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Every family needs to plan for the possibility of a disabling illness that prevents a breadwinner from earning income. Here is a summary of the part that Social Security benefits will play in your disability insurance planning—the amount you’re entitled to and the rules that apply. This Guide also informs you of what changes you need to report to Social Security and the easiest ways to report them.
An individual who is determined by the Social Security Administration to be disabled receives a Certificate of Award. This Certificate explains how much the disability benefit will be and when payments start. It also tells you when you can expect your condition to be reviewed to see if there has been any improvement. If family members are eligible, they will receive a separate notice and a booklet about things they need to know.
Generally, a worker is entitled to disability if he or she (1) is "insured" for disability (i.e., has accumulated sufficient credits in the Social Security system), (2) is under age 65, (3) has been disabled or is expected to be disabled for at least 12 months, (4) has filed an application for benefits, and (5) has completed a five-month waiting period. Disability is generally defined as the inability to perform substantial gainful activity due to a medical or mental impairment. Meeting this definition under Social Security is difficult.
If you are getting disability benefits on your own work record or on a deceased spouse's record, your payments cannot begin before the sixth full month of disability. If the sixth month has passed, your first payment may include some back benefits.
If you get Social Security, you may have to pay taxes on these benefits if you have substantial income. And if you are married and file a separate return, you probably will pay taxes on your benefits.
When To Expect Them
Your check should arrive on the third day of every month. If the third falls on a Saturday, Sunday, or legal holiday, you will receive your check on the last banking day before then. The check you receive is the benefit for the previous month. For example, the check you receive dated July 3 is for June.
Form Of Payment
Your benefit can either be mailed to you or deposited directly into your bank account.
Mail. Cash or deposit your check as soon as you receive it. If it is late, wait until three days after it was due and then contact Social Security. If it is determined to be lost or stolen, contact Social Security immediately. Your check can be replaced, but the process takes time.
If you receive a check you know is not due (for example, you are working and your condition has improved), take it to any Social Security office or return it to the U.S. Treasury Department, Division of Disbursement, at the address on the check envelope. Enclose a note explaining why you are sending the check back.
Direct Deposit. Direct deposit of your check can prevent problems with delayed, lost, or stolen checks. Direct deposit also adds convenience, especially if you are away from home. If you see a deposit in your account for a benefit that you know is not due you, you are, of course, required to refund it.
Most questions about direct deposit can be answered by your financial institution or any Social Security office.
Duration Of Payments
Your disability benefits generally continue for as long as you cannot
work and your impairment has not medically improved. They will not
necessarily continue indefinitely, however. Because of advances in medical
science and rehabilitation techniques, an increasing number of people with
disabilities recover from serious accidents and illnesses. Also, many
individuals, through determination and effort, overcome serious conditions
and return to work in spite of them.
If you become the parent of a child after you begin receiving Social Security benefits and the child is in your care, be sure to notify SSA so that the child can also receive benefits.
If you are still getting disability benefits when you turn 65, your benefits will be automatically changed to retirement benefits, generally in the same amount. You will then receive a new booklet explaining your rights and responsibilities as a retired person. If you are a disabled widow or widower, your benefits will be changed to regular widow or widower benefits (at the same rate) at 60, and you will receive a new instruction booklet that explains the rights and responsibilities for people who get survivors benefits.
After you receive disability benefits for 24 months, you will be eligible for Medicare. You will get information about Medicare several months before your coverage starts. (If you have chronic kidney disease requiring regular dialysis or a transplant, you may qualify for Medicare almost immediately.)
You should promptly report any changes that may affect your disability benefits. Family members receiving benefits also should report events that might affect their checks. The events that must be reported are explained in this section.
If You Change Your Address
You must notify the post office and Social Security immediately if you change your mailing address. In fact, failure to report a change of address is the leading cause of checks not arriving on time. Your report should include your claim number, your old address, and the new address, including the ZIP Code. Give the names of all family members who should receive benefits or information at the new address. Even if you have direct deposit, you should report a new address because important letters from Social Security are sent to your mailing address, not to a bank. Your benefits could be stopped temporarily if Social Security cannot locate you because of your failure to report a change of address.
If Your Condition Changes
You must notify SSA if there is any change for the better in your condition. Failure to do so could mean you will receive payments you aren't due--money that will have to be repaid. Remember, your case will be reviewed periodically to determine if you are still disabled, so any such abuses are easily detectable.
