WHAT IS A 'QUARTER OF COVERAGE'?

The Social Security disability program is really a government-sponsored disability insurance program.  You get it by working and having FICA taxes deducted from your pay.  However, you are not immediately insured when you begin working and you may stop being insured if you stop working.

A "quarter of coverage" is the basic unit used to determine whether a worker is insured under the Social Security disability program, or Title II. 

So, what is a "quarter of coverage"?  You will hear these informally called "Social Security credits," too. 

Until 1978, a "quarter of coverage" was awarded to workers who earned $50 or more in a calendar quarter.  After 1978, the amount of wages required to earn one quarter of coverage changed automatically each year based on the National Average Wage Index.

In 2015 you must earn at least $1,220 in a quarter to receive one quarter of coverage.  However, you cannot earn more than four quarters of coverage per year, no matter how much you earn.

To be insured, most workers need at least 20 quarters of coverage during the last 10 years.  Sometimes we use the rule of thumb that says, "You should have worked at least 5 out of the previous 10 years." That can vary based on your age.

Generally, if a person stops working prior to becoming "fully insured," disabled or retired, he or she will lose insured status after about 4 years of stopping work.

Usually when a person receives 40 quarters of coverage he or she becomes "fully insured" and permanently insured.  This means they will not lose Social Security disability insurance if they stop working after they have become fully insured.

In 2014, there were 151,092,000 workers covered by Social Security disability insurance (Title II).

FOCUS: WHY I AM DISABLED; NOT WHY I CAN'T GET A JOB

The Social Security Act provides benefits for long term disability.  It does not provide benefits for unemployment or the inability to get a job.  

Here are some examples of employment problems which have nothing to do with disability or Social Security:

•  Nobody will hire me.
• My job skills are ancient.
• The economy has tanked.
• The jobs I used to do have now moved to Mexico or overseas.
• The jobs I could once do are now done by machines.
• There are no jobs in my field (or in my hometown, etc.)

The above statements have nothing to do with Social Security and will never result in a Social Security benefit.  They are not disability issues, they are unemployment issues.

We need to focus on why you are disabled, not why you can't get a job.

We have to focus on specific limitations in the ability to perform work related activity.  These limitations, for example, could include a restriction in the ability to:

• sit for prolonged periods
• stand/walk for prolonged periods
• lift or carry
• remember, understand or carry out instructions
• concentrate or stay focused
• respond appropriately to co-workers or supervisors

The above items are examples of restricted functional capacity which may be a disability.  
Social Security is like any other court in the land,  in that, you must prove a certain allegation using admissible evidence according to the governing regulations.  In the case of Social Security disability, you must prove your inability to perform full time work activity using medical evidence from an accepted medical source (doctor, psychiatrist, clinical psychologist, etc.).  

See more information about Social Security disabiity.

"I must focus on why I am disabled, not why I can't get a job."

DISABILITY CLAIMS - NOT LIKE RETIRMENT CLAIMS

Many people are lured into a false sense of security by their experience with Social Security retirement claims.  With a retirement claim, it is very straight forward.  You apply for benefits and if you are old enough a check begins arriving each month.

Social Security disability benefits are not nearly as simple.  That is because the eligibility rules are much more complex with the disability program.  Before you can receive a disability benefit you must prove that you are disabled using objective medical evidence provided by acceptable medical sources.  Therein lies the challenge.

You must prove that you have a physical and/or mental impairment which produces symptoms so severe that you cannot perform any of your past relevant work or any other work which exists in significant numbers in the national economy.  This is not at all cut and dried but is open to a great deal of interpretation by Social Security decision makers.

What typically happens?  Very often, decision makers will conclude that you are unable to perform your past work but that you can perform other, easier work.  Under the regulations, you are not legally disabled and will be denied.

If it weren't so serious, it would be amusing to hear the kinds of work that Social Security says individuals can still perform.  Probably my two least favorite jobs in this category are parking garage attendant and surveillance system monitors.  Another one that crops up a lot is a theater ticket taker.  Or how about a silverware wrapper? 

Claimants often come away frustrated and confused because a decision maker told them they are not disabled because they can be a silverware wrapper.  Overcoming this type of scenario probably requires professional help.  

The bottom line is:  Social Security retirement benefits are cut and dried.  Social Security disability benefits are not.  They are much more difficult and require more legal wrangling.

 

DO YOU JUST KEEP APPLYING?

It's a well known fact that around 75 percent of disability claims are initially denied by Social Security.  So, what do you do?  Do you just keep reapplying again and again?

No.  That is not the best way to approach winning disability.  Once you have been denied,  it is probable that you will be denied over and over.  The same decision makers will look at the same evidence and make the same decision.

Usually, it is much better to appeal the denial and kick the case on up the chain of command to a higher level.  In Alabama, that means asking for a hearing before an administrative law judge (ALJ).  The ALJ is not bound by any previous decisions and can give you a totally new decision if the evidence justifies it.

Appeals (also called "request for hearing") must be filed in writing and they must be filed with 60 days of the initial denial.  After that, your lose the right to appeal.

An experienced advocate or representative may help you win your claim by directing the appeal process, gather new evidence, developing a legal theory of the case, attending your hearing with you and ensuring that you are paid the correct benefits.  The typical fee arrangement is a percentage of the back pay you recover and you cannot be charged a representative's fee unless you recover back pay.

YOUR DOCTORS PROGRESS NOTES

Your doctor's progress notes will be the most important piece of evidence examined by Social Security decision makers.  Be careful what you say to your doctor.  Doctors often take very short, cryptic notes and may misinterpret or misunderstand what you tell them.  This can hurt your Social Security disability claim.

We once had a claimant who told the doctor that he was helping a friend remodel a house.  The doctor noted this in the progress report.  It caused a lot of confusion with Social Security decision makers.

When I asked the claimant about the remark, he explained that he was once a carpenter and knew quite a bit about building.  He would walk over to his neighbor's house each afternoon, look at the work being done and give advice.  He never drove a nail, lifted a board or picked up a tool.  This, however, is not what the doctor recorded.

Decision makers at Social Security are required to make a judgment about the credibility of the claimant.  When you tell them your symptoms are so severe that you cannot work, they must decide whether to believe it.  Statements like the one above in the doctor's progress report can damage a claimant's credibility.  It can be explained but credibility issues may still remain.