Today's post comes from guest author Susan C. Andrews, from Causey Law Firm.
There is a mistaken notion floating around out there that a person can just waltz into Social Security, claim to be disabled, and voila—he’s granted benefits!There is a mistaken notion floating around out there that a person can just waltz into Social Security, claim to be disabled, and voila—he’s granted benefits! Nothing could be further from the truth. The burden of proof is on the claimant (the person claiming benefits) to show that he or she is disabled from engaging in substantial gainful activity (SGA) for a period of at least 12 continuous months. More about SGA in a bit. That proof starts with medical records, and diagnoses made by doctors. Self-diagnosing just doesn’t cut it, even if you’ve read up on your condition all over the internet, and you’re absolutely positive you know what’s wrong with you! Sometimes we get calls from people who do not have health insurance, and even though they have a serious medical condition, they have been unable to access much in the way of health care. Sadly, some of those folks who should be able to qualify for benefits do not, because they simply do not have the necessary treatment records to document the seriousness of their conditions.
As mentioned above, Social Security’s definition of disability is the inability, due to one or more medical impairments, to engage in substantial gainful activity for a period of at least 12 continuous months. Social Security defines SGA in part by a dollar figure that usually goes up a little every year. In 2013 it is $1,040. Social Security looks at a person’s GROSS earnings, not net earnings or take-home pay. So if I’m able to gross $1,040 or more per month, I can engage in substantial gainful activity and I do not qualify for SSD. This concept is important especially for individuals with progressive conditions.
Take, for example, a person diagnosed with Parkinson’s. One famous example is the actor Michael J. Fox. His Parkinson’s affects his functioning, but he is still working. Many people with progressive conditions continue to work for some time after receiving their diagnosis. At some point, progression of the disease may force some of them to go to part-time work. When the hours worked decrease, their earnings may no longer qualify as SGA. Or—and I see this a great deal in my practice—some people begin to have more bad days than good days, and work performance is impacted. There are days so bad that they really have no choice but to call in sick. Then this begins to happen more frequently than a couple of days a month. In my experience, at that point most employers become very unhappy campers. Not only are the employees taking sick leave faster than they are accruing it, they can’t tell their employers ahead of time which days they will wake up with an exacerbation of symptoms that keep them in bed, or at least in their bathrobe, all day.
Which brings me to my final point: Many of my clients look okay to the casual passer-by. Take the guy with a serious heart problem. Well sure, if I followed him around for half a day, I’d see that he can barely exert himself without getting out of breath. But if I just passed by, he might look fine. And the day he spends at home in his bathrobe because he can hardly catch his breath—I’m not going to see him at all when he’s having one of those really lousy days. His condition may be largely invisible.
To sum it up, I’d say there’s a bit of wisdom in being slow to judge. Thank goodness we take our good health for granted—it’d be a miserable existence if I spent too much time worrying about getting sick before it actually happened. But, of course, serious illness can strike any of us when we least expect it. And on the other side of that defining moment, the world can look a whole lot different.
Photo credit: Gemma Grace / Foter / CC BY-NC
