Many illnesses and injuries are disabling; these include congestive heart failure, advanced cancers and kidney diseases. However, there are a few medical conditions that become critical with age or residual illnesses that become acute over time and eventually become disabling. For example, an employee may have suffered from a back injury years ago. But, he failed to recover from it and reached a point where the pain made it almost impossible for him to work. That person could be eligible for benefits of disability even though the injury or illness wasn’t disabling in the beginning.
Disability benefits to workers may be provided under Social Security disability. Since the government runs this program, it has several qualifying regulations and rules. To receive benefits under Social Security disability program, these three conditions need to be true:
- The worker has a mental or physical impairment
- The impairment prevents them from doing gainful work of any kind
- The disability has lasted a minimum 12 months or is expected to last for the same amount of time or it is expected that the person will die from the disability
These terms may be interpreted differently by different people. The courts and Social Security has, therefore, developed guidelines regarding specific qualification for disability. Proving the disability is often extremely difficult. In preparing the disability claim, people should carefully examine the guidelines, discuss the case with a doctor and take help from an experienced attorney.
Table Of Contents
- Mental or Physical Impairment
- Gainful Work
- Lasting Disability
- Disability Freeze
- How the Administration of Social Security decides that the Individual has a Disability?
Mental or Physical Impairment
The general rule about disability is that if a condition that’s preventing an individual from working isn’t medically substantiated i.e. it cannot be discovered by doctors and described by them, then it isn’t considered a disability. In order for an individual to prove that they have a medical condition, when they file their disability claim, they should bring detailed records from the doctor and their statement; or from clinics and hospitals where they have been provided medical treatment. The records should describe the condition that is preventing them from working and also discuss how the limitations affect the individual. In addition, the records should state that the disability is likely going to last for a minimum of 12 months.
When an individual applies for Social Security, the Social Security will consider whether their condition is preventing them from working in the same job that they had before they become disabled. If the disability is preventing them from performing their usual job, the next thing that’ll be decided by Social Security is that whether they can do any sort of gainful work. Gainful work is defined currently as any kind of job that gives a salary of USD 1,180 or more per month.
The education, work experience, training and age of the individual will be taken into consideration when determining this as well the practicality of acquiring/learning new skills required for another job. It’ll be evaluated by the Social Security whether the individual is capable of earning from any sort of work and whether there are any jobs for the individual where they live.
Even if the condition is serious or has completely disabled the individual, the individual won’t be eligible for Social Security disability benefits unless their condition has at least lasted for a period of 12 months or it is expected that the condition will last for the same time period. Benefits will also be provided if it’s expected that the condition will result in the death of the individual. Even though the requirement is 12 months, the individual doesn’t have to wait a year to apply.
If the medical condition is indeed disabling and the doctor has predicted that it’s going to last for a minimum 12 months, the individual may be eligible for Social Security disability. After the person has started receiving benefits and the disability of the individual doesn’t last for one year, Social Security can’t ask them to return the money. The individual won’t be penalized if they recover sooner than a year since the expectation was that the illness is going to last for a minimum 12 months. However, Social Security carries out continuing reviews of disability and may terminate the benefits of the individual later.
The average income of an individual over the working years is used to determine the total amount of their disability and retirement benefits. If, after the disability, the individual is earning a lot less than they were before, then those earning may pull their average income down resulting in less payments by Social Security. However, if the disability of a person led to them earning lower wages, then disability freeze may be put by the Social Security on their earnings record. Disability freeze allows an individual to continue working and collecting their lower income without it having an impact on their lifetime average income.
How the Administration of Social Security decides that the Individual has a Disability?
The process used by the administration of Social Security for deciding whether an individual is disabled and entitled to benefits is as follow:
1st Step: Is the Individual Working?
If a person is working and their earnings average over USD 1,180 a month, then they aren’t considered disabled.
2nd Step: Is the Individual’s Condition Severe?
The claim of an individual will be considered only if their condition is severe enough to interfere with their work related activities.
3rd Step: Is the Disability of the Individual Listed in Disabling Conditions?
A specific list of disabling medical conditions is maintained by Social Security. If the condition of an individual is listed there, it automatically means that they’re disabled. If not, the administration of the Social Security will decide if the condition of the individual is equal in severity to a condition in the list.
4th Step: Can the Individual Carry Out the Work They Did Previously?
If the condition of the individual isn’t equal in severity to any condition on Social Security’s list, then the administration can determine if their condition interferes with their ability to carry out the same work they did previously.
5th Step: Can the Individual Perform any Other Work?
If an individual cannot do the same work they did previously, the administration of Social Security will determine if they’re capable of doing a less mentally or/and physically demanding job.