Disability

Eligibility to Work While on Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)

Under both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), disability beneficiaries may return to some form of work through programs designed by the Social Security Administration (SSA).

Those receiving SSDI benefits have the right to tentatively reenter the workforce without impacting their monthly benefit through SSA’s Trial Work Period (TWP). This 9 (non-consecutive) month program allows a beneficiary of SSDI to return to work and receive both income and monthly SSDI benefits. Following a Trial Work Period beneficiaries can continue to work for 36-months under an Extend Period of Eligibility. This period, however, does have an income cap each month, and if the beneficiary exceeds this cap than their benefit will be revoked for that month.

SSI beneficiaries may also reenter the workforce, but those who do should be cautious about the impact that will have on their monthly benefits. Those who work while receiving SSI do not have a Trial Work Period and will see an immediate decline in benefits while working.

Trial Work Period

During this period a beneficiary will continue to receive their full monthly benefit regardless of how high their earnings are. This allows a SSDI recipient to test their ability to work without having to worry that it will impact their benefits. The Trial Work Period is counted as any 9-months where beneficiary earns $850 or more. If a beneficiary earns under this amount then SSA does not count the month as a Trial Work Period service month. This means that the 9-month period does not have to be consecutive. The beneficiary must inform the Social Security Administration of their earnings each month that they work so that SSA can accurately assess which months count as a Trial Work Period service month. Failure to inform SSA could lead to a revocation of benefits or SSA counting a month as a service month even when the beneficiary earns under $850.

 Extended Period of Eligibility

This is a 36-month period following the Trial Work Period where SSDI recipients will continue to receive full benefits every month as long as the recipient earnings are under the “substantial gainful activity” (SGA) threshold. In 2019, SGA is $1,220 a month, but each year this number is subject to adjustment. SSA determines if a beneficiary is eligible for a benefit check on a month-to-month basis during this period. If a recipient earns above the SGA amount in a given month than they will lose that month’s entire benefit. After the 36th month, when the period is over, those who earn over the SGA threshold will have their SSDI benefits canceled entirely.

 Expedited Reinstatement

Those who lose their SSDI benefits by earning over the SGA threshold after the Extended Period of Eligibility have a five-year period where SSDI benefits may be reinstated. If working past the Extended Period of Eligibility results in a beneficiary losing their benefits, but then their monthly income slips below the SGA threshold, the beneficiary may file an application for expedited reinstatement. This allows SSA to reevaluate a former beneficiary’s eligibility without forcing them to submit an entirely new application. Once an application for expedited reinstatement is filed, SSA will pay the former beneficiary full benefits for six months while the application is processed. In order to deny an application of this nature, SSA must demonstrate that the beneficiary has medically improved enough to not qualify for disability since the last time they received benefits. In contrast, if this were a new application, the applicant, not SSA, would have to prove that they are medically disabled. This process allows those who have worked, but lost their benefits an opportunity to return to SSDI without the repercussions of having to apply from scratch.

 Working While on SSI

As stated before, SSI does not have a Trial Work Period. Instead those who seek employment while receiving monthly SSI benefits will be subject to adjustments in the pay scale for benefits. A beneficiary will be able to receive some benefit as long as they make under SSA’s income limit for SSI. In 2018, that limit is $750 dollars. If wages in 2018 exceed $750, an SSI beneficiary would receive no SSI benefits. SSA does not count the first $85 dollars a person earns when calculating the benefit reduction. However, after a beneficiary earns $85 in a month, for every additional dollar earned, SSA deducts 50 cents from the monthly benefit.

 For example, consider a beneficiary who earns exactly $500 in a month

$500-$85=$415
$415÷2=$207.50

This means that this person’s SSI benefits would be reduced by $207.50 a month. Those receiving SSI benefits should keep this in mind when attempting to return to the workforce.

