Part 3 - When Your Claim Is Approved

Your Benefits Start

Once a decision is made that you are disabled, you will receive your first Social Security disability benefits starting with the sixth full month from the date the Social Security Administration decides your disability began (but no more than one year of back benefits can be paid). You also will receive a booklet describing your responsibilities as a Social Security beneficiary: What You Need To Know When You Get Disability Benefits (Publication No. 05-10153). You should read this booklet carefully and keep it in a safe place with your other valuable papers in order to refer to it whenever questions arise.

How Much You Will Get From Social Security

The amount of your monthly disability benefits is based on your lifetime average earnings covered by Social Security. If you would like an estimate of your disability benefit, all you have to do is call or visit Social Security and ask for it. We'll send you a form you can use to get a Personal Earnings and Benefit Estimate Statement.

How Other Payments Affect Benefits

Eligibility for other government benefits can affect the amount of your Social Security disability benefits.

Other Disability Benefits

Social Security benefits may be affected if you are also eligible for workers' compensation (including black lung) or for disability benefits from certain federal, state, local government, Civil Service, or military disability programs. Total combined payments to you and your family from Social Security and any of these other programs generally cannot exceed 80 percent of your average current earnings before becoming disabled. (Note that for income tax purposes, your unreduced benefit is counted.)

Government Pension Offset

If you are a disabled widow or widower or the spouse of a disabled worker, a "government pension offset" may reduce your Social Security payment. The offset applies if you become eligible for a federal, state, or local government pension based on your own work not covered by Social Security. The amount of your Social Security spouse's benefit may be reduced by two-thirds of the amount of your government pension.

There are some exceptions when the offset would not apply:

Pension From Work Not Covered By Social Security
If you become disabled and entitled to a Social Security disability benefit and you also receive a monthly pension based on work not covered by Social Security, your disability payment will be smaller than normal. That's because the Social Security Administration uses a different formula to figure the Social Security benefit of people who get other public pensions.

Benefits May Be Taxed

Some people have to pay federal income taxes on their Social Security benefits. This usually happens only if your total income is high. At the end of the year, you will receive a Social Security Benefit Statement (Form SSA-1099) showing the amount of benefits you received. The statement is to be used for completing your federal income tax return if any of your benefits are subject to tax. You may use the Internal Revenue Service Publication 915 for additional information on the tax.

You Can Get Medicare If You're Disabled

You will be automatically enrolled in Medicare after you have been getting disability benefits for two years.

Medicare has two parts--hospital insurance and medical insurance. Hospital insurance helps pay hospital bills and some follow-up care. The taxes you paid while you were working financed this coverage, so it's premium free if you're eligible. The other part of Medicare, medical insurance, helps pay doctors' bills and other services. You pay a monthly premium for this coverage if you want it. Most people have both parts of Medicare.

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 the leaflet Medicare Savings For Qualified Beneficiaries (HCFA Publication No. 02184).

Reviewing Your Disability

Your benefits will continue as long as you are disabled. However, your case will be reviewed periodically to see if you are still disabled. The frequency of the reviews depends on the expectation of recovery.

• If medical improvement is "expected," your case will normally be reviewed within six to 18 months.
• If medical improvement is "possible," your case will normally be reviewed no sooner than three years.
• If medical improvement is "not expected," your case may be reviewed no sooner than seven years.

What Can Cause Benefits To Stop?

There are two things that can cause us to decide that you are no longer disabled and to stop your benefits:

• Your benefits will stop if you work at a level the Social Security Administration considers "substantial." Usually, average earnings of $500 or more a month are considered substantial.
• Your disability benefits would also stop if the Social Security Administration decides that your medical condition has improved to the point that you are no longer disabled.

You must promptly report any improvement in your condition, your return to work, and certain other events as long as you are receiving benefits. These responsibilities are explained in the booklet you will receive when benefits start.