When You Get Benefits U.S. Department of Health and Human Services Social Security Administration SSA Publication No. 05-10153 January 1994 ICN 480165 Who Should Read This Booklet? You should, now that you're receiving Social Security disability benefits. You might think that because the disability application process is over and your benefits are about to start, you no longer have to worry about Social Security. But what happens if your check doesn't arrive on time? Or what happens to your check if you're away from home for awhile? And what should you do if your condition improves? Or what if you want to go back to work but are afraid of losing your benefits? Knowing the answers to these and other questions now will save you a great deal of time, inconvenience, and maybe some money, later. That's why you should read this booklet now, then put it aside for reference later. For easy reference, this booklet is divided into four parts: Your Disability Benefits Reporting Changes That Can Affect Your Benefits Reviewing Your Disability Case Helping You Return To Work If you also receive Supplemental Security Income (SSI) checks, there are some additional rules for that program. Ask Social Security for a copy of the booklet, When You Get SSI What You Need To Know (Publication No. 05-11011). What's Inside Page Part 1: Your Disability Benefits 4 Your Benefit Amount 4 When To Expect Your Check 4 If Your Check Is Late, Lost, Or Stolen 5 About Direct Deposit 5 Returning Checks Not Due 6 Paying Taxes On Your Benefits 6 How Long Payments Continue 7 A Word About Medicare 8 Benefits For Children.............................. 8 If A Social Security Employee Visits You 10 Free Social Security Services 10 Part 2: Reporting Changes That Can Affect Your Benefits 10 If You Change Your Address 11 If Your Condition Changes 11 If You Go To Work 11 If You Go Outside The United States 12 If You Receive Other Disability Benefits 12 If You Get A Pension From Work Not Covered By Social Security 13 If You Are A Spouse Or Surviving Spouse Who Receives A Government Pension 13 If You Get Married 13 If A Person Is Not Able To Manage His Or Her Own Funds 14 If A Beneficiary Is Convicted Of A Felony 15 If A Beneficiary Dies 15 How To Report A Change 15 Part 3: Reviewing Your Disability Case 16 Frequency Of Reviews 17 What Happens During A Review 17 Special Appeal Rights 18 Part 4: Helping You Return To Work 19 Understanding Substantial Work 19 Nine-Month Trial Work Period................................20 36-Month Extended Period Of Eligibility 21 Medicare Continues.................................... 21 Help With Work Expenses 21 Vocational Rehabilitation 22 If You Become Disabled Again 22 Special Rules For Blind Persons Who Work 22 For More Information 23 Other Booklets Available 24 Part 1 Your Disability Benefits Your Benefit Amount Your Certificate of Award explains how much your disability benefit will be and when payments start. It also shows when you can expect your condition to be reviewed to see if there has been any improvement. If family members are eligible, they will receive a separate notice and a booklet about things they need to know. If you are getting disability benefits on your own record, or if you are a widow or widower getting benefits on a spouse's record, your payments cannot begin before the sixth full month of disability. If the sixth month is past, your first payment may include some back benefits. Your Social Security benefit may be reduced if you are eligible for workers' compensation, other public disability payments, or a pension from a job where you did not have to pay Social Security taxes. (See Pages 12 and 13 for more information.) You can expect your payment amount to go up in future years. Whenever the cost of living goes up in a year, benefits will be increased by that amount the following January. If there is an increase, you will get a notice telling you about it. You do not have to apply for this increase; it comes automatically. When To Expect Your Check Your check should arrive on the third day of every month. If the third falls on a Saturday, Sunday, or legal holiday, you will receive your check on the last banking day before then. The check you receive is the benefit for the previous month. For example, the check you receive dated July 3 is for June. Your benefit can either come to you in the mail or be deposited directly into your bank account. If Your Check Is Late, Lost, Or Stolen If your check comes in the mail and is late, you should wait three days after it was due to receive it. If you don't get it by then, contact Social Security. The people there will help you find out what happened and see that you receive any check due you as soon as possible. If your check is lost or stolen, contact Social Security immediately. Your check can be replaced but it takes time. To be safe, you should cash or deposit your check as soon as you can after you receive it. It is also a good idea not to sign your check until you are with the person who will cash it. If you sign it ahead of time and then lose it, the person who finds it could cash it. About Direct Deposit To help prevent problems with delayed, lost, or stolen checks, you should consider direct deposit. This is when your benefit is sent directly to your bank or other financial institution. Direct deposit is popular because of the added convenience. You won't have to stand in line waiting to cash your check, and if you are away from home, your check will be deposited for your immediate use. It is especially important to tell Social Security about any change in your mailing address when you receive