A client recently asked me if I could publish a general glossary of disability-related terms, so she could become more familiar with the Social Security Administration's (SSA'S) lingo. After all, no one loves an acronym more than the federal government! I happened to have a list of commonly used SSA terms that the average person may not be familiar with lying around. So here you go........
Glossary of Terms
Activities of Daily Living are
simply the normal, basic activities that most people must engage in as a
requirement of daily living. They include basic activities such as: personal hygiene
(bathing, dressing), meal preparation (breakfast, lunch, dinner), shopping
(grocery and other shopping), and standard home maintenance activities such as
sweeping, vacuuming, dusting, laundry, and dish washing.
The dollar amount used to
calculate your Social Security benefit if you attained age 62 or became
disabled (or died) after 1978. To arrive at your AIME, Social Security adjusts
your actual past earnings using an "average wage index," so you won’t
lose the value of your past earnings (when money was worth more) in relation to
your more recent earnings. If you attained age 62 or became disabled (or died)
before 1978, Social Security uses Average Monthly Earnings (AME).
Administrative Law Judges are appointed by, and work for,
the federal government for the purpose of rendering decisions on Social
Security Disability claims at the hearing level. In order to adjudicate a
claim, an ALJ will normally read a claimant's cumulative social security file,
which, at the time of a hearing, is referred to as an exhibit file. On certain cases, an ALJ may also rely on expert
testimony provided by medical and vocational experts.
The alleged onset
date is the date a person claims, or alleges, on the social security
application, that their disability began. The alleged onset date potentially
determines how much in past due
benefits, or retroactive benefits, a claimant can receive.
The dollar amount used in calculating your monthly Social
Security benefit if you attained age 62 or became disabled (or died) before
1978. The AME is determined by dividing the total earnings in the
"computation years" by the number of months in those same years.
You will receive a letter of explanation whenever Social
Security makes a decision regarding your eligibility for Social Security
Disability or Supplemental Security Income benefits. If you disagree with the
decision, you have the right to appeal (ask Social Security to review your
case).
The deadline to file an appeal after a Social Security
Disability or Supplemental Security Income claim has been denied is always 60
days from the date of the last denial. This date is usually stamped on the
first page of the denial letter in the upper right hand corner.
The Appeals Council
comprises the third step in the Social Security Disability system's appeal
process. This stage in the process is different from the others in that it's
purpose is not to evaluate the merits of a case, but, rather, to determine if
the Administrative Law Judge who denied the claim was in error. The Appeals
Council will conduct a thorough review of the ALJ’s decision and issue their
own independent decision either remanding the case, reversing the case, or
denying the appeal.
To receive Social Security Disability or Supplemental
Security Income benefits, you must complete and sign an application. You can
apply in person at your local Social Security Administration office, by
telephone at (800) 772-1213, or
online at www.socialsecurity.gov.
A worker's (wage earner) base years for computing Social
Security Disability benefits are the years after 1950 up to the year of
entitlement to retirement or disability insurance benefits. For a survivor's
claim, the base years include the year of the worker's death.
An official letter from Social Security that verifies the
amount an individual receives each month in Social Security Disability benefits
and/or Supplemental Security Income payments. These letters are normally
issued following a request from a beneficiary or his/her authorized
representative.
Social Security pays monthly cash benefits in four major
categories:
- Retirement
- Disability
- Family
(dependents)
- Survivors
Additionally,
Social Security provides medical coverage in the form of Medicare for qualifying
individuals.
Cessation
Cessation
refers to a discontinuation of benefits
for a person who was once thought eligible to receive disability benefits from
the Social Security Administration. In most instances, disability recipients
are ceased and taken off benefits
when they no longer meet Social Security's medical or non-medical program
requirements.
A closed period exists when a claimant for disability benefits is found to be ineligible for ongoing benefits, but eligible to receive benefits for a specific period of time in the past extending over a minimum period of 12 months.
Computation Years
Computation years are the years with highest earnings
selected from the "base years.” Social Security adds total earnings
in the computation years and divides by the number of months in those years to
get the AME or the AIME.