Federal Disability Insurance Eligibility for Non-Citizens

Subject to certain restrictions, individuals who are disabled and are not citizens of the United States may qualify for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) from the Social Security Administration. Note, however, that SSDI and SSI have different eligibility criteria and SSI for non-citizens is harder to qualify for than SSDI.

The Requirements for SSDI

To qualify for SSDI a non-citizen must have either (1) a Social Security Number that authorizes them to work in the US, or (2) a B-1, D-1, or D-2 non-immigrant visa. A non-citizen must also be able to demonstrate to the Social Security Administration that they are in the US lawfully while receiving benefits. Lastly, a non-citizen must be able to demonstrate the same basic medical and technical eligibility criteria required of all SSDI beneficiaries. These can be found bellow in the blog titled “Eligibility Requirements for the Two Types of Federal Disability Benefits.”

The Requirements for SSI

To receive SSI benefits a non-citizen must (1) be “qualified alien” and (2) must meet a condition that allows qualified aliens to receive SSI.

The categories of qualified aliens are as follows:

  • Lawfully Admitted Permanent Residents (LAPR)

  • Conditional Entrants granted entry under Section 203(a)(7) of the Immigration and Nationality Act (INA)

  • Parolees in the US for a period of one year or more

  • Refugees

  • Asylees

  • Haitian or Cuban entrants granted admittance under the Refugee Education and Assistance Act of 1980

  • American Indians the hold membership in a federally recognized tribe that were born in Canada

  • Special Immigrants from Afghanistan or Iraq who provided the US military assistance while overseas

Qualified aliens must also demonstrate that they meet one of the following conditions in order to qualify for SSI benefits:

  • The non-citizen was receiving SSI and lawfully residing in the US on August 22, 1996.

  • The non-citizen is an LAPR with 40 qualifying quarters of work

  • The non-citizen is active duty in the US Armed force, an honorably discharged veteran, or the immediate family member of US military personnel

  • The non-citizen was residing in the US on August 22, 1996 AND is blind or disabled

Note that Refugees, Asylees, and Cuban, Haitian, Iraqi, and Afghani entrants may only receive SSI benefits for a maximum of 7 years from the date Department of Homeland Security grants immigration status.

Eligibility Requirements for The Two Types of Federal Disability Benefits

In order to qualify for Social Security Disability benefits you have to be disabled. In order to qualify as disabled, an applicant must not be able to engage in any substantial gainful activity due to a physical or mental impairment. Substantial gainful activity is defined as work where a person earns more than a certain amount monthly and is performing actual work tasks. If you are disabled, there are two types of disability benefits that individuals can qualify for Social Security Disability Insurance (“SSDI”) or Supplemental Security Income (SSI).  SSDI benefits are sometimes referred to as Title II benefits and SSI are sometimes called Title XVI benefits.  The eligibility criteria for SSDI and SSI are different. 

Social Security Disability Income (SSDI)

Social Security Disability Income (“SSDI”) is available to individuals who have worked and paid FICA taxes before they became disabled. In order to qualify as disabled, an applicant must not be able to engage in any substantial gainful activity due to a physical or mental impairment. Additionally, the Social Security Administration requires applicants to pass two tests to be eligible for SSDI, the recent work test and the duration of work test.

The recent work test applies to those who are 31 or older and SSA looks at an applicant’s work history, requiring that the applicant has worked 20 of the past 40 quarters, or 5 of the last 10 years. Those under 31 are waived from having to meet this requirement.

The duration of work test requires applicants to have worked for a specific number of years based off of the age they became disabled. Below is a chart showing the number of years and credits required in order to qualify for SSDI.