your benefits by direct deposit. This is because you need to be able to receive any letters we may send about your benefits. If you decide to change the account or the financial institution where your benefits are going, it is important to keep the old account open until the first benefit is received in your new account. It usually takes one or two months to process the change from one bank or account to another. If you have any questions about direct deposit, you can ask your financial institution or any Social Security office. Returning Checks Not Due If you receive a check you know is not due, (for example, you are working and your condition has improved) you should take it to any Social Security office. Or return it to the U.S. Treasury Department, Division of Disbursement, at the address on the check envelope. Enclose a note telling why you are sending the check back. If you have direct deposit, you should refund any payments you receive that you know are not due. Paying Taxes On Your Benefits Some people who get Social Security have to pay taxes on their benefits. You will be affected only if you have substantial income in addition to your Social Security benefits. If you file a federal tax return as an individual, and your combined income* is between $25,000 and $34,000, you may have to pay taxes on 50 percent of your Social Security benefits. If your combined income is above $34,000, 85 percent of your Social Security benefits is subject to income tax. If you file a joint return, you may have to pay taxes on 50 percent of your benefits if you and your spouse have a combined income* that is between $32,000 and $44,000. If your combined income* is more than $44,000, 85 percent of your Social Security benefits is subject to income tax. If you are a member of a couple and file a separate return, you probably will pay taxes on your benefits. *On the 1040 tax return, your combined income is the sum of your adjusted gross income plus nontaxable interest plus one-half of your Social Security benefits. How Long Payments Continue Your disability benefits generally will continue for as long as your impairment has not medically improved and you cannot work. They will not necessarily continue indefinitely. Because of advances in medical science and rehabilitation techniques, an increasing number of people with disabilities recover from serious accidents and illnesses. Also, many individuals, through determination and effort, overcome serious conditions and return to work in spite of them. As explained on Pages 16 and 17, your case will be reviewed periodically to make sure you're still disabled. In addition, you are responsible for promptly reporting if your medical condition improves, if you believe that you can work, or when you actually do return to work. (See Pages 11 and 12 for more information.) Your benefits may be affected if you marry (unless you are getting disability benefits on your own record), if you receive certain other types of disability checks, or if you go to certain countries. Make sure you read and understand the information on what to report on Pages 10-16. In this way, you can avoid having to pay back some benefits later. If you are still getting disability benefits when you turn 65, your benefits will be automatically changed to retirement benefits, generally in the same amount. You will then receive a new booklet explaining your rights and responsibilities as a retired person. If you are a disabled widow or widower, your benefits will be changed to regular widow or widower benefits (at the same rate) at 60, and you will receive a new instruction booklet that explains the rights and responsibilities for people who get survivors benefits. A Word About Medicare After you receive disability benefits for 24 months, you will be eligible for Medicare. You will get information about Medicare several months before your coverage starts. (If you have chronic kidney disease requiring regular dialysis or a transplant, you may qualify for Medicare almost immediately.) Help For Low-Income Medicare Beneficiaries If you get Medicare and have low income and few resources, your state may pay your Medicare premiums and, in some cases, other out-of-pocket Medicare expenses such as deductibles and coinsurance. Only your state can decide if you qualify. To find out if you do, contact your state or local welfare office or Medicaid agency. For more general information about the program, contact Social Security and ask for a copy of the publication, Medicare Savings For Qualified Beneficiaries (HCFA Publication No. 02184). Benefits For Children If a child is getting checks on your account, there are important things you should know about his or her benefits. When A Child Reaches 18 A child's benefits stop with the month before the child reaches 18, unless the child remains unmarried and is either disabled or is a full-time elementary or secondary school student. About five months before the child's 18th birthday, the person receiving the child's benefits will get a form explaining how benefits can continue. A child whose benefits stopped at 18 can have them started again if he or she becomes disabled before reaching 22 or becomes a full-time elementary or secondary school student before reaching 19. If A Child Is Disabled A child can continue to receive benefits after age 18 if he or she has a disability. The child also may qualify for SSI disability benefits. Call us for more information. If A Child At 18 Is A Student A child can receive benefits until age 19 if he or she continues to be a full-time elementary or secondary school student. When a student's 19th