Social Security Benefits Handbook online edition 
What You Want To Know - What You Need To Know

Chapter Five Disability Benefits
§ 501 In General
§ 502 Definition of Disability
§ 503 The Earnings Record “Freeze”
§ 504 Substantial Gainful Activity
§ 504.1 Substantial Gainful Activity - Special Rules for the Blind
§ 505 The Date of Onset
§ 506 The “Unsuccessful Work Attempt”
§ 507 The Waiting Period
§ 508 The Closed Period of Disability
§ 509 The Trial Work Period
§ 510 The Re-entitlement Period
§ 511 The Effect of Workers’ Compensation Benefits
§ 512 The Effect of Other Kinds of Benefits or Payments
§ 513 When Disability Benefits End
§ 514 The Continuing Disability Review
§ 515 The Ticket To Work 

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Section 501 -     In General

      There are three different kinds of Social Security benefits which are paid on account of disability.  The most common and well known is the Disability Insurance Benefit (DIB) (Section 203).  This is the benefit paid to disabled workers.  The amount of the benefit is the same as if you were at full retirement age.  To be eligible for the DIB you must be specially insured (Section 604). To be eligible you must have worked long enough under Social Security to be fully insured, and you must have worked in the recent past, generally at least a total of 5 years within the last 10, although there are exceptions, discussed in Section 604.

       The other Social Security benefits paid on account of disability are Disabled Adult Child (DAC) Benefits (Section 205.3) and Disabled Widow/er) Benefits (DWB) (Section 204.6).  These benefits are paid to children of retired, disabled or deceased workers, and to widow(er)'s age 50 to 59.  See Chapter 2 for the eligibility requirements. 

      This chapter will discuss in detail those special rules which are unique to disability benefits. We cannot discuss specific medical requirements because they are too numerous and complicated.  An entire book is required to cover those issues.  If you should file a claim for disability and be denied, you should retain an attorney to represent you (see Chapter 13).

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Section 502 -     Definition of Disability 

            The law defines disability as the inability to do any kind of substantial gainful activity (Section 504) for a continuous period of at least one year, or to result in death.  The cause of disability can be either mental or physical, but it must be medically determinable.  This means there must be a medical basis for the condition.  Statutory blindness also is considered a disability.  Statutory blindness is defined as central visual acuity of 20/200 or less in the better eye with the use of glasses, or the field of vision limited so that the widest diameter subtends an angle no greater than 20 degrees.  The one year duration requirement also applies to blindness cases. 

      When evaluating your ability to work, SSA will consider your age, education and work experience along with your medical condition.  This means that even if your medical condition does not prevent all type of work, you may still be eligible if your background, is such that you cannot be expected to obtain the only work you are physically able to do.  The simplest example of this is the laborer in his late fifties who has a back condition which prevents him from performing his regular job.  He has done only this type of work.  Although he may still have the physical ability to do light work, SSA will consider him disabled because of his age and limited work background. 

      If you believe you are disabled, you should file an application for benefits.  If you are denied after your first application you should consult an attorney.  Many cases which are denied at first are won on appeal.  The rules regarding the medical requirements are very complex and you should have a lawyer represent you if you appeal.  See Chapter 13.

       To repeat:  the rules on proving disability are very complex.  If you are unable to do your regular work you should file a disability application.  If your claim is denied, consult an attorney and consider an appeal.

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Section 503 -     The Earnings Record "Freeze"

       When you are entitled to Disability Insurance Benefits (DIB) you are also entitled to what is called a "freeze" because of its effect on your earnings record.  The months or years during which you are entitled to a period of disability will not be considered for purposes of calculating benefits.  

    For instance, if you were disabled for five years during your fifties, when you reach retirement age and apply for Retirement Benefits, the five years of disability will be excluded.  This is important because Retirement Benefits are based on your average earnings over many years.  If these years of disability were considered, your average earnings would be much lower because you had no earnings during the disability.

