by Sharon Smith
In the past, Talk About Sleep has received many questions from members on a broad range of disability issues. In our continuing commitment to provide the information you need to manage your sleep disorder(s), we are presenting a five-part series titled “Sleep Disorders and Disability”.
- Part I: When a Sleep Disorder Becomes a Disability
- Part II: Types of Disability Programs and Their Requirements
- Part III: Applying for Disability Benefits
- Part IV: What to Expect Once You are Awarded Disability Benefits
- Part V: Pre-Disability Planning
If you or your loved one is experiencing difficulties in carrying out job responsibilities, or has no significant source of income and cannot work as a result of a sleep disorder, don’t miss this series!
As a part of this commitment to education on disability and other insurance benefits, the disability link section is being expanded. For resources and information, visit our expanded Disability Links.
Only a handful of medical conditions automatically qualify for government disability programs. They share some key attributes: they are all severe impairments, with no realistic possibility that they will improve in time. Conditions that automatically qualify include terminal cancer, mental retardation, and loss of two or more limbs.
In the vast majority of physical and/or mental conditions, including sleep disorders, great variation can be found from one person to another in the frequency and degree of symptoms as well as in the individual’s response to available treatments. In order for a sleep disorder to be considered a disability, post-treatment symptoms must regularly interfere in carrying out the responsibilities of the individual’s job or ability to work.
- Sleeptalking and sleepwalking generally do not produce symptoms severe enough to be considered a disability. Although one may sustain injuries while sleepwalking that would qualify as a disability, it is the injuries, rather than the underlying sleep disorder, that may be grounds for disability.
- Obstructive sleep apnea, in cases where excessive daytime sleepiness (EDS) is eliminated through use of a CPAP machine, also would not cause a person to be disabled. However, there are sleep apnea patients who continue to experience excessive daytime sleepiness even with use of a CPAP or other therapeutic treatment. This could be due to coronary/pulmonary damage sustained prior to treatment or to a secondary cause of EDS, such as idiopathic hypersomnia (unexplained sleepiness) that does not respond to treatment.
A fair number of people with narcolepsy or idiopathic hypersomnia do not respond well enough to EDS medications to be able to perform their job responsibilities without some interference of symptoms. One option is for the employee to request job accommodations under the Americans with Disabilities Act. A typical accommodation is to allow the employee to nap. If accommodations can’t be made or aren’t sufficient to alleviate symptoms, the employee may be a candidate for disability.
A common concern of people considering a claim for disability benefits is whether it might be determined that there is some type of work in a different field that they would be able to perform. This is especially of concern to individuals with high earning power, who wonder if they might be expected to take a less demanding job with substantially lower earnings.
Under the Social Security disability law, the determination of whether there is other work which the individual can perform takes into account the person’s education, work experience and qualifications. While this must be determined case by case, this provision is generally interpreted to limit other possibilities of employment to jobs similar to that which the person has been performing. Another point to note in this regard is that the main symptom of most sleep disorders is excessive daytime sleepiness, which would present similarly in any job setting.
There are both public and private sources of long-term disability insurance. At the federal level, the Social Security Disability Insurance (SSDI) program provides benefits to disabled workers who meet the eligibility criteria. The Supplemental Security Income program provides benefits to disabled persons who don’t qualify for SSDI and who fall below the income and asset threshold for eligibility. The same criteria is used in both programs to evaluate disability status. A disabled person may eligible for benefits under one or both of these programs, or neither. Some individuals also have private disability insurance through an employee group plan, union or individually.
The provisions of private disability insurance, whether through a group plan of an employer, union or trade association, or individually, may require a different standard to be met in determining whether a person is disabled. For instance, many private disability policies provide coverage for partial disability, whereas federal programs require one to be totally disabled.
Although you may have a disabling sleep disorder, in fact, you must also be able to prove this in order to obtain disability benefits. Two factors are important to the success of a disability claim. They are 1) that you have adequate medical records to substantiate your diagnosis and functional limitations, and 2) that your treating physician (the main doctor you visit on a regular basis for treatment of your sleep disorder) supports your disability claim.