Became Disabled at Age
Number of Credits You Need
Number of Years of Worked
21 through 24 6 1.5
24 through 31 6 to 18 1.5 to 4.5
31 through 42 20 5
44 22 5.5
46 24 6
48 26 6.5
50 28 7
52 30 7.5
54 32 8
56 34 8.5
58 36 9
60 38 9.5
62 or older 40 10

For both the recent work test and the duration of work test to receive a credit you must earn over a certain amount and have paid FICA taxes.  The amount needed to qualify for a credit changes yearly.  For example, in 2008, an individual needed to make $1,050 in a quarter to receive credit for working that quarter.  As of 2018, when a worker pays into FICA they receive a Social Security work credit for every $1,320 they earn. In 2018, workers can earn up to a maximum of four credits per year for earning $5,200 and these credits accumulate over a lifetime of work.

If an applicant is disabled and meets both for SSA’s work credit requirements than they are eligible for SSDI. Those who are disabled but do not have enough credits will not be eligible for SSDI, however, they may be eligible for SSI which has no work requirements

Additionally, disabled dependents of SSDI recipients, individuals receiving Social Security retirement income, individuals that passed away and were eligible to receive SSDI to SS retirement income before death are eligible for SSDI.   These are frequently called child benefits, meaning the child receives the benefit based upon the parent’s work record.  These child benefits are available to dependents starting at the age of 18.  To be eligible for these SSDI benefits, a child must become disabled prior to the age of 22.   Disabled children may receive these SSDI benefits into adulthood. Spouses or ex-spouses of disabled workers receiving SSDI may also receive benefits when they care for the children of a disabled worker.

Supplemental Security Income (SSI)

Supplemental Security Income is available to most individuals who are 65 or older, blind, or disabled and have limited income and financial resources. To qualify for SSI applicants must demonstrate that they have limited financial means. An applicant must not own more than $2,000 in countable assets. If the applicant is married they may own upwards of $3,000 in jointly held countable assets. Countable assets are anything of value that do not include a home or one vehicle.  (If more than one vehicle is owned, the additional vehicles are considered countable assets).

Similar to SSDI, to qualify as disabled an applicant must not be able to engage in any substantial gainful activity due to a physical or mental impairment. The physical or mental impairment must last longer than 12 months in order to qualify. There is no work requirement necessary, setting SSI apart from SSDI.

Children who are blind or disabled may also qualify for SSI benefits as early as the date of birth. While many of the conditions that SSA considers a disability apply to children, some additional physical and mental impairments are recognized. A full list can be found here.  When they reach the age of 18, children who receive SSI are reevaluated by SSA under the application requirements for adults.

If the applicant can demonstrate they fulfill both their disability and limited financial means requirements than they are likely eligible for SSI.

Social Security Administration (SSA) Grid Rules

Grid for Sedentary Work

Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.

Rule
Age
Education
Previous Work
Experience
Decision
201.01 Advanced Age
(55 and Over)
Limited or less
(No high school diploma or GED)
Unskilled or none Disabled
201.02 Advanced Age
(55 and Over)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Disabled
201.03 Advanced Age
(55 and Over)1
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
201.04 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Unskilled or none Disabled
201.05 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Unskilled or none Not disabled
201.06 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Disabled
201.07 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
201.08 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
201.09 Closely Approaching Advanced Age (50 to 54) Limited or less
(No high school diploma or GED)
Unskilled or none Disabled
201.10 Closely Approaching Advanced Age (50 to 54) Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Disabled
201.11 Closely Approaching Advanced Age (50 to 54) Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
201.12 Closely Approaching Advanced Age (50 to 54) High school graduate or more-provides for direct entry into skilled work Unskilled or none Disabled
201.13 Closely Approaching Advanced Age (50 to 54) High school graduate or more-provides for direct entry into skilled work Unskilled or none Not disabled
201.14 Closely Approaching Advanced Age (50 to 54) High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills not transferable Disabled
201.15 Closely Approaching Advanced Age (50 to 54) High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
201.16 Closely Approaching Advanced Age (50 to 54) High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
201.17 Younger Individual Age
(45-49)
Illiterate or unable to communicate in English Unskilled or none Disabled
201.18 Younger Individual Age
(45-49)
Limited or less
(No high school diploma or GED)
Unskilled or none Not disabled
201.19 Younger Individual Age
(45-49)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
201.20 Younger Individual Age
(45-49)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills transferable Not disabled
201.21 Younger Individual Age
(45-49)
High school graduate or more Skilled or semiskilled-skills not transferable Not disabled
201.22 Younger Individual Age
(45-49)
High school graduate or more Skilled or semiskilled-skills transferable Not disabled
201.23 Younger Individual Age
(18-44)
Illiterate or unable to communicate in English Unskilled or none Not disabled
201.24 Younger Individual Age
(18-44))
Limited or less
(No high school diploma or GED)-at least literate and able to communicate in English
Unskilled or none Not disabled
201.25 Younger Individual Age
(18-44)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
201.26 Younger Individual Age
(18-44)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills nottransferable Not disabled
201.27 Younger Individual Age
(18-44)
High school graduate or more Unskilled or none Not disabled
201.28 Younger Individual Age
(18-44)
High school graduate or more Skilled or semiskilled-skills not transferable Not disabled
201.29 High school graduate or more Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills transferable Not disabled