       Whenever you are eligible for Disability Insurance Benefits, a "freeze" is placed on your earnings record for that period.  This happens even if no disability benefits are actually paid, so long as you meet all the requirements.  Of course, it is very rare that you would be eligible without being actually paid.  

    When we say "eligible" in this section, we mean being officially determined eligible after making an application, as opposed to being potentially eligible.  The usual situation where someone is eligible for a period of disability but no benefits are paid is when the disability is based on blindness and the beneficiary is engaging in Substantial Gainful Activity (SGA).  See Section 504.1 below for this special case.

       The disability freeze applies to the computation of all benefits, not just retirement.  It also applies when determining the number of quarters of coverage required (Section 601).


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Section 504 -     Substantial Gainful Activity

       Regardless of your medical condition, if you have done work during a time you claim disability benefits, you will not be eligible if the work is determined to be Substantial Gainful Activity (SGA), unless you are in a trial work period (Section 509) or it is an unsuccessful work attempt (Section 506).   


      If you are an employee, rather than self-employed, the most important factor in determining whether the work is Substantial Gainful Activity is the amount of your earnings.  SSA has established dollar amounts of earnings to use as guidelines.  If the earnings average more than $940 per month (as of 2008), the work is considered SGA. This amount increases slightly each year. Note: see Section 509 - Trial Work Period, and Section 506 - Unsuccessful Work Attempt.

       When SSA considers your earnings, they will disregard any part of your pay which is not based on your actual services.  For example you may be working for an employer who is subsidizing part of your pay, as in the case of some sheltered workshops.  The employer may be paying more than your work performance is worth economically.  The amount of any such subsidy will be deducted from your earnings for the purpose of using the earnings guides discussed above.  If the employer does not set a specific amount for such a subsidy, SSA will investigate the circumstances to determine how much of your pay you actually earn and how much represents a subsidy.

       Likewise, SSA will deduct from the amount of your earnings any impairment-related work expenses.  These may include attendant care services, medical devices, equipment, prostheses, and similar items and services. Drugs and routine medical services are not deductible unless they are necessary to control the disabling condition to enable you to work. Expenses that are not directly related to the impairment cannot be deducted. 

      If your average earnings, after any allowable deductions as discussed above, are in between the high and the low monetary guidelines, SSA will compare your work activity to the work activities of non-disabled people in your community.  If unimpaired people are doing the same kind of work as a means of livelihood, your work will be considered SGA.  If your work activity is not comparable to the work activity of non-disabled people in your community who are doing it as a livelihood, your work will not be considered SGA.  When making these comparisons, SSA will take into account the time, energy, skill and responsibility involved in the work.

     Self-Employed Persons 

      If you are self-employed, the rules are somewhat different. There are three tests that SSA uses.  

       First Test- Significant Income & Substantial Services

        The work activity is considered SGA if, 1) you render services that are significant to the operation of the business, and 2) if you receive a substantial income from the business. If you run a one-person business without employees, your services are considered to be significant just by that fact alone. If more than one individual is involved in the business, you will be found to be rendering significant services if you contribute more than half the total time required for management of the business; or  render management services for more than 45 hours a month, regardless of the total management time required by the business.

        An income from the business is "substantial" if the countable earnings you receive are greater than the earnings guidelines used for employees (see above). Because monthly earnings can fluctuate depending on many variables unrelated to ability, SSA will average your "countable income" by figuring it over a representative period and then dividing by the number of months in that period. 

    To figure these "countable earnings" SSA will deduct from the actual net earnings such things as the reasonable monetary value of unpaid help furnished by a spouse, children, or others; impairment-related work expenses; business expenses which were incurred and paid by another person or agency; the value of things provided to you by another individual even though no actual expense was incurred; the value of things paid for by anyone for the things provided you to help run the business; and soil bank payments if you participate in that farming program. 

