IMPORTANTS SSA TERMS Flashcards
WHAT IS THE SOCIAL SECURITY DISABILITY PROGRAM
Social Security Disability is a program jointly administered by the state and federal governments that provides monthly ash benefits and medical assistance to individuals determined by the Social Security Administration (SSA) to be disabled and unable to perform any work activity. The SSA itself is a federal agency.
WHAT IS THE DEFINITION OF DISABILITY?
Federal law defines disability under the Social Security program as the inability to perform Substantial Gainful Activity (SGA) due to any physical or mental impairment. The impairment is not considered totally disabling unless it has or is expected to last for at least twelve months or result in death. To meet this definition, one must have a severe impairment that prevents them from performing work in the national economy.
WHAT IS SUBSTANTIAL GAINFUL ACTIVITY (SGA)?
Substantial Gainful Activity (SGA) is defined as work on a full or part-time basis in which an individual earns a monthly income equal to or greater than a limit determined by the SSA. If, for example, the SGA level is $1100 per month and a person’s disability only enables them to earn $850 per month, that person is below SGA and may be financially eligible to apply for disability benefits. The SSA calculates the SGA earnings ceiling. It takes into consideration inflation and other economic factors, so it changes from year to year.
WHAT IS A SEVERE IMPAIRMENT?
A severe impairment is a physical or mental disorder supported by medical evidence. The impairment also prevents a person from functioning normally in an ordinary working environment. If the impairment does not interfere with the claimant’s ability to perform work, it is considered not severe as defined by the SSA.
WHAT IS NOT-SEVERE IMPAIRMENT (NON-SEVERE)?
This term means that even when the claimant’s impairments are considered together they are still not sufficiently restrictive that it would rule out work.
HOW LONG MUST THE IMPAIRMENT LAST?
Unless the impairment is expected to result in death, it must last or be expected to last for twelve consecutive months. This requirement is called the duration requirement and is important part of the SSA’s definition of a total disability.
WHAT IS THE SEQUENTIAL ANALYSIS?
Sequential Analysis is a step-by-step process used to evaluate a Social Security disability case. The purpose of sequential analysis is to determine if an impairment meets SSA’s definition for total disability.
ADJUDICATION
A disability case is said to be adjudicating when moving through the Social Security disability process. When a decision is made, the case is said to be adjudicated.
ADMINISTRATIVE LAW JUDGE (ALJ)
Usually an attorney who holds case decision hearings at the 2nd or post reconsideration appeal level.
ALLEGATION
This term Allegation refers to the medical impaarment claimed by the applicant. For instance, the claimant alleges to be totally disabled as a result of diabetes. An alleged impairment must be severe and must be supported by acceptable medical evidence. The Advocate should allege any impairment that significantly reduces a claimant’s physical or mental capacities.
CLAIMANT
The person who is applying for disability benefits.
CLOSED PERIOD
A claimant is found to be not disabled at the time the case was adjudicated. However, the claimant did suffer one full year of total disability. That full year of disability is referred to as a closed period. the claimant may be eligible to receive benefits for this period of time.
CONTINUING DISABILITY REVIEW
The process by which the SSA reevaluates the severity of a claimant’s impairments to determine whether there has been a significant medical improvement. If medical improvement which would allow work can be shown on review, the claimant will be removed from benefits.
WHAT IS ACCEPTABLE MEDICAL EVIDENCE?
Acceptable Medical Evidence is any evidence that the SA can use to make a final decision in a disability claim. Any evidence submitted by a licensed physician, psychologist, psychiatrist, osteopath, optometrist, or ophthalmologist is considered acceptable for determining a disability case. Authorized summaries of medical records from hospital, clinics, sanitariums, and other medical institutions are also acceptable for case analysis.
Chiropractic and non-medical holistic sources are not considered acceptable medical sources for determining disability. However, these sources can be useful in giving a full picture of a claimant’s symptoms and real-world capabilities.
WHAT IS AN ALLEGED ONSET DATE?
the Alleged Onset Date (AOD) is the date the claimant provided as the date when the impairment began or the date it forced them to stop working. SSA uses the A(OD to determine the approximate date for requesting medical evidence in a case. SSA will generally request medical evidence dated from around the AOD to the present.
WHAT IS AN ESTABLISHED ONSET DATE?
The Established Onset Date (EOD) is the official date of onset of an impairment established by SSA. The AOD and EOD are usually the same, but they can be very different.
EX: A client injures himself on a given day and can no longer perform his customary work. The date of injury and the day he stops working is the same onset date or AOD. However, the claimant heals somewhat and can return to work for several weeks at full pay. After a few weeks, the claimant’s previous injury worsens and forces him to stop working. While the AOD (date of injury) remains the same, the EOD will be the second date the claimant stopped working. SSA will use the EOD to establish when benefits should be awarded. A claimant’s disability benefits will be calculated from the EOD, not the AOD.
WHAT IS THE 20/40 RULE?
For a person to be eligible to apply for SSDI benefits, they must be currently earning less than the SGA and must also meet the 20/40 rule. The 20/40 Rule refers to the total number of quarters a person must have worked in the past ten years in order to be insured under the SSDI program.
