September 2014

How disability payments are calculated


Determining benefit awards

Seeking Social Security Disability benefits can be an arduous task, as any Chicago Social Security attorney knows. Before applying for benefits, many people in Illinois want to know how much support they may qualify for. Prospective applicants can start by understanding how base benefits are calculated and why those awards may be adjusted.

Benefit calculations

SSD benefits are awarded based on personal earnings records. Financial need and the severity of the disability are not taken into account. If an individual paid Social Security taxes during a job, the employment is included in the earnings record. Work for employers that do not pay Social Security taxes, such as government agencies, is excluded.

The SSA calculates an individual’s average monthly earnings to determine whether the individual qualifies for SSD benefits. In 2014, the SSA counts $1,200 of income as a credit and requires individuals to have 40 credits. Applicants also must have earned half of their credits during the decade before disability onset.

To determine the benefit amount, the SSA uses an income-weighted system. Several resources can help people estimate SSD benefits under this system, including:

  • Benefits calculators. These are available on the SSA website and allow individuals to enter earnings history to generate estimates.
  • Social Security statements. These are also accessible through the SSA website. Each statement includes an estimated benefits section, based on the SSA’s earnings record.
  • Direct contact with the SSA. Applicants can call a local office and get an estimate from a representative.

Besides using these resources to estimate base benefits, individuals may want to consider factors that could increase or reduce their benefits.

Variables affecting benefits

The benefit amount may be decreased if an individual receives other government-regulated disability benefits, such as state disability or workers’ compensation. Public disability benefits are capped at 80 percent of the individual’s income. However, other benefits, including private disability insurance and VA benefits, will not affect the SSD benefit.

Some individuals may qualify for greater awards in the form of back payments or retroactive benefits. Back payments cover the gap between the SSD application and approval dates. Retroactive benefits address the gap between the disability onset and application date.

The mandatory waiting period for disability claims is 5 months. Therefore, back payments are not made if processing took less than 5 months. Similarly, retroactive benefits are not available if the disability began within 5 months of the application date.

Retroactive benefits can cover up to 12 months before the date of application. However, the SSA assumes that the application date is the disability onset date. Establishing an earlier onset date can be difficult; individuals planning to challenge the onset date may need to seek assistance from an attorney.

Preventing the loss of Social Security Disability benefits

Adult Male Ponders Future Looking Out Rain Covered Window


Loss is a legitimate risk

Qualifying for Social Security Disability benefits can be challenging, as any attorney Social Security can attest. Many Chicago SSD recipients know this but underestimate the difficulty of keeping their benefits. Unfortunately, individuals who are still disabled may face benefit loss after various life changes. People receiving benefits should understand what factors frequently result in this outcome and what measures can help prevent it.

Triggers for benefit loss

The SSA may stop benefits due to changes in a recipient’s medical condition, employment status or living arrangement. Changes in living arrangements include entering institutions such as nursing homes, becoming incarcerated and reaching retirement age. Losses relating to living arrangements often are unavoidable.

Medical improvements can lead the SSA to determine that an individual is not disabled. The SSA conducts disability reviews every three to seven years to determine whether a condition is still disabling. A review can also be triggered if one of the following things happens:

  • Medical evidence shows the condition improving.
  • The individual reports a medical change.
  • The individual breaks from the prescribed treatment plan.
  • Medical advances lead to new treatments.

Even after medical improvement, the SSA may find an individual disabled. However, if the SSA believes the individual can work, benefits will cease.

Resuming employment can also cause benefit loss. If an individual starts working while receiving benefits, this could trigger a continuing disability review and subsequent benefit loss. If the individual starts earning more than $1,070 monthly, he or she loses eligibility for benefits.

There is one exception to this earnings limit. Current benefit recipients may participate in a “trial work period” and work for a set period without losing benefits eligibility. If an individual’s monthly earnings exceed $770, the SSA usually considers the employment a trial work period. During the 9-month period, the individual continues receiving benefits. Afterward, the SSA reviews average monthly earnings to determine whether the job constitutes substantial gainful activity. If so, benefits stop.

Preventative measures

Besides recognizing these triggers, SSD recipients should take steps to prevent benefit loss. Recipients must always notify the SSA of medical changes and provide documentation to support an ongoing claim. Similarly, recipients should advise the SSA of changes in employment and discuss entering a trial work period.

If the SSA decides an individual is not disabled, the individual can ask for reconsideration. If this appeal is denied, there are three subsequent levels of appeals. Until the final decision, the individual can continue receiving benefits. However, if the SSA ultimately finds the individual is not disabled, the individual may have to pay back those benefits. Considering this, recipients facing benefit loss often benefit from partnering with an attorney.




Social Security Disability for children


Childhood disabilities create financial challenges for many families in Illinois. Unfortunately, many parents believe children cannot receive Social Security Disability benefits. Any Chicago disability attorney can explain, however, that it is possible for children to receive benefits if they and their family meet the qualifying criteria.

 Means of qualifying

There are two ways children may receive Social Security Disability benefits. First, the dependent child of an adult who receives benefits may collect benefits. Children are eligible if they are disabled, younger than 18, or taking full-time classes below grade level 12 at age 18 or 19.

Any child of a disabled adult can collect as much as half of the adult’s benefit amount. However, the SSA caps monthly benefits for families, so the award may be reduced if other children also receive benefits. Generally, SSD recipients and their family members can receive up to 150 to 180 percent of the original benefit.

A child’s benefit is also available to adults older than 18 who sustained disabilities before age 22. If the individual was able to work enough in the past, he or she could collect benefits based on a personal earnings record. Typically, though, an adult child will collect benefits based on the earning record of one parent. The parent must currently receive SSD benefits, or the child can qualify based on the record of a deceased parent.

Disabled adult children

Children under age 18 can receive dependents benefits regardless of their physical health. Disabled adult children, however, must meet the Social Security Administration’s general definition of disability:

  • The disabling condition must be expected to last longer than 12 months or result in death.
  • The individual must be incapable of performing jobs he or she has held in the past.
  • The individual cannot reasonably be expected to perform, learn, or adjust to another kind of work.

A disabled adult child can work in a reduced capacity and still receive benefits. The SSA defines “substantial gainful activity” as work with income greater than $1,070 per month. Individuals with income below this threshold still qualify for benefits. The SSA actually encourages employment among disabled adult children, by offering programs providing vocational training and assistance with expenses associated with working.

After adult child’s benefits are awarded, the SSA conducts periodic disability reviews. Benefits will stop if the individual’s condition changes and no longer prevents gainful employment. Benefits also usually cease if the recipient marries. However, the adult child may keep the benefits if he or she marries someone who also qualifies for SSD benefits.


Brain injuries: Complicated and unpredictable


Complex, debilitating injuries

As many as 2.5 million traumatic brain injuries occur yearly, according to the Centers for Disease Control and Prevention. TBI victims in Illinois may experience life-changing physical and cognitive effects, which can make living with the injury incredibly challenging. Fortunately, with the help of Social Security lawyers in Chicago, people with severe TBIs may find aid through Social Security Disability benefits.

Permanent losses

Some traumatic brain injury symptoms subside shortly after the injury occurs. These include memory problems, disturbed sleep patterns and mood swings. Unfortunately, other effects are permanent, and these lingering changes can be highly debilitating.

TBIs can have significant cognitive impacts. Victims may have trouble remembering, learning and processing information. Concentrating, planning and making decisions may become difficult. Communication can also present a challenge. A TBI victim may struggle to speak or write and understand or remember words. Some TBI survivors also have trouble interpreting tone or body language, following conversations and interacting appropriately.

A traumatic brain injury can also result in debilitating physical symptoms. These include:

  • Dizziness
  • Headaches
  • Seizures
  • Nausea or vomiting
  • Loss of strength or coordination in the limbs and body
  • Sensory loss, including tinnitus, hearing loss, blurred vision, reduced smell and reduced taste

Some of these symptoms may not surface for months. Additionally, long-term complications, including potentially heightened stroke risk, may not become evident for years.

TBI has no known cure, and determining the prognosis of a specific injury can be challenging. This makes it crucial yet difficult for individuals who cannot work to receive SSD benefits.

Seeking benefits

The Social Security Administration recognizes several conditions that can result from TBI as disabling. These include epilepsy, stroke and organic mental disorders. If an individual proves he or she suffers from one of these conditions, and the condition meets SSA severity criteria, the individual qualifies for benefits without further scrutiny.

Alternately, an individual may seek a medical vocational allowance. This allowance is granted based on the SSA’s appraisal of the individual’s ability to work despite the TBI. The SSA will grant an allowance if the individual is not fit to perform current jobs, past jobs or new types of work.

Several forms of evidence can support a claim of disability due to TBI. Physical examinations and lab tests can establish the injury and its extent. Other assessments, such as hearing and vision tests, can document physical functional limitations. Cognitive tests and observations from professionals such as neurologists and psychologists can attest to cognitive effects of the injury.

It’s crucial for victims to collect and provide extensive documentation. Many TBI effects can be difficult to detect, and the SSA maintains strict standards of proof, so poorly documented claims are more likely to be denied.



Depression may qualify for Social Security Disability


A crippling burden

Many people in Illinois struggle with depression. The National Institute of Mental Health estimates that in 2012, as many as 16 million U.S. adults suffered one or more depressive episodes lasting at least two weeks. As most disability lawyers in Chicago know, these episodes can be seriously debilitating.

Depression can be characterized by feelings of anxiety, fatigue and apathy, in addition to sadness. Many victims experience physical symptoms, including appetite changes, excessive or disturbed sleep, cramps and headaches. Some people struggle with memory, concentration and decision-making. These symptoms can interfere with daily life and ability to work. Fortunately, people with severe depression may be eligible for Social Security Disability benefits.

Defining disabling depression

An individual with depression may receive a medical vocational allowance if the Social Security Administration finds the individual incapable of “substantial gainful activity.” SGA is work yielding monthly income greater than $1,070. More directly, an individual may qualify for benefits by meeting one of two sets of criteria for affective disorders established in the SSA’s “Blue Book” of impairment listings.

The first set of requirements involves specific symptoms of depression. The individual must prove the condition causes at least two of four effects. These effects are episodes of decompensation; problems with concentration or task completion; difficulty performing “activities of daily living,” such as self-care; and inability to appropriately interact socially. Additionally, the individual must document four symptoms from the SSA’s list, which includes:

  • Physical changes, such as low energy levels, disturbed sleep, changes in appetite and weight, purposeless movements or a slowdown of physical activity
  • Emotional changes, such as feelings of inadequacy or guilt, loss of interest in most activities and suicidal thoughts
  • Cognitive changes, such as issues with thinking or focusing
  • Perceptive changes, such as hallucinations, delusions or paranoia

The SSA also allows individuals with depression to qualify for benefits under broader criteria. The individual must experience persistent, worsening episodes of decompensation and rely on a supportive living arrangement. The individual also must show that changes to his or her personal environment and daily mental demands would trigger decompensation.

Preparing the claim

Many effects of depression cannot be objectively proven, so individuals should provide as much evidence as possible. Acceptable documentation includes professional assessments, lists of medications or other treatments and records of hospitalizations associated with the depression. Applicants also should ask a treating physician to complete a Residual Functional Capacity form. This details how the individual’s specific symptoms prevent him or her from performing work-related tasks.

Individuals who suffer from other physical conditions should also document those. Qualifying for SSD benefits based on mental disorders alone can be difficult; individuals who establish multiple impairments may have a higher likelihood of claim approval.

Seeking disability benefits for an autoimmune disease

Help for challenging conditions

Autoimmune diseases occur when the immune system attacks healthy cells. These diseases cause various complications and adverse symptoms for victims in Illinois, including pain, fever, malaise and exhaustion. These effects often interfere with an individual’s ability to work and live independently, as any Social Security lawyer knows. Social Security Disability benefits may be available to help victims with especially debilitating autoimmune conditions.

Meeting a listing

The Social Security Administration includes several immune system disorders in its “Blue Book” of impairment listings. These include lupus, HIV, systemic sclerosis, systemic vasculitis and inflammatory arthritis. Applicants who suffer from a listed condition and meet accompanying criteria may qualify for benefits without further evaluation.

The SSA criteria are based on symptoms specific to each condition. The SSA also establishes more general criteria that applicants can qualify under. Individuals with many autoimmune diseases may receive benefits if they document the following:

  • Recurring manifestations of the condition
  • At least two of these symptoms: fever, malaise, fatigue or inadvertent weight loss
  • Difficulty performing daily living activities, functioning socially or finishing tasks promptly

Medical tests that support an autoimmune disease diagnosis, such as antinuclear antibody tests or complete blood counts, can support an applicant’s claim. Symptoms can also be documented through assessments or statements from a treating physician. A Residual Functional Capacity form, which is completed by a physician, can attest to any physical or cognitive limitations resulting from the disease.

Functional capacity evaluations

If an applicant does not meet the listing criteria for the autoimmune disease, there are other ways to qualify for benefits. The individual could contend that the condition has the same impact and duration as a listed condition. The SSA may find an applicant’s condition “equals” an impairment listing if symptoms are comparable to the listed symptoms.

An applicant could also seek a medical vocational allowance. When granting these allowances, the SSA makes no assumptions about whether a condition is disabling. Instead, the SSA considers an individual’s specific limitations and how those limitations affect working ability.

As an example, if a person suffers from rheumatoid arthritis, the SSA might evaluate how it affects the person’s ability to stand, sit still for prolonged periods and perform fine motor tasks. If these limitations prevent the applicant from performing his or her present job, the SSA judges whether the applicant could work in another capacity. The applicant’s age, work history and education are used to determine whether a new job would be reasonable.

It can be difficult to prove that symptoms “equal” listing symptoms or that functional limitations prevent all forms of employment. Individuals hoping to qualify in these ways often benefit from working with an SSD attorney when completing their applications.

Common mistakes found on Social Security Disability applications

Unemployed and divorced woman with debts reviewing her monthly bills

Potentially costly errors

Obtaining Social Security Disability benefits is often difficult, even for people in Illinois who suffer from seriously debilitating conditions. Mistakes during the benefit application process are a leading reason for claim denials. People who seek benefits without the help of a Social Security attorney may be especially at risk for making the following missteps.

Undermining credibility

The Social Security Administration evaluates how credible a claim is by considering the applicant’s work history, medical history, current activities and more. When applying for SSD benefits, applicants must not give the impression that they are capable of gainful employment.

Collecting unemployment benefits can hurt an applicant’s SSD claim. Unemployment benefits are awarded to people who can perform work but cannot find employment. SSD benefits are awarded to people who are physically incapable of substantial gainful activity (SGA), or work yielding over $1,070 per month, for a period of at least 12 months.

Similarly, people who are engaged in SGA when they file an SSD claim cannot qualify for benefits, regardless of how the disability affects ability to work. These people would need to reduce their hours or quit working to become eligible for benefits.

SSD applicants must provide records showing they have sought reasonable treatment for physical or emotional health problems. If an individual has not visited a doctor, the SSA may assume the condition is not truly disabling. Relatedly, if an individual has not tried all prescribed treatments, the individual cannot prove the condition is unlikely to improve. The SSA recognizes some valid reasons for failure to seek treatment, including:

  • Financial constraints
  • Religious beliefs
  • Adverse side effects of treatment

Outside of these circumstances, however, a lack of documented treatment can hurt an individual’s claim.

Staying with an unsupportive doctor is another common error. A doctor can provide statements that attest to a patient’s disability, which often act as decisive evidence. A doctor who is busy or doubtful of the disability may be reluctant to complete paperwork, supply records or dedicate adequate time to the claim. In this case, patients should see another doctor.

Filing mistakes

When filing for SSD benefits, applicants should document all disabling conditions. Many people experience mental health issues, such as depression, in conjunction with physical conditions. In some cases, the physical condition may not be severe enough to warrant benefits, but the physical and mental condition together may be considered disabling.

Finally, when filing or appealing a decision, many applicants assume they cannot afford or do not need a Social Security Disability lawyer. However, SSD attorneys work on a contingency basis; they only collect payment if benefits are awarded. Furthermore, working with an attorney can greatly lower an applicant’s risk of not receiving any benefits.