    Even if "countable income" does not average more than the amount referred to above, you are still considered to be receiving substantial income if you the livelihood the business provides to you is: comparable to your livelihood before becoming disabled, or comparable to that of unimpaired self-employed individuals in your community engaged in the same or similar businesses as their means of livelihood. 

       If your services are not significant or if  your earnings are not substantial under this first test,  SSA will look further at your work activity, using the following tests. 

       Second Test- Comparable Work Activity

       You will be found to be engaging in SGA if your work activity is comparable to that of unimpaired individuals in the same community engaged in the same or similar businesses as their means of livelihood. SSA will consider your hours spent working in the business, your skills, energy output, efficiency, duties, and responsibilities. If your work is found not comparable, SSA will then evaluate the value of your work under the Third Test.

        Third Test- Worth of Work 

      You will be found to be engaging in SGA if your work activity is clearly worth more than the earnings guidelines for employees (above) considering its value to the business, or when compared to the salary an owner would pay to an employee for such duties in that business setting. 

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Section 504.1 -   Substantial Gainful Activity -
                  Special Rules for the Blind

       If your disability is based on blindness (see Section 502) you will be eligible for monthly benefits even if you are working as long as your monthly earnings do not average more $1,570 (as of 2008). Subsidies and impairment-related work expenses may be deducted from the countable earnings as in the case of employees (above).  This amount increases slightly each year.  

      If you have shown an ability to earn amounts equal to the above, your disability benefits will be terminated.  However, if you are age 55 or over your benefits will not be terminated if your present work is not comparable to the work you did before you became blind.  If your new work requires skills and abilities less than or different from those you used before, your benefits will only be suspended for months in which you have earnings over those listed above.  The difference between termination of benefits and suspension is discussed in Chapter 10.  If your benefits are only suspended, then you can have them started again without re-applying, and without meeting the one-year duration of disability requirement (Section 502).

      If you meet the eligibility requirements for disability based on blindness (Section 502) including the work requirement (Section 604), you are eligible for a period of disability, called a "freeze" (Section 503), even if you are performing Substantial Gainful Activity.  Although no monthly benefits are paid while you are working or able to work, you are entitled to the advantage of the earnings record freeze.  You must file an application for this and meet all the requirements as if you were applying for monthly benefits.

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Section 505 -     The Date of Onset

       The date your disability begins is very important.  This date determines how your benefit is computed (Section 702.2) and is used to determine how much work you need to be eligible, and when (Section 604).  It determines when the waiting period (Section 507) begins and whether or not you can receive retroactive benefits (Section 406.2). 

      Your waiting period begins with the first full month of your disability.  If you become disabled on the first day of a month, that month will be the first month of the waiting period.  If you become disabled on the second or later day of a month, then the next month will be the first month of the waiting period.  For example, if you become disabled on June 10, your waiting period begins with July.  If you become disabled on June 1, June is the first month of the waiting period.

       The earlier your date of onset, the better it is for your.  Your waiting period will be used up that much sooner so that benefits can start with an earlier month.  If your onset is an earlier year, you may require fewer work credits, or quarters of coverage (Section 604), and your benefit amount will usually be slightly higher.  And the further back you can go for retroactive benefits (Section 406.2), the more money can be paid for past due benefits when your claim is awarded.

       The date of onset is determined by the date your disability actually began, regardless of whether or not your salary continued.  For example, if you became disabled on June 10, but your salary was paid until December 20, your date of onset is June 10, not December 20, as long as you actually stopped working in June.  If your medical condition started before you stopped working, the time you stopped working is used, not when the condition started.  When we say "work" in this section, we mean Substantial Gainful Activity (Section 504).  

