What if My Disability Gets Worse After I’m Approved for Benefits?

You worked hard to prepare your disability claim, and the Social Security Administration (SSA) approved you for monthly benefits. You’ve been receiving disability benefits for weeks, months, or years – but now your condition has gotten worse. Do you need to file for benefits again? Could you reapply to increase your monthly payments? Our Philadelphia disability lawyers explain how SSI and SSDI (Social Security Disability Insurance) are affected.

How is Disability Calculated?

Congratulations on being approved for disability benefits. You’ve already beaten the statistical odds since the rejection rate during the initial application stage is well over 50% in most states, including Pennsylvania and New Jersey.

While getting approved is a triumph in its own right, many beneficiaries are confronted with a new problem later down the road: their original benefits cannot keep up as the underlying medical condition worsens. While effective management can help to stabilize or even reverse many conditions, such as Type 2 diabetes, many conditions tend to become more severe as time passes. Some common examples of conditions that are prone to gradually worsening over time include HIV/AIDS, various forms of cancer, Parkinson’s Disease, and fibromyalgia (in about 25% of cases).

As you probably remember from filing your initial claim, being approved for disability is contingent upon demonstrating that your disability is severe. Simultaneously, the number of your disability payments depends not on the severity of your condition but upon your earnings and work history. The SSA uses complex calculation methods to determine how payments should be set.

What is the SSA’s SSDI Qualification Process?

It is essential to understand the qualification process established by the SSA in order to know whether you can receive SSDI benefits. Both benefit programs have different requirements. While we already touched on their most fundamental aspects, it is essential to dive deep into what the SSA looks for when deciding on SSDI benefits. We discuss each of them separately below:

The SSDI Qualification Process

The SSDI benefits are approved by the SSA to those with working history – or accumulated working credits – who are unable to return to work because of a disability or chronic condition. This is basically the first element the SSA will look at when evaluating your request. If you have enough working credits to support your claim, you can go to the next step in your qualification process.

After determining that you have enough working credits, the SSA will look at your condition. Not every condition is considered disabling. For this reason, the SSA has a definition of what a disabling condition or disability is in order to qualify for their benefits. As we mentioned, a disability is a condition that is expected to last for at least a year, must be severe, or is expected to cause an individual’s death. Your condition or disability must be in the SSA’s Blue Book of medical conditions, or be related to one of them, to qualify for their benefits.

Additionally, the SSA will look at whether your condition allows you to return to your previous work. If your condition does not allow you to work your previous job, they will look at whether you can do another type of job. If you can’t perform any other job because of your condition, you may be qualified and approved for your SSDI benefits.

Will My SSDI Benefits Increase if My Condition Worsens?

The short answer to this question is no. Typically, the SSA will not add benefits because your condition gets worse. As an SSDI benefit recipient, you may feel like this approach is unfair. However, there is an explanation behind the SSA’s reasoning. Your SSDI is based on your earning history, one of the main qualifying requirements – and not your condition, impairment, or disability. The practical effect of your SSDI benefits approval is the same as your retirement benefits based on your working credits and if you were at full retirement age when you got disabled.

Keep in mind that, when evaluating your case and determining your qualification for SSDI benefits, the SSA must have determined that your condition was severe enough to qualify. In other words, the SSA must have already decided that your condition prevented you from working, and it was expected to last for at least a year or lead to your death.

Suppose you were approved for SSDI benefits based on a chronic condition. Three months after beginning to receive your benefits, your condition deteriorates. Your condition may have gotten worse in this circumstance, but you’d still be fully disabled in the SSA’s eyes. Therefore, you would have already satisfied the requirements for your benefits, and you would continue to receive them as usual.

Conversely, if you were disabled and were getting SSDI benefits, but your condition improves to the point you can return to work, your benefits may be stopped, and you would need to return to work.

Decreased Earnings Can Mean Increased Payments

You might remember that you also had to meet certain income thresholds in addition to meeting specific medical standards. The SSA refers to these thresholds as SGA, which stands for Substantial Gainful Activity.