If You Go To Work
You should tell SSA if you take a job or become self-employed no matter how little you earn. If you are still disabled, you will be eligible for a trial work period and can continue receiving benefits for up to nine months. Also, notify SSA if you have any special work expenses resulting from your disability (such as specialized equipment, a wheelchair, or even some prescription drugs), or if there is any change in the amount of the expenses.
|Note: For more information, ask at any Social Security office for the fact sheet A Pension From Work Not Covered By Social Security (Publication No. 05-10045).|
If you are a disabled widow or widower or the spouse of someone getting disability benefits, your Social Security payments may be reduced if you worked for a federal, state, or local government agency where you did not pay Social Security taxes and you receive a pension from that agency. Notify Social Security if you begin to receive such a pension or if the amount of the pension changes.
|Note: Ask for the fact sheet Government Pension Offset (Publication No. 05-10007) for more information.|
Here is how marriage may affect your disability benefits:
If you leave the United States but remain a U.S. citizen, your Social Security payments can generally continue for as long as you are outside the country and meet all requirements. (The Social Security office has a list of 60 other countries whose citizens can also get Social Security checks if they leave the United States.) However, you must notify Social Security when you plan to leave the U.S. for 30 days or more so that any letters can be sent to the right address. Notifying SSA will also enable you to learn about any special rules that apply to those receiving benefits outside the U.S. Finally, remember to let Social Security know when you return to the U.S.
|CAUTION: If you are a citizen of a country not approved for SSA to send checks, your benefits will be suspended after you have been outside the U.S. for six months, unless you meet specific conditions. Furthermore, if you go to a country where U.S. Treasury Department regulations prohibit sending checks, your benefits will stop immediately.|
|Note: For more information, ask any Social Security office for the booklet Your Social Security Checks While You Are Outside The United States (Publication No. 05-10137).|
When a beneficiary dies, no payment is due for the month of death. For example, if the person dies in June, even if it was on the last day, the check dated July 3 (which is the June check) should be returned. However, if the check is issued jointly to a husband and wife, the survivor should contact any Social Security office about cashing the check. If the beneficiary was using direct deposit, the bank should also be notified of the death so it can return any payments received after death.
When a person getting disability benefits dies, payments to his or her family will be changed to survivors benefits. If the worker received benefits on behalf of children, a new representative payee must be appointed. A death certificate or other proof of death is needed.
You can report a change by simply calling Social Security at (800) 772-1213, visiting any SSA office or mailing in the reporting form given to you when you applied for benefits. If you send a report by mail, be sure to include:
If you are getting benefits on somebody else's record (a spouse, for example), SSA needs his or her Social Security number as well.
Under federal law, all disability cases must be reviewed from time to time. This review is to make sure that people receiving benefits continue to be disabled and meet all other requirements. Your benefits generally will continue unless there is strong proof that your condition has medically improved and there is evidence that you are able to return to work.
How often your case is reviewed depends on the severity of your condition and the likelihood of improvement. The frequency can range from six months to seven years. Your Certificate of Award states when you can expect your first review. Here are general guidelines for reviews:
After you get a letter announcing the review, someone from your Social Security office will contact you to explain the review process and your appeal rights. You will be asked to provide information about any medical treatment you have received and any work you might have done. Then your file will be sent to the state agency that makes disability decisions for Social Security. An evaluation team that includes a disability examiner and a doctor will carefully review your file and request your medical reports. If reports are not complete or current enough, you may be asked to have a special examination or test that the government will pay for.
Once a decision is reached, SSA will send you a letter explaining it. If SSA decides you are still disabled, your benefits will continue. If they decide you are no longer disabled, you can file an appeal (see below); otherwise, your benefits will stop three months after SSA determined that your disability ended.
|MORE: If you disagree with SSA’s decision, you can appeal it, see Your Right To Appeal.|
Even after you start receiving disability benefits, you may want to try working again. To help you, there are many "work incentives"—rules that are designed to ease the transition back to work. These rules continue cash payments and Medicare while you work, help with the extra work expenses associated with working with a disability, and help with rehabilitation and training that may lead to a new line of work. A brief description of these rules follows.
|Note: For detailed "work incentive" information, ask Social Security for the booklet Working While Disabled...How Social Security Can Help (Publication No. 05-10095).|
To understand how work affects your disability benefits, you need to understand how Social Security measures your work. Disability benefits can be paid only if you are unable to do any "substantial" work. The amount of your earnings determines whether your work is substantial:
If you are self-employed, your business income alone may not be the best measure of whether you are doing substantial work. Business income may depend on many other factors, such as the economic situation and services of other people. In such cases, more consideration is given to the amount of time you spend in your business than the amount of your income.
