Understanding Social Security Disability
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Transcript of Understanding Social Security Disability
Two Different ProgramsTitle 2 SSDIRequires work: 5 years out of last 105 month waiting period24 month Medicare waiting period12 months retroMay pay family benefits
Title 16 SSIDINo work requiredIncome: < $710/$1066Resources: < $2K/$3KLiving arrangements1 month waiting periodNo retroactivityMedicaidNo family benefits
Definition Of Disability
Inability to engage in Substantial Gainful Activity
(work) (2013 - $1,040 month) by reason of a
physical or
mental impairment that has lasted or is expected
to
last at a severe level for a period of at least 12
continuous months.
Substantial Gainful Activity2013 – Generally SGA if over $1040 month
Impairment related work expenses (Rx co-
pays, doctor co-pays, special equipment,
transportation, etc.) can reduce earnings
Subsidy/special considerations can reduce earnings
Office Processes
Local SSA Office
Paperwork processing centerApplication/appeal intakeDetermination of non-medical factors
Disability Unit
Located in RaleighNever sees the clientObtains medical recordsMakes medical decision
Work Requirements – T2
Credits earned by working
2013 - $1,160 per credit up to 4
10 years minimum work (40 credits)
5 of the years (20 credits) must be within the
10 years prior to onset of disability (current
connection)
Onset Date
Not always equivalent to diagnosis date
2 different factors:
1. Not engaging in SGA (2013 - $1,040
month)
2. Have a severe condition (12 months
duration)
Onset/Entitlement ExampleDiagnosis date: 03/15/2012
Stop work date: 09/30/2012
Correct onset date would be 09/30/2012
Waiting period: 10/12 – 02/13
Entitlement date: 03/2013
First payment: 04/2013
Medicare: 03/2015
Onset/Entitlement Example 2Diagnosis date: 03/15/2012
Stop work date: 03/15/2012
Correct onset date would be 03/15/2012
Waiting period: 04/12-08/12
Entitlement date: 09/12
First payment date 10/12
Medicare: 09/2014
Retroactivity: dependent on application
Onset vs EntitlementUnder T2 SSDI, can delay as long as 17 months from
onset to file application with no loss in benefits
Allows up to 12 months retro benefits from date of
application (subject to onset/waiting period
restrictions)
Onset 10/15/2011, Waiting Period Nov., Dec., Jan.,
Feb., Mar
Application Date 04/15/13 = Potential Retro benefits
to 04/2012
Offset 1Workers Compensation – WC + SSA cannot exceed
80% of monthly average current earnings. Excess is
offset against SSA benefit.
Example, average earnings = $3,000 month, ACE =
$2400
Workers Comp = $500 week, or $2,165 month
SSA = $2000
Total of $4,165 in benefits, $1,765 offset
Net SSA = $235.00
Offset 1 (cont)
WC lump sum payments are also offset
Lump sum pro-rated based on weekly wage
will result in offset
Lump sum pro-rated on life expectancy will
usually avoid offset
WC offset is removed at age 65
Offset 2Employer long term disability is usually offset
by Social Security (even if paid for by
employee)
LTD: $2500 per month
T2 SSDI: $2000 per month
Insurance offsets the $2000, paying only $500
per month under the LTD
Varies from policy to policy
Application ProcessCan apply through local office appointment
(telephone) or via internet
Application takes about 1 ½ hours
See green worksheet
Client can have consultant or representative
if desired
Decision takes from 3-5 months
AppealsReconsideration (SSA-561) 2-3 months
Paper review, DDS in Raleigh
Hearing (HA-501) 18-24 months
Administrative Law Judge in Greensboro
Need representative
Appeals Council Review 6-12 months
Council is in Arlington VA
Benefit RatesT2 benefits are based on average earnings over an
“elapsed period” from age 22 to date of disability
onset, less 5 drop out years
Example:
Disabled at age 45. From age 22, there are 23
“elapsed years”, less 5 drop out years = 18 used in
the computation
Disability rate is equivalent to age 66 retirement rate