Source: http://www.law.cornell.edu/socsec/martin/1socsec.htm
Timestamp: 2013-12-12 19:15:41
Document Index: 744028411

Matched Legal Cases: ['art 1', 'art 1', 'art 2', 'art 1', 'art 2', 'art 1', 'art 2', 'art 1', 'arts 1', 'art 1', 'art 1', 'art 1', 'art 2', 'art 1', 'art 2']

Martin on Social Security Treatise - Part 1
This novel reference work was designed to take full advantage of today's online legal research environment. It was written to be surrounded by and linked to the primary law material of its field. The author�s aim has been to create a fully integrated electronic reference work. Issue by issue it provides immediate, �point and click� access to the relevant portions of the Social Security Act, Code of Federal Regulations, Hallex, and POMS as well as all important cases and rulings. In this way it organizes a comprehensive library of Social Security material. While it can be used apart from the Internet or printed out, in whole or part, separated from its companion online library it is far less useful.
The reference work, like the full collection it integrates, can be entered in several different ways. It is divided into two distinct parts, designated Part 1 and Part 2. Part 1 contains an overview of Social Security law, with extensive links from its �broad brush� sections to the topically focused sections of Part 2. Part 1 is organized around different benefit types and general features of the program. Its structure reflects the initial questions an individual may have about benefits under Social Security and how they are pursued. Part 2, by contrast, is organized around issues or topics that are particularly important in appeals or litigation. Using the Table of Contents or by moving into a part directly from the front menu a researcher can find a useful starting point in Part 1 or 2. Each section carries its own small table of contents, a set of linked references to related sections in Parts 1 and 2. Consequently, once a researcher has started off in a useful direction that direction can be pursued without frequent need to return �to the top.�
Print reference works must do a great deal of summarizing and excerpting. Since they are separated, often by significant physical distance, from their underlying primary material, it is important that they provide detailed description. A reference work that can take you straight to its cited sources with a �point and click� need not quote them. The central value of this reference work to the user lies in the links between its topic structure and the Social Security Act, the agency regulations and rulings, and the thousands of Federal court decisions that comprise this fully integrated collection. The reference work text that accompanies those links was written with three principal aims: to provide context, to highlight particularly important primary materials among the many accessible to the user, and to note when there are relatively recent changes in law or regulation that should be considered when reading older decisions.� Because the detailed provisions of both Act and regulations are close at hand, this work does not repeat their every qualification or condition.� Its description of governing rules is at a more general level.� As a consequence, on any point about which you need precise and authoritative information, you should follow the links to the pertinent sections of the Act, regulations, and other primary material.
No work of this magnitude is a single person achievement. Meeting the challenges of building a new reference work, from scratch, for electronic publication necessarily required contributions of many kinds, from many quarters. Those who have helped in major ways are far too numerous to mention so I must acknowledge my indebtedness to them by category, secure in the knowledge that the individuals know both who they are and the depth of my gratitude. The National Center for Automated Information Retrieval and Cornell University furnished the necessary time, space, and funds to launch this project in 1988. Mead Data Central furnished data and an initial experimental run on LEXIS along with a serious opportunity to explore the design issues of CD-ROM publication. Last not least, Clark Boardman Callaghan took on the challenge of building and publishing the full work on CD-ROM. In addition to these institutions (of which only Cornell remains) and their people, I am deeply indebted to successive cohorts of student assistants who wrestled with the thousands of Social Security decisions that had to be read and classified against an evolving reference work structure, making use of an ever changing set of software tools, to several law colleagues at institutions scattered across the map who not only shared and, at times, helped buoy my enthusiasm for this new form of law scholarship but furnished useful criticism, and finally to my family who have been very, very patient.