If you have not recently been under the care of a physician for your sleep disorder, consider doing so in advance of filing a disability claim. It is also important to request and keep personal copies of all diagnostic tests relating to your sleep disorder as a backup. Over time, you may change doctors; records can be lost or destroyed, and records are not maintained indefinitely. If you change doctors, be sure to have all pertinent records transferred to your new doctor for safekeeping.
This section provides an overview of the major types of short and long-term disability programs available to workers and non-workers.
Long-Term Disability – Overview of Federal Programs
Federal law provides for two separate income programs to assist persons whose disabilities prevent them from working. One is Social Security Disability Insurance (SSDI), which is available to individuals who have earned salaries subject to FICA (Federal Payroll Tax Withholding or Social Security Tax Withholding) and who have the required minimum number of “work credits” (calculated below). The other is Supplemental Security Income (SSI), which is available to individuals who either don’t qualify for SSDI, or whose benefit calculated under SSDI falls below the amount SSI would pay. In the latter case, the individual would receive the calculated SSDI amount, with the difference between the SSI and SSDI amounts being made up by SSI. The chief difference in these programs is that SSDI is based on past earnings, where SSI is based on need.
Both of these programs use the same criteria to determine whether a person is disabled. The criterion for both SSDI and SSI require:
- The individual be totally disabled
- Your disability must be expected to last more than one year or end in death
- Your condition must be severe enough to prevent you from carrying out the basic requirements of your job, or any other job for which you are qualified, taking into account your education and work experience.
In the case of disability due to a sleep disorder, daytime sleepiness would generally interfere with any job you might be qualified to do. Excessive daytime sleepiness also makes vocational rehabilitation difficult, if not impossible.
Individuals approved for SSDI must wait until the sixth month from the date of disability to be eligible for a monthly benefit. Under SSI, benefits for approved persons become payable in the month following the date of disability. Retroactive payments (limited to 12 months) to that date will be made upon approval of your disability claim.
Social Security Disability Insurance (SSDI)
SSDI covers individuals who have earned wages subject to FICA withholding during their working years and who have accumulated the minimum number of work credits required under the SSDI program. A work credit is defined by reference to earnings, rather than calendar quarters. For the year 2001, one work credit is earned for each $830 of earnings, up to a maximum of 4 work credits for the year.
This amount of earnings needed to earn a work credit is adjusted annually for inflation. The number of quarters required increases with age. To determine the number of quarters you need to be eligible for SSDI, see SSA Publication Number 05-10072, How You Earn Credits, at www.ssa.gov/pubs/10072.html.
The monthly award under SSDI is based on a complex calculation which averages past earnings (up to the amount of wages subject to FICA withholding) after adjustment for inflation. The amount resulting from this calculation is then multiplied by 85% to arrive at the maximum family award. If you have dependents under the age of 18, you may receive the full family benefit. If not, your monthly benefit is 2/3 of the family maximum.
To estimate the amount of your SSDI award, see the Social Security Benefits Calculator at www.ssa.gov/planners/calculators.htm.
The monthly SSDI award is always less than your earnings. The extent of the difference is greatest for high income earners whose wages have exceeded the maximum earnings subject to FICA.
Individuals who qualify under SSDI automatically receive Medicare coverage after a two-year waiting period. Medicare provides hospital coverage (Part A) to all eligible individuals at no charge. Doctor coverage (Part B) is optional. A monthly premium is charged for Part B coverage. The amount of this premium is currently $45.50 (based on the year 2001). Only the disabled worker is covered by Medicare. Although some states provide prescription coverage, Medicare generally does not include such coverage.
Supplemental Security Income (SSI)
Unlike SSDI benefits, which are based on past earnings, benefits under the Supplemental Security Income program are based on need. A disabled person is eligible for SSI when total household income and assets fall below established ceilings. The maximum household income a person can have and still qualify for SSI depends partly on location. The typical income ceiling is $531 for an adult or child and $796 for a couple (2001). You may find out the income ceiling for your location by calling Social Security at 1-800-772-1213.