You can continue to receive benefits for up to nine months while you try to work. The months need not be consecutive, but they must take place within a 60-month period. Generally speaking, a "trial work" month is any month in which you earn over $200 in gross wages (regardless of amount of time worked) or spend 40 hours in your own business (regardless of amount of earnings). You will receive your full benefits during this period.
Your trial work period will continue only if you are still disabled. If you recover during a trial work period, your benefits will stop after a three-month adjustment period.
At the end of nine months of trial work, SSA will decide if you are able to do "substantial" work. If you can, your benefits will stop after a three-month adjustment period. If you are not able to work, your payments will continue.
If your benefits stop because you have returned to work even though you are still medically disabled, you receive special "benefit protection" for the next 36 months. During that time, you can receive a benefit for any month your earnings fall below $500. You do not have to file a new application, but you do have to notify Social Security. If you are unable to continue working, your benefits continue indefinitely so long as you remain disabled.
If you are working even though you are still disabled, your Medicare coverage may continue for at least 39 months after the trial work period. Beyond that, you may purchase the coverage with a monthly premium.
If you need certain equipment or services to help you work, the money you pay for them can be deducted from your earnings in deciding whether you are doing "substantial" work. It does not matter if you also need the items or services for daily living (such as a wheelchair).
The cost of medical equipment, certain attendant care services, prostheses, and similar items and services is generally deductible. The cost of drugs or medical services is deductible only if required because of your condition.
When you applied for disability benefits, information about you and your impairment may have been sent to the state vocational rehabilitation agency. If they offer you services and you refuse them without good reason, your monthly benefits may be withheld. If you have not heard from them and are interested in receiving rehabilitation services, you should give them a call.
Your disability benefits will continue while you receive rehabilitation services. Under a special rule, benefits can continue even if you medically recover while participating in an approved vocational rehabilitation or training program.
|Note: For more information, review the Social Security booklet How Social Security Can Help With Vocational Rehabilitation (Publication No. 05-10050).|
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If a child is getting checks on your account, there are several important things you should know about his or her benefits.
When a child reaches 18, the child's benefits stop with the month before the child reaches 18, unless the child remains unmarried and is either disabled or is a full-time elementary or secondary school student.
About five months before the child's 18th birthday, the person receiving the child's benefits will get a form explaining how benefits can continue.
A child whose benefits stopped at 18 can have them started again if he or she becomes disabled before reaching 22 or becomes a full-time elementary or secondary school student before reaching 19.
If a child is disabled, the child can continue to receive benefits after age 18 if he or she has a disability. The child also may qualify for SSI disability benefits.
If a child at 18 is a student, the child can receive benefits until age 19 if he or she continues to be a full-time elementary or secondary school student. When a student's 19th birthday occurs during a school term, benefits can be continued up to two months to allow completion of the term.
Social Security should be notified immediately if the student drops out of school, changes from full-time to part-time attendance, is expelled or suspended, or changes schools. SSA should also be told if the student is paid by his or her employer for attending school.
We send each student a form at the start and end of the school year. It is important that the form be filled out and returned to us. Failure to return the form could result in a suspension of benefits..
A student can keep receiving benefits during a vacation period of four months or less if he or she plans to go back to school full time at the end of the vacation.
A student who stops attending school generally can receive benefits again if he or she returns to school full time before age 19. The student needs to contact Social Security to reapply for benefits.
Benefits for the child of someone getting disability benefits always end if the child marries. The must be reported right away.
If a person receiving benefits becomes unable to manage his or her funds, someone should let Social Security know. Social Security will arrange for an organization or person called a "representative payee" to receive and use the benefits for that person. The representative payee is responsible for:
|Note: Having a power of attorney does not automatically qualify you to be the representative payee.|
|Note: For more information, ask Social Security for A Guide For Representative Payees (Publication No. 05-10076).|
If someone getting Social Security benefits is convicted of a criminal offense, Social Security should be notified immediately. Benefits are not generally paid for time during which a person is imprisoned for a criminal conviction, but any family members who are eligible may continue to receive benefits.
Benefits are also not paid to individuals confined in an institution by court order who, in connection with a criminal offense:
If you are addicted to drugs or alcohol, there are important things you should know about your benefits.
|Note: To get more information, ask Social Security for the fact sheet Disability Based On Drug Addiction Or Alcoholism (Publication No. 05-10047).||
If you disagree with SSA’s decision, you can appeal it. You have 60 days to file a written appeal with any Social Security office. Generally, there are four levels to the appeals process. They are:
If you disagree with the decision at one level, you have 60 days to appeal to the next level until you are satisfied with the decision or have completed the last level of appeal.
You have two special appeal rights when a decision is made that you are no longer disabled. They are:
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