Social Security Disability, the Trial Work Period, EPE, and Expedited Reinstatement

"After my 9 month work window has depleted, what happens with my family's benefits next?"


Kest,

The nine month trial work period is a time that an individual can earn over the SGA limit and not have it affect their ability to receive a disability check.

Remember, that nine month period does not have to be continuous, but can occur at any time in a rolling five year period. Your disability benefit will not stop as long as your work activity in the tenth month is not SGA (a monthly earnings amount established by SSA that they consider to equate with substantial gainful activity).

If you are earning over the SGA monthly amount in the tenth month your disability benefits as well as the benefits payable to your family will be suspended due to your work activity and you will begin a period of extended period of eligibility known as the EPE.

The EPE allows an individual to restart their disability benefits anytime they become unable to work at an SGA level. The EPE lasts for 36 months. Once the 36 month period elapses, then the first month you perform SGA your disability benefits will be ceased.

At this point. You have an additional five years to file an expedited reinstatement of your benefits if you stop work due to the same disabling conditions, or you file a new disability claim all together. The expedited reinstatement will give you six months of provisional payments while they make a decision as to your disability status.

A Social Security claims representative will go over your options with you. Sometimes if you can wait, a new disability decision will increase your monthly benefit amount.

These are your options as far as what happens after the nine month trial work period. Anytime your disability benefit is stopped, your family's benefits stop as well.






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How Does Social Security Use Information About My Jobs?

Social Security disability decisions are based upon two factors: mental and/or physical impairments and work history. The definition of disability for Social Security holds that a mental or physical impairment is disabling if it is one that is severe enough to have prevented an individual from working for the past twelve months, can be expected to prevent them from working for twelve months, or may result in death.

When you consider the actual definition of disability and what it entails, you can easily see why Social Security needs information about the types of work you have performed in your past relevant work history (the fifteen years before your disability onset), prior to you becoming unable to to work at what is known as the SGA or substantial gainful activity level).

Part of the Social Security disability process is to determine if your residual functional capacity (what you are able to do in spite of your disabling condition or conditions) precludes, or rules out, all of your past work activity as well as any other type of work activity that you might have the skills to perform, or the ability to be trained for.

If Social Security determines that you are unable to work at an SGA level (remember: this means being able to work and earn at least a certain amount each month before taxes due to your impairments), you may possibly be approved for disability benefits, provided your case satisfies the social security administration's non-medical criteria as well (i.e. if you are working your earnings must fall under the allowable limit and if you are filing for SSI disability, you must not have more than $2000 in countable assets).

Work is so important to the Social Security disability process that it affects your initial disability decision and continues to affect your eligibility to receive disability benefits after you are approved for disability. Reason being, Social Security disability is really focused on whether or not a person can perform substantial work activity, and not so much about having a particular medical or mental condition.

There are particular physical or mental conditions which are listed in the social security disability list of impairments, or blue book. However, even if an adult claimant's medical records provide documentation that sufficiently meets or equals the criteria set forth for an impairment listing (such as seizure disorder, for example), the claimant will still not be approved for benefits if they are working and earning in excess of the SGA limit set for the year. Note: the current limit for SGA may be viewed by visiting the link in the second paragraph of this post.

To elaborate, many individuals with severe mental or medical impairments continue to work at a level above the SGA earnings limit, so they would not be eligible for disability. These same individuals might be eligible with the same impairments, however, if they were not working at a SGA level. And, thus, an applicant's evalution for SSD or SSI disability benefits is not limited to simply a review of medical records.







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What Information Does Social Security Need About Your Past Work?

The Social Security definition of disability allows disability benefits to be paid when a mental or medical condition has A) prevented an individual from engaging in substantial and gainful work activity for twelve months, B) can be expected to prevent such work activity for twelve months, or C) may result in death.

Obviously, one of the chief components of the Social Security decisional process is an individual’s comparative ability to engage in work activity. This is measured by their ability to work and earn at least a certain a minimum amount known as SGA, or substantial and gainful work activity.

Meaning that if a claimant has a severe physical or mental impairment, their disability claim can be denied for the performance of substantial gainful activity (SGA) meaning that they are working and earning over the monthly SGA earnings amount.

In order to ascertain if you, the applicant, are able to engage in any of your past work, Social Security must know the types of work that you have performed in the fifteen years previous to your filing for disability.