For more on eligibility, visit the SSA web site at www.ssa.gov/pubs/11001.html.
The asset ceiling for SSI is $2000 for single persons and $3000 for married individuals. Certain assets are not considered for SSI purposes. These include one’s house, automobile (with certain exceptions), life insurance policies and burial funds valued at under $1500, and cemetery plots.
Individuals who qualify for SSI are generally also eligible for programs administered at the state or county level such as Medicaid and food stamps. Programs vary by state. Dependent members of the disabled person’s household may also qualify for these additional benefits. To learn about the specific programs in your area, contact your local social services or public welfare office.
Short-Term Disability Programs
SSDI provides long-term benefits to disabled workers, beginning in the sixth month of disability. In the interim, short-term disability benefits are often available through one’s employer. Most states require employers to participate in the state disability fund, which can provide short-term benefits to disabled workers. However, state disability benefits generally replace only a portion of one’s full salary.
Most companies have established policies on the payment of salary during short-term disability. These benefits vary greatly from one company to the next, and are often dependent on length of service and one’s position in the company. Some employees, especially newer and part-time workers, may not qualify for any short-term disability benefits. Others may receive full or partial salary during the short-term disability period.
If you are a member of a union, you may be entitled to short- and/or long-term disability benefits through your union.
Private Disability Benefits
In addition to coverage under federal disability programs, an individual may have long-term disability insurance through their employers or trade associations. Insurance companies also offer long-term disability insurance policies to individuals, although few people take out this type of policy.
The provisions of employer-provided disability plans vary in terms of who is covered, the percent of salary covered and the period over which benefits are payable. Most employers who offer long-term disability coverage charge the full premium to the employee so that any benefits paid are free of federal income, FICA and most state income taxes.
This allows employers to insure employee’s after-tax earnings, rather than their full salaries. Disability benefits are generally based on the most recent salary (as opposed to SSDI, which pays benefits based on average earnings during your period of employment). If the employer pays even a small percentage of the long-term disability premium, all benefits are subject to federal, FICA and often state income taxes.
Most long-term disability plans have an offset provision for Social Security Disability benefits. This means that the disability insurer guarantees a total monthly benefit, but requires the employee to file a claim for SSDI. The monthly benefit payable by the insurance company is reduced by any
benefit payable to the employee under SSDI.
Example of Social Security offset provision:
Mr. B becomes disabled after working for Company XYZ for ten years. His current salary is $100,000. XYZ’s disability insurance policy provides benefits to employees based on 75% of the most recent salary. The full amount of the monthly disability insurance premium has been deducted from Mr. B’s salary. Mr. B is guaranteed $75,000 in benefits from the employer-provided disability plan. If he is awarded SSDI benefits of $22,000 per year, the disability plan will pay him $53,000 ($75,000 – $22,000).
In order to accommodate the varying needs and abilities of disabled persons, the Social Security Administration provides mail, phone and in-person options for filing an application for disability benefits.
The first step in filing an application for disability benefits is to obtain and complete SSA Form 3368: DISABILITY REPORT – ADULT. You may pick up this form at any Social Security Office.
Alternatively, you may call 1-800-772-1213, Monday through Friday between 7 a.m. and 7 p.m. (Eastern Time) to request this form be mailed to you. Or, you may print Form 3368 from the Internet site www.ssa.gov/online/ssa-3368.pdf.
SSA Form 3386 is a ten-page form designed to collect all the information Social Security will need to determine if you qualify for SSDI and/or SSI. It asks for personal information, including work history, education and job skills, as well as information about your medical condition, doctors and medications.
It’s important that you fill in this form as completely as possible, especially as it pertains to how your disability interferes with your ability to work. Although a social security representative may ask you for clarification when your application is reviewed, it’s best not to leave this to chance.
Completing this form is often a challenge for persons suffering from excessive daytime sleepiness. You may need to enlist the help of a family member or friend. If you complete the form on your own, be sure to do so only when you are alert. While it may take you longer if you have to complete the form in several sessions, the resulting accuracy and completeness will translate into fewer delays once you submit the form.
