This page contains definitions that are important to Social Security Disability and Worker’s Compensation claims. For longer, more detailed explanations of the terms and additional terms, please click on the specific links from the drop down menu on the Legal Resources-Legal Glossary bar for each term.
CFR: Code of Federal Regulations: These are regulations which are promulgated by various agencies. Basically Congress has delegated to rule making and regulatory power where if they have a limited ability to write their own regulations consistent with the Federal Statutes known as the States Code. The Federal Regulations are treated as legal statute in almost all respects.
USC: United States Code Service: These are federal statutes governing many aspects with the federal law. These laws were passed by Congress and signed by the President.
SSR: Social Security Regulation: The SSR rules govern the adjudication process. In many ways, the SSR is similar to the CFR (Code of Federal Regulations). The SSR is more easily changed or supplemented and usually governs (procedure? in session?). The SSR is used by Adjudicators and Judges to assess and decide disability claims and regulate how many aspects of hearings and appeals are handled.
SSI: Stands for Supplemental Security Income. This is a disability program for poor or indigent people. Only people who are disabled and who have very limited assets or income will qualify for benefits.
COMPASSIONATE ALLOWANCES: A list of diseases and conditions the Social Security Administration is supposed to consider for disability at a higher degree than normal. There is no guarantee a person who has a disability that is also listed on the “Compassionate Allowances” list will automatically win their claim, however, disabilities under that category are supposed to get special consideration. The diseases and conditions listed under the “Compassionate Allowances” are constantly changing.
LISTING OF IMPAIRMENTS: Specific conditions or diseases which, when present, are supposed to allow an immediate approval of a disability claim. These rules are very specific and are considered at Step 3 of the Adjudication process. These “Listing of Impairments” cover all major body systems and diseases including mental disorders. There are separate “Listing of Impairment” rules for adults and claimants under the age of 18.
ODAR OFFICE: The term “ODAR” is an acronym for Office of Disability Adjudication and Review. This is the office where the Administrative Law Judges who hear Social Security Disability claims preside. This office used to be known as the Office of Hearing and Appeals or “OHA”. Currently there are two types of “ODAR” Offices. There are Regional Offices in most major metropolitan areas throughout the country and National Offices. Many claims are heard by an Administrative Law Judge who actually appears on a television screen conducting a video hearing. The Administrative Law Judge might appear from an “ODAR” Office far removed from the claimant.
SSI SSD DISABILITY: Most people, when they file for disability, have no real idea about what the requirements are for having a successful disability claim.
There are two different types of disability:
Social Security Disability (SSD)
Supplemental Security Income (SSI)
There are some similarities in both programs but there are also some very important differences.
The eligibility requirements for either SSI (which is income dependent) or SSD (which is income independent but requires a strong work history) are the same in that you must be disabled to qualify for both programs. There is also a requirement that the disability has lasted or will last for 12 consecutive months. What this usually means is unless an applicant has been off work for a year or more, it will be very difficult to get their disability approved without the presence of a very severe condition.
However, the eligibility requirements for Social Security Disability (SSD) require substantial work history and that a person be insured overall in the Social Security System in order to entitle them to benefits. Additionally, they must have worked 20 of the 40 quarters preceding their date of onset of disability.
The financial requirements for SSI require indigency to qualify for benefits regardless of how disabled the person may be. There are very strict rules used by the Social Security Administration as to the household assets and income a person may have and still qualify for SSI benefits.
Doctors, by nature, are very reluctant to give reports that predict the future as far as their patients are concerned. But, it is usually not too hard to find a physician who will indicate whether or not it is their medical opinion the individual has been disabled for a period of 12 consecutive months in the past.
One of the significant differences between SSI and SSD is that with SSD, if one is found to be disabled, there is no benefit payable for the first 5 full months of disability. That is not the case with SSI. SSI benefits can be paid from the day of disability onward but cannot go back any further than the date of application for disability.
RECONSIDERATION: The second step in the disability process. A “Reconsideration” is filed when the claimant has been denied in the initial application process. Upon Reconsideration, a new set of individuals will evaluate the merits of the claim and make an administrative determination. There is no in-person appearance at a “Reconsideration” determination. In the event a “Reconsideration” is denied, a claimant has to request a hearing in order to have the case presented to an Administrative Law Judge.
