When a person who has filed for Social Security Disability Income (SSDI) benefits or Supplemental Security Income (SSI) payments returns to work less than one year after the onset of his/her disabling condition, the 12 month duration requirement for initially qualifying for disability may become an issue. Depending on various factors, the Social Security Administration (SSA) may revisit and revise the initial disability decision.
SSDI Program
For the SSDI program, SSA determines if the person’s disability benefits should be stopped immediately or continued subject to a trial work period, or if the initial favorable disability decision should be reopened and revised to a denial. Following are the different scenarios that could arise under SSDI.
If the person’s work is Substantial Gainful Activity (SGA) and performed less than 12 months after the official onset of the disabling condition and before the date of the final medical allowance decision, the person’s application for benefits will normally be denied.
If a SSDI applicant returns to work at the SGA level while still in the 5 month waiting period and the work continues, SSA can deny the claim even if the medical allowance determination has already been made.
When SGA is performed after the date of the final medical allowance determination and after the 5 month waiting period, the person has the right to a trial work period, whether or not the work occurs less than or more than 12 months after onset.
When SGA is performed in or after the month of entitlement and more than 12 months from disability onset date, the person is protected by the trial work period provisions, whether or not such work occurs before or after the date of the final medical allowance decision. This would occur when an applicant is found disabled retroactively.
Even when work activity is protected by the trial work period provisions as described above, the work can still be a factor that SSA uses in initially profiling a beneficiary’s disability for a medical Continuing Disability Review (CDR); that is, the work may make the case more likely to be considered a Medical Improvement Expected (MIE) or a Medical Improvement Possible (MIP) case.
SSI Program
Under the SSI program, if a person works at the SGA level less than one year after the onset of his/her disabling condition, the same basic issues as under SSDI arise but are handled somewhat differently. SSA can reopen and revise an allowance decision to a denial or a later onset (if the determination is final), or cease benefits, or continue benefits under section 1619. When the basis for an SSI disability allowance is blindness, SGA is not applicable at the initial claim or later.
When the work is SGA and performed before the final medical determination date, the person’s application for SSI payments will be denied if the one year duration requirement has not been met. If the work is SGA and later stops, SSA may consider a possible later onset date. If the SGA work is performed after the final allowance determination date, the case is subject to the 1619 provisions so that payments will normally continue until the recipient medically improves or eligibility is terminated for a non-disability reason.
Source: Social Security Administration POMS DI 24010.001, DI 13010.105, DI 13010.110