birthday occurs during a school term, benefits can be continued up to two months to allow completion of the term. Social Security should be notified immediately if the student drops out of school, changes from full-time to part-time attendance, is expelled or suspended, or changes schools. We should also be told if the student is paid by his or her employer for attending school. We send each student a form at the start and end of the school year. It is important that the form be filled out and returned to us. Benefits could be stopped if the form is not sent back. A student can keep receiving benefits during a vacation period of four months or less if he or she plans to go back to school full time at the end of the vacation. A student who stops attending school generally can receive benefits again if he or she returns to school full time before age 19. The student needs to contact Social Security to reapply for benefits. Having A Child After Benefits Start If you become the parent of a child after you begin receiving Social Security benefits and the child is in your care, be sure to notify us so that the child can also receive benefits. If A Social Security Employee Visits You If anyone comes to your home to talk about Social Security or SSI, ask for his or her identification. Anyone who is from Social Security will be glad to show you proper identification. If you have any doubts about the person, you can call us to ask if someone was sent to see you. And remember:Social Security employees will never ask you for money to have something done. It's their job to help you. Free Social Security Services You never have to pay for information or service at Social Security. Some businesses advertise that they can provide name changes, Social Security cards, or earnings statements for a fee. All these services are provided free by Social Security. So don't pay for something that's free. Call us first. Social Security is the best place to get information about Social Security. Part 2 Reporting Changes That Can Affect Your Benefits You should promptly report any changes that may affect your disability benefits. Family members receiving benefits also should report events that might affect their checks. The events that must be reported are explained on the next few pages. If You Change Your Address You must notify the post office and Social Security immediately if you change your mailing address. In fact, failure to report a change of address is the leading cause of checks not arriving on time. Your report should include your claim number, your old address, and the new address, including ZIP Code. Give the names of all family members who should receive benefits or information at the new address. You should report a new address even if you have direct deposit because important letters from Social Security are sent to your mailing address, even though your benefits go directly to a bank. Your benefits could be stopped temporarily if Social Security cannot locate you because you have not reported a change of address. If Your Condition Changes You must notify us if there is any change for the better in your condition. Failure to do so could mean you'll get payments you aren't due money that will have to be repaid. Your case will be reviewed periodically to determine if you're still disabled. (See Pages 16-18 for more information.) If You Go To Work You should tell us if you take a job or become self-employed no matter how little you earn. If you are still disabled, you will be eligible for a trial work period and can continue receiving benefits for up to nine months (see Pages 20-21). Also, notify us if you have any special work expenses resulting from your disability (such as specialized equipment, a wheelchair, or even some prescription drugs), or if there is any change in the amount of the expenses. If You Go Outside The United States If you are a citizen of the United States, your Social Security payments generally can continue for as long as you are outside the United States and meet all requirements. (The Social Security office has a list of 60 other countries whose citizens also can get Social Security checks if they leave the United States.) However, you must notify Social Security when you plan to leave the U.S. for 30 days or more so that any letters can be sent to the right address. Notifying us also will enable you to learn about any special rules that apply to those receiving benefits outside the U.S. And remember to let Social Security know when you return to the U.S. If you are a citizen of a country not approved for us to send checks, your benefits will be suspended after you have been outside the U.S. for six months, unless you meet specific conditions. And, if you go to a country where U.S. Treasury Department regulations prohibit sending checks, your benefits will stop immediately. For more information, ask any Social Security office for the booklet, Your Social Security Checks While You Are Outside The United States (Publication No. 05-10137). If You Receive Other Disability Benefits If you are disabled, and under 65, Social Security benefits for you and your family may be reduced if you are also eligible for workers' compensation (including black lung payments) or for disability benefits from certain federal, state, or local government programs. Tell us if you: Apply for another type of disability benefit; or Begin receiving another disability benefit or a lump-sum settlement; or Already receive another disability benefit and the amount changes or your payment stops. If You Get A Pension From Work Not Covered By Social Security If your disability