Social Security Disability Benefits are widely misunderstood.  This is certainly no surprise, as few Americans consider the possibility of becoming disabled and unable to work. But when the unfortunate happens friends, doctors and other professionals often suggest filing a claim for social security disability insurance benefits. Pursuing the path toward disability, however, raises a plethora of questions: what does it take to qualify for social security disability? Can I still work?  Can I get a partial disability?    Do I have to hire a lawyer?  Is my doctor’s opinion important?

Before we clear these issues up, let’s be clear about the disability benefits we are talking about. We are only addressing social security disability insurance benefits. We are not addressing Supplemental Security Income (SSI), a welfare program for the disabled that do not have a sufficient work history).

Disability is defined under the Social Security Act as follows:

“The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

That’s a dry and dense “legalese” sentence. Lets break it down into English:

  • You Can’t be Working

It is possible to work at such a minimal level that social security will not consider it be to “substantial gainful activity”, but social security may be skeptical in such cases and worry that you are artificially keeping your work activity to a minimum.

  • Inability to engage in any substantial gainful activity (SGA)

“Any” me “any”.  No reduced hour jobs.  No alternative, simple or menial jobs.   Folks are often surprised to find that they are not disabled under the Social Security Act even though it is clear they cannot perform their chosen profession if they could do low pay, low skill work.  For example, the airline pilot who is unable to maintain his FAA license due to a heart condition is not disabled if he could do a wide range of light or sit-down jobs.

  • Your inability to work has to be the result of a “medically determinable physical or mental impairment(s)”

This just means that you need to have a legitimate illness diagnosed by a medical professional.  No disability due to an alien virus implant when abducted by aliens will do (though a mental disability would be a strong possibility).

  • Disability Lasts or is Expected to Last at Least 12 months or End in Death.

Another surprise to many.  Social security disability insurance benefits are not available for a “short-term” disability   A disability that lasts only 11 months, for example,  will not be approved.  Terminal diseases like cancer do not have the 12 month requirement.  In this of the 12-month rule, many legitimately disabled Americans may decide to wait the 12 months before filing their disability claim.  This is a big mistake, because the disability assessment system is so backlogged that many claimants are waiting several years to get their disability. Moreover, disability claims based upon degenerative conditions like arthritis are often approved even though they have not lasted 12 months, since it is reasonable to conclude that they will last at least 12 months.

Disability must begin while “Fully Insured”

Social Security Disability Insurance benefits require “fully insured status” at the time the disability starts.  Most people have little worry about their insured status, saying they that “have paid into social security” all their lives. But social security disability benefits have an additional “insured status” requirement beyond “paying in the maximum”:  you also must have paid at least 20 quarter of coverage in the last 40 quarters. This work out to a requirement that in general you must have been working and paying FICA taxes at least 5 of the past 10 years.  Therefore, delaying a social security disability insurance applications for a long time can be detrimental.

Functional Limitations

Securing social security disability benefits centers upon the functional limitations resulting from your medical or mental condition, as well as your ability to sustain work-activities during a normal 8-hour work day.    The ability to stand, walk, lift, carry, sit, stoop are all important in determining disability.  The opinions of treating doctors are important, but the conclusory short doctor letters that many disability claimants secure stating that their patient is “permanently and totally disabled” are of limited value.  The social security administration reserves the right to determine if one if “disabled”.  Doctor supporting documentation that address the specific functional limitations results from the medical condition are more helpful.

Working While on Social Security Disability

Deciding to file a claim for social security disability benefits can be a big decision.  You should realize you are able to leave the disability rolls if you improve and can return to work. Social security regulations have attempted to provide those on the disability rolls with incentives to try and work. They are complicated and many Americans on disability create problems for themselves without a clear return to work strategy. These rules are designed to assist claimants in returning to work; they are not designed to help disability recipients supplement disability benefits through work.  Working part-time to supplement disability benefits is dangerous, and can lead to “overpayment” situations or worse, a termination of disability benefits.

There are many lawyers and non-attorney representatives that handle social security disability cases exclusively.  Most will provide a no-charge consultation.  These social security disability lawyers charge a fee only if they win the case and past due benefits are received.