Social Security FAQs

What is the basic definition of "adult disability?"

In order to prove that you are disabled you must be unable to perform any "Substantial Gainful Activity (SGA)" by reason of a medically determinable physical or mental impairment that has lasted or is expected to last a continuous period of at least 12 months or result in death. There are exceptions to this general rule (of course), for example, for individuals who are able to perform SGA, but who qualify for benefits under Social Security's Medical-Vocational Guidelines.

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What is Substantial Gainful Activity (SGA)?

The Social Security Administration defines " Substantial Gainful Activity (SGA) as "...work activity that is both substantial and gainful:

  • Substantial work activity. Substantial work activity is work activity that involves doing significant physical or mental activities. Your work may be substantial even if it is done on a part-time basis or if you do less, get paid less, or have less responsibility than when you worked before.
  • Gainful work activity. Gainful work activity is 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.

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What does it mean to be insured for Disability Insurance Benefits?

Whether you are insured for Disability Insurance Benefits depends upon your age and how much you earned prior to becoming disabled. The Disability Insurance Benefit (DIB) program of the Social Security Administration pays DIB benefits if you are proven disabled and you, or the wage earner upon whose account your claim is based, have paid enough total quarters of coverage (or "credits") and have earned a sufficient number of these quarters of coverage prior to becoming disabled. One earns quarters of coverage by paying Social Security taxes. For the year 2009, for example, $1,090 of gross, pre-tax, earnings gets you one quarter of coverage. Here is some basic information about quarters of coverage from SSA's website.

You may be eligible for Disability Benefits (also called SSDI, DIB or Title II benefits) if you can show that you became disabled prior to the expiration of your Date Last Insured (or other date if you have applied for Disabled Widow's or Widower's Benefits or Disabled Adult Child's Benefits). Here is a link to SSA's website regarding being insured for benefits.

Check with the Social Security Administration to see what your Date Last Insured is and consider talking to an attorney to help guide you through this process. You should also inquire whether or not you are eligible to receive Supplemental Security Income benefits.

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Do I need to be out of work for 6 months before I apply for Disability Insurance Benefits?

You do not need to be off work for 6 months to be able to apply. However, if approved, the first 5 months after the determined onset date, one is not eligible to receive SSDI benefits. This is called the "waiting period." In addition, SSA will pay benefits only up to one year prior to the SSDI application date. So in order to receive that full year of benefits prior to the application date, one would have to be disabled 1 year and 5 months prior to the application date because of the five month waiting period.

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Why is it taking so long to receive my past due Disability Insurance Benefits?

If you have applied for Disability Insurance Benefits (also called Social Security Disability Benefits) and have won your claim and are entitled to and awaiting your past due benefits, sometimes the past due benefits are delayed because the Social Security payment center responsible for paying the past due benefits is waiting for information from the local Social Security office as to whether or not you received SSI (Supplemental Security Income) benefits and in what amount. Even if you are not entitled to SSI benefits, sometimes this is the reason that Disability Insurance benefits are delayed.

If one of our client's past due benefits are delayed, we will determine the payment center responsible for paying the claim and contact them to see whether or not they received the SSI information and whether or not the Windfall Offset Computation has been done. This is an offset that may apply to the past due DIB benefits because of the receipt of or entitlement to SSI benefits. If the payment center tells us that they do not have the Windfall Offset information from the local Social Security office, we will contact the local office and make sure that they have appropriately communicated with the payment center so that the past due Disability Insurance Benefits can be released.

Claimants do not have access to the payment center information so they can contact their local Social Security office to determine what is the reason for the delay and to request that any issue be quickly resolved.

Another possible reason for the delay in receiving past due Disability Insurance Benefits is simply the backlog of cases awaiting payment.

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Age – does it matter?

Age is a factor that Social Security considers in determining whether or not one is disabled at step five of the five step adult disability process. At step five, SSA considers whether or not one can perform any other work in the local or national economy given one's age, education, past work experience, transferable skills and residual functional capacity. In some cases, even if one is able to perform full-time work, for example, at the sedentary exertional level, one still could be found disabled. So age is a factor considered by Social Security as a matter of law.