    If you are disabled and return to work, and then stop again because of the disability, the date of onset will be the second time you stopped work, unless your return to work can be considered an unsuccessful work attempt (Section 506).  For example, you become disabled for the first time as of January.  You are out of work for the entire month of January, but return to your job on February 15 and work until June 15, when you again stop work, this time for good.  Unless the work period from February to June is considered an unsuccessful work attempt (Section 506), your date of onset will be July.  If the work period from February to June is determined to be an unsuccessful work attempt, your date of onset is January.

      If you are out of work for an entire year before returning, you may be entitled to a closed period of disability (Section 508).

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Section 506 -     The "Unsuccessful Work Attempt"

       As noted in Section 504.1 above, the date of onset of your disability is very important.  The earlier your onset, the better it is for you.  People who have stopped working because of a disability but have then returned to work before stopping work again may be able to use the earlier date as the date of onset.  For example, if you become disabled and dont work at all in the month of January, but then return to work in February and work until April 15, when you finally stop working, you may be able to establish January as your date of onset.

       A period when you return to work may be considered an unsuccessful work attempt if it lasts less than three months and you are forced to stop work again because of the physical or mental conditions imposed by your disability.  You must still meet the medical requirements of disability as of the first time you stopped working.  The first period of disability must have lasted a full month or longer, and there can not have been any medical improvement during the time you went back to work.

       A period of work can still be considered unsuccessful if it lasted longer than three months as long as all the conditions discussed above are present and the work period does not last more than six months. In addition, as a result of the impairment one of the following is true: there must have been frequent absences; or the work must have been unsatisfactory; or the work must have been done during a temporary remission; or the work must have been done under special conditions or special considerations given by the employer.

       You may have more than one unsuccessful work attempt, as long as there is at least one full month of disability between them and there has been no medical improvement.


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Section 507 -     The Waiting Period 

      There are no benefits payable to either the disabled worker or to any dependents for the first five full months of disability.  No benefits are payable during the waiting period, nor will benefits be payable later for any months within the waiting period.  No waiting period is required if you were previously entitled to disability benefits within five years of your current disability.  

    The waiting period begins with the first full month of disability after the date of onset (Section 506).  If you become disabled on the second or later day of the month, that month will not count towards the waiting period.  For example, if you become disabled on April 15, the first full month of disability will be May, and the waiting period will start counting with the month of May, so that May, June, July, August and September will be the months chargeable to the waiting period and no benefits will be payable for those months.  The first month of entitlement to a monthly benefit in that case would be October.  

    The month you become eligible for the payment of the monthly benefits is called your date of entitlement. The waiting period is only used to determine when the monthly benefits should begin.  You must still meet the one year duration requirement mentioned in Section 502, unless the disability is expected to result in death.  

    You do not have to wait until the end of the waiting period before filing an application for disability.  You may file for disability benefits at any time after you stop working due to disability.  If you file for disability benefits before your waiting period is up, no benefits will be paid until the waiting period has passed.  

    If it appears from the nature of your disability that it will be permanent or will exceed one year, then it is a good idea to file the application as soon as you stop working because the application will take usually two to three months, and often much longer, to be processed and approved.  If the waiting period has passed during the time the application is being processed, your benefit checks could begin right away.

      For example, you become disabled on April 15, and it appears that your disability will be permanent.  The waiting period will be the first five full months of disability, namely May, June, July, August and September.  If you apply for your disability benefits during your waiting period, lets say in June, and it takes three months (until September) for the application to be approved, you will get your first disability check as soon as it is payable.  The month of entitlement would be October and you would receive your check on November 3, for October.  (Checks are paid in arrears - Section 1003).

       If you wait for the waiting period to pass before your make your application, remember that the processing time usually takes up to three months or more.  You would be without benefits during the processing time.  Of course, if the claim is approved, the first payment will include any past due benefits payable after the waiting period.  In the example just discussed, if you waited to apply until November and it took three months, until February, for the claim to be approved, you would be without your benefit payments for those months, but when the first check comes, it will include payment for October, November, December and January (Section 1002).

