Social Security Questions and Answers

English,



In general one can be denied no matter how advanced any illness is. While there are lots of rules, at the end of the day the system requires human input which leads to error. If I recall correctly, for the last fiscal year stats are available, something like 2 million people applied. Even if we assume an error of 1%, that is 20,000 incorrect grants and denials.



So yes you can be denied even if you are at stage IV. The question is if it will stick on appeal.



With respect to your doctor's opinion that can carry weight. But at the third step of the analysis, SSA looks first to the diagnostic criteria and objective findings. If a person has the medical findings that satisfy what is required then they are disabled regardless of what their physician says. That opinion may matter at the fourth and fifth step.



When you file initially their is not much any can help you with. If you can fill out the application and describe your question adequately and list your medical sources, SSA will contact your doctors, gather the evidence and make a decision. As long as you can complete the application and other forms you will be okay.



Finally, one must always relate their disability to why they stop working. So if you are working now and stop, try to remember that you need to relate it to your diagnosis. Losing your job because your company relocated, and hey now you want your SSA money, may hinder the process.



Steve

Fearless:

Here is the genral answer to your question on how to think of SS:

Social Secuirty is not a medical disability system in that people get benefits because they have a medical problem(s).  

SS is a medical-vocational program that provides benefits whose medical problems prevent them from working, i.e. cause vocational relevant limitaitons on the ability to function in the workplace.

 So no matter how serious or debilitating the injury or illness if someone is perform an activity that is earning them an income they are not disabled for SS purposes. 

 Best example I give my clinets (a bit dated now) was Christopher Reeves.  Quadraplegic yes.  Made money for public speaking and or consulting yes.  Disabled No.

So to answer your question: Most people who are working and stop because of medical reasons will apply and put down the next day as their disablity onset date.  So if you work to 6/20/11 and never go back, for SS purposes you would put down 6/21/11 as when your disability started.  Because from a SS point of view that is when it did cuz you were working.

 Now this simple example applies to someone who is working pretty full time.  If for a year you are working off and on, missing a lot of work, and making less than on average $1,000 a month, I would put down the date that all that began cuz I would make the arguyment that the past year was not SGA and merely an work attempt.

But in general, your disablity onset date is not when you were first diagnosed but when your medical problem first stopped you from being able to work.

Now the sticky thing is this, if you are diagnosed with an impairment that SS persumes to be automatically disabling and you continue to work, then you are rebuting the presumption that SS has made.

 So just make sure that if you are diagnosed Stage IV and continue to work for a time afterward to document that you stopped wortking because your problem grew worse.

Which leads me to another point.  Someties I have client's who have demanding jobs, either physically/mentally/or both.  They try to go back to work and thier employer gives them modified duty, lighter or not so mentally taxing.  this can hurt you because while you may be not able to do what you consider your prior demanding work, if you do the modifed work long enough SS may conider that w hole seprate job that you can still do.

 Steven

Blondie:

 In regards to what?  If you mean amounts you can earn it is per month averaged.

$720 is the amount for a trial work period.  $1,000 is the current amount with respect to SGA and an unsuccessful work attempt.

Before making this separate topic I posted a few times here

http://community.breastcancer.org/forum/8/topic/424992?page=31#idx_911

This is what I posted with respect to earnings:

This is from SSA website:

***

Earnings trigger a trial work period
During a trial work period, 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. In 2010, any month in which earnings exceed $720 is considered a month of services for an individual's trial work period. In 2011, this monthly amount increases to $720.

***

here is link:

http://www.ssa.gov/oact/cola/twp.html

So making $1000 in any month, regardless of the hours one works, more than 9 times in a rolling 60 month period may effect benefits. But also the regulation also makes clear that unpaid services like volunteering as long as it is a service that people do get paid for can count towards the trial work period.

Example: if a person volunteers to answer phones for some type of charity for 10 hours a week that this charity normally pays $20 to do that job, SSA may consider that as part of trial work period.

So the. answer to your question is yes, working can always cause you a headache. In my experience SSA is big and slow, but at some point the computer notices the data being inputted.

Best chance is to keep earnings below the amount SSA considers the trigger, this year that is $720.

And I posted this:

Correct. Once you exceed the trial work period limitations, SSA then looks at whether or not you are engaged in substantial gainful work activity (SGA). Which currently the bright line is $1,000.

But remember, this is a very large agency. So making $990 a month does not me a person safe because the regulations and rules state that SSA will "generally" not consider amounts below a certain amount ($1,000 this year) as SGA. But that does not mean they won't

So I guess to put it in list form in order from safest to risky:

A. Do not work.

B. If you do work keep it under the TWP max. which this year is $720.

C. If you do work above $720 and are out of TWP keep it below SGA levels (this year $1,000) and document how you were able to work. Here are some examples to show why what a person does is not SGA no matter what they make:

***

Performance of Work Under Special Conditions: One situation under which your SGA-level work may have ended, or may have been reduced to the non-SGA level, as set out above, is "the removal of special conditions related to your impairment that are essential to your further performance of work." That is, you may have worked under conditions especially arranged to accommodate your impairment or you may have worked through an unusual job opportunity, such as in a sheltered workshop. Special or unusual conditions may be evidenced in many ways. For example, you:

May have required and received special assistance from other employees in performing the job; or

Were allowed to work irregular hours or take frequent rest periods; or

Were provided special equipment or were assigned work especially suited to your impairment; or

Were able to work only within a framework of especially arranged circumstances, such as where other persons helped you prepare for or get to and from work; or

Were permitted to perform at a lower standard of productivity or efficiency than other employees; or

Were granted the opportunity to work, despite your medical condition, because of family relationship, past association with the firm, or other altruistic reason.