Grid for Light Work

Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, SSA determines that he or she can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

Rule
Age
Education
Previous Work
Experience
Decision
202.01 Advanced Age
(55 and Over)
Limited or less
(No high school diploma or GED)
Unskilled or none Disabled
202.02 Advanced Age
(55 and Over)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Disabled
202.03 Advanced Age
(55 and Over)1
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
202.04 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Unskilled or none Disabled
202.05 Advanced Age
(55 and Over)
High school graduate or more-provides for direct entry into skilled work Unskilled or none Not disabled
202.06 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Disabled
202.07 Advanced Age
(55 and Over)
High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills transferable Not disabled
202.08 Advanced Age
(55 and Over)
High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
202.09 Closely Approaching Advanced Age (50 to 54) Illiterate or unable to communicate in English Unskilled or none Disabled
202.10 Closely Approaching Advanced Age (50 to 54) Limited or less
(No high school diploma or GED) -at least literate and able to communicate in English
Unskilled or none Not disabled
202.11 Closely Approaching Advanced Age (50 to 54) Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
202.12 Closely Approaching Advanced Age (50 to 54) Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills transferable Not disabled
202.13 Closely Approaching Advanced Age (50 to 54) High school graduate or more Unskilled or none Not disabled
202.14 Closely Approaching Advanced Age (50 to 54) High school graduate or more Skilled or semiskilled-skills not transferable Not disabled
202.15 Closely Approaching Advanced Age (50 to 54) High school graduate or more Skilled or semiskilled-skills transferable Not disabled
202.16 Closely Approaching Advanced Age (50 to 54) Illiterate or unable to communicate in English Unskilled or none Not disabled
202.17 Younger Individual
(45-49)
Limited or less (No high school diploma or GED)-at least literate and able to communicate in English Unskilled or none Not disabled
202.18 Younger Individual
(45-49)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
202.19 Younger Individual Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills transferable Not disabled
202.20Younger IndividualHigh school graduate or moreunskilled or noneNot disabled
202.21 Younger Individual High school graduate or more Skilled or semiskilled-skills not transferable Not disabled
202.22 Younger Individual High school graduate or more Skilled or semiskilled-skills transferable Not disabled

Grid for Medium Work

Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If someone can do medium work, SSA determines that he or she can also do sedentary and light work.