If you still need help, you can obtain assistance from the Social Security Administration by calling 1-800-772-1213 or by visiting your local SSA office.
For further information on completing and filing SSA Form 3368, see ‘Social Security Administration Office of Disability – Disability Programs’ at www.ssa.gov/disability/3368.
Once you have completed Form 3368, you must contact Social Security. A representative will tell you where to send the forms. Once Social Security receives your forms, you will be asked to schedule an interview, either in person or by telephone. The purpose of this interview is to enable SSA to review your application (Form 3368) for completeness and to request any additional information or documents necessary in order to process your application.
It typically takes several months for Social Security to process an application for disability benefits. Once the review is complete, you will receive a Notice of Initial Determination, which will indicate whether you have been approved, and the reasons for the decision. This notice will also explain your right to appeal the initial determination, including the time frame for filing an appeal.
Social Security Disability claims are rarely approved in the initial determination. If your initial application is denied, you may file a written request for reconsideration within 60 days from the date you received the initial determination. Additional information may be submitted at this time. Your application for reconsideration will be reviewed by someone other than the person who made your initial determination. You will receive a Notice of Determination once a decision has been made. However, most often, the request for reconsideration will also be denied. This does not mean that your claim is weak or unfounded!
Administrative Law Judge Hearing
An individual has the right, within 60 days of receiving an unfavorable Notice of Reconsideration, to request a hearing before an Administrative Law Judge (ALJ). You will be assigned a court date, at which time you and/or your representative will have the opportunity to present your case before a judge. Most successful SSDI claims are approved at the Administrative Law Judge level!
If you receive an unfavorable decision from the ALJ, but still wish to pursue your claim, there are several levels of appeal available. First, you would request a review by the Appeals Council within SSA, where another ALJ will review your case. If unsuccessful, and your case merits, you may take your case through the federal courts: District Court, Court of Appeals, and finally the Supreme Court.
As a practical matter, very few Social Security Disability cases go beyond SSA’s Appeals Council. Keep in mind that the federal courts have no specific Social Security expertise, so that you will almost assuredly require legal representation if appeal your case in federal court.
Do You Need An Attorney?
Whether you choose to hire an attorney or represent yourself depends on several factors. Many people believe that being represented by an attorney increases one’s chances of a favorable decision. Approximately 90% of SSDI claims handled by attorneys result in favorable decisions. The success rate is much lower for individuals who represent themselves.
However, this difference is not solely attributable to the attorney’s expertise. Built into this discrepancy is the fact that attorneys screen potential clients and accept only those cases they believe will be successful. Those individuals with weak or unfounded claims are forced to represent themselves.
Since the initial application for SSDI/SSI requires information that only the disabled person can provide, there is little an attorney can do at this stage to affect the outcome of your claim. However, once you receive an unfavorable Notice of Initial Determination, it is time to consider whether to retain an attorney.
If you do choose to have an attorney represent you, look for one that specializes in disability claims. Many disability attorneys offer free consultations, which afford an opportunity for the attorney to assess the merits of your case, as well as for you to determine if the attorney has the appropriate experience and qualifications to handle your case.
An individual need not be an attorney to represent Social Security claimants. Since SSA does not currently have specific criteria that must be met in order to represent claimants, care must be taken in choosing a non-attorney representative. The National Organization of Social Security Claimants’ Representatives (NOSSCR) can provide useful tips in choosing a representative and help you locate members in your area. See nosscr.org for more information.
