When should you File for Disability benefits with the Social Security Administration?

Should you file for disability? When should you do it? These are two very important questions for individuals who have significant and limiting impairments (mental or physical).

Answer: You should consider filing for disability if your medical condition interferes with your ability to perform work activity. This includes the jobs you have done in the past and, potentially, other forms of work for which your job skills, training, and education may suit you.

How Social Security decides claims

Social Security will base its decision to award medical disability benefits on an individual's ability to engage in past work or "other" work activity. This decision is made by reviewing both a claimant's work history and a claimant's medical history--which is done by gathering a claimant's medical records.

Note: Past work may potentially include any job done by the claimant in the fifteen year period prior to becoming disabled, as long as the job was performed long enough for the person to actually learn the duties of the job. "Other work" is potentially any type of job that a claimant may be thought capable of doing based on their education and job skills, and mediated by their current limitations.

As an example, an individual with a work history as a machinist who is unable to go back to their old job due to their functional limitations...may be considered capable by the social security administration of doing a similar job (in the same industry or a related industry) if:

A) That job makes use of the individual's education and training and

B) The job does not require, mentally or physically, more than the individual is capable of doing (because, obviously, you cannot be expected to switch to some new type of employment that your training qualifies you for if your physical or mental limitations would stand in the way of you actually doing the job).

When does Social Security consider a condition disabling?

Basically, a person should file for Social Security Disability or SSI if their physical or mental conditions have prevented them from working and earning a substantial and gainful income (this is known as SGA) for twelve months, or if they expect to be out of work for twelve months due to the severity of their impairments.

As the Social Security Administration views things, the standard for being considered disabled is that the condition must last (or be projected to eventually last) for one full year, minimum. Conditions that are severe enough to prevent work activity but which do not last a year or longer will not be considered as a disability. Also, conditions that are severe, last a full year, but are not yet severe enough to prevent a person from working up to the level of being able to earn a substantial and gainful income will, likewise, not be considered to be disabling.

To put it another way and to reiterate: to be considered disabled by the social security administration, a person's condition must be severe enough that it lasts for at least 12 months and prevents the performance of work activity that earns at least a substantial and gainful income, a.k.a. SGA.

How does Social Security measure "severity", i.e. how severe a condition is? By evaluating a person's medical records and then determining what types of physical or mental limitations they have as a result. This is known as a residual functional capacity rating (RFC) and it is compared to the jobs that a person has held to see if they can return to any of those jobs, or do some type of work that their skills will transfer to.

That said, even if a person is found to have limitations that are so severe that Social Security considers them unable to work, but that same person is found to be working and earning what is considered to be a substantial and gainful income, then they will be denied benefits, if they are in the process of filing, or be taken off benefits if they are currently receiving benefits.

More on what happens if you are working when you put in your disability claim

There are individuals who file for disability when they are working, and, likewise, there are individuals who become approved for disability benefits and then later become involved in work activity. Working is not a bar to receiving disability benefits. However, the amount a person earns can rule out receiving benefits, and that amount, as we've already mentioned several times, is the SGA income limit.

If you are working and earning under the SGA limit when you file, your claim will be processed with no interruption. If you are earning more than the SGA limit, however, you will receive what is known as a technical denial. This type of denial occurs almost immediately, meaning that the claimant's case is not actually given a medical evaluation (i.e. the case is not assigned to a disability examiner, and, thus, the claimant's medical records are not gathered).

If a person begins working at the SGA-earnings level when they are already receiving disability benefits, their case will undergo what is known as a work CDR (continuing disability review) to determine if they still meet the requirements of the Social Security Disability or SSI disability program.

Social Security Disability and SSI are not temporary or partial disability programs

Keep in mind that Social Security Disability and SSI disability benefits are total disability programs and neither is a partial or short-term disability program. In other words, the system does not operate on the basis of being 20 percent disabled or 50 percent disabled. To receive disability benefits from social security, a person must be considered completely disabled and unable to work ("unable to work", of course, means being unable to work and earn more than the SGA limit referenced above).

However, it should be said that strong consideration is given based on a person's age, education, and the types of jobs they have performed in the past. In other words, information about a person's job history and work skills, and certainly their age, can help influence a decision on a claim. Built into the system is the concept that people may often have difficulty switching to new forms of employment, as well as the fact that job skills learned many years in the past may not necessarily transfer to other jobs.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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