Generally, being a younger individual, under age 50, does not prevent one from obtaining benefits if one is unable to perform any work at all, including one's past relevant work (work that they have performed in the past fifteen years).

Sometimes it may seem more difficult for a younger individual to obtain benefits given their age, however, if a younger individual does meet (or equal in severity) one of SSA's Listings of Impairments or cannot perform his or her past relevant work or any other work, he or she should be found disabled.

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If I receive Disability Insurance Benefits, can my family also receive benefits on my earnings record?

Yes. Eligible beneficiaries can include:

Your spouse:
Benefits are payable to your spouse age 62 or older, unless he or she collects a higher Social Security benefit based on his or her earnings record. The spouse benefit amount will be permanently reduced by a percentage based on the number of months up to his or her full retirement age.

At any age if he or she is caring for your child under age 16 or disabled and receiving Social Security benefits. Your spouse would receive these benefits until the child reaches age 16. At that time, the child's benefits continue, but your spouse's benefits stop unless he or she is old enough to receive retirement benefits (age 62 or older) or survivor benefits as a widow or widower (age 60).

If your spouse also worked under Social Security:
If your spouse is eligible for retirement benefits on his or her own record, Social Security we will always pay that amount first. But if the spouse benefit that is payable on your record is a higher amount, he or she will get a combination of benefits that equals that higher amount. It doesn't matter if your spouse starts getting benefits before, after, or at the same time you do; Social Security should check both records to make sure that your spouse gets the higher amount whenever he or she becomes entitled to it. If your spouse will also receive a pension based on work not covered by Social Security, such as government or foreign work, his or her Social Security benefit on your record may be affected.

Your Divorced Spouse:
If you are divorced, even if you have remarried, your ex-spouse may qualify for benefits on your earnings record. (Please note, though, that if your ex-spouse will also receive a pension based on work not covered by Social Security, such as government or foreign work, his or her Social Security benefit on your record may be affected.)

To qualify on your record, your ex-spouse must:

  • have been married to you for at least 10 years;
  • be at least 62 years old;
  • be unmarried; and
  • not be eligible for an equal or higher benefit on his or her own Social Security record, or on
  • someone else's Social Security record.

Benefits for your children:
When you qualify for Social Security disability benefits, your children may also qualify to receive benefits on your record. Your eligible child can be your biological child, adopted child or stepchild. A dependent grandchild may also qualify.

To receive benefits, the child must be unmarried; and

  • be under age 18; or
  • be 18-19 years old and a full-time student (no higher than grade 12); or
  • be 18 or older and have a disability that started before age 22.

Normally, benefits stop when children reach age 18 unless they are disabled. However, if the child is still a full-time student at a secondary (or elementary) school at age 18, benefits will continue until the child graduates or until two months after the child becomes age 19, whichever is first.

Within your family, each qualified child may receive a monthly payment up to one-half of your full disability amount, but there is a limit to the amount that can be paid to the family as a whole. This total depends on the amount of your benefit and the number of family members who also qualify on your record. The total varies, but it is approximately 150 to 180 percent of your disability benefit.

Benefits for Disabled Children:
A child under age 18 may be disabled, but Social Security does not need to consider the child's disability when deciding if he or she qualifies for benefits as your dependent. The child's benefits normally stop at age 18 unless he or she is a full-time student in an elementary or high school (benefits can continue until age 19) or is disabled.

For a child with a disability to receive benefits on your record after age 18, the following rules apply:

  • The disabling impairment must have started before age 22, and;
  • He or she must meet the definition of disability for adults.

Important Note: An adult may become eligible for a disabled child's benefit from Social Security later in life. For example, a worker starts collecting Social Security retirement benefits at age 62. He has a 38-year old son who has had cerebral palsy since birth. The son will start collecting a disabled "child's" benefit on his father's Social Security record.

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Can I return to work and still keep my Disability Insurance Benefits?