Social Security law provides that attorney or other representative fees be limited to a percentage (currently 25%) of the back award, with a $4000 cap. For fee arrangements approved after February 1, 2002, this cap is raised to $5300. The back award is the amount of benefits you will receive for the period commencing with your date of disability, and ending with the decision date. If your case is unsuccessful, your attorney or representative does not get paid. While many people choose to forego an attorney based primarily on the cost of representation, this may not be the best choice for you. Other factors you should consider in deciding whether to hire an attorney include:
- How comfortable you are with Social Security laws, rules and regulations, and how they pertain to your case
- How comfortable you are with the legal process, should your case progress to the Administrative Law Judge level
Whether your functional ability is predictable and will allow you to properly prepare for and present your case
- Whether you have private disability insurance with a Social Security offset (if so, your insurance will likely pay the attorney fees since they have a vested interest in the success of your case)
- How the stress of handling your own case may affect your health
Your doctor is probably your best source for attorney referrals, since doctors must work hand-in-hand with disability attorneys. Your doctor will know which attorneys have the best success rates, while your attorney will know which doctors provide medical evidence that adequately supports a disability claim.
Other sources of referrals include your state and local Bar Associations and local law schools. You may also consult your telephone directory to identify law firms in your area that specialize in disability matters.
You’ve been approved. Now what? In this section, we discuss the administrative aspects that follow a successful claim for Social Security benefits.
Once you are approved for SSDI or SSI benefits, whether upon the first or second application, or at the Administrative Law Judge level, the Social Security Administration must calculate your back award and current benefit. You will be notified in writing of their decision as well as the amount of your monthly benefit and back award.
The back award is the amount you are owed from the date you became disabled to the end of the month in which Social Security approved your claim. It generally takes four to six weeks to receive the back award. You will also be asked to complete and return some additional forms so they can process your monthly benefit and calculate the amount of any dependant’s award to which you are entitled.
If you have dependants living with you, they are collectively entitled to up to one-half of your basic award until the youngest dependant turns 18. Your spouse or divorced spouse may also be eligible for benefits under your SSDI claim. Dependants’ benefits do not affect the amount of the benefit you receive.
Recipients of SSDI are eligible for Medicare benefits after a two-year waiting period. This period begins with the date the person became disabled; some of this waiting period will have expired while awaiting Social Security’s decision.
Medicare has two types of coverage. Part A covers hospitalization and is provided to all SSDI recipients automatically at no charge. Part B covers doctors and must be elected. There is a monthly premium for Part B coverage, which is $54 as of January 2002. In most states, neither prescriptions nor dental care are covered by Medicare. A Medicare recipient may opt to join an HMO, usually for an additional premium. Another option is to purchase a Medicare supplement which will pay some or all of the costs not paid by Medicare (copayments, deductibles, etc.)
Individuals who are approved for SSI qualify for Medicaid coverage immediately. Since Medicaid coverage is established at the state level, you should check with your local Social Services or Public Welfare office for the types of medical expenses covered in your state.
Effect of SSDI on Retirement Benefits
Under current law, if your disability continues until you reach retirement age, your retirement benefit will be equal to your SSDI benefit immediately before retirement. Since SSDI benefits are adjusted annually for inflation, your SSDI benefit immediately before retirement will be your current benefit, adjusted annually for inflation through your date of retirement.
Earning Wages While Collecting SSDI
An individual collecting SSDI may continue to work without losing SSDI benefits provided the work is not considered ‘substantial’. Currently, Social Security considers earnings substantial if they average $700 or more per month.
Earning Wages While Collecting SSI
The rules under SSI are not as generous as those under SSDI, because SSI is an income-based (need-based) program. The monthly SSI benefit is reduced by one-half of monthly earnings over a certain amount. This amount was $85 for the year 2000. SSI benefits are also adjusted for changes in other types of income. If your assets increase (through inheritance, for example), you may become ineligible for continued SSI benefits.
For additional information on working while disabled, see Publication No. 05-10095 at www.ssa.gov/pubs/10095.html.
Social Security conducts periodic reviews of individuals who are collecting SSDI and/or SSI in order to determine if they are still eligible for benefits. Generally, this review is done once every three years. You will be required to complete a questionnaire which asks for information such as recent work, medical condition and contact information for all doctors you have seen since your last review. You may also be required to submit to a medical exam conducted by a physician designated by Social Security. If Social Security concludes that you are still disabled, there will be no interruption in your benefits.
In this final section, we focus on several areas in which careful pre-disability planning can help smooth the disability claim process and/or avoid loss of valuable benefits.
