Social Security Disability Related Terms

Applying for Social Security Disability Insurance benefits can be a confusing process, in part because some of the language used by the Social Security Administration isn’t necessarily clear. People may also be unsure whether they can qualify for other forms of federal assistance and, if so, how other benefits could affect SSDI eligibility.

Activities of Daily Living (ADL)

Activities that one engages in when he or she performs everyday tasks such as home cleaning and maintenance, cooking, shopping, taking public transportation, paying bills, personal grooming and hygiene, corresponding via phone, email, letters, etc.

Administrative Law Judge (ALJ)

Employed by the Office of Disability Adjudication and Review as a neutral fact-finder whose job it is to consider the evidence and make a determination as to whether or not a claimant is entitled to benefits under the law.

Alleged Onset Date

The date on which a claimant alleges that he or she became disabled due to a physical or mental impairment.

Appeals Council

Reviews the decisions made by ALJ’s to determine if a request for review should be granted, denied, or dismissed. They are the highest level of administrative appeal and are located in Falls Church, VA.

Auxiliary Beneficiary

Additional monthly benefits payable to family members of the claimant, such as a spouse or child, where the benefit payments are based upon the earnings record of the person entitled to Social Security benefits

Back pay

Monies are payable to a disabled claimant for that period of time for which the individual was disabled prior to a decision being made in their claim. There are many different technical rules that apply when calculating back pay in SSDI and SSI cases that are contingent upon certain dates such as the application date and date of the disability.

Claims Representative (CR)

An employee of the Social Security Administration whose job it is as a federal employee to provide assistance to individuals seeking Social Security and SSI benefits. During the claims process, the CR determines if a claimant meets entitlement requirements pursuant to the applicable law and regulations.

Consultative Examination (CE)

A physical or mental examination normally undertaken by an examiner retained at the government’s expense to evaluate the claimant’s impairment on behalf of SSA.

Continuing Disability Review

A periodic review conducted to determine if disability continues. They are oftentimes scheduled when the original finding of disability indicated that improvement is expected; however, the review can also occur if the beneficiary or the state vocational rehabilitation agency reports improvement.

Date of Entitlement to Disability

The date from which past-due benefits will be paid.

Date Last Insured (DLI)

The date on which a claimant’s coverage for Title II disability expires based upon the number of quarters of work credits reported in the claimant’s earnings record.

Date of Onset

The date on which the claimant became disabled.

Disability

Inability to engage in any substantial 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 12 months.

Disability Determination Service (DDS)

Also known as the “state agency” that makes disability determinations in regards to the initial and reconsideration levels.

Earnings Record

A report maintained by the Social Security Administration that details the history of earnings reported to SSA that are used to determine entitlement to a disability, health insurance, retirement, and survivor benefits and to calculate cash benefit rates.

Earnings Requirement

A Title II DIB claimant is required to have worked and earned at least 20 quarters of coverage in the last 40 quarters before the “onset of disability” and be found “fully insured” to be entitled to Title II disability benefits. A blind claimant under the age of 31 with fewer than 20 quarters of work may be entitled to disability benefits..

Entitlement

Refers to when a person who has filed an application for disability benefits meets all the eligibility requirements under both the medical and non-medical rules, for a specific type of benefit.

Established Onset Date

The date used in Title II disability refers to the date on which medical and work information substantiates that the claimant became disabled.

Family Benefits

SSDI benefits based on your work record paid to a spouse, ex-spouse, or child who meets the age and/or disability criteria. For example, if a man and his 20-year-old son are both seriously injured in a car crash, and the son has never worked, the son could still be eligible to receive monthly SSDI benefits of up to 50 percent of the father’s total disability rate.

Federal Benefit Rate (FBR)

The monthly SSI benefit payment is due from the federal government.   The SSI benefit payment can be reduced or eliminated if the individual’s monthly countable income exceeds the Federal Benefit Rate.

