Social security benefits provide coverage for all living expenses, medical treatments, and any other financial needs related to the disease, for eligible candidates. According to the SSA (Social Security Administration), a person is considered as disabled, if he/she can’t work due to a severe medical condition that has lasted, or is expected to last, at least one year or result in death. Medical record analysis plays a key role in eligibility determination.
Social security attorneys have to deal with many complex terminologies. Not only attorneys, medical review companies providing medical review solutions to attorneys and insurers must also be aware of all the important terms related to social security disability.
Here’s a list of the most important terms and acronyms related to social security.
Administrative Law Judge (ALJ)
Administrative law judges are similar to trial judges and they preside over hearings and make rulings on Social Security application and benefit decisions. During the hearing, the ALJ explains the issues in the case and may question the claimant and any witnesses brought to the hearing. If the initial application and the request for reconsideration are denied, claimants have to appeal the SSA’s decision in front of an administrative law judge (ALJ).
Appeal
If a SSDI claim is denied, the claimant has to appeal the decision. The appeals process involves reconsideration of the initial application, hearing with an ALJ, appealing the ALJ’s decision with the Social Security Appeals Council, and bringing an appeal in Federal Court.
AME (Average Monthly Earnings)
AME is a major factor in determining an individual’s eligibility for SSD benefits. It refers to the average amount of money a person earns from the job. This amount is calculated by taking the total amount of money that a person has earned in a specific time period and dividing it by the number of months in that time period. AME amount required for eligibility varies depending on the type of disability and the individual’s age.
Application for Benefits
It is the application form that claimants have to complete and sign to apply for Social Security benefits, Supplemental Security Income (SSI), or Medicare.
Award Letter
It is an official letter that notifies that the claimant’s application for Social Security benefits has been approved and they will receive payments. This letter includes details such as the amount of the monthly disability benefit payments, the date each month they can expect to receive your SSD payment, the amount of “past due” benefits the claimant will receive, and the expected date that the past due benefits will be sent to the claimant.
Back Pay
Back pay or retroactive benefits are past due benefits that began to accrue 5 months after the onset of the disability, once the claimant win their SSDI or SSI claim. It is limited to 12 months before the date of the application.
Blue Book
It is an online publication officially entitled Disability Evaluation Under Social Security, which explains their complex disability determination process. This book details listing of the 14 impairments which the SSA considers severe enough to prevent SSDI claimants from performing substantial gainful activity.
Break-even Point
It refers to the dollar amount of total income a claimant can have so that countable income equals the applicable Federal benefit rate (FBR). Break-even point is calculated based on the person’s earned and unearned income, applicable income exclusions, living arrangements, and state supplement.
Consultative Exam
It is a medical appointment scheduled by the SSA to determine the current functioning of an applicant for disability, if the medical evidence provided by the claimant is insufficient for the SSA to make a determination on their disability.
COLA (Cost-of-Living Adjustment)
It refers to the increase in the amount of benefits paid to claimants of Social Security benefits, including Social Security Disability benefits under Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). It increases a person’s Social Security retirement benefit by approximately the product of the COLA and the benefit amount.
Disability Benefits
Disability benefits are monthly payments to an individual whose physical or mental condition meets Social Security’s definition of disability. SSA operates two such benefit programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
According to the SSA, to meet the definition of disability, the candidate must not be able to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s) that is either: expected to result in death or has lasted or is expected to last for a continuous period of at least 12 months.
Early Retirement Benefits
It refers to the benefits that are reduced, when claimed early, between age 62 and full retirement age. Workers who have paid into the Social Security system for at least 10 years become eligible for early retirement benefits at age 62.
Full Retirement Age (FRA)
This is the age at which the claimant becomes entitled to the full retirement benefit. The FRA is calculated, based on the year they were born. Waiting until the “full retirement age (FRA)”-between 66 and 67 depending on the year of birth—results in higher monthly benefits.
Substantial Gainful Activity (SGA)
This is an income-based factor and a person whose work earnings exceed a monthly threshold is considered as substantial gainful activity, and the person will be considered as ineligible for disability benefits.
Experienced providers of medical review services will be up to date with such terminology related to the SSD claims. Managed Outsource Solutions (MOS) has extensive experience in providing medical record review for Social Security Disability firms and attorneys. The company helps attorneys prove their client’s disability with substantial medical evidence that meets the requirements of SSA.
For professional record review support, you can contact MOS at 1-800-670-2809!