Before You Leave Your Job
It is not uncommon for people with undiagnosed sleep disorders to lose one or more jobs because symptoms negatively impact work performance. Unfortunately, there is little one can do after the fact. If you are diagnosed with a sleep disorder while still employed, there are several steps you can take to protect your job and/or continued earnings should available treatments fall short of resolving your daytime sleepiness.
Americans with Disabilities Act (ADA)
This federal law was enacted in July 1990 to protect individuals with disabilities from discrimination in the workplace. It requires employers with greater than 50 employees to make reasonable accommodations to disabled employees to enable them to continue working. The determination of what is reasonable is made on a case-by-case basis.
The accommodation must not create an undue burden on the employer, and the employee must be able to carry out his/her job responsibilities once the requested accommodation is provided. Typical accommodations for people with sleep disorders include providing the time and place to take naps, modifying the time the workday begins and ends to facilitate commuting or allow for difficulty in waking, and allowing the employee to work from home part or all of the time.
Many employees who qualify for accommodations under the ADA wrestle with the decision of whether to request accommodations since the employee must inform the employer of the disability in order to be protected by this law. In the ideal situation, the employer has a well-established, ADA-friendly policy with respect to accommodating employees.
In reality, it is usually not so clear what repercussions an employee might face once accommodations are requested. While disabled employees have the law on their side, enforcing this law can create an adversarial situation between the employee and employer or coworkers. In addition, a less than ideal accommodation can add an unnecessary element of stress to one’s workday. On the other hand, most people would rather continue working than go on disability.
A good rule of thumb is to request accommodations only if you truly need them. In a new job setting, waiting until you have established your value as an employee can result in greater understanding and cooperation from supervisors and coworkers. If, even with accommodations, you are not able to meet the requirements of your job, it’s time to consider disability programs.
If, after seeking protection under the ADA, you lose your job because of your sleep disorder, you may be entitled to sue your former employer for discrimination under the ADA. The U.S. Equal Employment Opportunity Commission (EEOC) handles complaints under the ADA. For assistance with ADA matters, contact the EEOC through their web site at http://www.eeoc.gov/.
Review provisions of employer-provided plans
If you are diagnosed with a sleep disorder that may not respond to treatment, you should check into the status and nature of your employee benefits, as well as any private insurance benefits, particularly your long-term disability coverage and your company’s policy regarding continuation of medical benefits.
Employee disability benefits vary greatly, and may depend upon length of service, job position, etc. Learning about your benefits early can put your mind at ease, and help you to plan for the possibility that your sleep disorder will progress to the point that you are no longer able to work.
In addition to employer-provided plans, you may have private disability insurance that will provide income in the event you become disabled. Be sure to keep current with these policies so they are there when and if you need them. Once diagnosed, it may be impossible to take out new policies due to ‘preexisting condition’ clauses.
Also check to see if you have disability riders on life insurance policies, mortgage insurance, installment plans and/or credit cards which will pick up the monthly payments on these accounts in the event you become disabled. (There is usually a maximum period of coverage.) Knowing where you stand financially will help you make wise choices if and when the time comes.
Job Changes – Full-ToPart-Time: Know the Pitfalls!
If you are in a field where part-time work is readily available, and you are able to work part-time without undue hardship, you will not qualify for SSDI unless your average part-time earnings fall below $740/mo. However, there are people whose medical conditions qualify them for SSDI but who choose to switch to part-time work even under difficult circumstances.
For instance, it may take a person with excessive daytime sleepiness 8 hours to work a 4-hour day after factoring in naps, extra commuting time, and time at work lost to sleepiness. The following discussion applies to this latter group.
If switching from full-time to part-time employment is an option, think twice! Often, part-time employees don’t qualify for the same employee benefits provided to full-time workers, or are covered only for their part-time salaries. You may lose valuable benefits such as medical, disability, retirement and life insurance.
Although you may still earn work credits towards qualifying for SSDI while you work part-time, lower part-time wages will most likely reduce your SSDI benefit, which is calculated on the basis of past earnings. In most cases you will not qualify for SSDI benefits while you are working part-time, unless your average part-time monthly earnings fall below $740.
There are certain limited circumstances under which a change from full- to part-time employment would be beneficial. If you do not yet have sufficient work credits to qualify for SSDI, and cannot continue to work full-time, part-time employment can enable you to earn the remaining work credits needed to qualify.
For higher-salaried individuals who don’t have private disability coverage, working part-time may produce more income than SSDI would pay. However, keep in mind that if your wages subject to Social Security tax are reduced, your ultimate SSA retirement benefit will also be reduced.
Changing Jobs After Diagnosis
Once you are diagnosed with a sleep disorder, obtaining new health and/or disability insurance can be a challenge. If you have health insurance at the time of your diagnosis, and later change jobs, the Health Insurance Privacy and Portability Act (HIPPA) requires the new insurer to grant you similar coverage.
This law is particularly beneficial to individuals who have a pre-existing condition. However, the new insurer still may set the premium so high that it is cost-prohibitive. There is no mirror law pertaining to disability insurance. In this case, it’s best to seek an employer with a group plan, since group plans cannot discriminate against new employees with pre-existing conditions.
We have presented the basics of disability coverage as it relates to sleep disorders. There are numerous additional resources available on this subject which include government sponsored web sites and printed material, private support sites, legal resources, and special interest groups.
We have assembled a collection of the best of these resources in the Talk About Sleep disability links section. Use these links to find additional answers and to receive the full benefits to which you are entitled.
Administrative Law Judge – The judge within the Social Security Administration who hears and decides disability cases.
Americans with Disabilities Act – A federal law enacted in July 1990 to protect individuals with disabilities from discrimination in the workplace. It requires employers with greater than 50 employees to make reasonable accommodations for disabled employees to enable them to continue working.
Attorney Fees – Attorney fees are limited to 25% of the back award amount or $4000 ($5300 after Feb. 2, 2002), whichever is less, and are frequently handled on a contingency basis; that is, the attorney is paid a predetermined percentage of the award.
Back Award – The amount of benefits you will receive for the period commencing with your date of disability, and ending with the decision date. Back awards are not paid for periods in excess of 12 months prior to the date of filing the disability claim.
Disability Report – Adult – Social Security Administration Form Number 3368 which is a 10-page document used to record all the information pertaining to a disability claim.
Excessive Daytime Sleepiness (EDS) – the inability to stay awake during the normal wake period of a sleep-wake cycle or may involve involuntary sleep. Common causes include: insufficient sleep, sleep apnea, narcolepsy, and insomnia.
Health Insurance Privacy and Portability Act (HIPPA) – A law which, in part, mandates, that if you have had continuous health insurance coverage, a subsequent insurer must offer you future insurance coverage regardless of your health or preexisting conditions.
Long-term Disability Insurance – Private, employer sponsored disability programs typically provided by an employer as an employee benefit.
Monthly Award – A complex calculation which averages past earnings (up to the amount of wages subject to FICA withholding) after adjustment for inflation and, with adjustments, is used to determine the monthly disability benefit award.
Notice of Initial Determination – A notice which indicates the result of your initial disability application, and the reasons for the decision. This notice will also explain your right to appeal the initial determination, including the time frame for filing an appeal.
Offset Provision – A provision in a private long-term disability benefit award which allow the insurance carrier to reduce the award by the amount received from SSDI.
Social Security Disability Insurance (SSDI) – A disability benefits program for individuals who have earned wages subject to FICA withholding during their working years and who have accumulated the minimum number of work credits required under the SSDI program.
Supplemental Security Income (SSI) – A need based disability benefits program administered by the Social Security Administration. The program features strict income and asset limitations.
Vocational Rehabilitation – Programs designed to help people learn new job skills and to re-train for other job opportunities.
Work Credit – A benefit eligibility unit which measures the number of quarters of earnings in a given year, adjusted annually for inflation. For the year 2002, one work credit is granted for each $870 in earnings, up to a maximum of 4 credits for the year.