Field Office

Refers to the approximately 1300 local offices located throughout the United States where the Social Security Administration maintains services to assist individuals with applying for a Social Security number, obtaining a copy of earnings records. The local field office can also be used to apply for benefits and obtain information on the types of government benefits available to an individual or family member under the applicable Social Security laws and regulations. For general information, an individual can also visit the Social Security’s website at www.ssa.gov.

Fully Insured

Refers to the requirement for claimants to qualify to receive Social Security Title II disability that they must also have obtained one-quarter of coverage for every year after age 21, up to the calendar year before becoming disabled. A claimant can never be required to have more than 40 quarters of coverage to be found fully insured

Insured Status

Refers to when a claimant has obtained the requisite number of quarters of coverage for entitlement to Social Security Title II disability benefits. Please refer to “Earnings Requirement” for the number of quarters required for “insured status” that can be dependent upon the type of benefits sought and the age of the claimant.

Listing of Impairments

The Social Security Administration’s Listing of Impairments includes certain medical conditions that can automatically prove disability; however, a person with a listed impairment must still provide proof that the impairment severely interferes with a person’s ability to perform a substantial gainful activity (work).

Medicaid

The name for joint state and federal health insurance for disabled, elderly, and those with children who meet income limitation requirements. Also known as Title XIX. The federal eligibility requirements that cover all states look at factors such as income, household size, disability, and other factors. In states that have expanded Medicaid, people may qualify based solely on their income level.

Medicare

A federal health insurance program for people age 65 or older, and for people with permanent kidney failure who require dialysis or have had a kidney transplant. Parents who have dependent children with certain disabilities may also qualify for Medicare. SSDI recipients with long-term disabilities also could qualify for Medicare, regardless of age, two years after they receive their first SSDI payment.

Medicare has four components:

• Part A – Known as Hospital Insurance, this benefit helps pay for inpatient care in a hospital, in a rehabilitative facility following hospitalization, and some home health and hospice care.

• Part B – Known as Medical Insurance, this benefit helps pay for regular health care visits to doctors and other providers, outpatient care, home health care, and durable medical equipment.

• Part C – Known as Medicare Advantage, this benefit allows people receiving Part A and Part B to consolidate all health care services with a single provider.

• Part D – This benefit is used only to help pay for prescription drugs.

Medical Evidence of Record

The claimant’s medical records provided to the Social Security Administration.

Medical Source Statement

A statement from the claimant’s treating source addressing the claimant’s abilities and limitations in view of the claimant’s impairments when considering the claimant’s medical history, clinical and laboratory findings, diagnosis, and treatment.

Office of Disability and Adjudication and Review

An office of the SSA that Conducts hearings on denied claims, separate from the entity that denied the claim initially and upon reconsideration.

Past Relevant Work

A claimant’s work history over the previous 15 years lasted long enough for them to learn the job in addition to being substantial gainful activity.

Quarters of Coverage

Social Security Credits are earned for a designated period of time spent working.

Reconsideration

The next level of administrative appeal after an initial denial, wherein a claimant can request that the claim be reconsidered if the claimant is not satisfied with the previous determination and submit new evidence if available.

Residual Functional Capacity (RFC)

The claimant’s capacity for sustained performance in regards to the physical and mental requirements of jobs in spite of the limitations imposed by their medically determinable impairment.

Restriction

What a claimant cannot do, either exertional or non-exertional, because of their limitations due to a medical impairment.

Retirement, Survivors Disability Insurance

The federal program provides benefits to individuals who are either retired, eligible dependents of deceased workers, or disabled workers.

Social Security Disability Insurance (SSDI)

The official name of the Social Security disability program

SSI v. SSDI

SSI – Supplemental Security Income – is similar to SSDI, in that it provides payments to individuals who are disabled. However, SSI benefits are not dependent on one’s work history, as SSDI is. A person who has never worked could qualify for SSI, but not necessarily SSDI (see the entry on “Family Benefits,” for exceptions to SSDI ineligibility).

Recipients of SSDI may be eligible to receive Medicare, whereas SSI recipients are covered by Medicaid. SSDI is funded at the federal level, so no state-level supplemental payments are available for recipients. In some states, SSI recipients may receive state-level supplements.