An electronic work is not static. This reference work is not done. It will be revised as Social Security law evolves and its links must be kept up-to-date. By its nature, a work in electronic media, existing in a software environment that enables electronic annotation, invites those who use it to suggest improvements � of all kinds. If you have such suggestions, please send them, in electronic format or on paper to: Prof. Peter W. Martin, Cornell Law School, Myron Taylor Hall, Ithaca, NY 14853. By e-mail, I am: peter-martin@lawschool.cornell.edu
Part 1 � Overviews
Scope of Reference Work
� 100. Scope of Reference Work � In General
This reference work and accompanying on-line resources �cover issues of entitlement and benefit calculation arising out of the set of programs popularly referred to as Social Security. These programs touch the lives of well over 90 percent of all persons living or working in the United States and provide critical income to those who have retired or ceased working due to severe physical or mental disability. They also provide income to other members of a worker�s family when the worker has retired, become disabled, or died. The law directing these payments and setting their amount is complicated. Questions about proper application of this law are raised in hundreds of thousands of administrative hearings and well over ten thousand federal court proceedings each year. This collection of materials is assembled to assist those who must resolve questions of Social Security law as judges, those who represent individuals and families seeking Social Security benefits, and individuals, family members, and organizations seeking a clearer understanding of the law that directs the distribution of hundreds of billions of dollars each year.� Since these benefits are centrally important to individuals at critical points in their lives, understanding under what circumstances they are available and how much the payments will be is vital information for planning and making decisions about other forms of savings or insurance.
[Related Sections: Part 1]
� 101. The Programs Covered � Old-Age, Survivors, and Disability Insurance (OASDI) and Supplemental Security Income (SSI)
Although the Social Security Act of 1935 established a wide range of income support programs and many additional programs have since been added to the Social Security Act, the phrase �Social Security� is used throughout this reference work to refer more narrowly to the programs found in Title II of that act. These include old-age insurance (retirement) benefits, survivors� benefits, and disability benefits. The full collection is referred to as Old-Age, Survivors and Disability Insurance or OASDI. This reference work and accompanying on-line resources also cover questions of entitlement and benefit amount under Title XVI, the Supplement Security Income program (SSI). As its name suggests, Supplemental Security Income can be viewed as a backstop for Social Security, providing benefits for individuals in the same population segments who have insufficient income, either because they do not qualify for Social Security (having not had enough past covered employment) or because their Social Security benefits are too low.
� 102. Programs Not Covered Although Closely Affiliated With Social Security � Black Lung, Medicare, AFDC, Private Pensions
For many individuals and families, Social Security benefits overlap with or interact with other important benefits. While SSI is a special case, other close program-to-program relationships exist. These relationships are, in most cases, structured by provisions of the statutes or regulations that regulate the interaction from both sides. Although such related benefits and their interaction with Social Security can have a major impact on the Social Security claimant, this reference work and accompanying on-line resources do not provide detailed treatment of Black Lung benefits, Medicare, private pensions, or the many other forms of income support that resemble Social Security in some respects. It does, however, include summary treatment of the Social Security side of the relationship between its benefits and the more important overlapping programs.
[Related Sections: Part 1 - Part 2]
� 103. The Issues Covered � Entitlement, Amount, Procedure, Proof or Evidence, Issues of Representation, Planning in Relation to Benefits
For the programs covered, this reference work and accompanying on-line resources �cover all issues bearing on entitlement, those elements an individual must establish in order to secure benefits in the first place or keep benefits once started. Depending on the benefits involved, the issues can range from the generally straightforward matter of establishing the claimant�s age, through the more frequently troublesome question of whether a specified family relationship exists, to the nearly always difficult complex of issues surrounding a disability determination. This reference work and files cover the law of Social Security and SSI benefit calculation, including the effect on monthly payments of continuing earnings and benefit claims by other family members. The reference work deals with the administrative and judicial procedures that govern appeals from unfavorable agency determinations, and also with associated rules of proof or evidence. It covers the rules concerning representation of individuals by lawyers or others, including the provisions controlling the fees charged for such representation. Finally, the work focuses on areas where the contours of Social Security law may affect private planning, such as decisions about retirement or continued part-time work and about divorce, marriage, and adoption.