Rule
Age
Education
Previous Work
Experience
Decision
203.01 Closely approaching retirement age Marginal or none Unskilled or none Disabled
203.02 Closely approaching retirement age Limited or less
(No high school diploma or GED)
None Disabled
203.03 Closely approaching retirement age Limited Unskilled Not disabled
203.04 Closely approaching retirement age Limited or less (No high school diploma or GED) Skilled or semiskilled-skills not transferable Not disabled
203.05 Closely approaching retirement age< td> Limited or less (No high school diploma or GED) Skilled or semiskilled-skills transferable Not disabled
203.06 Closely approaching retirement age High school graduate or more Unskilled or None Disabled
203.07 Closely approaching retirement age High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
203.08 Closely approaching retirement age High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills transferable Not disabled
203.09 Closely approaching retirement age High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
203.10 Advanced Age (55 and Over) Limited or less
(No high school diploma or GED)
None Disabled
203.11 Advanced Age (55 and Over) Limited or less
(No high school diploma or GED)
Unskilled Not disabled
203.12 Advanced Age (55 and Over) Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
203.13 Advanced Age (55 and Over) Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills transferable Not disabled
203.14 Advanced Age (55 and Over) High school graduate or more Unskilled or none Not disabled
203.15 Advanced Age (55 and Over) High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
203.16 Advanced Age (55 and Over) High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills transferable Not disabled
203.17 Advanced Age (55 and Over) High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
203.18 Closely Approaching Advanced Age
(50 to 54)
Limited or less
(No high school diploma or GED)
Unskilled or none Not disabled
203.19 Closely Approaching Advanced Age
(50 to 54)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills not transferable Not disabled
203.20 Closely Approaching Advanced Age
(50 to 54)
Limited or less
(No high school diploma or GED)
Skilled or semiskilled-skills transferable Not disabled
203.21 Closely Approaching Advanced Age
(50 to 54)
High school graduate or more Unskilled or none Not disabled
203.22 Closely Approaching Advanced Age
(50 to 54)
High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
203.23 Closely Approaching Advanced Age
(50 to 54)
High school graduate or more--does not provide for direct entry into skilled work Skilled or semiskilled-skills transferable Not disabled
203.24 Closely Approaching Advanced Age
(50 to 54)
High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
203.25 Younger Individual Limited or less (No high school diploma or GED Unskilled or none Not disabled
203.26 Younger Individual Limited or less (No high school diploma or GED Skilled or semiskilled-skills not transferable Not disabled
203.27 Younger Individual Limited or less (No high school diploma or GED Skilled or semiskilled-skills transferable Not disabled
203.28 Younger Individual High school graduate or more Unskilled or none Not disabled
203.29 Younger Individual High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills not transferable Not disabled
203.30 Younger Individual High school graduate or more-does not provide for direct entry into skilled work Skilled or semiskilled-skills transferable Not disabled
203.31 Younger Individual High school graduate or more-provides for direct entry into skilled work Skilled or semiskilled-skills transferable Not disabled

Unskilled work. Unskilled work is work which needs little or no judgment to do simple duties that can be learned on the job in a short period of time. The job may or may not require considerable strength. For example, SSA considers jobs unskilled if the primary work duties are handling, feeding and offbearing (that is, placing or removing materials from machines which are automatic or operated by others), or machine tending, and a person can usually learn to do the job in 30 days, and little specific vocational preparation and judgment are needed. A person does not gain work skills by doing unskilled jobs.

Semi-skilled work. Semi-skilled work is work which needs some skills but does not require doing the more complex work duties. Semi-skilled jobs may require alertness and close attention to watching machine processes; or inspecting, testing or otherwise looking for irregularities; or tending or guarding equipment, property, materials, or persons against loss, damage or injury; or other types of activities which are similarly less complex than skilled work, but more complex than unskilled work. A job may be classified as semi-skilled where coordination and dexterity are necessary, as when hands or feet must be moved quickly to do repetitive tasks.

Skilled work. Skilled work requires qualifications in which a person uses judgment to determine the machine and manual operations to be performed in order to obtain the proper form, quality, or quantity of material to be produced. Skilled work may require laying out work, estimating quality, determining the suitability and needed quantities of materials, making precise measurements, reading blueprints or other specifications, or making necessary computations or mechanical adjustments to control or regulate the work. Other skilled jobs may require dealing with people, facts, or figures or abstract ideas at a high level of complexity.

