Is SGA too complicated?
Even if you know the definition of a substantial gainful activity (SGA), could you apply it? Can you be sure that the last job you tried before you applied for Social Security disability benefits was SGA?
Charles Hall proposes that substantial gainful activity (SGA) has become just too complicated.
If one is engaging in SGA, one cannot be considered disabled, but SGA is a term of art. Work may not be SGA if low earnings, unsuccessful work attempts, made work, subsidized employment, impairment related work expenses, trial work periods, etc. are taken into consideration.
…The …
Will I get Medicare or Medicaid with Social Security?
If you are wondering whether you will get Medicare or Medicaid with Social Security, it all depends on the type of Social Security you receive.
Social Security disability insurance (SSDI) comes with Medicare.
Social Security Supplemental Security Income (SSI) comes with Medicaid.
What’s the difference between Medicare and Medicaid?
The Colorado Bar Association has a great page discussing the differences. Here is a quick summary:
Medicare provides only partial coverage, and requires beneficiaries to pay premiums, deductibles, and co-payments.
Medicaid provides more complete coverage, without significant payments from the beneficiaries.
Click to read more about the differences.
24 month waiting period for Medicare
If you win your claim for Social Security disability insurance (SSDI), you are also eligible to receive Medicare benefits. But, you don’t get Medicaid right away, with some exceptions, you have to be “in pay status” for 24 months before you become eligible for Medicaid.
That means you have to be receiving 24 months of Social Security disability insurance to get Medicare.
Another two years? I just waited two years to get my case approved.
Fortunately, Social Security considers your back benefits when they count the 24 months. So, if Social Security 24 months of back Social Security disability insurance, you …
What is an Unsuccessful Work Attempt?
I previously wrote about the various exceptions which may allow you to keep your Social Security disability benefits even if you return to work. The most common of these is an Unsuccessful Work Attempt (UWA).
If you work for 6 months or less at a substantial gainful activity (SGA) level, your work may qualify as an Unsuccessful Work Attempt and not affect your application for benefits (or your current Social Security disability benefits if you have already won your case).
Another benefit of the Unsuccessful Work Attempt exception is that it applies for both Social Security Disability Insurance (20 CFR 404.1574) and Supplemental Security Income (SSI) (20 CFR 416.974) cases. This is a major difference between Unsuccessful Work Attempts and Trial Work Periods.
You have to be disabled for 12 months – the Durational Requirement
Have you ever seen this in a Social Security denial?
While your condition may prevent you from working at the present, we do not feel that your condition will remain disabling for 12 months.
First, Social Security says that you are disabled. Then, they deny the claim. What is going on?
What is the difference between Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI)?
We previously discussed Social Security’s Disability Insurance Benefit (DIB) and Supplemental Security Income (SSI) programs.
The big difference between DIB and SSI is type of income which affects eligibility.
Under the “Disability Insurance” Program, Social Security considers whether you are working and earning money (engaging in a Substantial Gainful Activity – SGA). If you earn too much money as income, you may be denied Social Security DIB benefits. Of course, there …
What is the “5 month waiting period” in Disability Insurance cases?
If you apply for Social Security Disability Insurance benefits (SSDI or DIB), you may be surprised that Social Security keeps the first 5 months of back benefits.
This is referred to as the “5 month waiting period.”
If you awarded benefits back to January 1st, Social Security actually keeps the benefits for January, February, March… all the way through May. Your disability insurance benefits will start in June.
What?!?! But, it is my money!
I know! But, that is how the system works!
However, there is an exception to the 5 month waiting period.
What is the Alleged Onset Date (AOD) in a Social Security disability case?
Here is a quick “Term of the Day”
Alleged Onset Date (AOD) - the Alleged Onset Date is the date your disability began. Or, the date you claim entitlement to Social Security disability benefits.
Also see, “what if the Judge wants me to change the date my disability began?”
What is a Protected Filing Date (PFD) in a Social Security disability case?
The Protected Filing Date (PFD) is the date you contacted Social Security and asked to file an application.
What is so special about that?
The PFD is used to determine how far back your benefits can be paid.
What makes it “protected?”
Since the application process takes time, Social Security does not want to penalize you for delay between the time you ask to start an application and the time you actually finish it.
For example: if you contact Social Security on January 2nd to start an application (Social Security is closed on new year’s day), but do not turn in all the paperwork until February 1st, Social Security will …
How Social Security reviews cases: the 5 step sequential evaluation process
I have written about how Social Security defines disability, work, and a substantial gainful activity.