� 104. Related Tax Issues Not Addressed
Social Security benefits are financed by special taxes. Those taxes, paid by employees, employers, and self-employed individuals, are set out in a separate set of statutory provisions that can be found, today, with the other provisions of the Internal Revenue Code. In many respects these tax provisions track the benefit provisions of the Social Security Act in perfect parallel. The definitions of employment, wages, and self-employment income that operate in the benefit context are nearly identical to those that determine the incidence of the Federal Insurance Contributions Act (FICA) and Self-Employment Contributions Act (SECA) taxes. Consequently, there are times when decisions about a tax question furnish useful authority on a benefit issue. On the other hand, the tax and benefit settings are so distinct, involving different public agencies and private attorneys, that the practical overlap is slight. This reference work and accompanying on-line resources �are limited to the benefit side of Social Security. References to the program�s tax provisions are limited to a few situations in which they constitute important authority on benefit questions.
The Different Types of Social Security Benefits
Social Security � Basic Categories
� 150. The Different Types of Social Security Benefits � In General
When first enacted, in 1935, the Social Security program was almost exclusively a retirement benefit program.� It provided for monthly benefits to covered workers who had reached the age of eligibility (then 65) and also retired.� The program has since acquired two additional types of benefits.� It now includes benefits for covered workers who become severely disabled, long before they reach retirement age.� It also includes benefits for others, related to the worker, in the event of the worker�s retirement, disability, or death.
� 151. Benefits Categorized According to the Claimant�s Relationship to the Worker
The Social Security program provides two types of benefits for the worker whose own earnings have established entitlement: 1) disability benefits, available to covered workers who become severely disabled, and 2) old-age insurance (retirement) benefits, available to workers after reaching the age of 62.� These benefits received directly by the worker are sometimes called primary Social Security benefits.� In addition to these two types of primary benefits, the Social Security program provides for auxiliary or derivative benefits.� These are benefits that are paid to children, spouses, former spouses, and parents of a covered worker under certain circumstances.
� 152. The Different Types of Social Security Benefits � Benefits Categorized According to the Worker�s Situation
Three different events in the worker�s life can trigger Social Security benefits � retirement, disability, and death.� Benefits are available to the worker and certain family members once the worker has attained 62 and meets the program�s definition of retirement.� Benefits are available to the worker and certain family members if the worker becomes severely disabled.� And finally, benefits are available to certain surviving family members in the event of the worker�s death.
� 160. Old-Age Benefits � In General
Monthly old-age insurance (retirement) benefits are available to workers covered by Social Security upon reaching age 62.� The amount of the monthly benefit depends upon the worker�s earnings history, upon the age at which the worker commences receiving the monthly benefit, and upon the level of the worker�s continuing earned income.
� 161. Old-Age Benefits � Entitlement
To receive monthly old-age insurance (retirement) benefits a person must have sufficient past work covered by Social Security to have the necessary �fully insured� status.� The person must be 62 or older and, prior to the Social Security Act�s �full retirement age� (which is between 65 and 67 depending on year of birth), must not have a high level of continuing earnings.� Unless the person is already receiving Social Security benefits of some other kind old-age benefits await the worker�s decision to file an application.� However, if the person has waited until after his or her �full retirement age� to file an application, benefits can be recovered for up to 12 months prior to the application but not for months prior to the �full retirement age.�
� 162. Old-Age Benefits � Amount
The monthly old-age insurance (retirement) benefit is pegged to a �full retirement age� defined in the Social Security Act (which is between 65 and 67 depending on year of birth).� Those who start benefits at that age get their full �primary insurance amount,� an amount that is based on their personal earnings history.� Those who start benefits prior to that �full retirement age� receive a smaller monthly sum; those who start benefits later, a larger one.� Prior to that �full retirement age,� benefits are also affected by the worker�s continued receipt of significant earned income.� Claimants seeking benefits while they continue to work may have their monthly benefit reduced or even eliminated because of the resulting earnings.
� 163. Old-Age Benefits � Relationship to Prior or Subsequent Benefits Received by Worker
Old-age insurance (retirement) benefits are primary benefits; they rest on the claimant�s own earnings record rather than the earnings record of another. When a person entitled to old-age insurance benefits is also eligible for a family benefit, as a spouse, say, that auxiliary benefit is reduced by the amount of the primary benefit. If the auxiliary benefit is larger than the primary, the total amount received by the individual will be that larger amount but the total will be made up of the full primary benefit plus a reduced auxiliary benefit.