Skills that can be used in other work (transferability)—(1) What we mean by transferable skills. SSA considers you to have skills that can be used in other jobs, when the skilled or semi-skilled work activities you did in past work can be used to meet the requirements of skilled or semi-skilled work activities of other jobs or kinds of work.

Transferability is most probable and meaningful among jobs in which—

(i) The same or a lesser degree of skill is required;

(ii) The same or similar tools and machines are used; and

(iii) The same or similar raw materials, products, processes, or services are involved.

Degrees of transferability. There are degrees of transferability of skills ranging from very close similarities to remote and incidental similarities among jobs. A complete similarity of all three factors is not necessary for transferability. However, when skills are so specialized or have been acquired in such an isolated vocational setting (like many jobs in mining, agriculture, or fishing) that they are not readily usable in other industries, jobs, and work settings, SSA considers that they are not transferable.

Transferability of skills for persons of advanced age. If you are of advanced age (age 55 or older), and you have a severe impairment(s) that limits you to sedentary or light work, SSA will find that you cannot make an adjustment to other work unless you have skills that you can transfer to other skilled or semiskilled work (or you have recently completed education which provides for direct entry into skilled work) that you can do despite your impairment(s). SSA will decide if you have transferable skills as follows. If you are of advanced age and you have a severe impairment(s) that limits you to no more than sedentary work, SSA will find that you have skills that are transferable to skilled or semiskilled sedentary work only if the sedentary work is so similar to your previous work that you would need to make very little, if any, vocational adjustment in terms of tools, work processes, work settings, or the industry. If you are of advanced age but have not attained age 60, and you have a severe impairment(s) that limits you to no more than light work, SSA will apply a series of factors to decide if you have skills that are transferable to skilled or semiskilled light work. If you are closely approaching retirement age (age 60 or older) and you have a severe impairment(s) that limits you to no more than light work, SSA will find that you have skills that are transferable to skilled or semiskilled light work only if the light work is so similar to your previous work that you would need to make very little, if any, vocational adjustment in terms of tools, work processes, work settings, or the industry.

Obtaining Disabilty Benefits From the Maryland State Retirement Agency

In Maryland, many state employees are eligible for disability retirements benefits if they are no longer able to work for a state agency or other government agencies, such as Baltimore City Public Schools.  There are three types of disability retirement benefits: Ordinary Disability Benefits, Accidental Disability Benefits, and Special/Accidental Disability Benefits.  

Ordinary Disability Benefits are disability benefits received because an individual cannot work because they are disabled.  Typically, claims for Ordinary Disability Benefits have to filed within four years after paid employment ends. Individuals who are part of the Teachers’ Retirement Plan have five years to apply for benefits.

Accidental Disability Benefits are awarded when the cause of the injury occurred in the performance of the claimant’s work duties at a definite time and place.  The disability cannot stem from willful negligence.  Moreover, the claimant must be totally and permanently unable to perform their job as a natural and proximate result of the accident.   Claims for Accidental Disability Benefits have to filed within five years of the accident occurring.

Special/Accidental Disability Benefits are Similar to Accidental Disability Benefits, but are available for State Police or individuals participating in the Law Enforcement Officers Pension System (LEOPS).  To be awarded these benefits a claimant needs to be totally and permanently disabled for duty and the disability needs to arise out of and in the course of the performance of their job, without any willful negligence on the part of the claimant. 

When applying for Accidental Disability or Special/Accidental Disability Benefits, the Maryland State Retirement Agency should automatically consider you for Ordinary Disability if you have at least five years of eligibility service.  However, the State Retirement Agency has been known not to consider applicants that do not check box on the application for Ordinary Disability Retirement. Moreover, if you apply for Ordinary Disability, and you do not simultaneously apply for Accidental Disability or Special/Accidental Disability, you cannot request Accidental Disability or Special/Accidental Disability for an injury that occurred prior to the application date for Ordinary Disability.  Checking the right boxes on the application is critical.