Additionally, Social Security needs a detailed description of your jobs as you performed them. Why? Disability examiners who evaluate SSD and SSI claims must, as part of processing a claim, identify the relevant jobs a person has worked in the past; obviously, the more detailed the information that is supplied by a claimant, the more accurately the identification of past jobs will be which can make a difference as to the outcome of a claim.

So what kind of information does Social Security need about your past work?

Social Security needs to know when your physical or mental condition first affected your ability to work and what changes the limitations of your disability forced you to make. For instance, did you work fewer hours, have help from your employer (special considerations like extra breaks or rest periods or lighter work), get help from coworkers, take more sick time, etc.

Social Security also needs to know when you reduced your work activity below the SGA limit, or, if you stopped working due to your disabling condition or conditions, when this occurred.

When you file for disability and supply information about your work history, you should include some of the following information in your job description:

1. Main work responsibilities for your job (s)
2. What you had to lift or carry, and how much these items weighed.
3. How often you had to crouch, walk, stand, sit, stoop, kneel, crouch, or crawl
4. Dates of employment
5. How many days and how many hours per day you worked per week
6. What types of tools, equipment, or machinery were involved in your job (s)
7. Were you a supervisor, and if you were how many individuals did you supervise?
8. What skills or knowledge your job (s) required
9. What were the speaking, vision, and hearing requirements of your job (s)

Social Security considers it your responsibility to make sure they get any information needed for a decision in a disability claim, and this includes information about your medical or mental conditions, treatment sources, activities of daily living, third party questionnaires (information requested of the person you provided as your third party contact at your disability interview). And, of course, your work history.






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What is the Maximum You Can Earn While Applying For Social Security Disability?

Social Security is a total disability program, which means that you can only earn so much money and still be able to be considered eligible to apply for Social Security disability benefits.

The definition of disability for Social Security requires that an applicant has been unable to work at a substantial gainful work activity level for the past twelve months, or expects to be unable to work at this level for twelve months, or has a condition that is expected to result in death.

Looking at the Social Security definition of disability, you can clearly see that there are limitations to the amount of earnings a person can have while being eligible to either apply for disability (or receive disability benefits).

What is the earnings limit? Each year, Social Security sets a monthly gross earnings amount that it is considered equivalent to substantial gainful work activity (SGA), and if an individual exceeds that monthly amount their disability claim will be denied without a medical determination.

If an individual is working, can they apply for disability benefits and receive a medical determination? Yes, if their earnings are under the substantial gainful activity amount. However, they must provide Social Security with information about their work activity such as the hours they work and rate of pay so that an SGA (substantial gainful activity) determination can be included with the disability claim.

If a person is self-employed, Social Security will have to address the amount of hours that the individual works at their business and their net self-employment earnings.

Self employed or corporate officers may be denied, even if they are not taking any money from the business, if the worth of their work as performed in the local economy is over the SGA monthly limit.

If an individual is contemplating filing for disability, they should check with their local Social Security office to ascertain what the current monthly SGA amount is prior to making their disability appointment. If they are earning over that amount monthly, there is very little use in filing an application for disability benefits until A) they stop work or B) their gross monthly earnings are under the substantial work activity limit.







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Social Security Disability and Jobs Within the National Economy

If you apply for disability benefits from the social security administration, either under the SSI or social security disability program, there will be a good chance that your claim will be denied at the initial claim (aka disability application) level. Not to sound morose, but, statistically, that's simply how it plays out for the majority of all individuals filing disability claims.

If you get denied for disability, what will the reason be? Well, some claims are denied on the basis of SGA, which stands for substantial gainful work activity. This basically means that the claimant was working and earning too much. Typically, this type of denial occurs at the social security office before the case ever has the chance to be sent to a disability examiner, though sometimes it happens after medical development (gathering and evaluating the medical records) has begun.

Some claims, a small percentage, are denied due to NSI, or non-severe impairment. This basically means that the disability examiner was easily able to conclude that the claimant's alleged condition was not even remotely disabling. Example: sprained wrist.

However, most claims are denied using the rationale that the claimant can return to their past work (one of the jobs they performed within the past 15 years), OR the rationale that, even if they can't return to their past work, they can do some form of other work.

"Other work" is sort of a catch-all way to deny a lot of social security disability and SSI claims. Basically, this is what happens: a disability examiner will identify the claimant's past jobs, what the exertional requirements of those past jobs were, and what the skill levels of those past jobs were (represented by numbered ratings). If it is determined that the claimant cannot go back to one of their past relevant jobs, the examiner will consult a resource book that lists thousands upon thousands of jobs in the national economy and try to come up with three jobs that match the exertional requirements and skill levels of the claimant's past work. Very often, this is quite easy for the examiner to do, meaning that the claimant will be denied for disability on the basis that they can perform some type of other work.

This is basically what is meant by jobs within the national economy, the simple fact that a disability adjudicator was able to identify three jobs that the claimant could potentially perform other than work that they've done in the past. In fact, many disability examiner processing units already have preset sheets of "other work jobs" that a claimant might be able to do based on exertion level and work skill level.

Here's one problem, though, with the whole concept: when disability examiners scout for "other jobs" in the reference book (known as the DOT, or dictionary of occupational titles), it is done without regard for geographical location. Meaning, those jobs might exist in the national economy but only a thousand miles away on the other side of the country. Not an easy proposition for older workers (fortunately, the vocational rules give consideration for older workers). Here's another problem: the reference work used by disability adjudicators is very much out of date. It would probably not be a stretch to say that there are hundreds or even thousands of jobs that exist today, that have been created in the last 15 years, that are not in the DOT. Technology jobs would likely be a good example of this.

This is all the more reason, of course, for supplying accurate and detailed information about your work history when you file for disability. It is very important to not only include job titles and dates of employment, but also detailed descriptions of what was actually done on each job. Because this can make the difference as to how a job is identified by a disability examiner. And how a job is identified can have a decisional impact on a claim.

Note: some DDS agencies are now putting extra special emphasis on researching all jobs listed by a claimant at the time of application in an effort to strengthen denials that are issued on the basis of a claimant's ability to return to their past work.








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Can You Apply For Disability If You Used To Get Disability But Went Back To Work?

Social Security disability is available to an individual even if they have received disability benefits in the past. Many individuals receive disability benefits more than one time in their life, especially if they suffer from some chronic medical and/or mental condition (s).

Contrary to what many mistakenly believe, Social Security disability benefits do not replace an individual’s total income, and most individuals who receive disability benefits suffer some financial hardship. Consequently, at some point after being approved for disability, many individuals make an attempt to return to work in order to better provide for themselves and their families, even if their disabling condition continues to affect them.

There are a couple of possibilities open to an individual who had received disability in the past...but had returned to work and then found themselves unable to work due to their impairments.

The most common possibilities are a new disability claim or an expedited reinstatement. If an individual’s disability was terminated due to work activity (without a finding of medical improvement) and the disability termination month is less than five years in the past, they may be eligible to receive an expedited reinstatement of their disability benefits.

An expedited reinstatement gives an individual six months of provisional benefits while Social Security determines if they are still disabled according to the rules and guidelines of the Social Security disability program. Additionally, they must be alleging the same medical impairment (s) as their previous disability claim to file an expedited reinstatement.

Unfortunately, expedited reinstatements are not allowed for disability applicants whose disability benefits were terminated more than five years in the past or individuals who were found to have medically improved. If this is the case, the individual will have to file a new disability claim in order to be awarded disability benefits again.

In summary, there is no limit to the amount of times an individual can file for disability and be approved for disability. If an individual had disability benefits in the past but lost them for whatever reason, they are allowed to file a new disability claim with Social Security.




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What Will Happen If I Draw Disability Benefits, Work, and do not tell Social Security?

Depending on an individual's circumstances, it may seem worth it at first glance, but Social Security will eventually find out about all work that you are performing whether or not you “tell” them about your job. At the very least, you may find yourself in the situation of owing Social Security money (an overpayment), and at the worst you may find yourself being charged with Social Security fraud. Social Security is cracking down on individuals who knowingly do not report work activity.

So, just how does Social Security know if an individual is working and how much they have earned? Social Security earnings records are provided through information reported to the Internal Revenue Service each year. If your social security number has reported earnings from employers, Social Security will access those earnings and your employers. Other times, Social Security becomes aware of an individual’s work activity through a tip from someone (generally Social Security finds individuals working for cash from individual reports). Often, individuals are reported by friends, family members, ex or estranged spouses, co-workers, supervisors, or even neighbors.

