This article reviews the basic social security rules concerning earnings after a finding of disability.
A frequent question from former clients who have been awarded either a period of disability and disability insurance benefits, or SSI benefits, is what work they can perform after the award and still maintain their eligibility for assistance. This article will review the basic social security rules concerning earnings after a finding of disability. We will examine the following areas:
1. Returning to work on SSDI:
a). Trial Work Period;
b). Extended Period of Eligibility;
c). Extended Medicare Coverage.
2. SSI and Work Efforts;
3. Impairment Related Work Expenses;
4. Ticket to Work Program.
It is first important to know whether SSDI or SSI benefits are being paid. The rules differ for each program.
I. RETURNING TO WORK WHILE ON SSDI
A. TRIAL WORK PERIOD (TWP)
The first return to work benefit for persons on SSDI is the "trial work period (hereinafter "TWP"). The TWP is a period during which a beneficiary may test his or her ability to work and still be considered disabled and still receive your monthly SSDI benefits. The TWP lasts for nine months, but these months do not have to be consecutive. You use up your trial work period by working nine months in any 60-month block of time.
For example, if your onset date for disability was in 2000 and you worked 3 months in 2002, 3 months in 2003 and 3 months in 2005 you will have used up your trial work period. Those months would total 9 months in a 60 month block of time. If, however you worked 2 months in 2001, 3 months in 2005 and 3 months in 2007, by 2007 the months you worked in 2001 would no longer count since they were outside of the 60 month period.
In 2006 a TWP month will be used if you work as an employee and earn at least $620.00 gross income in that month. In 2005 the figure was $590.00 gross income in a month; in 2004 it was $580.00 gross income in a month. For 2003, $570.00, and SSA considered your work as an employee to be work for purposes of a TWP if you earned $530.00 gross income in a month and from 1989 through 2001 $200.00 gross income in one month used up a TWP. Each year the amount shall be adjusted by the Cost of Living Adjustment calculation.
SSA generally does not consider work done without pay to be services toward a trial work period if it is done merely as therapy or training or if it is work usually done in a daily routine around the house or in self care.
Self-employed individuals have a much more difficult analysis when determining TWP months since gross earnings are not the only focus. SSA will also look at the nature and value of the work performed and the number of hours you spent working each month, as well as your earnings.
SSA will not consider that your disability has ended until you have performed trial work period services for at least nine months. However, after the trial work period has ended SSA will conduct a Continuing Disability Review to determine whether your disability ended at any time after the trial work period.
B. EXTENDED PERIOD OF ELIGIBILITY (EPE).
Once the TWP is completed, an individual is entitled to an "Extended Period of Eligibility" ("EPE"). However to be eligible for the EPE, an individual must continue to be considered by SSA as "medically disabled" after a Continuing Disability Review. The EPE provides a disabled individual a safety net for another three years as work continues.
As you continue to work after the end of your TWP, and gross monthly earnings exceed whatever that years current definition of substantial gainful activity ($860.00 gross per month in 2006, in 2005 that is $830.00 gross per month in 2005; in 2004 it was $810 gross income in a month) then no SSDI benefits will be paid.
However, if in any month during that 36 month period you are unable to earn at least $860.00 gross income in a month, your SSDI cash benefits are started again without any need to file a new application. For example, if you have used up your TWP and are now in your EPE in 2003, and your hours are reduced in a month so that you only earn gross wages of $750.00 in the month, you will be eligible for SSDI benefits for that month.
IMPORTANT NOTE: There must be diligent reporting of income on a month by month basis when you return to work. It is the burden of the Claimant to be able to "prove" all earnings were reported. We suggest mailing a certified letter, return receipt requested, with a copy of your pay check stubs, each month.
C. EXTENDED MEDICARE COVERAGE
Medicare continues during both the TWP and the EPE. You can also retain your Medicare coverage for another 4.5 years after the end of your EPE. That means you can return to work on SSDI and keep Medicare coverage for more than eight years, even if you are no longer receiving an SSDI monthly benefit. This extension was enacted to help remove the lack of health insurance as a barrier for the disabled wanting to return to work.
II. RETURNING TO WORK ON SSI
Eligibility for SSI required proof of total disability, and proof of limited assets and virtually no income. Once an SSI recipient returns to work and receives income, eligibility is changed.
The basic formula for an SSI recipient returning to work is: the first $85.00 earned in a month is disregarded; after that, the SSI benefit is reduced by $1.00 for every $2.00 earned.
For example, an SSI beneficiary receiving $603.00 a month goes to work part time and earns $285.00 during the month will have a partial reduction of the SSI check.. The first $85.00 is disregarded; the balance of $200.00 causes a reduction of $100.00 in that month's SSI check after the $1.00 for every $2.00 earned formula is applied. Therefore the beneficiary will receive $503.00 in SSI benefits for the month, along with the $285.00 earned, for a total income for the month of $788.00 for the month - significantly improved over the basic SSI grant.
NOTE: Work earnings may have an impact on Medicaid and food stamp eligibility and for that each person must check with their state's public assistance departments.
NOTE: The reporting requirements and recommendations are the same as those made above for persons on SSDI.
III. IMPAIRMENT RELATED WORK EXPENSES (IRWEs)
In order to be able to return to work some people require special equipment, custom devices, particular medications, job coaching or incur other expenses directly related to their medical impairment and work. To the extent a beneficiary incurs these IRWEs, and they are NOT reimbursed by any third party (such as Medicaid, Medicare, private insurance, prescription cost waivers), then the amount of earnings each month will be reduced by the amount the beneficiary actually pays. The need for these IRWEs must be supported by the treating physicians, and they must relate to ameliorating the specific impairment and allowing the beneficiary to return to work.
NOTE: SSA will look very carefully at claims for IRWEs so careful record keeping is required. Make certain that your treating physician agrees with the need for the expense, and keep copies of all receipts, canceled checks and other proof of the expenses.
IV. TICKET TO WORK PROGRAM
Many disabled beneficiaries would like to return to work, but can not perform the work they have done in the past. Until recently, access to extensive vocational rehabilitation and training was limited. The Ticket to Work will allow people on SSDI and SSI to access approved private vocational rehabilitation programs whose services will be paid by the SSA.
These services can include programs that will help people secure and maintain self-supporting employment. Education, training, and other vocational rehabilitation services may be included. This greatly expands the ability of beneficiaries to learn new skills, new trades and develop the talent necessary to return to work.
SSA has hired a company known as Maximus to serve as "Program Manager" to run the Ticket to Work program. Disability beneficiaries will receive a paper "Ticket" in the mail which will contain some personal information, and information on the Ticket to Work Program. This Ticket can then be taken to an approved "Employment Network" which is the name for the private vocational rehabilitation providers. These Networks will then review the medical limitations and mutually decide with the SS beneficiary whether the services available from that Employment Network are appropriate.
Information on the Program Manager and on local Employment Networks will be on the Ticket received in the mail, and on SSA's website at www.ssa.gov.
Use of the Ticket is voluntary and as of January 1, 2001, SSA is precluded from conducting a Continuing Disability Review on anyone using a Ticket. This is an important consideration for persons receiving benefits who are improving and may be facing a Continuing Disability Review. Participation in the Ticket to Work program will allow you to continue receiving benefits, while also receiving the training and new skills needed to return to the work force.
Article provided by Jeffrey A. Rabin & Assoc. Visit us at www.rabinsslaw.com