WHAT IS A CONCURRENT CASE?
A Concurrent Case is a Social Security disability claim involving an individual applying for SSI and SSDI benefits simultaneously. To apply for benefits concurrently, the claimant must meet the 20/40 rule and SSI income criteria.
WHAT IS A CONSULTATIVE EXAMINATION
A Consultative Examination is a physical or mental examination of a claimant at the request and expense of the SSA. A representative can ask SSA to schedule a consultative examination if they feel that the available evidence is not enough to show the full extent of the claimant’s conditions.
WHAT IS A DIARY DATE?
The term Diary Date has two meanings within the SSA disability process.
- The date when a claim is re-evaluated after benefits are allowed.
- The medical hold date. The medical hold date defines the time interval an agency holds a claim to determine the outcome of a medical procedure before making a final decision. This situation usually occurs in conditions like an acute heart attack where the SSA will wait three months to determine if the claimant is recovering. If there is no improvement, the case will be processed as usual.
WHAT IS A “DATE LAST INSURED”?
The Date Last Insured (DLI) is the last date a person was insured to receive SSDI benefits. If an applicant has not worked in five of the previous seven years at the SGA level, they may have a DLI in the past.
The claimant with a DLI might not be eligible for current benefits unless they declared a disability on or before the DLI. If a person has a DLI in the past, they are eligible to apply for benefits from the original onset date to the DLI. In an SSDI case, the client must be found disabled on or before the DLI to receive benefits.
If you find yourself working on a case with a DLI in the past, you need only be concerned with medical evidence dated on or before that DLI date. The Date Last Insured, like case types, is determined by the SSA.
MEDICAL LISTINGS
Lists of rules giving the medical criteria that must be fulfilled for benefits to be granted without consideration of age, education or work experience.
MEET THE MEDICAL LISTINGS
A case is said to meet the medical listing if the impairment meets SSA’s definition of disease severity. You can find SSA’s severity of disease definitions in the SSA listing manual.
EQUALS THE MEDICAL LISTINGS
To meet a listing, one must have the same signs and symptoms outlined in the Medical Listings Guide. If a person’s signs and symptoms are equivalent to the listings, that person equals the listing. You can find SSA’s disease definitions in the SSA listing manual
MEDICAL CONSULTANT
A medical doctor, osteopath, or psychologist who works under contract or as an employee of a state agency (DDS), or who works in some similar role in some other level of the SSA.
PRIMARY DIAGNOSIS
The most severe impairment that affects a claimant’s ability to perform work.
SECONDARY DIAGNOSIS
The second most severe impairment that affects a claimant’s ability to perform work.
WHO CAN APPLY FOR BENEFITS?
Any American citizen aged one month to sixty-four-and-one half years of age may apply for SSA disability benefits. They must be suffering from a severe physical or mental impairment. With the exception of child cases, the impairment must prevent the applicant from performing SGA-level work. In child cases, the impairment must prevent the child from performing age-related or age-appropriate activities.
WHAT IS A WAITING PERIOD?
The actual starting date for cash benefits is the onset date minus the six-month waiting period. (We don’t know for sure, but perhaps the SSA invented this period hoping most people would return to work or at least medically improve within six months, saving taxpayer dollars.)
In any event, if the onset date is 1/1/10, the Advocate’s fee will be based on the 1/1/10 onset date minus the six-month waiting period. The actual amount owed to the Advocate is determined by SSA using factors such as the claimant’s EOD and income history.
WHAT IS AN SSDI CASE?
Few people realize that when they pay Social Security premiums each month from their paychecks, they are also paying a Social Security Disability Insurance premium (also referred to as the Title Two Program). This program ensures those paying into the system making them eligible for SSDI.
WHAT IS AN SSI CASE?
The second most common disability case type is the Supplemental Security Income, or Title Sixteen Program. Anyone, child or adult, who is claiming disability, may apply for SSI benefits. As in all disability cases, the applicant must be impaired and unable to work or perform age-appropriate activities. However, in an SSI case, the applicant must also be without income or resources.
The SSA determines case types and income requirements. However, SSI and SSDI cases are medically evaluated in exactly the same way.
WHAT IS A DISABILITY HEARING OFFICER?
A Disability Hearings Officer (DHO) is an experienced Disability Adjudicator who interviews claimants during the appeals process. The Office of Hearings and Appeals is an office or building used for these activities. During the Reconsideration Appeal, the DHO may be located at the District Office. The Adjudicative Law Judge hearing will be most likely held remotely or at a Hearings and Appeals Office.
WHAT IS A VOCATIONAL ANALYSIS?
Vocational Analysis is the process used by SSA to determine the claimant’s ability to perform work. Vocational Analysis compares the claimant’s remaining ability to work – Residual Functional Capacity, with the availability of work at their activity level in the national economy.
RESIDUAL FUNCTIONAL CAPACITY (RFC)
Residual Functional Capacity (RFC) is a claimant’s remaining ability to function despite their impairments. The lower the RFC, the more likely the client will be found disabled.
SUBSTANTIAL GAINFUL ACTIVITY (SGA)
Earning level too high to be eligible for disability benefits. The amount that you can earn without losing benefits is increased yearly.
