What Does Disability Mean to Social Security?

Disability May Not Mean What You Think It Means

The word “disability” has a very specific legal meaning under the Social Security laws. To the average person, this can be confusing because Social Security’s definition may be different than the definition of disability under other disability laws and programs, such as worker’s compensation, temporary disability programs, long term disability insurance, special education programs, the Americans with Disabilities Act (“ADA”), the Department of Veteran Affairs, or the Division of Motor Vehicles definition when you obtain a handicapped plate. In fact, what your treating doctor or therapist thinks is a disability may not be the same as Social Security’s definition.

In other words, even if you are considered disabled by another government agency, insurance program or medical professional, this does not always mean you are disabled for Social Security benefits. If you are considering applying for disability benefits, you should not be discouraged by this information though because the fact that you were found disabled under some other program or by your own doctor may still be useful as partial evidence of your disability.

There are also non-medical and financial eligibility requirements for Social Security Disability Insurance (commonly referred to as “SSDI”, “SSD”, “Disability Insurance Benefits”, or “DIB”) and Supplemental Security Income (commonly referred to as “SSI”) benefits. The requirements are detailed and are beyond the scope of this article. This article is specifically only meant to address the medical eligibility requirements.

The Less Legal Explanation of Disability

Generally, Social Security will consider you disabled for both SSDI and SSI benefits if you meet all of the following criteria:

  1. you are not working or you are working but your earnings are limited (the earnings limit is set by the Social Security Administration, and for 2011, the limit is $1,640 if you are blind and $1,000 if you are not blind);
  2. you have severe medical conditions that are expected to last for 12 months or more, or are expected to result in death;
  3. your severe medical conditions significantly interfere with your ability to work;
  4. you can not perform the jobs you used to have; and
  5. you can not learn how to perform other less physical jobs, even if you never had any other jobs in your life (for example, even if you never worked in an office before, if Social Security thinks you are able to meet the physical requirements of a file clerk and they think you can be retrained to work in an office, then you will not be considered disabled.).

You generally have to meet all of the criteria listed in order to be found disability. However, depending on the type of medical condition you have and its severity, you may be eligible for disability benefits even if you have the skills to perform certain types of jobs as long as your earnings are limited.

Rules-of-Thumb

Below are some rules-of-thumb that may help make Social Security’s definition of disability more meaningful to you.

Scenarios where you may be found disabled

  • You may be found disabled based on having only one medical condition or on the combined effect of multiple medical conditions.
  • You may be found disabled based on having a physical and/or psychiatric medical condition.
  • You may be found disabled even if you have a poorly understood medical condition, such as fibromyalgia, migraines, or chronic fatigue syndrome. However, in these cases, there is probably a higher chance of being denied on the initial application, but with the right evidence, you may still be able to be found disabled on an appeal.
  • You may be found disabled, even if your medical conditions do not prevent you from working, but the treatments to control your medical conditions prevent you from working. Treatments like radiation therapy or chemotherapy with debilitating side effects, surgery with a very long rehabilitation time, pain medications that cause drowsiness or difficulty concentrating, or treatments that require regular overnight hospitalizations can all be considered by Social Security to find you disabled.

Scenarios where you probably will not be found disabled

  • You probably will not be found disabled, if your medical condition(s) will prevent you from working for less than 12 months. This is because Social Security disability was designed to cover only long term or permanent disabilities.
  • You probably will not be found disabled, if your medical conditions are under control with treatment and your treatments do not cause side effects that would prevent you from working. The Social Security system is concerned with the severity and frequency of the limitations caused by your medical conditions and treatments, not just having a medical condition, so if you are still able to work with proper treatment, you are not disabled.
  • You probably will not be found disabled, if you are able to work but you are having a hard time finding a job because of high unemployment. This is because Social Security was not meant to be a substitute for the unemployment insurance system. However, if you have significant impairments caused by severe medical conditions and you or your doctors are not sure if you are able to work, you may want to file an application for disability benefits or have your case evaluated by a Social Security disability lawyer.

Facts that are commonly (but incorrectly) thought to automatically prove disability

  • You are not automatically disabled if your medical conditions limit you to work that will pay less than your old job, even if your disability benefits would be higher than what you could earn in a lower paying job. When the Social Security Disability Insurance laws were first enacted in 1956, a fundamental concept was that a disability should be “totally” disabling. If you are still able to earn some money and it is over the earnings limit, then you would not be totally disabled. However, this analysis can be complicated and other factors, such as your age, past work experience and education, could still lead to an award of disability benefits.
  • You are not automatically disabled if you can not obtain health insurance. Unfortunately, the laws did not include the availability of health insurance as a factor to consider when Social Security makes a disability determination.
  • You are not automatically disabled if your medical conditions prevent you from driving. Under current interpretations of the law, the ability to drive may be considered as a factor when evaluating your case, but the inability to drive is not absolute proof of disability because there is typically a presumption that if you are still able to walk to work or to use public transportation, you are able to make it to work. However, why you are unable to drive is something Social Security will consider when evaluating how severe your limitations are

Although this is not a strict legal interpretation of Social Security’s definition of disability, hopefully, this will give you a general idea about what Social Security is looking for.