DATE LAST INSURED: In all Social Security Disability claims there is a “Date Last Insured”. The “date last insured” concept does not apply in SSI cases. What the “date last insured” means for a person who applies for Social Security Disability benefits is that a person must show they are disabled on or before their “date last insured” or they cannot draw any disability benefits. The “date last insured” always ends in a quarter of the year, being either March 31, June 30, September 30 or December 31. These “dates last insured” apply to “quarters” of the year in which substantial earnings occurred. The general rule is a person’s “date last insured” can be no later than no more than 5 years after they were last substantially employed and specifically that any disabled person must have worked 20 of the 40 quarters immediately preceding their date of onset of disability. This means it is important not to delay filing for disability benefits so as to not pass your “date last insured” which can make a successful application very difficult or impossible.
CONTINUING DISABILITY REVIEW: In many cases a Judge will make a determination that benefits should be awarded but that a claim should be reviewed in the future, many times in the very near future. Because of this, it is essential for a claimant even with a successful determination to continue to treat regularly for their condition of disability so that if a review is instituted, there will be sufficient ongoing data to sustain the award.
APPEALS COUNCIL: An appellate body that hears appeals from adverse determinations made by an Administrative Law Judge. If a claimant goes to a hearing in front of an Administrative Law Judge and loses, the first step in the appeal process is to the Appeals Council. These appeals have to be in writing and have to be filed within a specific time frame after the denial by the Administrative Law Judge. The issues raised here are very similar to any other appeal.
UNITED STATES DISTRICT COURT: A court of original jurisdiction in the Federal Court System. For Social Security Disability applicants, in the event that they have been denied by the Administrative Law Judge and then been denied by the Appeals Council, a further appeal may be effectuated to the United States District Court for the district in which they reside. The court then reviews the record and renders an opinion. The claimant’s representative must be an attorney, licensed to practice law in that jurisdiction in order to file an appeal. Social Security “Advocates” cannot represent the claimant in Federal Court.
UNITED STATES COURT OF APPEALS: The appellate court from which appeals are taken from District Courts. What this means to a Social Security applicant is that if they have been denied by an Administrative Law Judge and subsequently denied by the Appeals Council and the United States District Court, a further appeal can be filed to the United States Court of Appeals. In order to represent a claimant in the United States Court of Appeals they must be a licensed attorney. Non-attorney “advocates” cannot represent a claimant in front of this body.
TRANSFERABILITY OF SKILLS: In Social Security Disability claims the fifth step of the evaluation process is to determine whether a claimant has transferable skills from their old jobs that would enable them to do other, possibly less strenuous or less stressful occupations. The more skilled a person’s past profession, the more likely it is that they will have “transferable skills” that will allow them to work in other occupations which would normally result in a denial of disability benefits.
VOCATIONAL EXPERT: (abbreviation V.E.) A paid witness who appears at Social Security Disability hearings and answers hypotheticals posed by both the Administrative Law Judge and the claimant’s representative as to the availability of jobs and the claimant’s ability to perform same based upon a hypothetical situation.
MEDICAL EXPERT: (abbreviation M.E.) A physician, psychologist or psychiatrist who appears in a neutral capacity and testifies at Social Security Disability hearings in front of an Administrative Law Judge. They evaluate medical records and give their opinions of limitations based upon the record and whether or not the records indicate whether or not the claimant would meet a “Listing of Impairment” or would preclude certain work activities. Both the Judge and the claimant or claimant’s representative may cross-examine the Medical Expert.
SOCIAL SECURITY ADVOCATE: Anyone who represents a Social Security Disability claimant. Being an “Advocate” does not necessarily indicate any particular expertise if the “Advocate” is not an attorney. Many advocates these days are not attorneys. There is a program where some “advocates” may have a fee withheld from a claimant’s back pay to pay them for representation of the claimant if they successfully complete and pass a government sponsored test. Attorneys, unlike “Advocates”, must have graduated both from undergraduate school and law school and passed a BAR Examination in order to be recognized by the Social Security Administration.
If you have any questions about any of these terms or would like us to help you with your Social Security Disability or Worker’s Compensation claim, please call us at 800-842-0426.