Because of this interplay, if a person below his or her �full retirement age� is simultaneously eligible for a reduced spouse benefit, based on the earnings record of a retired or disabled worker, and also a reduced old-age insurance benefit, the individual cannot put off applying for the primary benefits. Application for one is deemed an application for the other.� (This is not the case, however, with surviving spouse benefits and old-age insurance benefits.)
Prior receipt of disability benefits, the other form of primary benefits, has no direct effect on the amount of old-age insurance benefits. The disability will, however, result in the period of disability being dropped from the �primary insurance amount� calculation. (This prevents any ultimate old-age benefits from being dragged down by the years of no or low earnings.) If the person continues to receive disability benefits up through the month before he or she reaches the �full retirement age� defined by the Social Security Act (which is between 65 and 67 depending on year of birth), those benefits convert to old-age or retirement benefits at that point without any need to file an application.
When a person is entitled to both an old-age insurance and a disability benefit, he or she can receive only one. Rev. 11/05
� 164. Old-Age Benefits � Benefits for Others That Are Linked To
When an individual is entitled to old-age insurance (retirement) benefits, his or her spouse, divorced spouse, or child may be entitled to derivative benefits on the worker�s account.� Since an individual is not entitled to old-age insurance benefits until he or she has filed an application, these derivative benefits, too, must await the worker�s application.� There is one exception to this rule: benefits for most divorced spouses do not depend on the worker�s having filed an application.
� 170. Disability Benefits � In General
Several different types of Social Security benefits are available on the basis of disability.� First, disability insurance benefits are available to qualifying individuals on the basis of their own past earnings record.� The amount of the benefit depends on that earnings history.� Second, a surviving spouse can receive widow(er)s benefits prior to the eligibility age of 60 normally applicable to such benefits if he or she meets the Act�s disability test.� Such benefits can begin as early as age 50.� Third, a child can receive benefits on the basis of the earnings record of a parent beyond the normal cutoff age for such benefits if the child meets the disability test.� Finally, those who are not entitled to any of these other Social Security benefits or whose benefits are low may be eligible for Supplement Security Income disability benefits.
� 171. Disability Benefits � Entitlement
To be entitled to monthly disability insurance benefits an individual must meet the program�s definition of disability, and the disability must have lasted for at least five months.� In addition, the individual must have insured status for disability benefits, must be below the Act�s �full retirement age� (which is between 65 and 67 depending on year of birth), and must have filed an application.
� 172. Disability Benefits � Amount
The monthly disability insurance benefit is the individual�s full �primary insurance amount,� an amount that is based on his or her earnings history. The age at which disability benefits begin has no effect on the monthly amount except in the unusual situation in which the person becomes eligible for disability benefits after having begun old-age insurance (retirement) benefits. In such a case, the individual will be between the age of 62 and his or her �full retirement age� (which is between 65 and 67 depending on year of birth) and the disability benefit amount will be reduced to reflect the months of early payment of old-age insurance benefits. When a person is entitled to both an old-age insurance and disability benefit, he or she can receive only one. Disability insurance benefits may also be reduced when an individual is also receiving workers compensation or equivalent benefits under a state or federal program. Such reduction occurs when the combined total of disability insurance and such other benefits (including benefits to other family members) exceeds 80% of the worker�s average earnings immediately prior to the onset of disability.
� 173. Disability Benefits � Relationship to Prior or Subsequent Benefits Received by Worker
When a person becomes eligible for disability insurance benefits after having begun old-age insurance (retirement) benefits, which can happen only when the individual is between the age of 62 and the Social Security Act�s �full retirement age� (which is between 65 and 67 depending on year of birth), the disability benefit amount will be reduced to reflect the months of early payment of old-age insurance benefits.
Disability benefits are primary benefits; they rest on the claimant�s own earnings record rather than the earnings record of another.� When a person entitled to disability benefits is also eligible for a family benefit, as a spouse, say, that auxiliary benefit is reduced by the amount of the primary benefit.� If the auxiliary benefit is larger than the primary, the total amount received by the individual will be that larger amount but the total will be made up of the full primary benefit plus a reduced auxiliary benefit.