Social Security has to investigate each of these reports to ascertain if an individual is indeed working. Even if an individual is working on a cash basis, those earnings count for Social Security disability purposes. There are many ways that Social Security can find out about employment, so for anyone wondering about the possibility of shielding earnings from discovery, the truth is that it is really useless to think that they will not find out about work activity.

So what will happen when Social Security finds unreported work activity? There are times that Social Security finds work activity during a routine disability review or other times an individual’s work activity triggers a "work review".

What is a work review? Social Security work reviews involve Social Security contacting all of your employers for a monthly breakdown of your earnings. Once all employment information is received, Social Security will complete monthly totals for all months worked and determine which months you were not entitled to receive a benefit check.

For example, your monthly earnings determine when your trial work months--the nine months in any five year period that you can earn over the substantial gainful activity monthly amount without it affecting your disability--come to an end (The important thing to remember about trial work months is that they do not have to be consecutive, can occur anytime during a five year period, establish when your extended period of eligibility (EPE) begins and ends, and what your termination month will be).

As you can see, work activity "touches" a lot. And not reporting it can cause an overpayment (which for many claimants can become a truly awful situation). However, it can cause more than a simple overpayment; failing to report income can lead to benefit suspensions and terminations.

What happens if you receive money from social security that you were not actually entitled to receive and incur an overpayment? If you have an overpayment with Social Security, your benefits may be suspended until they collect all the money owed, or you may be allowed to make a payment arrangement with Social Security to pay back any money owed.

Reporting all work activity, by contrast, will prevent overpayments and will allow you to receive information that may prevent your disability benefits from being suspended or terminated.









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Work and Qualifying for Disability Benefits

In order to be approved for disability benefits, be it social security disability insurance (SSDI) or supplemental security income (SSI), claimants must provide proof (and medical records are the only acceptable proof here) that they have a severe impairment that has lasted or is expected to last more than 12 months, and that this impairment prevents them from earning a certain amount set each year by the social security administration (SSA).

The SSA refers to the minimum amount a disability applicant is allowed to earn as the SGA, which stands for substantial gainful activity. If your medical records indicate that you have a severe impairment that prevents you from earning the SGA ($900 per month in 2007, $940 per month in 2008, $980 per month in 2009, and $1000 per month in 2010--to see the current amount, visit this page: SGA), then you may qualify for disability benefits, but only if you can then prove that you are unable to perform not only your current job but any other work.

Not surprisingly, many disability claims are rejected because the disability examiner has determined that, though the applicant’s medical condition is severe enough to prevent him from returning to his current job, he is qualified to perform other work. In fact, it is rare that disability claims are turned down because a disability examiner feels the individual has a non-severe impairment (NSI); most people do not go through the long, frustrating process of filing for disability unless they are truly facing financial hardship as a result of their impairment.

How does a disability examiner determine what types of other work an applicant is able to perform? By looking at all jobs the applicant has performed in the past 15 years, what social security calls the “relevant period,” to see what job skills the applicant has acquired and the types of positions he or she has held. For this reason it is very important for anyone applying for disability to be really thorough when it comes to their work history. List not only past places of employment and job titles, but the exact duties performed at each company. Do not leave it up to the disability examiner to guess what you are capable of doing; e.g., how much walking sitting or standing was done, how much physical exertion was required, how many employees you supervised, etc.

In addition to your work history, the disability examiner must refer to a vocational grid, which takes into account your job skills, age, education, and the types of activities you are capable of performing in light of your physical or mental impairment. The grid is meant to ensure some measure of fairness to disability applicants, as well as consistency in disability decisions made across the country (disability decisions are made by state-run disability determination services agencies, referred to as DDS).

Unfortunately, the grid does not truly ensure fairness to those applying for SSD or SSI, because a disability examiner can suggest any type of work to which an applicant may be suited, even if that job does not exist in his area. Of course, those who are already struggling financially and suffering from a severe physical or mental impairment may not exactly be up to relocating, but this is not something that a disability examiner has to consider at all when rendering his or her decision, and this is a real flaw in the entire disability determination process that is not likely to be corrected in the near future.

So, if you have been turned down for disability benefits because an examiner has concluded that you are capable of performing “other work,” you should seriously consider getting a disability lawyer or non-attorney representative, who can greatly increase your chances of winning a medical vocational allowance.

A good attorney specializing in these types of cases will have a thorough knowledge of the grid rules. It’s also important to note here that statistics have shown that disability claimants who appear at a hearing without an attorney are as much as 50% less likely to win benefits.





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