began after 1985, tell us if you start receiving a pension (for which you were first eligible after 1985) from a job where you did not pay Social Security taxes. For more information, ask at any Social Security office for the fact sheet, A Pension From Work Not Covered By Social Security (Publication No. 05-10045). If You Are A Spouse Or Surviving Spouse Who Receives A Government Pension If you are a disabled widow or widower or the spouse of someone getting disability benefits, your Social Security payments may be reduced if you worked for a federal, state, or local government agency where you did not pay Social Security taxes and you receive a pension from that agency. Notify Social Security if you begin to receive such a pension or if the amount of the pension changes. Ask for the factsheet, Government Pension Offset (Publication No. 05-10007), for more information. If You Get Married Here's how marriage may affect your disability benefits and when you must report. If you are getting disability benefits on your own record Your payments will continue and you don't need to report the marriage. But, report any change of name so it will appear on your future checks. If you are a disabled widow or widower Payments will continue, but remember to report the name change. If your current spouse dies, you may be eligible for higher benefits on his/her work record. If you are an adult who was disabled before age 22 and you are getting benefits on the Social Security record of a parent or grandparent You should report your marriage. Payments generally will end unless you marry a person receiving certain types of Social Security benefits. If your benefits stop because of marriage, they cannot be started again unless the marriage is declared void. Benefits for the child of someone getting disability benefits always end if the child marries. This must be reported right away. If A Person Is Not Able To Manage His Or Her Own Funds If a person receiving benefits becomes unable to manage his or her funds, someone should let Social Security know. Social Security will arrange for a representative payee to receive and use the benefits for that person. Generally, the payee is a close relative or person caring for the beneficiary. The payee is responsible for: Properly using the benefits on behalf of the beneficiary, Reporting any events that may affect payments, Completing a Representative Payee Report when asked to do so by Social Security. Please Note: If a person has power of attorney for someone, that does not automatically qualify him or her to be the representative payee. For more information, ask Social Security for the booklet, A Guide For Representative Payees (Publication No. 05-10076). If A Beneficiary Is Convicted Of A Felony If someone getting Social Security benefits is convicted of a felony, Social Security should be notified immediately. Benefits generally are not paid for months a person is imprisoned for a felony, but any family members who are eligible may continue to receive benefits. A felony conviction may also affect a disability claim in other ways. (Contact any Social Security office for more information.) If A Beneficiary Dies When a beneficiary dies, no payment is due for the month of death. For example, if the person dies in June, even if it was on the last day, the check dated July 3 (which is the June check) should be returned. However, if the check is issued jointly to a husband and wife, the survivor should get in touch with any Social Security office about cashing the check. If the beneficiary was using direct deposit, the bank also should be notified of the death so it can return any payments received after death. When a person getting disability benefits dies, payments to his or her family will be changed to survivors benefits. If the worker received benefits on behalf of children, a new representative payee must be appointed. A death certificate or other proof of death is needed. How To Report A Change You can report a change simply by calling Social Security at 1-800-772-1213. You can also visit any office or mail in the reporting form given to you when you applied for benefits. If you send a report by mail, be sure to include: Your name, and if different, the name and Social Security claim number of the person on whose account you get benefits; Name of person(s) about whom the report is made; Your Social Security claim number; What new information is being reported; Date of the change; and Your signature, address, phone number, and date. If you need help in completing a report, the people at any Social Security office will be glad to help you. Or, you can call our toll free number 1-800-772-1213 24 hours a day. Be sure to have your Social Security number handy. If you are getting benefits on somebody else's record (a spouse, for example), we need his or her Social Security number, too. Part 3 Reviewing Your Disability Case Under Social Security law, all disability cases must be reviewed from time to time. This is to make sure that people receiving benefits continue to be disabled and meet all other requirements. Your benefits generally will continue unless there is strong proof that your condition has medically improved and there is evidence that you are able to return to work. Frequency Of Reviews How often your case is reviewed depends on the severity of your condition and the likelihood of improvement. The frequency can range from six months to seven years. Your Certificate of Award shows you when you can expect your first review. Here are general guidelines for reviews: Improvement expected If medical improvement can be predicted when