WHAT IS A CASE ASSESSMENT?
A case assessment occurs when an advocate estimates the strength of a potential client’s claim prior to accepting the case. An assessment is performed by weighing several cse characteristics to determin the probability of winning the case.
WHAT IS CASE DEVELOPMENT?
Case Development is the process of acquiring the claimant’s medical and vocational evidence to determine the extent of disability.
WHAT IS A CASE EVALUATION?
A case Evaluation is when the Advocate reviews all available medical evidence to create a case strategy and formal argument on the client’s behalf.
THE TRIAL WORK PERIOD (TWP)
After a claimant has been found eligible for disability benefits they are also entitled to receive a trial work period at any time during the disability period. The provision of the trial work period allows the claimant to work up to nine months above SGA and still collect disability benefits. The TWP provision is significant from a vocational rehabilitation standpoint because it encourages claimants to return to work.
If a claimant completes the full nine months of the TWP without problems, the SSA will discontinue their benefits after two additional months. In many cases, this early financial support will allow a claimant to get back on their feet and re-enter the workforce.
DE NOVO DECISION
The De Novo indicates that the decision made was not based on a prior disability decision.
ADVANCED DESIGNATION
Advance designation allows ou to elect up to three individual who could serve as a representative payee for you if the need ever arises.
BAPTISMAL CERTIFICATE
An official religious record of your birth or baptism. In some situations, we can use a baptismal certificate to establish your age.
BASE YEARS
In initial computation, a worker’s (wage earner’s) base years for computing Social Security benefits are the years after 1950 up to the year before entitlement to retirement or disability insurance benefits. For a survivor’s claim, the base years include the year of the worker’s death.
COMPUTATION YEARS
Computation years are the years with highest earnings taken from the base years. We add total earnings for the computation years and divide by the number of months in those years to get the AME or the AIME. (We use your 35 highest years of earnings to compute your retirement benefits.
DECISION NOTICE
When a person applies for Social Security, SSA decide if benefits are paid. The most common decision notices in the disability program are the Personalized Denial Notice (PDN) and the Allowance Notification.
FICA TAX
FICA stands for “Federal Insurance Contributions Act.” It’s the tax withheld from your wages that funds the Social Security and Medicare programs. Paying this tax is what makes a claimant eligible to apply for and receive SSDI benefits.
INSURED STATUS
If you worked and earned enough Social Security credits to be eligible for retirement or disability benefits or for your dependents to be eligible for benefits due to your retirement, disability, or death, you have insured status.
REPRESENTATIVE PAYEE
If a person receives Social Security benefits or Supplemental Security Income (SSI) and becomes unable to handle their own financial affairs, SSA appoints a relative, a friend, or an interested party to handle their Social Security and financial issues. A claimant (adult) also has the right to designate in advance up to three individuals who could serve as their payee should the need arise in the future. Representative payees are required to maintain complete accounting records and periodically provide reports to Social Security.
RES JUDICATA
This term refers to claimants whose application has been denied on the initial or reconsideration levels. Res Judicata implies the right of the applicant to appeal their case to an ALJ hearing. The applicant or representative also has the right to inject new allegations or evidence into the case for SSA consideration.
DURATION
How long a claimant has had an impairment(s) severe enough to qualify for Social Security disability benefits.
EMERGENCY PAYMENT
As part of a presumptive disability decision in an SSI case, a person under extreme hardship can be issued emergency payments. These payments must be paid back over time by the claimant.
EXTREME HARDSHIP
This term means that without the emergency payments, the claimant’s immediate health and safety are at risk.
IMMEDIATE PAYMENT
The SSA will issue immediate payments through a Field Office in critical cases within 24 hours. These payments can be made to both SSE and SSDI claimants who qualify. To qualify, the claimant must have a financial emergency. The claimant must already be on SSI or SSDI benefits.
PROJECTED RATING
The opinion of the SSA about the level of residual impairment severity that is expected to exist 12 months after the onset of allowance level severity. Allowance level severity must persist 12 months before benefits are granted. Such a projected rating could result in either allowance or denial, depending on medical findings.
PRESUMPTIVE DISABILITY (PD)
A privilege of SSI/Title 16 claimants in which they can receive benefits (and sometimes Medicaid) for up to six months before a final decision is made on their SSA disability claim.
HIGH POTENTIAL FOR A PD
SSA is most likely to grant presumptive disaability for the following impairments:
Cancer
Paralysis
Mental Retardation
Central Nervous System Diseases
Kidney Disease
HIV Infection
Congenital Disorders
CAUTION IN GRANTING A PD
SSA uses caution in granting PD in the following disabilities because of the difficulty in predicting severity or duration of the impairment:
Diabetes
Epiliepsy
High Blood Pressure
Peptic Ulcer
Cirrhosis of the Liver
Fractures
Acute Injuries
LOW POTENTIAL FOR PD
SSA rarely authorizes presumptive disability payment fort the following disorders:
Drug Addiction
Mental Impairments
Breathing Disorders
Back Disorders
WITHOUT REDACTION
Means that the evidence was edited or otherwise changed in any way.
