able to return to an SGA level of employment while you are awaiting a decision on your initial application for SSDI benefits, you may choose to apply for closed period benefits or the SSA may decide that you are only entitled to benefits under this definition.
- It may be easier to receive these benefits than to receive longer SSDI benefits. The SSA doesn’t like open period SSDI claims because they are more expensive. It is much less of a financial risk for the SSA to approve a closed period benefit.
- Also, there is a bit of a human factor involved. If you applied for SSDI benefits but then went back to work after your conditions improved, some SSA examiners are more inclined to believe that you honestly suffered an impairment the prevented you from working.
If you find yourself in this situation, you should speak to a lawyer experienced with Social Security benefits matters. They can advise you on whether or not it is a good idea to apply for closed period benefits or longer-term benefits.
Let the Experienced Lawyers at KBG Injury Law Help You With Your Social Security Benefits Claim
If you would like to file a Social Security disability or have already been denied and need to build a strong appeal, contact KBG Injury Law. During your free consultation, we will help you determine whether you qualify for disability benefits. If you do, we can put together a strong case to prove your eligibility.
You can call us at 1-800-509-1011 or visit our contact us page and leave us your contact details and some information about your case. A member of our team will get back to you as soon as possible.