Consultative Examinations
Consultative examinations
are medical examinations that Social Security Disability and Supplemental
Security Income claimants are sometimes sent to in the course of processing a claim
for disability benefits. The doctors who perform consultative examinations for
the Social Security Administration are independent physicians who have
contracted to perform such services.
Consultative examinations can be mental or physical. They can also include
ophthalmologic exams, bloodwork, and the taking of x-rays. Consultative
examinations conducted for social security objectives are not for the purpose
of delivering medical treatment. Instead, their purpose is to provide a recent
snapshot of a claimant's conditions and various limitations.
Claimants who receive appointment letters indicating that they have been
scheduled for a consultative examination, should always attend them since
examiners are empowered to close disability claims for "failure to
cooperate". However, when a claimant misses a scheduled exam and has a
valid reason for this happening, an examiner will usually allow for the
examination to be rescheduled.
To maintain eligibility for Supplemental Security Income
benefits, disability recipients cannot have more than $2,000 in countable assets
for individuals, and $3,000 in countable assets for couples.
Credits
Previously called "Quarters
of Coverage." As you work and pay taxes, you earn credits that
count toward your eligibility for future Social Security benefits. You can earn
a maximum of four credits each year. Most people need 40 credits to qualify for
benefits. Younger people need fewer credits to qualify for disability or
survivors’ benefits. During their working lifetime most workers earn more
credits than needed to be eligible for Social Security. These extra credits do
not increase eventual Social Security benefits. However, the income earned may
increase the benefit amount.
Date Last Insured (“DLI”)
Your DLI can be an important date for your Social Security
Disability claim. Social Security Disability is an insurance program, and a
portion of the FICA payroll taxes withheld from every paycheck pays the
disability premium. However, if you stop working, you stop paying the premium.
Eventually, your disability insurance will lapse. The date your insured status
ends is called the "date last insured." To prevail with a Social
Security Disability claim, you must show that you were disabled prior to
your date last insured. If you cannot demonstrate that you were disabled
prior to your DLI, you will be denied Social Security Disability benefits.
Critical case processing may be warranted when a person has
insufficient income or resources to meet an immediate threat to health or
safety, such as the lack of food, clothing, shelter or medical care.
This is the standard way to receive Social Security
Disability benefits and Supplemental Security Income payments. Your money is
sent electronically to an account in an accredited financial institution, such
as a bank or credit union.
DDS is the state-level agency whose basic task is
determining the eligibility of
claimants to receive monetary disability benefits, or benefits from a state's adult
Medicaid program. DDS is where cases are resolved at the initial application
and reconsideration levels. DDS examiners evaluate and process
disability claims at these two levels.
All disability cases (prior to the hearing level where an
Administrative Law Judge decides a claim) are evaluated and processed by disability examiners. Disability
examiners work at state agencies generally referred to by the acronym DDS, or Disability Determination
Services and they are responsible for determining medical eligibility for
claimants attempting to win Social Security Disability and Supplemental
Security Income benefits.
A durational denial occurs when a disability examiner
determines that a claimant's medical condition has not been disabling for at least a 12 month period, or cannot be projected to be disabling
for at least this long.
A chronological history of the amount of money you earn each
year during your working lifetime. The credits you earned remain on your
Social Security record even when you change jobs or have no earnings.
The established
onset date, is the decided commencement date for a claimant's
disability.
The exhibit file contains copies of everything accumulated during the course of processing a claimant's disability claim. This includes copies of applications and other paperwork submitted by claimants, letters sent to the Social Security Administration by claimants, and medical evidence gathered by disability examiners at the initial application and reconsideration levels. Exhibit files are made available to a claimant and their representative for viewing and copying.Family Benefits (Dependent Benefits)
When you’re
eligible for Social Security Disability benefits, the following people may
receive benefits on your record:
- Spouse
if he or she is at least 62 years old (or any age but caring for an
entitled child under age 16)
- Children
if they are unmarried and under age 18, under age 19 and a full-time
elementary or secondary student
- Children
age 18 or older but disabled
- Divorced
ex-spouse.
