1. Understanding Social Security Disability

2. Two Different Programs Title 2 SSDI Requires work: 5 years out of last 10 5 month waiting period 24 month Medicare waiting period 12 months retro May pay family benefits Title 16 SSIDI No work required Income: < $710/$1066 Resources: < $2K/$3K Living arrangements 1 month waiting period No retroactivity Medicaid No family benefits

3. Definition Of Disability Inability to engage in Substantial Gainful Activity (work) (2013 - $1,040 month) by reason of a physical or mental impairment that has lasted or is expected to last at a severe level for a period of at least 12 continuous months.

4. Substantial Gainful Activity 2013 – Generally SGA if over $1040 month Impairment related work expenses (Rx co-pays, doctor co-pays, special equipment, transportation, etc.) can reduce earnings Subsidy/special considerations can reduce earnings

5. Office Processes Local SSA Office Paperwork processing center Application/appeal intake Determination of non- medical factors Disability Unit Located in Raleigh Never sees the client Obtains medical records Makes medical decision

6. Work Requirements – T2 Credits earned by working 2013 - $1,160 per credit up to 4 10 years minimum work (40 credits) 5 of the years (20 credits) must be within the 10 years prior to onset of disability (current connection)

7. Onset Date Not always equivalent to diagnosis date 2 different factors: 1. Not engaging in SGA (2013 - $1,040 month) 2. Have a severe condition (12 months duration)

8. Onset/Entitlement Example Diagnosis date: 03/15/2012 Stop work date: 09/30/2012 Correct onset date would be 09/30/2012 Waiting period: 10/12 – 02/13 Entitlement date: 03/2013 First payment: 04/2013 Medicare: 03/2015

9. Onset/Entitlement Example 2 Diagnosis date: 03/15/2012 Stop work date: 03/15/2012 Correct onset date would be 03/15/2012 Waiting period: 04/12-08/12 Entitlement date: 09/12 First payment date 10/12 Medicare: 09/2014 Retroactivity: dependent on application

10. Onset vs Entitlement Under T2 SSDI, can delay as long as 17 months from onset to file application with no loss in benefits Allows up to 12 months retro benefits from date of application (subject to onset/waiting period restrictions) Onset 10/15/2011, Waiting Period Nov., Dec., Jan., Feb., Mar Application Date 04/15/13 = Potential Retro benefits to 04/2012

11. Offset 1 Workers Compensation – WC + SSA cannot exceed 80% of monthly average current earnings. Excess is offset against SSA benefit. Example, average earnings = $3,000 month, ACE = $2400 Workers Comp = $500 week, or $2,165 month SSA = $2000 Total of $4,165 in benefits, $1,765 offset Net SSA = $235.00

12. Offset 1 (cont) WC lump sum payments are also offset Lump sum pro-rated based on weekly wage will result in offset Lump sum pro-rated on life expectancy will usually avoid offset WC offset is removed at age 65

13. Offset 2 Employer long term disability is usually offset by Social Security (even if paid for by employee) LTD: $2500 per month T2 SSDI: $2000 per month Insurance offsets the $2000, paying only $500 per month under the LTD Varies from policy to policy

14. Application Process Can apply through local office appointment (telephone) or via internet Application takes about 1 ½ hours See green worksheet Client can have consultant or representative if desired Decision takes from 3-5 months

15. Appeals Reconsideration (SSA-561) 2-3 months Paper review, DDS in Raleigh Hearing (HA-501) 18-24 months Administrative Law Judge in Greensboro Need representative Appeals Council Review 6-12 months Council is in Arlington VA

16. Benefit Rates T2 benefits are based on average earnings over an “elapsed period” from age 22 to date of disability onset, less 5 drop out years Example: Disabled at age 45. From age 22, there are 23 “elapsed years”, less 5 drop out years = 18 used in the computation Disability rate is equivalent to age 66 retirement rate

17. Benefit Rates Family benefits are payable, usually 50% of the worker’s primary rate. Worker’s benefit $1500, family = $750.00 Divided pro-rata share for multiple children in family