For DIB benefits, there is something called a Trial Work Period monthly amount of $700/month (gross earnings, before taxes, for an employee). If you earn over that amount for 9 months in a 5 year period, then you have exhausted your Trial Work Period months. During a TWP month, your benefits are not affected by work over $700 (year 2009). After the TWP has ended, there is something called an Extended Period of Eligibility, which lasts 36 months. During this period, if you work and earn over the Substantial Gainful Activity amount of $980 in a month (year 2009 amount) (once again, gross income, before taxes, for an employee) your benefits can be stopped, but if you go under that amount in another month, they can be reinstated. After that, work over the SGA level (year 2009 - $980/month) can result in benefits being terminated. See the SSA website for more information.

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How much emphasis does Social Security place on the records and opinions of Medical Providers?

By far, the most important evidence that SSA examines in a disability claim is the medical evidence. This is somewhat obvious, because the definition of disability requires that there exist a "medically determinable impairment."

Medical evidence not only includes objective medical evidence, such as medical signs and laboratory findings, but also other evidence from medical sources, such as the medical history, opinions, and statements about treatment received. Statements that a disabled individual makes about his or her impairments are also considered, but they must be corroborated by the medical evidence in order for them to be found credible and be given weight.

To help interpret the medical evidence, and to give binding guidance on disability and other benefit programs, SSA publishes several Rulings each year. In 2006, SSA published a Ruling entitled, "Considering Opinions and Other Evidence From Sources Who Are Not 'Acceptable Medical Sources' in Disability Claims; Considering Decisions on Disability by Other Governmental and Nongovernmental Agencies."

In part, this Ruling clarifies how SSA considers opinions from sources who are not considered "acceptable medical sources." The Ruling recognizes that with the growth of managed health care and the emphasis on containing medical costs, many people get much of their care from health care practitioners who are not doctors. These sources include nurse practitioners, physician assistants and licensed clinical social workers. This Ruling gives guidance on how much weight SSA will give to their opinions.

In general, "acceptable medical sources" include, for example, licensed physicians (medical or osteopathic doctors); licensed or certified psychologists (including school psychologists); and licensed optometrists, although SSA may need a report from a physician to determine other aspects of eye diseases.

There are three categories of sources besides "acceptable medical sources" considered under the new Ruling:

  1. "Medical sources who are not acceptable medical sources" (for example, nurse practitioners, physicians' assistants, therapists, psychiatric social workers and chiropractors);
  2. "Non-medical sources" such as teachers, counselors and social welfare agency staff acting in their professional capacity. These sources often have close contact with the individual and personal knowledge and expertise to make judgments about the impairment, activities, and level of functioning over a period of time.
  3. "Non-medical sources" such as spouses, other relatives, friends, employers, and neighbors.

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Can one work while receiving Social Security Disability Insurance (SSDI) Benefits?

One can work and receive Social Security benefits, however, there are limitations on what one can earn. For SSDI claims one can engage in nine Trial Work Period months without the work affecting one's benefit. A Trial Work Period month is a month in which you earned over $700 (before taxes; amount for the year 2009). Once one has engaged in nine Trial Work Period months in a five year period, then one enters the thirty-six (36) month Extended Period of Eligibility (EPE). During this period, if one earns over the Substantial Gainful Activity amount (for the year 2009 - it is over $980/month for a non-blind individual) then one's benefit stops. If one earns under the SGA amount after that, one's benefit is reinstated.

After the EPE ends, if one continues to earn over the SGA amount, one's benefit can be terminated by SSA.

The Supplemental Security Income (SSI) has different return to work rules.

Remember, this is just general information. You can review your specific situation with the Social Security Administration. Examine SSA's website for more information in this regard.

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Social Security Hearing Offices

Cincinnati hearing office – 312 Elm St., Suite 2100, Cincinnati, OH 45202

Columbus hearing office – 401 N Front St, Rm 400, Columbus, OH 43215

Dayton hearing office – 10 N Ludlow St, Ste. 300, Dayton, Ohio 45402

Indianapolis hearing office – 151 N Delaware St, Ste. 400, Indianapolis, Indiana 46204

Lexington hearing office – 125 Lisle Industrial Ave, Ste. 200, Lexington, Kentucky 40511

Louisville hearing office – 601 W Broadway, Louisville, KY 40202

Madison hearing office – 150 Demaree Dr, Madison, Indiana 47250

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