But, how does Social Security really evaluate a case?
Social Security reviews cases using the five-step sequential evaluation process to decide is a person is disabled. Here are the 5 questions that make up the sequential evaluation process:
Does your impairment keep you from being able to perform a substantial gainful activity (SGA), generally full-time, competitive, work?
Is your impairment severe? AND, is your impairment expected to remain severe for at least 12 months?
Does your impairment “meet or equal” one of Social Security’s “Listing of Impairments?” A listing of medical conditions, acceptable medical evidence, and the severity necessary for an impairment to be considered disabling. There are separate listings for adults and for children.
Does your impairment prevents you from being able to perform any job you performed over the last 15 years which was also a substantial gainful activity?
Does your impairment prevent you from being able to perform any other type of work which exists in substantial numbers of the national economy?
Let’s take these one at a time:
Trial work period and Social Security disability benefits
Social Security encourages you to try to go back to work to see if you can do it. A Trial Work Period (TWP) lets you work and still be considered disabled by Social Security.
A beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled. We do not consider services performed during the trial work period as showing that the disability has ended until services have been performed in at least 9 months (not necessarily consecutive) in a rolling 60-month period.
To sum up, a Trial Work Period lets you work and still be considered disabled by Social Security. Not only that, but Social Security does not count all the months you work, just the ones where you earn more than a threshold Trial Work Period amount:
2012 - $720 per month.
2011 - $720 per month.
2010 - $720 per month.
2009 - $700 per month.
2008 - $690 per month.
2007 - $630 per month.
Supplemental Security Income (SSI) or Social Security Disability Insurance Benefits (DIB)?
Social Security has two different benefit programs for individuals who are disabled.
Disability Insurance Benefits (DIB, also known as SSDI, or Title 2 benefits); and
Supplemental Security Income (SSI or Title 16 benefits).
Because of its name, it is a common misconception that must apply for “Disability Insurance” if you are disabled. Actually, both programs provide disability benefits.
What is Disability Insurance Benefits (DIB)?
Generally, Disability Insurance Benefits are based on your payroll contribution to Social Security. To qualify for DIB, you have to have earned enough Social Security credits, in the right time frame, by paying into Social Security through payroll taxes.
There are several circumstances in which you may not have enough credits for Social Security Disability Insurance:
What is the “date last insured” in Social Security disability cases?
Social Security a bit like car insurance: you pay your premiums to obtain insurance covered.
When it comes to Social Security, your premiums are your payroll taxes and the coverage is disability insurance.
In order to qualify for Social Security Disability Insurance, you have to have paid enough into the Social Security system through payroll taxes. Once you have worked long enough, you become insured for Disability Insurance benefits should you become unable to work.
What happens when you stop paying your premiums?
Am I disabled? Should I apply for Social Security benefits?
A lot of people ask me how Social Security decided if they are disabled.
I can’t do the work I have done for 35 years. Am I disabled?
I stopped working to take care of a family member, but now I am sick. Am I disabled?
I got hurt at work, then they fired me. I keep applying for jobs, but there just isn’t much work around here. Am I disabled?
The doctor tells me I will probably need serious surgery later on. Am I disabled?
I will need to be on medication for the rest of my life. Am I disabled?
Social Security focuses on ability to work to test for disability.
Under the Social Security system, in order to be disabled you have to have a physical or psychological impairment that is expected to keep you from being able to engage in a “substantial gainful activity” (SGA) – typically some type of full time work, for 12 months or longer. Or, simply put: do you have a condition that keeps you from being able to work?
Social Security overpayments: what you need to prove to win!
Overpayment cases are very tough to win. If you decide to fight an overpayment, you need to know what you are up against.
Here is what the law says about how Social Security evaluates whether you have to pay back an overpayment or not. This is taken from Social Security Ruling 88-6c.
42 U.S.C. § 404(b)
The regulations state in part:
Sections 204(b) and 1870(c) of the Act provide that there shall be no adjustment or recovery in any case where an incorrect payment . . . has been made . . . with respect to an individual:
(a) Who is without fault, and
(b) Adjustment or recovery would either:
(1) Defeat the purpose of title II of the Act, or
(2) Be against equity and good conscience. 20 C.F.R. § 404.506.
So, in order to have Social Security not collect an overpayment you have to be withouth “fault” for the overpayment AND the recovery would either defeat the purpose of the Social Security Act or be against equit and good conscience.
Lets take these one at a time:
