Find out the best time to file a Social Security Disability application and how to protect your filing date to avoid losing back pay benefits.
When should I file my Social Security Disability application?
Benefits Advisor recommends that you file your Social Security Disability application as soon as it appears that you may be disabled for twelve months or that you are not expected to survive for twelve months.
File Your Social Security Application Early
Except for compassionate allowances for terminally ill individuals and a few other expedited claims, most disability claims take from three to five months to get a medical decision and longer for benefits to start. Unless you have a clear-cut disability, you might even have to appeal, which would extend the time before an approval even more. So, the sooner you get started on your claim, the sooner you will have a determination. You do not have to wait for other benefits such as workers compensation, sick pay, or short-term disability to run out before you apply. In fact it is very desirable to have your claim approved while you still have other income so that you are not left with an income gap.
Protect Your Filing Date and Your Benefits
Getting started is especially important if you have already been off work or have been working below substantial gainful activity (SGA) level for seventeen months or more. If you have already been disabled for seventeen months, you need to start your application now—before the end of the month—in order not to lose potential back pay. You can establish an application filing date by calling Social Security’s national toll-free number 1-800-772-1213 and telling them that you want to file a disability application. You do not have to complete the application that day. Alternatively, you can protect your disability application filing date and your potential back pay by starting your disability application online at www.ssa.gov and saving the application online to finish later. (Be sure to save the access number you are given so you can get back to the application.) The date that you first contact Social Security about filing a claim will be your disability application date. Then you can take time—up to six months—to gather information for your application and, if desired, appoint an attorney representative.
Are You Disabled?
It can be hard to decide whether or not you are disabled to a degree that you should apply for Social Security Disability (and/or Supplemental Security Income disability if you have limited income and assets). If you think you are disabled or you are not sure, be sure to file a claim to get a formal determination.
In the meantime, here’s some information to help you decide:
Social Security law defines disability as “as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment 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 twelve months.”
Let’s take that apart and look at what “substantial gainful activity” and “continuous” mean.
“Inability to perform substantial gainful activity” (SGA) means that you are unable to work in any occupation that you could do or learn to do in on-the-job training if you did not have the physical or mental or emotional limitations you have or that you could not work enough hours regularly to have your earnings to be substantial.
What is “substantial”?
If you are an employee, the usual benchmark amount in 2020 is $1,260 gross earnings. (Gross earnings means before taxes and other deductions.) If you are blind or legally blind, the benchmark is $2,110. If you are self-employed, during the first two years of disability both your earnings and your work hours and responsibilities are considered in determining whether your work activity is substantial. The benchmark is $1,220 net profit ($1,950 if blind). In addition eighty hours of work in a month usually is considered substantial even if your profit is less than the benchmark. If you are a key figure in your company, how essential your work activity is to the company is also considered.
What is “continuous”?
Usually when we say something is continuous we are saying that it goes on with no breaks in it. However, in qualifying for disability benefits, there can be breaks in the required twelve months of disability if the breaks occur due to one or more unsuccessful work attempts. Here’s an example: Let’s say that you are off work for five months and decide to try to go back to work. You work in your old occupation or a different one performing substantial gainful activity for four months but have to stop again because of your disabling medical condition. In that case, your return to work was an unsuccessful work attempt and the five months off work before the work attempt count toward the twelve months of disability needed to qualify for benefits.
Exceptions
You might be disabled even if you are earning more than $1,260 (with blindness $2,110) if you have Impairment (disability)-Related Work Expenses (IRWE’s) including but not limited to medication and medical treatment that makes it possible for you to work. The amount of those expenses will be used to reduce your earnings before evaluating for SGA. Similarly, if you are receiving special accommodations in the workplace such as getting to take extra or longer breaks, being allowed to go home early or call in sick more often than workplace norms, the special accommodations may indicate that you are not able to work and earn what you are being paid in a competitive workforce. This could result in a determination that your work is not substantial gainful activity.
It’s About More Than Your Medical Condition
Unless you have a very serious illness or injury with very severe limitations that meets Social Security’s medical disability listings, your education and work history and the transferable skills you have obtained from your education and work are key to whether or not you can work in a new occupation after becoming unable to work in jobs you have held in the past. For that reason it is important to complete the vocational questionnaire fully listing all the physical and mental demands of past jobs and stating the duties clearly. If you have any literacy challenges despite your education, be sure to mention those, too.
If you think you are disabled as defined by Social Security law file a claim to get a formal determination. If you are not sure, either file a claim or arrange a usually free consultation with one or more experienced Social Security attorneys to get professional opinions.
Must I stop working before I can apply for Social Security Disability (SSD)?
You do not have to be completely incapacitated to be eligible for any of the three kinds of Social Security disability benefits or to be medically or financially eligible for Supplemental Security Income (SSI). You do not even have to stop working entirely. You do have to prove with medical documentation and vocational information that you are unable to perform substantial gainful activity (SGA). The first step in this process is either to stop working or reduce your work to below SGA level.
SGA Thresholds
Evaluation of whether someone is performing SGA is tailored to the person’s situation, but certain guidelines exist. In 2019, if your gross wages reach or exceed $1,260 per month ($2,100 for blind individuals) after being reduced by your out-of-pocket Impairment-Related Work Expenses (IRWE’s), your work likely will be determined to be SGA and your claim is likely to be denied based on your work activity alone. However, if you are being subsidized by your employer, it could be determined that your work is not substantial gainful activity because you are not earning the entire amount you are being paid.
Self-employment profit is also compared to the SGA dollar threshold, but the review is not limited to your earnings. The number of hours you are working per month and how essential to the business your duties are also come into consideration. For example, you might be the owner of a company who is working four hours a week. During those four hours you decide which jobs to bid on and how much to bid. Because your work is essential to the functioning of the business, the work might be considered substantial and worth more than you are being paid by the business.
If so, the work will be judged gainful as well. In another circumstance, the work of a self-employed person might be found substantial if he is putting in nearly forty hours a week with a profit of $1,000 a month. The work could be considered SGA because that number of work hours in that industry would normally result in gainful employment at the SGA level.
Impairment-Related Work Expenses (IRWEs)
Let’s take a closer look at IRWEs. Any out of pocket expense you have because of your disabling condition can be claimed as an IRWE if the item or service purchased enables you to work. IRWEs can include items you would need to pay for because of your disability even if you were not working. Some examples of IRWEs are certain attendant care services, medical devices, equipment, prostheses, and similar items and services. Also, medications taken to control your disabling condition are typically deductible as IRWEs.
In summary, you usually do not have to stop working completely to successfully apply for Social Security Disability if your reduction in work hours and earnings is the result of physical or mental impairment.
If I am getting workers comp, do I have to wait until it ends before applying for disability benefits from Social Security?
Applying for Social Security Disability while you are receiving workers’ compensation payments or while your workers’ comp claim or appeal is pending is just fine. In fact, it is especially advisable if the following conditions apply:
- you are disabled not only from the occupation you were in when you were injured, but also from performing other occupations; or
- you have been in one occupation all or most of your working years or at least the last fifteen years and can’t do that job any longer; and
- you believe that your disability will last longer than twelve months.
By applying for disability early, it will be easier for you to remember details of when you were first injured, as well all the doctors you have seen, and other important information needed for your Social Security claim.
Don’t Lose Social Security Benefits
If you wait to apply for Social Security Disability until your workers compensation ends, you may be left without income while your Social Security claim is being processed. You might even lose Social Security Disability back pay because retroactive benefits are limited to twelve months before application.
Workers Compensation Offset and Social Security Payments
Be sure to tell Social Security that you have a workers’ compensation claim so Social Security can calculate your payments correctly.
Can I apply for Social Security Disability while I am still getting sick leave or long term disability from my employer?
You can apply for Social Security disability while you are receiving sick pay or short-term disability benefits from your employer and while you are using vacation pay or annual leave to cover sick days. You can also apply if you are receiving or expect to receive long-term disability from your employer’s plan. If you think that your disability will last longer than twelve months or that it is expected to result in your death, you should apply for Social Security Disability as soon as possible without waiting for your other benefits to expire.
File as soon as you think you qualify for Social Security Disability, regardless of other benefits you receive. By applying for disability early, it will be easier for you to remember details of when you were first injured or became ill, as well as all the doctors you have seen, and other important information needed for your Social Security claim.
Don’t Get Caught Without Income or Lose Back Pay
If you wait to apply for Social Security Disability until your annual leave, sick leave, or short-term or long-term disability benefits end, you may be left without income while your Social Security claim is being processed. Additionally, there is a twelve-month limit on the number of months of Social Security Disability back pay you can receive for months before application.
Report Other Benefits to Social Security
When you file your claim, be sure to tell Social Security that you are receiving or have received benefits or pay from your employer to cover your time off. That way, Social Security will know that you were not working during periods when your earnings record may make salary continuation or taxable short-term or long-term disability benefits look as if you were working when you weren’t.