The family maximum represents the maximum amount of benefits
payable to an entire family on any one worker’s record.
Claimants who have been approved to receive Social Security
Disability benefits are subject to a five
month waiting period. The five month waiting period simply means that
the Social Security Administration will withhold five months of an approved
claimant's benefits.
*Note: Claimants who have been approved to receive Supplemental
Security Income benefits are not subject to the five month waiting period.
FICA stands for "Federal Insurance Contributions Act."
FICA is the tax withheld from your salary or self-employment income that funds
the Social Security and Medicare programs.
If you worked and earned enough Social Security credits to
meet the eligibility requirement for retirement or disability benefits or
enable your dependents to establish eligibility for benefits due to your
retirement, disability, or death, you have insured status.
People admitted to the
The Listing of Impairments describes,
for each major body system, impairments that are considered severe enough to
prevent a person from doing any gainful activity (or in the case of children
under age 18 applying for SSI, cause marked and severe functional limitations).
Most of the listed impairments are permanent or expected to result in death, or
a specific statement of duration is made. For all others, the evidence must
show that the impairment has lasted or is expected to last for a continuous
period of at least 12 months. The criteria in the Listing of Impairments are
applicable to evaluation of claims for Social Security Disability benefits and
Supplemental Security Income benefits.
A one-time payment of $255 paid in addition to any monthly
survivors insurance benefits that are due. Upon an individual’s death
this benefit is paid only to their widow(er) or minor children.
The maximum amount of earnings Social Security can count in
any calendar year when computing your Social Security benefit.
A joint federal and state program that helps with medical
costs for people with low incomes and limited resources. Medicaid programs vary
from state to state, but most health care costs are covered if you qualify for
both Medicare and Medicaid.
Medical experts
may testify at Social Security Disability hearings at the request of an
Administrative Law Judge. Medical
experts are provided a copy of the claimant’s medical records file prior
to the hearing and are called upon to provide informed testimony regarding the
interpretation of a claimant's medical records.
The Grids are medical-vocational guidelines that the
Administration must consider in evaluating your ability to work. The Grids address
your ability to work by weighing age, education, and the exertional and skill
levels of your past work performed in the last 15 years.
The federal health insurance program for:
- People
65 years of age or older,
- Certain
younger people with disabilities, and
- People
with permanent kidney failure with dialysis or a transplant, sometimes
called ESRD (End-Stage Renal Disease).
Once Social Security determines that you are eligible for
benefits, you will receive an official letter explaining the amount you will
get each month and the amount you will receive in past due benefits. Typically,
award letters are received about 8-12 weeks from the notice of decision.
Social Security will send you an official letter at the
initial application level, the reconsideration level, and the hearing level
explaining their decision and your appeal rights.
The Office of Hearings Operations (OHO) is
responsible for holding hearings and issuing decisions as part of the Social
Security Administration's process for determining whether or not a person may
receive disability benefits. Each OHO is staffed with Administrative Law
Judges (ALJs) who conduct impartial "de novo" hearings and make
decisions on appealed determinations involving claims for Social Security
Disability benefits and Supplemental Security Income benefits.
An on the record
decision occurs when an Administrative Law Judge, prior to a hearing having
been held, approves a case because the medical evidence available to an ALJ is
strong to enough to enter a finding of disability without the need for a formal
hearing.
Past relevant work is work that you have done within the
past 15 years, that was substantial gainful activity, and that lasted long
enough for you to learn to do it.