***

Basically, if the only way yo work is because you are accommodated or treated specially then SSA may not count that as SGA. Why? Because unlike the ADA, SSA does not consider employer accommodation in the analysis. A person must be able to perform work without accommodation for their disability.

D. If you do make consistently over $1,000 be upfront with SSA to avoid any overpayment issue and to establish a history of credibility if you need to re-apply or re-start your benefits.

Again this is not meant to be legal advice but just a more detailed discussion of the issues you have raised.

Fianlly and unrelated to your quesiton I did put this up there:

 Here is something that may be of interest from SSA website.

***

Compassionate allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate allowances allow Social Security to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly.

http://www.ssa.gov/compassionateallowances/

***

What qualifies for a passionate allowance?

Here is the link to list:

http://www.ssa.gov/compassionateallowances/conditions.htm

Of note number 14 is:

Breast Cancer - with distant metastases or inoperable or unresectable

Finally, here is a link to a section of the POMS Manuel.

Essentially POMS is a non-binding Manuel that takes the law of SSA and writes it in a manner thatnthe field staff in local offices can follow to process claims correctly. This document is how they should handle a claim involving someone who is Stage IV diagnosed.

Before you click though, it ain't pretty. Bottom line SSA does notmlike to make mistakes. Therefore, the fact that an impairment is fast tracked to being approved as disabling may be a good thing as far as getting paid SSA benefits, but like I tell my clients, often whatnisngoodmto help in SSA claim is bad for health overall.

https://secure.ssa.gov/apps10/poms.nsf/lnx/0423022125

All:

Here is a link to SSA website that gives a good overview of working and getting SSA.

http://www.socialsecurity.gov/pubs/10095.html 

Another good link that takes the complex law and puts it into easy to read format:

http://www.socialsecurity.gov/redbook/eng/introduction.htm 

Fox:

Self employed are different.  They still have $720 limit for TWP or a 80 hour per month max work in your business no matter what net is.  And yes SSA looks at net not gross.  Also unlike employees who have to get 12 months of ssa before TWP applies you need to get 24 months.

I recently has a client who was a hairdresser.  He was making $200-300 a month for several years just keeping long term clients (10-20 years) he had.  It took a while and a couple of appeals andf hearings but we got him benefits.

So if you can keep your income below the threshold that would be best. So keeping a few of your long term clients and staying below the $$ and time limit would be best. Or an easy way to avoid the hour limit is to do what you mentioned which is act as a referring person to a groomer who pays you a commission.  Just watch the income and time spent. 

If you have family you can trust you can also turn it over to them and perhaps turn it into a passive income stream. Get it off Sch. C and I think a K.  That is just an idea and not something I ever researched.

Steven

To all:

Ok here is an overview of the extent of the disability system in America right now.  I will describe what is here in California.  Where you are may be a bit different.

There are typically 5 different disability programs one may apply for, both private and government based.I will cover them all although you may not eligible for all of them.

1. State disability.  This one most people are familiar with.  If you have some type of illness or injury that will keep you out of work anywhere form a couple of week up to a year you can file for state disability.

2. Workers Compensation.  If your illness or injury occurs at work or as a result of work you can file a workers compensation claim and receive medical treatment, wage replacement, and permanent disability benefit.

3. SS benefits.

4. Private STD/LTD.  Many people as part of their employment package have a disability benefit with a ins. co.  Conceptually it is similar to SS in that you are paid a certain % of money base don your earnings if you demonstrate you are disabled.

5.  Disability Retirement Pension.  Not as common any more but for those who have a traditional defined benefit retirement plan (not a 401k type defined contribution plan, but a plan that pays you a set amount for a period, usually unions, government workers and large employers) you can ask for your retirment benefit early because of disability and not be penalized as if you took early retirement.

Finally, not a disability type benefit but there is also Unemployment one could file for.

Steven

Chick



It is not easily found on website. I actually am taking it from the regulations an rulings. Basically you should never work during the 5 month waiting period. Also if you work in the first 12 months of your onset of disability date and before you get your award letter then that is no good. Of course does not mean you lose benefits just that work is looked at under SGA standard not TWP.



Example: found disabled June 15 based on onset date of may 15. 5 month waiting period June to October Back to work august. Not eligible for trial work period.



Example: allege disability June 15...8 months pass no decision...you need money and go to work february ...get approved in march..not TWP.



Anyway best policy is not to work before you receive approval letter and not within the 5 month waiting period after approval.



Steven