� 174. Disability Benefits � Benefits for Others That Are Linked To
When an individual is entitled to disability insurance benefits, his or her spouse, divorced spouse, or child may be entitled to derivative benefits on the worker�s account.� Since an individual is not entitled to disability insurance benefits until he or she has filed an application these derivative benefits, too, must await the worker�s application.
� 180. Disability Benefits � Disability Determination � In General
The Social Security Act has both a general definition of disability and a specific definition of blindness as a disability.� The general definition of disability requires the claimant to show a medically determinable physical or mental impairment.� That impairment must be expected to result in death or to last for at least 12 months.� This definition combines both medical and vocational components.
� 181. Disability Benefits � Disability Determination � Procedure Employed
While the overall administration of the Social Security program lies with the Social Security Administration disability determinations are made by state agencies.� Those agencies operate under agreements with the Federal Agency and are subject to Federal law.� Moreover, their determinations are ultimately subject to appeal to Federal administrative law judges and the Federal courts.
The regulations prescribe a sequential evaluation process to be followed in determining whether an individual meets the Act�s disability test.� A conclusion at any step that the individual is disabled or not disabled ends the evaluation; subsequent steps do not apply.� In order, the steps of that process are as follows:
1) Substantial gainful activity � If the claimant is, in fact, continuing to work and that work is found to be substantial gainful activity the process calls for a finding that he or she is not disabled.
2) Severity � A conclusion that the claimant�s medical impairments do not significantly limit the ability to perform basic work activities calls for a finding that he or she is not disabled.
3) Listed Impairments � The regulations provide a catalog of impairments that are deemed severe enough to warrant a finding that the claimant is disabled.� If the claimant suffers from a listed impairment or its medical equivalent, he or she is to be found disabled.
4) Relevant past work � If a claimant�s impairments do not prevent performance of relevant work he or she has done in the past, a finding of not disabled is called for.
5) If the claimant cannot perform his or her past relevant work, the issue becomes whether or not the individual has the capacity to perform other work available in the national economy.� Here, in appropriate cases, the Agency makes use of the Medical-Vocational Guidelines (also known as the grid).
� 182. Disability Benefits � Disability Determination � End of Disability
A claimant who has been found entitled to disability benefits may lose those benefits if he or she later ceases to be disabled.� A determination that the disability has ended can come from the individual�s return to substantial gainful activity without any other evidence that the level of impairment has changed.� However, beneficiaries are entitled to a period of trial work before that judgment is reached.� A determination that the individual�s medical condition has improved to the point that he or she no longer meets the disability test will also lead to the end of benefits.� The Agency is required to reevaluate beneficiaries� impairments from time to time to determine whether they remain disabled.� The frequency of such reviews depends on the likelihood of improvement.� The process of reevaluation is termed a �continuing disability review.�
Before beginning such a review, the Agency must notify the individual of the review and the grounds for it.� Because those subject to review have previously been determined disabled, determinations that disability has ceased generally require substantial evidence of a change.
Disability beneficiaries threatened with termination have an option to continue payments through the hearing stage, subject to having those payments treated as overpayments should the hearing decision by the Administrative Law Judge affirm the termination. [Related Sections: Part 1 - Part 2]
� 190. How Disability Affects Non-Disability Benefits
When an individual meets the Act�s test of disability and the insured status test for disability benefits, his or her earnings record is protected by a disability �freeze.�� The freeze applies for the length of the disability (or until the individual�s �full retirement age� if that comes first).� One result of a freeze is that quarters during the period of disability are not counted in determining the number of quarters needed for insured status.� A second consequence of a freeze is that years included within the period are not included in calculation of the individual�s �primary insurance amount.�
To secure recognition of a period of disability, the claimant must file an application while disabled or within 12 months after the disability period has ended.� An extension of that deadline for an additional 24 months is available in cases where the failure to file within 12 months was due to the individual�s mental or physical incapacity.
Benefits Based on Family Relationship
� 200. Benefits Based on Family Relations