benefits start, your first review should be 6 to 18 months later. Improvement possible If medical improvement is possible but cannot be predicted, your case will be reviewed about every three years. Improvement not expected If medical improvement is not likely, your case will be reviewed only about once every five to seven years. What Happens During A Review After you get a letter announcing the review, someone from your Social Security office will contact you to explain the review process and your appeal rights. You will be asked to provide information about any medical treatment you've received and any work you might have done. Then your file will be sent to the state agency that makes disability decisions for Social Security. An evaluation team that includes a disability examiner and a doctor will carefully review your file and request your medical reports. If reports are not complete or current enough, you may be asked to have a special examination or test that the government will pay for. Once a decision is reached, we will send you a letter explaining it. If we decide you are still disabled, your benefits will continue. If we decide you are no longer disabled, you can file an appeal (see section on next page). If you don't, your benefits will stop three months after we said your disability ended. Special Appeal Rights If you don't agree with a decision we make, you can appeal it. You have 60 days to file a written appeal with any Social Security office. Generally, there are four levels to the appeals process. They are: Reconsideration: Your claim is reviewed by someone who did not take part in the first decision. Hearing Before an Administrative Law Judge: You can appear before a judge to present your case. Review by Appeals Council If the Appeals Council decides your case should be reviewed, it will either decide your case or return it to the administrative law judge for further review. Federal District Court If the Appeals Council decides not to review your case or if you disagree with its decision, you may file a lawsuit in a federal district court. If you disagree with the decision at one level, you have 60 days to appeal to the next level until you are satisfied with the decision or have completed the last level of appeal. You have two special appeal rights when a decision is made that you are no longer disabled. They are: Disability Hearing This is part of the reconsideration process. You can meet face-to-face with the person who is reconsidering your case to explain why you feel you are still disabled. You can submit new evidence or information and can bring someone who knows about your disability. This special hearing does not replace your right to also have a formal hearing before an administrative law judge (the second appeal step) if your reconsideration is denied. Continuation of Benefits While you are appealing your case, you can have your disability benefits and Medicare coverage (if you have it) continue until an administrative law judge makes his or her decision. However, you must request the continuation of your benefits during the first 10 days of the 60 days mentioned earlier. If your appeal is not successful, you may have to repay the benefits. Part 4 Helping You Return To Work Even after you start receiving disability benefits, you may want to try working again. The chance of returning to the workplace for a person with a disability has increased dramatically in recent years. That's why Social Security has improved and expanded its work incentives rules that are designed to ease the transition back to work. These rules continue cash payments and Medicare while you work, help with the extra work expenses associated with working with a disability, and help with rehabilitation and training that may lead to a new line of work. Understanding Substantial Work To understand how work affects your disability benefits, you need to understand how Social Security measures your work. Disability benefits can be paid only if you are unable to do any substantial work. The amount of your earnings is the key to determining whether your work is substantial. In general, if your wages average more than $500 a month (after allowable deductions), you are performing substantial work. If your average monthly earnings are between $300 and $500 a month, your work could be considered substantial if the amount and quality of your work are about the same as that done by workers in your area who are not disabled. In making this decision, we consider the time, energy, skill, and responsibility involved in your work. Earnings of less than $300 a month are not considered substantial. (See Pages 22-23 for special rules for blind people who work.) If your earnings are subsidized that is, if your employer says you are paid more than the reasonable value of your work the subsidy part of your pay is not counted as earnings in deciding whether you are performing substantial work. If you are self-employed, your business income alone may not be the best measure of whether you are doing substantial work. Business income may depend on many other factors, such as the economic situation and services of other people. In such cases, more consideration is given to the amount of time you spend in your business than the amount of your income. Following are the rules that may help you return to work. Nine-Month Trial Work Period You can continue to receive benefits for up to nine months while you try to work. The months need not be in a row, but they must take place within a 60 month period. Generally speaking, a trial work month is any month in which you earn over $200 in gross wages (regardless of amount of time worked) or spend 40 hours in your own business (regardless of amount of earnings). You will receive your full benefits during this period. At the end of nine months of trial work, we decide if you are able to do substantial work. If you can, your benefits will stop after a three-month adjustment period. If you are not able to work, your payments will continue. Remember, your trial work period will continue only if you are still disabled. If you recover during a trial work period, your benefits will stop after a three-month adjustment period. 