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Social Security Benefits
Unfortunately, time does not stand still for any of us. As more and more of us become eligible for AARP benefits, we must consider how we are to get along when we our health fails us, whether due to illness, accident, or simple old age. One important benefit we enjoy as Americans is our entitlement to Social Security. The United States Social Security Act provides major benefits to Americans and their dependents who are disabled and those who reach retirement age.
Social Security Retirement benefits accrue by virtue of the recipient having paid enough money into the Social Security system and having reached the appropriate age to retire. Generally an application to the Social Security office will initiate payment of these benefits. There are times, however, when questions arise which can throw a wrench into the approval process. Technical details such as the entitlement of a divorced spouse to retirement benefits based on the social security account of the wage earner, or issues as to whether the alleged spouse is in fact the spouse, can derail an application. In the event that there is a denial of retirement benefits, the Social Security Administration will forward a written reason for the denial, and that is the time to seek a consultation with an attorney.
Other Social Security issues arise when a person makes a claim to be disabled and requests disability before retirement age. The application for Social Security Disability benefits is initially reviewed by the Social Security authorities to determine whether the Claimant has paid enough money into the system to allow the grant of benefits and whether the payments into the system were made in enough of the previous calendar quarters (usually 20 of the last 40 quarters) close enough to the onset of disability. Benefits may be denied if these technical requirements of the Act and the accompanying regulations are not met.
If the technical conditions are met, then a finding must be made as to whether the person is in fact disabled from performing any substantial gainful employment. The initial decision as to whether the claimant’s condition is disabling is made at the Social Security Administration’s request by a state agency, which in Pennsylvania is the Bureau of Disability Determination. If the Bureau of Disability Determination finds that the claimant meets the disability standards of the Social Security Act and the Social Security Regulations, the benefits are granted. If not, a notice is sent indicating the reason for the denial. At this point, again, one would be well advised to seek legal help in filing an appeal to an Administrative Law Judge, who will make an independent decision based upon medical records and vocational evidence provided by the claimant, and upon the opinion of a vocational expert hired by the Social Security Administration.
The Social Security standards for determining disability are quite complex. If you meet their requirements, you are disabled, and if you do not, you are not. However, the actual determination of those facts is rarely simple. Social Security has a precise listing of conditions that are considered disabling, and if you meet or exceed the exact definitions in this list, you qualify. The problem occurs when the claimant’s symptoms do not meet the requirements of these precise definitions. Under these conditions, a claimant can still be found to be disabled and qualify for benefits, but the decision now rests on various factors including whether the claimant has a severe condition, or a combination of severe conditions, which when taken together would meet the exact medical definition of disability. As an example, if the disabling condition involves lung problems, there are standards of performance gauged by pulmonary functions tests, such as how much capacity the lung has, and how much and how fast air can be expelled from the lungs. If you meet the standards you are disabled. Under the Act, a claimant can show that he has two severe conditions, neither one of which alone meets the standards for disability, but the combination of which may equate to a determination that the claimant is disabled.
If a claimant does not meet the standards for disability according to the defined medical conditions, he may still be found to be disabled if he has a severe condition that prevents him from doing gainful activity in the national economy. The formula changes, however, depending on the claimant’s residual functional capacity, age, work history, and educational level. At the hearing, the claimant or his counsel will present testimony and other evidence to convince the Administrative Law Judge that the claimant meets the requirements of the Act and is thus disabled.
If the claimant cannot demonstrate disability solely by meeting the definitions of a qualifying medical condition, then other factors effecting the ability to work are considered including age, education, residual ability to do work, and work history. Unfortunately, the opinion of a family or treating doctor that the claimant is disabled carries little weight with Social Security. One needs to meet the exact definitions under the law and the regulations.
Much the same process is used for Supplemental Security Income benefits. These programs are administrated by the Social Security Administration, and to qualify one must meet the disability requirements in addition to having income and assets below a certain amount.
As we, our friends, and our relatives rely more and more on governmental programs such as Social Security, those benefits can mean the difference between a difficult existence and a life of relative comfort. It is important to seek expert help if you or someone you know is having difficulty obtaining Social Security benefits.