Each year, the federal Social Security Administration makes slight alterations to benefits and requirements. Although these changes are small, knowing the numbers can have a significant impact on people attempting to navigate a Social Security disability claim. Particularly for those who are working or returning to work while coping with a disability, understanding the guidelines can mean the difference between keeping a claim active or having it dismissed.
Jeanette Laffoon of Laffoon & Maddox Attorneys at Law specializes in representing clients in disability cases. Here, she explains the new numbers for 2019 and what people need to be aware of in order to keep their claims viable.
Cost of Living Adjustment (COLA) to Social Security benefits and Supplemental Security Income. This year, all Social Security benefits increased by 2.8 percent. The SSI benefit in WA was raised from $750 per month to $771.
Medicare Premiums. For those on Social Security Disability, Medicare premiums impact their monthly disability payments. “The premiums come right out of their check,” says Laffoon. “They went up a bit this year to $135.50 per month.” The increase is relatively miniscule – up from $134 in 2018 – but still worth noting for those living on fixed incomes.
Substantial Gainful Activity (SGA) Rates. “In order to prove you’re disabled, the very first step of the five-step process involves whether or not you’re working,” Laffoon explains. To be eligible for disability benefits, individuals must be unable to engage in SGA up to a certain threshold. In 2018, that number was $1,180 per month gross; in 2019, it has increased to $1,220.
Staying aware of the cut-off matters for people with open claims, says Laffoon. “People who are probably disabled but are doing their very best to work have to be careful of those numbers. Whether they earn $1,219 per month gross or $1,121 per month gross makes a huge difference. In the first scenario, they can continue through the sequential process to determine whether they’re disabled. But if they are earning even one dollar above SGA levels, Social Security will dismiss their claim.”
Quarters of Coverage/ Disability Credits. In order to receive Social Security Disability benefits, applicants must be insured. Working and paying taxes translates to earning credits that qualify them for future disability benefits. However, claimants can earn no more than four credits per year. As of 2019, the new number for one quarter of coverage is $1,360, up from $1,320 in 2018.
Trial Work Month Threshold. Those on disability who have not been working but return to work need to report their earnings to the Social Security Administration. “They can get up to nine months of work activity where they’re able to both work and receive their Social Security Disability check,” says Laffoon. “The threshold for that trial work month is $880 per month.” If they earn less than $880 per month, it will not be counted as part of the nine month trial work period. Important note: the nine months don’t have to be consecutive and can occur over a 60-month (5-year) period as long as the applicant has paid taxes in at least 20 of the last 40 quarters.
Perhaps the most significant shift has to do with the percentage of claims currently being allowed. Upon investigation of the Tacoma Hearing Office, which is responsible for cases in Thurston County, Laffoon discovered a distressing number. “I checked the judges’ allowance rate and none of them are approving more than 50 percent of their cases anymore,” she says. “It’s been a steady decline over the last three years. They’re moving the target on what constitutes disability and it’s getting harder and harder to prove.”
One major factor: as of March 27, 2017 the Treating Physician Rule is no longer in effect. Prior to that date, adjudicators in disability cases needed to consider the opinions of “acceptable medical sources” such as licensed physicians, psychologists, optometrists and podiatrists when making a determination. A new rule states that such medical opinions will be evaluated equally alongside opinions from non-examining consultants, i.e. doctors paid by Social Security who never meet the claimant and spend as little as 12 minutes reviewing a file.
“It’s really scary,” says Laffoon. “Your doctor can say, ‘You’re disabled. You shouldn’t be trying to work, and you need to get on Social Security Disability.’ But the judge doesn’t have to give that weight anymore. They can rely on an employee who works behind the scenes for Social Security, spends 20 minutes looking at the medical file, and says, ‘Yeah, I think they can work.’”
While claimants have less recourse in the latter scenario (other than litigation, which is costly and time-consuming), understanding overall Social Security Disability guidelines can help to maintain their claims and ensure they get the support they need.
Learn more by visiting the Maddox & Laffoon website or by calling 360-786-8276 or 800-640-8295.