36 Month Extended Period Of Eligibility If your benefits stop because you have returned to work even though you are still medically disabled, you receive special benefit protection for the next 36 months. During that time, you can receive a benefit for any month your earnings fall below $500. You do not have to file a new application, but you do have to notify Social Security. If you are unable to continue working, your benefits continue indefinitely so long as you remain disabled. Medicare Continues If you are working even though you are still disabled, your Medicare coverage may continue for at least 39 months after the trial work period. After that, you may purchase the coverage with a monthly premium. Help With Work Expenses If you need certain equipment or services to help you work, the money you pay for them can be deducted from your earnings in deciding whether you are doing substantial work. It does not matter if you also need the items or services for daily living (such as a wheelchair). The cost of medical equipment, certain attendant care services, prostheses, and similar items and services is generally deductible. The cost of drugs or medical services is deductible only if required because of your condition. Vocational Rehabilitation When you applied for disability benefits, information about you and your impairment may have been sent to the state vocational rehabilitation agency. If they offer you services and you refuse them without good reason, your monthly benefits may be withheld. If you have not heard from them and are interested in receiving rehabilitation services, you should give them a call. Your disability benefits will continue while you receive rehabilitation services. Under a special rule, benefits can continue even if you medically recover while participating in an approved vocational rehabilitation or training program. If You Become Disabled Again If you become disabled a second time within five years after your benefits were stopped, your cash payments can begin again with the first full month you are disabled. Another waiting period is not required (as it was the first time you applied for Social Security disability benefits). However, you must file a new application. There is also no waiting period if you are a disabled widow or widower or a person disabled before 22 who becomes disabled again within seven years after benefits ended. If you had Medicare coverage, that will also resume without the 24-month waiting period explained on Page 8. Special Rules For Blind Persons Who Work If you receive disability benefits because of blindness, there are two special rules that may help you when you work: Average monthly earnings of $930 or less in 1994 are not considered substantial work. This monthly amount will increase in future years. (Pages 19-20 explain how substantial work affects your disability check). If you are 55 to 65, monthly benefits will continue if you cannot do the regular (or similar) work you did before turning 55 or becoming blind, whichever is later. For more information, ask Social Security for a copy of the booklet, If You Are Blind . . . How Social Security And SSI Can Help (Publication No. 05 10052). For More Information You can get more information 24 hours a day by calling Social Security's toll free number, 1-800-772-1213. You can speak to a service representative between the hours of 7 a.m. and 7 p.m. on business days. If you have a push-button (tone) phone, recorded information and services are available after 7 p.m. weekdays and all day on weekends and holidays. If you want to speak to a representative, the best times to call are early in the morning and early in the evening. And if you can, it's best to call later in the week and later in the month. When you call, have your Social Security number handy. Hearing-impaired callers using TDD equipment can reach Social Security between 7 a.m. and 7 p.m. on business days by calling 1-800-325-0778. The Social Security Administration treats all calls confidentially whether they're made to our toll-free numbers or to one of our local offices. We also want to ensure that you receive accurate and courteous service. That is why we have a second Social Security representative monitor some incoming and outgoing telephone calls. Other Booklets Available Social Security has a number of publications that contain information about other Social Security programs. Con-tact Social Security to get a free copy of any of these publications all of which are also available in Spanish. They include: Understanding Social Security (Publication No. 05-10024) A comprehensive explanation of all the Social Security programs. Retirement (Publication No. 05-10035) Explains Social Security retirement benefits. Survivors (Publication No. 05-10084) Explains Social Security survivors benefits. Medicare (Publication No. 05-10043) Explains Medicare hospital insurance and medical insurance. SSI (Publication No. 05-11000) Explains the SSI program, which provides a basic income to people who are 65 or older, disabled,