Social Security may make presumptive disability or blindness
payments available for up to six months, if you applied for Supplemental
Security Income benefits because of a disability or blindness and are waiting
for the DDS to make a final decision. You may be
eligible to receive SSI benefits right away on the basis of a presumptive
disability or blindness determination if you have one or more of the following
medical conditions:
·
amputation of a leg at the hip,
·
allegation of total deafness,
·
allegation of total blindness,
·
allegation of bed confinement or immobility
without a wheelchair, walker, or crutches, allegedly due to a longstanding
condition––excluding recent accident and recent surgery,
·
allegation of cerebral palsy, muscular
dystrophy, or muscular atrophy and marked difficulty in walking (e.g., use of
braces), speaking, or coordination of the hands or arms,
·
allegation of Down syndrome,
·
an applicant filing on behalf of another
individual alleges severe mental deficiency for claimant who is at least
seven years of age,
·
Human Immunodeficiency Virus (HIV) infection,
·
allegation of a stroke (cerebral vascular
accident) more than three months in the past with continued, marked
difficulty in walking or using a hand or arm,
·
infants who weighed less than 1200 grams at
birth, or less than 2000 grams at birth and they were "small for
gestational age" (For example, they weigh at least two standard
deviations below the mean, or below the third growth percentile, for
gestational age.) and have not yet attained age one,
·
allegation of inability to ambulate without the
use of a walker or bilateral hand–held assistive devices more than two weeks
following a spinal cord injury with confirmation of such status from an
appropriate medical professional,
·
a physician confirms by telephone or in a signed
statement that an individual has a terminal illness with a life expectancy of
6 months or less OR a physician or knowledgeable hospice official confirms
that an individual is receiving hospice services because of a terminal illness,
·
end stage renal disease with ongoing dialysis,
and the file contains a completed CMS–2728 End Stage Renal Disease Medical
Evidence Report–Medicare Entitlement and/or Patient Registration,
·
allegation of severe mental deficiency made by
another individual filing on behalf of a claimant who is at least
seven years of age,
·
allegation of Amyotrophic Lateral Sclerosis
(ALS, Lou Gehrig's disease).
Social Security does not ask you to repay these presumptive disability
payments, even if you are later found not to be disabled or blind.
Primary Insurance
Amount (PIA)
The monthly amount payable if you are a retired worker who
begins receiving benefits at full retirement age or if you're disabled and have
never received a retirement benefit reduced for age.
The date you first contact Social Security about filing for
benefits is referred to as your protective filing date. It may be used to
establish an earlier application date than when Social Security receives your
signed application.
A remand is a
disability claim that has been:
1. denied by an Administrative
Law Judge,
2. reviewed, upon request, by
the Appeals Council, and
3. returned to the hearing
office for a second hearing.
Representative Payee
If you receive Social Security Disability or Supplemental
Security Income benefits and become unable to handle your own financial
affairs, after a careful investigation, Social Security might appoint a
relative, a friend, or an interested party to handle your Social Security
matters and benefits.
A medical assessment of what an individual can do in a work
setting in spite of the functional limitations and environmental restrictions
imposed by all of his or her medically determinable impairment(s). RFC is the
maximum degree to which the individual retains the capacity for sustained
performance of the physical-mental requirements of jobs.
Commonly referred to as “Back Pay." Retroactive
benefits represent the monthly benefits that you may be entitled to before the
month you actually file an application, if you meet the entitlement
requirements. The amount of back pay a claimant can receive will always
depend on:
- when
a claimant filed for disability, and
- when
a claimant's disability is decided to have begun.
Social Security is based on a simple concept: While you
work, you pay taxes into the Social Security system, and when you retire or
become disabled; you, your spouse and your dependent children receive monthly
benefits that are based on your reported earnings. Also, your survivors can
collect benefits if you die.
The Social Security Administration is an independent agency
of the United States federal government that
administers Social Security, a social
insurance program consisting of retirement,
disability, and survivors' benefits. To qualify for these benefits, most
American workers pay Social Security taxes on their earnings; future benefits
are based on the employees' contributions.
SSA is headquartered in Woodlawn, Maryland, just
to the west of Baltimore, at what is known as Central Office.
Social Security Disability
Benefits
You can get Social Security Disability benefits if you:
- Are
under full retirement age,
- Have
enough Social Security credits, and
- Have a
severe medical impairment (physical or mental) that’s expected to prevent
you from doing "substantial" work for a year or more, or have a
condition that is expected to result in death.