When it comes to evaluating claimants who are children, SGA measures the ability to perform necessary social, mental, and physical activities. However, for claimants who are adults, SGA refers primarily to how much money you earn every month. In other words, your SGA is expressed in terms of how much work you can perform.

The SSA will not grant benefits to someone with an SGA, which is too high because the implication is that the claimant can perform steady work and is therefore not disabled. You would not have been approved for benefits on the first occasion if your SGA had surpassed the SSA’s SGA limits for the appropriate year.

So how does this affect you today? If you receive SSDI and your earnings drop lower because your condition gets worse – for example, perhaps you used to perform several hours of work per week, but now cannot perform any work because your pain has increased or your mobility has decreased – you could potentially receive a larger monthly payment. Your payment is reduced by how much “countable income” you earn, so your monthly benefits can potentially go up if your income goes down.

Blind SGA Amounts Set Higher Monthly Income Limits

As we mentioned a little earlier, SSDI is determined by your past earnings and employment record. Therefore, your monthly SSDI payments will not increase because your condition gets worse. However, if your vision begins to deteriorate, you could potentially increase your monthly income.

The SSA does not award larger payments to disability recipients because they are legally blind. However, vision loss can indirectly raise your monthly earnings because it has a significant impact on SGA. The SSA uses dramatically increased income limits for blind individuals, which means you could continue to receive your regular monthly payments even if you start earning more money each month.

While SGA changes annually, the blind SGA amount consistently remains hundreds of dollars higher than the non-blind SGA amount. For instance, in 2021, the SGA limit for non-blind individuals is $1,310. For blind individuals, the SGA limit is of $2,190. Compared to prior years, the SSA has been increasing the number of benefits blind people and non-blind beneficiaries can receive.

Will My SSDI Benefits Be Cancelled if My Condition Improves?

There are people receiving the financial assistance provided by the SSA’s SSDI who have seen an improvement in their medical condition. However, they may fear this help will be lost or that their condition – while better – may force them to lose their job because of a lack of adequate performance. However, you should not be afraid to lose your job because of this. The SSA can help workers ease into their return to the workforce if their exiting condition improves.

The SSA provides what is known as a trial work period (TWP). This program can be an excellent opportunity to measure your ability to return to your job and see if you are able to perform well. Under this program, you can keep receiving the SSA’s assistance for the first nine months. Your SSDI benefits will continue even if your income surpasses the SSA’s SGA limits.

Your nine-month trial period doesn’t have to be consecutive. This means that there can be gaps in this trial period. The essential fact that you need to remember is that you need a total of nine months worth of TWP within five years before the SSA can make a final determination on your SSDI status.

If you have used your nine TWP months as stated by the SSA, you may not re-apply for another nine months. However, this doesn’t mean you can’t apply for SSDI benefits again. If you have gone back to work after your TWP, your SSDI was terminated, but your pre-existing condition doesn’t let you work, you can re-file for SSDI benefits through what is known as an expedited reinstatement.

An SSDI Lawyer Can Help if Your Disability Worsens After Getting Your Benefits

Facing the SSA and filing for SSDI benefits can be challenging, especially if this is your first try. Hiring a Bucks county SSDI attorney before your filing can improve your chances of approval. As you may know, the SSA rejects most first applications. However, an experienced attorney may help you avoid mistakes that can cause your application to be dismissed.

However, even if your initial application is rejected, your attorney can still fight for the SSDI benefits you need. You can appeal your case and have a second turn to fight for your claim. A skilled Doylestown disability attorney who is familiar with these processes can help you through your appeals process and get the compensation you deserve. Your SSDI attorney can make a difference between an accurate, complete, and pristine first SSDI claim submission and your case’s dismissal.

Pennsylvania Disability Attorney Offering Free Consultations

If you need help applying for benefits, or if your claim was denied, the Bensalem social security lawyers of Young, Marr, Mallis & Associates can help. We have more than 20 years of experience and offer free initial consultations. To talk more about how we can help you in a free, confidential case evaluation, call our law offices right away at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania.