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The Basics
Although SSA administers a wide range of entitlement programs, including retirement and survivors benefits, issues concerning disability benefits cause the most dispute, that is, whether a person is “disabled”.
The test of disability for most disability programs is the same and involves two issues: severity of condition(s) and duration. The basic definition of “disability” is the inability to engage in any substantial gainful activity (work) due to a physical or mental impairment or combination which has lasted or which can be expected to last at least twelve continuous months. A person who recovers the ability to work, but was disabled for at least twelve months can receive benefits during the period of inability to work, what is called a “closed period of disability”.
Impairment(s) must not only prevent the person from performing work they have done in the past, but also any other work for which they may be suited based on education, skills from past work and age. The law provides that the unavailability of work is not a factor to be considered. The only issue is whether the person is capable of work, generally on a full-time basis, unless they have performed substantial part-time work.
There are different types of Social Security disability benefits. The most familiar, Disability Insurance Benefits providing monthly family income and eventually Medicare for workers who become unable to work. To receive these benefits the worker must be “insured” which for most means they have paid Social Security taxes for at least five out of the ten years before they became unable to work. Workers who become disabled after early retirement could be entitled to higher disability benefits.
For the children of retired, deceased or disabled workers there are disability benefits if they become disabled before age 22. For widows/widowers there are disability benefits if disability began within seven years of the worker’s death, payable as early as age 50. If disabled, Supplemental Security Income Benefits may be available for those who have never worked or have had very low earnings. Disability benefits through the Railroad Retirement Board are also available for career railroad workers or those who have had substantial railroad employment.
A finding of disability does not result in permanent entitlement. All disabled beneficiaries are subject to periodic disability review. If medical improvement in the opinion of SSA is shown to the extent of being able to return to work, cessation of disability will be found and benefits terminated. This adverse determination like the denial of an initial claim is subject to appeal. Benefits can be continued during the appeals process if requested within 10 days of the cessation notice.
There is a rather elaborate and potentially long appeals process for those whose claims are denied initially or disability found to have ceased. These denials often require appeal to a hearing before a Federal Administrative Law Judge for resolution. Mr. Koster has successfully represented thousands of clients obtain the benefits to which they are entitled. All clients are personally represented by him at their hearings.
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