Collecting medical records will be an important part of the application process.  These records, along with a narrative that you provide the State Retirement Agency will be how Maryland State Retirement Agency decides whether are you are eligible for benefits.  If you are denied benefits after you first apply, you have the right to appeal the denial.  As part of the appeal, you will have a hearing to determine if you should be awarded benefits.

Once awarded benefits you will have multiple options as to how to select your benefits.  It is important that you select the benefits that you want correctly the first time.  Once the State issues you a check, the State does not have to let you change your mind as to the amount of benefits you receive.  Plans will vary in terms of whether you can name a beneficiary or medical coverage.

If your employer is forcing you to retire or quit, it is important that not only do you apply for the required disability benefits, but that you also submit certain forms, such as Form 129, prior to the date you are forced to retire.  If Form 129, is not submitted prior to the date you are forced to retire, you may become ineligible for benefits, even if you submitted your application date before the retirement date.

If you need someone experienced in this matter to help you obtain disability benefits from the Maryland State Retirement Agency, please contact the Law Office of Phillip E. Chalker at phillip@attorneychalker.com or (443) 961-7345..

ERISA: The Standard that Companies Should Use When Determining if an Employee is Eligible for Benefits

An individual eligible for a company’s pension, life insurance, or disability insurance benefits is called a participant.  The company that provides those benefits is called a provider or administrator.  Often the administrator is a third party and not the company that employees the participant. 

An administrator must follow certain steps prior to denying a participant’s application for benefits.   First an administrator must establish and maintain reasonable procedures governing the filing of benefit claims, notifications of benefit determinations, and appeals of adverse benefit determinations.   When denying a claim, the administrator must provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan was denied.  In simple English, the administrator must state the specific reasons for denying the claim and reference the provisions of the plan for which the denial is based.  After denying a claim, the administrator must provide the participant with a description of the plan’s review procedures and the time limits applicable to such procedures.  Moreover, the administrator must inform the participant whether the administrator needs any additional information to make a favorable decision.   

After an initial denial, an administrator must provide an opportunity for the participant to appeal the denial.  During the appeal, the administrator must provide a full and fair review.  During the entire review process, the administrators must ensure that benefit determinations are made in accordance with governing plan documents and that, where appropriate, the plan’s provisions have been applied consistently with respect to similarly situated claimants.  The administrator must include a statement of the claimant’s right to bring a civil action under section 502(a) of ERISA following a denial on review; provide the specific rule or a statement that a rule was relied upon in making the adverse determination, and a statement that a copy of such rule will be provided free of charge to the claimant upon request.

To provide a full and fair review an Administrator must:

  1. Upon request of a claimant, provide free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits.
  2. Take into account all comments, documents, records and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination;
  3. Consult with a healthcare professional that has appropriate training and experience in the relevant medical field when deciding an appeal of any adverse determination that is based in whole or in part on a medical judgment.
  4. Conduct a second review that does not afford deference to the initial adverse benefit determination.
  5. Have the person that conducts the second review be a new person and not be a subordinate of the person that performed the initial determination. 
  6. Consult a healthcare professional for an appeal of an adverse determination.  This healthcare should not be the individual who was consulted in connection the with initial adverse benefit determination that is the subject of the appeal nor the subordinate of any such individual.

In the Fourth Circuit, which Maryland is in, administrators cannot identify a new reason on appeal to justify why a participant is ineligible for benefits without giving the beneficiary the opportunity to appeal the new reason for the denial.  Moreover, prior to terminating benefits, an administrator needs to rely on substantial evidence and consider all symptoms, not just a select few.

If you have questions concerning your ERISA claim, contact the Law Office of Phillip E. Chalker at phillip@attorneychalker.com or (443) 961-7345.