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Section 508 -     The Closed Period of Disability

       As noted in Section 502, you may be eligible for a disability benefit if your disability lasts for at least one year.  An application for disability benefits may be retroactive for up to one year (Section 406.2).  

    If you have been disabled for at least one year, but then have returned to work, you may be eligible for disability benefits for the period of disability even if you didnt file for the disability benefits at the time.  This past period during which you were disabled is referred to as a "closed period" of disability.  You will be eligible for the payment of benefits only for months within the twelve-month retroactive life of a disability application (Section 406.2).

    For example, you become disabled on April 15, 2008, and you recover on June 15, 2009. You return to work at your regular job. You do not file an application for disability benefits until February of 2010. The waiting period (§507) starts running from the first full month of disability, which would be May. It runs from May through September. Your first possible month of entitlement to a disability benefit would be October 2008, and your last month of possible entitlement to a disability benefit would be August 2009 (you receive benefits for 3 months following cessation of the disability, see §513). 

    However, because you did not apply until February 2010, your application can be retroactive for only twelve months, which brings it back to February 2009. Because at the time you apply you have recovered from your disability, the period of time that you were disabled is referred to as a closed period of disability. If the claim is approved, you will be paid retroactive benefits for the months of February 2009 through August 2009. 

    If you had applied for the benefits no later than October 2009, you would have received the benefits for all the months which would be payable, namely from October 2008 (the first month of entitlement) through August 2009.

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Section 509 -     The Trial Work Period 

      After you have become entitled to disability benefits you may attempt to work without having your disability benefits immediately terminated if you are still medically disabled.  This is referred to as a trial work period.  It is different from the unsuccessful work attempt discussed in Section 506.  The trial work period only applies after you have become entitled to disability benefits, but the unsuccessful work attempt applies to work periods before you apply. 

      The purpose of the trial work period is to allow a disabled beneficiary who is still physically disabled to try to work without penalizing him or her.  Earnings during a trial period have no effect on benefits, even if they exceed the earnings limits which apply to other kinds of benefits.  The Work Test (Section 801) does not apply to disability benefits. 

      You are not eligible for a trial work period if you have made a medical recovery from your disability or if your medical condition has changed to the extent that you are no longer totally disabled, even if you are partially disabled.  You must still meet all the medical requirements of total disability to be eligible for a trial work period. 

      If you are still medically totally disabled, then your work, even if it is Substantial Gainful Activity (Section 504 above), will not be considered in determining whether or not your benefits should be cut off.  Of course, if the work activity you are performing is not Substantial Gainful Activity, then your benefits will continue.  Only months in which you have earnings more than $670 (as of 2008- the amount was lower in earlier years) will count towards the trial work period. If you are self-employed, a trial work period month will be charged if you spend more than 80 hours per month at work, or if your net earnings exceed the $670 figure.  This amount increases slightly each year.

       The nine months of the trial work period do not necessarily have to be consecutive.  If you use up two months of the trial work period, stop working altogether for a while, then work for another two months, you will have used up four months of the trial work period and will only have five months remaining. 

    For example, you become entitled to disability benefits in January 2007.  In December you obtain part-time employment and earn $800.00 per month until March 2008.  This work activity is below the earnings guidelines described in §504 and therefore does not constitute Substantial Gainful Activity.  It has no effect on your disability benefits but it does use up four of your trial work period months because it is over the trial work period monthly earnings limit stated above.  

    However, in April 2008 you begin making $1,500 per month.  This is Substantial Gainful Activity because it exceeds the earnings guidelines of §504.  You continue earning $1500 per month from April 2008 through June 2008.  You have now used up seven months of your trial work period.  You stop working in June and have no earnings until September 2008, at which time you again begin earning $1500 per month, and you continue earning at that rate from then on.  Your trial work period months are December 2007 through June 2008 and September and October 2008. 

 That is nine months.  Please note that to be eligible for the trial work period, your medical condition must still constitute a total disability.  If your medical condition has improved, you will not be entitled to the trial work period.

       You are allowed the nine months for the trial work period within a 60 month rolling period. Work months outside the rolling period will not count.  This is how SSA applies the 60 month rule: When you have completed 9 months of the trial work they will count back 60 consecutive months to see if the 9 work months were completed in that 60-month period. If not, they will disregard the work months that fall before the 60-month period, and will only count the work months that fall within the 60-month period. If there are less than 9 work months within that 60 months, the trial work period continues. Only when 9 work months are identified within a 60-month period will the trial work period be completed. 

    After this if you continue working and earning above the Substantial Gainful Activity guidelines (Section 504), then your work activity would mean that you are no longer disabled regardless of your medical condition.  Accordingly, your disability would cease with the first month of Substantial Gainful Activity (Section 504) after the trial work period expires.  You receive an additional two checks after the month that your disability is determined to have ceased (Section 513).


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Section 510 -     The Re-entitlement Period
                  Extended Period of Eligibility


           The Social Security law is designed to encourage disabled beneficiaries to attempt to return to work. If the beneficiary contuse in substantial gainful employment, disability benefits will eventually be terminated. However, there are rules that make it easier to re-apply if the disability resumes. The extended period of eligibility and the expedited re-instatement of benefits rules are designed to eliminate delays in getting benefits re-instated after a period of work activity. These provisions are discussed below. 

     The re-entitlement period is an additional 36 month period after nine months of trial work during which you may continue to test your ability to work if you continue to have a disabling impairment.  You will be paid benefits for months during this period in which you do not perform substantial gainful activity, but you will not receive benefits for any month after the first three in this period during which you perform such work.  

    If anyone else is receiving monthly benefits based on your earnings record, that individual will not be paid benefits for any month for which you cannot be paid benefits during the re-entitlement period.  If your benefits are stopped because you perform substantial gainful activity they may be started again without a new application and a new determination of disability if you discontinue doing substantial gainful activity during this period.  

    In determining, for re-entitlement benefit purposes, whether you do substantial gainful activity in a month, SSA considers only your work or earnings for that month; they do not consider the average amount of your work or earnings over a period of months.

Expedited Reinstatement of Benefits 

      If your disability benefits were terminated because of work activity, you can request reinstatement within 60 months from the month of termination and SSA may make provisional payments to you while they decide whether to reinstate your benefits. You must be unable to work because of the original medical condition.

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Section 511 -     The Effect of Worker's
                  Compensation Benefits


      If you receive Social Security disability benefits and also receive Workers Compensation benefits due to an on-the-job disability, your Social Security benefits may be affected. 

      If the combination of Social Security benefits (including benefits for your wife/husband and children) plus the amount of the Worker's Compensation benefits you receive per month is greater than 80% of your Average Current Earnings (ACE), then your Social Security benefits will be reduced so that the total will come down to the 80% level.  

    Benefits payable to dependents will be reduced first.  For example lets say that your Social Security disability benefit is $1,500 and that you have a child under age 18 who is entitled to $750.  You are also eligible for Workers Compensation benefits in the amount of $1,200 per month.  The total of these benefits is $3,450.  Lets say that your Average Current Earnings before your disability were $4,000 per month.  80% of this is $3200 per month.  Because the combination of the Social Security benefits and the Workers Compensation benefits is $3,450 and 80% of the Average Current Earnings is $3,200, the difference, $250, must be subtracted from your Social Security benefits.  

      When determining the Average Current Earnings, Social Security considers the gross amount of your prior earnings, not your net amount after deductions.  The Average Current Earnings are figured three different ways.  Whichever way will give you the highest average is used. 

      The first method of figuring the Average Current Earnings (ACE) is to take the average monthly earnings during any one calendar year within the year of your onset of disability or the five preceding years.   

      The second method of determining the Average Current Earnings is to take the average monthly earnings in any five consecutive calendar years after 1950.  Note that the five years must be consecutive.  You cannot pick any five after 1950; they must follow one after another. 

      The third method of determining Average Current Earnings is to take the average monthly earnings of all years used in computing the disability benefit (See Section 702.2). 

      Whichever of the three methods produces the highest average per month will be used.  It is important to note that for purposes of determining Average Current Earnings, your actual earnings are used even if they exceed the amount of earnings subject to FICA tax for that year.  Because your earnings record only shows the earnings in a calendar year which are subject to the FICA tax, it is important if your yearly earnings for a particular year exceeded the FICA maximums to bring this to the attention of the Social Security Administration.    A listing of the FICA maximum for all years is located at Appendix 3. 

      The Workers Compensation offset does not apply if the Workers Compensation Law under which you are receiving Workers Compensation benefits provides that compensation benefits will be reduced by the amount of Social Security benefits you receive.

       If the total of the Social Security benefits payable on the individuals earnings record is greater than 80% of the Average Current Earnings, then this higher figure is used to figure the offset instead of the 80% figure.  

    For example, if the Average Current Earnings are $1,000.00 per month, 80% is $800.00.  If the total amount of benefits payable on the account, including the dependents, is $900.00 per month, then the Social Security benefits will be reduced so that the combination of Workers Compensation and Social Security benefits do not exceed $900.00.  It is rare, however, that the total Social Security benefits exceed 80% of Average Current Earnings.

     The Average Current Earnings (ACE) will be adjusted upward every three years to take account of inflation.  This is called a "triennial redetermination."  The current inflation factor for redetermination year 2008 is 1.08424.  Your ACE will be multiplied by this factor when figuring the offset.

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Section 512 -     The Effect of Other Kinds of
                  Benefits or Payments


      Benefits paid under private disability insurance policies have no effect on Social Security disability benefits.  Employee salary continuation will not have any effect, nor will any back pay, retroactive increases past due, commissions or any other such payments from an employer.  Besides Workers Compensation discussed in Section511 above, the only type of disability benefits which affect your Social Security disability are those which are required by any federal, state or local law.  

    For example, some states have laws which require employers to pay disability benefits to disabled employees.  Such benefits would be used to offset Social Security disability benefits in the same way as Workers Compensation.  These benefits are added to the amount of Workers Compensation and the computation of the offset is then the same.  

    You should note, however, that if the statute requiring the special disability benefit provides for an offset for Social Security benefits, then this offset provision does not apply.

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Section 513 -     When the Disability Benefits

       There is a difference between "cessation" of disability and "termination" of disability benefits.  Cessation of disability occurs when Social Security determines you are no longer totally disabled within the definition of disability for Social Security purposes (Section 502).  Termination of benefits occurs two months after cessation of disability.  For example, if Social Security determines that your disability ceased in June, your disability will terminate as of August so that you will receive the benefits for June, July and August, but not thereafter.

       Cessation of disability occurs when your medical condition is no longer considered to be totally disabling or when you begin performing Substantial Gainful Activity (Section504). 

      Social Security conducts periodic reviews of many Social Security disability cases to reconsider the medical condition of the beneficiary.  If, after such a medical review, Social Security determines that your condition is no longer totally disabling, your disability will be considered to have ceased.  It is the policy of the Social Security Administration to send you a notice of this determination and if they fail to do so, your disability will not be considered to have ceased until such time as you receive the notice.  

    For example, lets say the Social Security Administration conducts a medical review of your case and determines that based on your medical records, your disability ceased as of June 19.  However, due to office problems, they did not mail out the notice to you until August.  It is the Social Security Administration's policy to make your official cessation of disability in August, the month you received the notice, rather than June, the month that they determined your medical evidence no longer was considered totally disabling. 

    Even if your medical condition remains the same or worsens, if you are performing Substantial Gainful Activity (Section 504), your disability will be considered to have ceased.  Note that if you are entitled to a trial work period (Section 509) your work activity will not be considered Substantial Gainful Activity until nine months of the trial work period have passed.  You may then be entitled to further benefits for non-work months.  See Section 510.  Also note that not all work activity is considered Substantial Gainful Activity (Section 504).


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Section 514 -     The Continuing Disability Review


      The Social Security Administration conducts periodic reviews of disability cases to determine whether or not you are working or whether or not your medical condition has changed.  Some cases are reviewed more frequently than others and some cases are not reviewed at all.  It depends on the nature of your disability.  When your claim is first awarded a date is usually set at that time for a future review. SSA will not conduct a review based on work activity alone if you have received benefits for at least 24 months. SSA will still conduct regularly scheduled reviews unless you are using a Ticket to Work (see Section 515 below).


      You will be notified when your case is being called for review and generally you will be called to the District Office to give current information about any work activity you may be doing, to obtain the names of your current doctors and any recent periods of hospitalization.  The Social Security Administration may have you examined by one of their consultant physicians, at their expense. If you medically recover while participating in a vocational rehabilitation program that is likely to lead to  your becoming self-supporting, benefits may continue until the program ends.


      If you do not cooperate with this continuing disability review, Social Security has the authority to stop your disability benefits because you fail to cooperate.


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Section 515-       The Ticket To Work


    This law was enacted to provide health care and employment services to people with disabilities to help reduce their dependence on cash benefit programs. Provisions of the law that involve social security include the "Ticket to Work and Self-Sufficiency Program" (Ticket to Work program) that allows Social Security disability beneficiaries to get employment services, vocational rehabilitation services, or other support services that will help them to work.  Additionally, people with disabilities will have the option of maintaining Medicare coverage while working. The law extends premium-free Medicare Part A (Hospital Insurance) coverage to 8 and 1/2 years, including the trial work period, for beneficiaries who work.


      Eligible Social Security disability beneficiaries will receive a "ticket" they may use to obtain vocational rehabilitation, employment or other support services from an approved Employment Network or State Vocational Rehabilitation agency of their choice. The Ticket to Work program is voluntary for beneficiaries and Employment Networks.


      When disability benefits stop because of work activity, the beneficiary can request reinstatement of benefits, including Medicare, without having to go through the difficult process of filing a new application. To be eligible for expedited reinstatement, you must be unable to work because of your medical condition; your impairment must be the same or related to the impairment that was the basis for your previous disability benefits; and you must file the request for reinstatement within 60 months from the month your benefits are terminated. This time limit may be extended for good cause.


      In addition, you may receive provisional benefits, including Medicare, for up to six months while your case is being reviewed. If you are found not disabled, the benefits generally will not constitute an overpayment.

If you are using a "ticket" (a document which SSA issues for participation in the program) you will not be subject to continuing disability reviews. However, benefits may be stopped if your earnings are above the substantial gainful activity level. Beneficiaries who have been receiving benefits for at least 2 years will not be medically reviewed just because they are working. The law also requires SSA to staff work-incentives specialists to provide information about employment support programs to beneficiaries who want to work.


            In general, you must be 18 or older and under 65 to be eligible for a ticket. You may receive only one ticket during a period of disability. If your benefits cease but you become re-entitled, you may receive another one. The ticket will terminate when you reach age 65. You will no longer be able to obtain employment or vocational services when the ticket terminates. If you are not making timely progress in preparing for self-supporting work, SSA may conduct a continuing disability review which may find that you are no longer medically disabled. If you are making timely progress, such reviews will not be done. Timely progress rules require that you actively participate in an employment plan during the first two years after the month you begin using the ticket, and an increase in your work activity and earnings during the next two years. This means you must work in at least 3 months within the first 3 years, and at least 6 months in the fourth year. You must earn at least as much as the earnings level for determining non-blind substantial gainful activity, see Section 504.1 above.


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