SOCIAL SECURITY DISABILITY OUTLINE 2005 

By Douglas M. Smith, Attorney at Law

o Entitlement to cash benefit begins the 6th full mo. after your disability begins

o The amount of your cash benefit varies according to your earnings history

o Medicare starts 24 mos. after date of entitlement to first monthly check. This may leave a health insurance gap for you.

Try filling the health insurance gap with paid sick leave, spouse’s insurance, unpaid Family Medical Leave Act time, COBRA, state health plans, etc.) For information, on the Internet see:

COBRA (Source - U.S. Dept. of Labor)

FAMILY AND MEDICAL LEAVE ACT (Source - U.S. Dept. of Labor)

o Your age must be under 65 years, for SS DI.

o You must be insured --"FICA" tax from employees and employers pays for DI. In 2005 you must earn $920 in a quarter to get a good quarter. Assure that your earnings record is correct; get a "Social Security Statement of Earnings and Benefits" (formerly called a personal earnings and benefit statement - "PEBES"). SSA may be mailing you one already. To order one, telephone 800-772-1213 or see SSA.

o Birth and marriage records should be taken to the Social Security Administration. To learn how to obtain birth, death, marriage or divorce certificates, see the Internet:

http://travel.state.gov/birthcertificaterequest.html

http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm

o Social Security numbers: to get duplicate SS card call 1-800-772-1213

o Benefits: In 2005, the federal SSI benefit is $579 a mo. for an individual; $869 a mo. for couples who both qualify, plus Medicaid. 

o Concurrent benefits: Some DI beneficiaries get SSI too.

MEDICAL PROOF OF DISABILITY IS THE SAME  FOR DI & SSI

II. YOU MUST PROVE YOUR DISABILITY

References: Disability Workbook for Social Security Applicants ,  Disability Evaluation in a Nutshell, and Recipe for Winning Disability Benefits from SSA

A. The legal burden of proof is yours.

"An individual shall not be considered to be under a disability unless he furnishes such medical and other evidence of the existence thereof as the Commissioner of Social Security may require." Social Security Act, Sec. 223(d)(5)(A)

o You must be unable to do substantial gainful activity - that is, you must be unable to work regularly and must not be working and earning over $830 a month in 2005 (People disabled by blindness can earn $1,380 per month in 2005).

o Due to one or more medically determinable physical/mental impairments;

o That are expected to result in death; or have lasted or are expected to last at least 12 months. Social Security Act, Section 223(d)(1)(A)

1. Get information before filling out SSA forms:

2. Apply promptly;

3. Apply in person if possible;

4. Write things down; keep copies;

5. Monitor the progress of your claim through your SSA office or DDS

6. Appeal any unfavorable decisions--if you and your doctor believe you are disabled.*

III. AFTER AWARD, DISABILITY REVIEWS 

Reference: Preparing for Your Disability Review 

The Notice of Award of benefits you receive when SSA approves your disability claim, specifies approximately when you can expect SSA to review your disability status. 

Under Social Security law, all disability cases must be reviewed from time to time. This is to assure that people receiving benefits continue to be disabled and meet all other requirements.

A. What is the purpose of a continuing disability review?

The purpose of a continuing disability review (or “CDR”) is to decide whether an individual has ceased to be entitled to disability benefits because:

1. the physical and/or mental impairment has ceased,

2. does not exist, or

3. is not disabling.

Social Security Act, Section 223(f)

B. When can you be reviewed?

You may be reviewed:

n At any time if your review is due or overdue;

n  Any time you have worked and earned at or above the amount SSA calls "substantial gainful activity" for a total of nine months. This doesn't have to be nine consecutive months. 

You would be earning SGA in 2005 if you worked and earned an average of $810 a month or more (or $$1,380 per month if legally blind);

n Six to 18 months after award if medical improvement can be predicted at the time benefits start;

n About every three years if medical improvement is possible but cannot be predicted; or

n About once every five to seven years if medical improvement is unlikely.

See Social Security: What You Need To Know When You Get Disability Benefits (SSA Pub. 05-10153).

C. How will SSA notify you?

Most people will receive one of two kinds of review:

Full Medical Review. When SSA wants a full medical review they send you a letter announcing the review, and someone from your Social Security office contacts you. They ask you to provide information on Form SSA-454-BK about any medical treatment you've received and any work you have done. SSA generally wants information about your medical and hospital visits in the past 12 months, including copies of records. You may be asked to come to the SSA office without much notice -- seven days notice isn’t uncommon. Ask for more time if you need it.

Mailer Review. Some people receive a Disability Update Report (Form SSA-455 or Form SSA-455-OCR) in the mail, and are asked to fill it out, and return it to SSA. These usually are people whom SSA considers unlikely to have their benefits terminated. Most people who receive mailers do not undergo full medical review unless their responses indicate possible medical improvement or increased work capacity. A few people have both mailer and full scale reviews.

Consult your doctor before responding to a notice of review. In a mailer review you need only answer a few questions and return the mailer, but despite the apparent simplicity of the process it is wise to talk with your doctor about the questions before answering because some involve medical conclusions. In a full medical review you should provide substantial medical evidence showing that you continue to be incapable of sustained work on a regular basis, and this necessarily involves input from your doctor.

SSA estimates it will terminate benefits for 3.5 to 3.7 percent of beneficiaries reviewed in fiscal years 2004 through 2008, inclusive.

F. If SSA stops your benefits, what should you do?

If SSA proposes to stop your benefits, you have a valuable right of appeal.

è Appeal if you and your doctor believe you are unable to work on a sustained regular basis.

è If you want your benefits to keep coming while you appeal, elect continuation of benefits in writing within ten (10) days after your termination notice. Probably it’s best to both elect benefit continuation and file your appeal within 10 days.

See your doctor regularly. Ask your doctor at least annually whether or not you are well enough to do full time competitive work. Keep copies of all records of medical or hospital care or tests; especially care or tests received since your last SSA disability award or disability review decision.

Conclusion. CDRs are nothing to dread. They are routine inquiries by the government to assure that people receiving disability benefits continue to be disabled. If a beneficiary remains medically unable to work, he or she will keep the benefits without interruption. If SSA should err, and try to terminate benefits, the prospects for reversing the erroneous decision through an appeal are very good.

For More Information: See Preparing for Your Disability Review, Pds Disability Facts newsletter, Special Issue: September 2003, $7.50, Physicians Disability Services, P.O. Box 822, Severna Park, MD 21146. Download the same publication as an e-Book for $5.00.

Updated January 31, 2005

Copyright 2001, 2002, 2003, 2004, 2005 Douglas M. Smith, P.O. Box 822, Severna Park, MD 21146

This outline may be reproduced for your personal use, but you may not delete any part of it including this copyright notice. To request permission to edit or distribute it contact, Pds, P.O. Box 822, Severna Park, MD 21146, fax (410) 647-5312.