What To Do When Facing A Social Security Disability Judge

There are so many reasons as to why people apply for social security disability benefits. Unfortunately, not everyone who applies enjoys an approval and you might be among the lucky ones who manage to file for a hearing before a judge successfully and actually win your case. When you finally get your appointment to the court, you want to make sure that you present yourself in the best way possible to increase your winning chances. Here are a few pointers of what you can do to help you get the best results from the disability hearing.

Dress the part – Just because you are dressing for social security disability does not mean that you should appear pitiful and desperate. Take time to dress up and look presentable because what you say and the documents you have to present is what will make all the difference in the hearing and not how you look. Dressing your worst to attract sympathy will only come out as a lack of respect and not one will actually take you as seriously as you expected them to. At least wear clean clothes that are well-ironed, even if they are not that formal.

Be there on time – Remember that the hearing could have taken a long time to come along and this could be your only chance to get what you really deserve. It is therefore only reasonable that you make sure you are on time for the hearing. It is actually best that you are there several minutes before the scheduled time for the hearing.

Be honest – The best way to increase your chances of winning your disability claim is being as honest as possible even when you feel that some truths could hurt the claim benefits in a way. When you choose to lie to the judge, the effects could be worse when the truth manages to seep out. It is better to win something than have the claim denied completely just because of a lie you choose to tell.

Try and be a very good listener – Interrupting the judge reviewing the case is not only annoying, but can actually also anger them and lead them to making a quick decision that may not be the best. Listen to questions carefully and understand what the judge is asking before providing them with an answer. Avoid being rude at all but feel free to ask for more time to explain your case in details if you feel the judge is not doing that.

Give an ear to your lawyer – Most disability cases are handled by attorneys and you may have one to ease out the process for you. If you have a lawyer representing you then make sure that you listen to them before the hearing. The truth is that most know what kinds of questions will be asked during the hearing and will take you through them and help you know how to approach the questions to finally enjoy the reward that you truly deserve.

What Type of Disability Insurance Is Right for Me?

In the event of an accident, injury or illness that prevents you from working, disability insurance provides you with a percentage of your income. But not every disability insurance policy is the same. In fact, almost all of them will compensate different percentages of your income (generally between 50 and 70 per cent), along with different elimination periods and benefit periods. Elimination periods refers to the length of time to wait before your benefits kick in. Benefits periods refers to the length of time benefits will be payable, which depends on your disability and the policy you take out.

Most plans have a start date ranging from 30 days to 120 days after a disability has occurred. Coverage generally focuses on sickness or injury, and your plan cannot change without your permission until you are 65 years old.

In general, experts agree that disability insurance is a must for people, whether you are on a group plan with an employer or you take out an individual policy for yourself. But with so many plans available, it is important to understand the differences among each. Here's a breakdown of the major disability insurance types available:

• Group Disability Plans: This is the most common type of disability insurance plan and they are typically offered through your employer. The lowest tier of group coverage is often focused on affordability, which is beneficial, but it does mean that the benefits and payouts can vary drastically. Bear in mind that group plans generally will not cover your income levels significantly, and this can be difficult in times when you cannot work. They also often have monthly or annual caps on the dollar amount that will be paid, and set up maximum timeframes that may be shorter than what you require. Group plans should always be read carefully since you can often discover that what you may have thought you would be getting is quite different from what you actually get.

• Individual Disability Plans: If you are without a group plan or do not like your group plan, you can always opt for an individual disability insurance policy. Without a group, pricing is often very different and will be tailored to your unique situation and needs, which can be both a benefit and drawback. In general, plans are cheaper if you are young, healthy, and work a low-risk job compared to if you are older, in poor health, or work a job that is considered high risk for disability. Still, looking at your individual options means that you could find a plan that fits your needs, wants and budget more-so than a group plan. Doing the research could result in a better policy and position for yourself.

• Creditor disability insurance: Disability insurance is now commonly attached to debts, like car loans, leases, mortgages and lines of credit. With creditor disability insurance, your financial institution buys a group policy, and you become part of the policy when you take out a loan with that institution. These policies make loan payments on your behalf rather than sending the money directly to you.

While group plans are less expensive in general, individual plans offer better coverage and can be tailored to your specific needs, including better terms and conditions when compared to a group plan. Remember that premiums, terms and conditions are locked in until you turn 65, unless changes are made with your express permission. Individual plans are an excellent option for self-employed individuals, as well as professionals and executives, since they can have an "own occupation" definition of disability. That means an insurance company cannot force you to work in another occupation based on your experience and training, an important feature for many professionals. Professionals should be wary of association disability plans, since terms, conditions and rates for these group policies can change at any time, and often do.

If you are in need of disability insurance, be sure to do your research on any policy you take out or are currently under.