Your first and continuous link with the Social Security
Administration is your nine-digit Social Security Number (SSN). Your SSN helps
Social Security maintain an accurate record of your wages or self-employment
earnings that are covered under the Social Security Act, and to monitor your
record once you start getting Social Security Disability benefits.
Your local Social Security office is the place where you
can:
- Apply
for a Social Security Number,
- Check
on your earnings record,
- Apply
for Social Security Disability benefits, Supplemental Security Income, and
Medicare, and
- Enroll
for Medicare,
The address and telephone number of your local Social
Security office can be obtained by calling (800) 772-1213. You can also locate
a local office online at www.ssa.gov.
You are the spouse of the worker if, when he or she applied
for benefits:
- You
and the worker were married, or
- You
would have the status of a husband or a wife for that person’s personal
property if they had no will, or
- You
went through a marriage ceremony in good faith, which would have been
valid except for a legal impediment.
Substantial Gainful
Activity is the dollar amount that a disability beneficiary may earn
each month while simultaneously maintaining eligibility for benefits.
Currently, the SGA amount for 2022 is $1,350.00. Individuals who work and have
earned gross monthly income exceeding the SGA threshold are not considered
disabled and are ineligible to receive
benefits.
A Federal supplemental income program funded by general tax
revenues (not Social Security taxes). It helps aged, blind, and
disabled people, who have little or no income by providing monthly cash
payments to meet basic needs for food, clothing, and shelter.
Survivor Benefits
Social Security Disability benefits based on your record (if
you should die) are paid to:
- Your
widow(er) age 60 or older, 50 or older if disabled, or any age if caring
for a child under age 16 or who became disabled before age 22
- Your
children, if they are unmarried and under age 18, under 19 but still in
school, or 18 or older but disabled before age 22
- Your
parents if you provided at least one-half of their support.
A special one-time lump sum payment of $255 may be made to
your spouse or minor children.
A TERI case is a critical case involving a terminal illness
that requires additional special handling and tracking to ensure that it is
expedited. TERI cases include any case involving:
- an allegation that the claimant's illness is
terminal,
- an allegation or diagnosis of AIDS,
- a claimant registered in a hospice or receiving
hospice care at home,
- a claimant with a condition which medical records
indicate cannot be reversed and is expected to end in death.
The presence of one of the above criteria does not mandate a
finding of disability. The impairment(s) must be fully evaluated.
Trial Work Period
(“TWP”)
The Social Security Administration does permit claimants to
test their ability to work once they become entitled to Social Security
benefits. A TWP continues until an individual has performed “services” for 9
months (not necessarily consecutive) within a consecutive 60 month period.
Unsuccessful Work
Attempt (“UWA”)
An UWA is an effort by a disabled
individual to do substantial work that either stopped or produced earnings
below the Substantial Gainful Activity level after 6 months or less due to the
individual’s disabling condition or the elimination of the special
services or assistance that the individual needed in order to work.
Vocational experts
may testify at Social Security Disability hearings at the request of an
Administrative Law Judge. A vocational expert’s role at the hearing is to
provide testimony regarding the jobs performed by the claimant is the past 15
years and the range of available jobs for various occupations.
A person who earns Social Security credits while working for
wages or self-employment income. Sometimes referred to as the "Number
Holder" or "Worker."
You are the widow(er) of the insured person if, at the time
the insured person died:
- You
and the insured person were validly married, or
- You
would have the status of a husband or a wife for that person’s personal
property if they had no will, or
- You
went through a marriage ceremony in good faith that would have been valid
except for a legal impediment.
The minimum age for disabled widows benefits is age 50.
Got a question that you need answered? Please check out our
website at www.westcoastdisability.com. We try to
provide you with valuable information on our website that may help you navigate
the Social Security Disability process. Also, feel free to shoot us an email at megan@westcoastdisability.com
or call us at
(800) 459-3017.
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