Martin on Social Security

Part 2 – Topics

General Issues Unrelated to Establishing Disability

§ Q 100. Special Insured Status Test for Disability Benefits – In General

The Act has a special two-part insured status test for disability benefit claimants.  The first part can be satisfied by covered work performed at any time; it applies to all disability insurance claimants.  This part of the test is derived from the fully insured status test.  Anyone who would have met the test for fully insured status had they turned 62 at the point their disability began satisfies this element of the disability benefits insured status test.

The other part of the test can only be satisfied by recent work.  This second component must be met by all disability insurance claimants, except those who are disabled by virtue of blindness.  This part of the insured status test has two different versions.  Which one applies to a given case depends on the age at which the individual became disabled.

One version of the recent work test applies to individuals who become disabled in or after the quarter in which they become 31.  It requires 20 quarters of coverage during the 40-quarter period immediately prior to disability, not counting quarters falling even partially within a recognized period of disability.

A sliding-scale version of the recent work test applies to individuals who become disabled at a younger age.  It requires only that there be quarters of coverage equal to 1/2 the quarters falling after the claimant became 21 and before the claimant became disabled, subject to a minimum requirement of 6 quarters of coverage out of the last 12.

Rev. 11/05

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]

§ Q 110. Special Insured Status Test for Disability Benefits – Variant Applied to Blind Claimants

Disability benefit claimants who meet the statutory definition of blindness meet the insured status test without having to satisfy the recent work requirements.  Such claimants are insured for disability benefits if they have enough quarters to qualify for fully insured status with that calculation being made as though they turned 62 at the point their disability began.

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]

§ Q 200. Interplay of DI With Benefits Under Railroad Retirement Act

Benefits paid under Social Security and the Railroad Retirement Act have been integrated by bringing work covered by the Railroad Retirement Act under Social Security for short-term railroad workers and leaving benefits for long term railroad workers under the Railroad Retirement Act.

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]

§ Q 300. Workers’ Compensation Offset

The Act provides for a reduction of disability benefits if the individual and his or her family would otherwise receive total disability and workers compensation payments above a threshold set in terms of the disabled individual’s prior earnings.  If that threshold, 80% of prior earnings, is exceeded the disability benefit is reduced by the amount of the excess.

Workers compensation payments, whether lump sum or periodic, that are intended to cover medical or other expenses rather than replace earnings are not covered by this provision.

Social Security Ruling, SSR No. 94-6, makes clear that legal expenses incurred in obtaining a workers compensation should be deducted from that award before applying the offset provision.  Social Security Ruling, SSR No. 97-3, provides that when an initial workers compensation settlement is subsequently amended or supplanted by a second one the Agency is not necessarily bound by the terms of that second stipulation.  Specifically, the Agency will disregard terms of the second that have the effect of altering the terms in the original settlement so as to circumvent the offset provisions of the Act.

In Richardson v. Belcher, 404 U.S. 78 (1971), the Supreme Court upheld enactment of a workers’ compensation offset provision against an attack based on the 5th Amendment.

Rev. 12/97

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]

§ Q 400. Public Pension Offset

The Act provides for an offset against disability benefits not only for workers compensation payments but also for state disability benefits under comparable circumstances and other Federal disability benefits as well.  The terms of this offset are the same as for workers compensation.  Excluded from this treatment are need-based benefits, public pension benefits paid for work covered by Social Security, and veterans benefits.

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]

§ Q 500. Interplay of DI with SSI Disability Benefits

Because of the potential overlap between Social Security benefits paid under Title II and Supplemental Security Income (SSI) payable to individuals with low incomes who are 65 or over, blind, or disabled, occasions will arise where one type of benefit is paid for a period and then subsequently entitlement for the same period is established in the other program.  The “windfall offset” provisions of the Act apply in such cases.

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]

§ Q 600. Interplay of DI With Black Lung Benefits

Black Lung benefits that are required by Federal law to be paid by employers are covered by the offset provision that applies to workers compensation and other federal or state disability benefits.

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]

§ Q 700. Effect of Claimant’s Being Confined to an Institution

Judgments about an individual’s ability to engage in substantial gainful activity can be especially difficult when the individual is confined to an institution under circumstances that prevent employment.  Although the Act suspends benefits to individuals convicted of a felony during imprisonment, this suspension is limited to the convicted person.  Thus, the question of a prisoner’s disability remains important to the prisoner’s family.  Furthermore, it is important to the individual’s own entitlement upon release.

The Act specifically excludes from disability determinations impairments that arise from the commission of a felony or from imprisonment for such a crime.

[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2]