Will My Disability Benefits Change If My Diagnosis Changes?

Getting approved to receive disability benefits from the U.S. Social Security Administration (SSA) begins with a great deal of paperwork. A variety of different forms and records are necessary to demonstrate your work history and provide proof of a legally defined long-term disability.

This process can also require the cooperation of multiple medical offices. Unfortunately, after this complex application process, many patients are also required to appeal a denial before receiving benefits. This can mean attending a hearing with an administrative law judge or even hiring a lawyer to help navigate the process.

If you are awarded Social Security Disability benefits after this long and complicated process, the amount you receive each month will be unique to your application. Still, you may wonder: what happens if my diagnosis changes?

What if my diagnosis changes?

Will my medical condition be reviewed?

If you receive Social Security Disability benefits, the SSA will review your medical condition from time to time. This review is to ensure that you continue to have a qualifying legal disability. The frequency of these reviews ranges from 6 months to 7 years and will depend on the nature and severity of your medical condition as well as whether it is expected to improve.

When the SSA determines it is time for a medical review, you will receive a letter in the mail. At the review you’ll be asked to provide patient records for hospitals and medical offices that have treated you since you were awarded benefits (or since your last review). If you’ve worked at all during that time period, you will also need to provide information about the dates you worked, the pay you received, and the kind of work you did.

Should I worry about my benefits ending?

Under what circumstances might benefits be stopped?

If your health hasn’t improved, or if your disability still keeps you from working, you will usually continue to receive your benefits. If you have more than one diagnosis that qualifies as a legally disabling condition, the SSA will consider the combined effect of all your impairments on your ability to work. In most cases, cash benefits are only stopped if the evidence shows that your medical condition has improved enough for you to work regularly.

When will my benefits change?

Will my benefits change if my health worsens or I receive an additional diagnosis?

While the SSA does look at the combined effect of multiple diagnoses when determining eligibility from a health perspective, the severity of your disability or the number of diagnoses you’ve been given does not come into play when determining the amount of benefit you will receive. Instead, your payment amount is calculated using your earnings record from when you were able to work prior to becoming disabled. The SSA uses a complex weighted formula to calculate benefits for each individual.

Calculating your PIA

Briefly, the calculation starts with the amount of income on which you’ve paid Social Security taxes in the past, which is called your “covered earnings.” If you’d like to see your entire covered earnings history, you can check your annual Social Security Statement online. Your average covered earnings over a period of years is known as your average indexed monthly earnings (AIME). A formula is then applied to your AIME to calculate your primary insurance amount (PIA).

Your PIA is the maximum amount of Social Security Disability benefits that you will be entitled to. In general, the longer you worked the higher your benefit amount is likely to be. Since your PIA is based on your work history prior to becoming disabled and not your medical history, it does not change if your health worsens or you receive an additional diagnosis. This means that the amount of benefits you are entitled to will not change in those circumstances either.

What may cause my benefits to increase?

Are there any situations where benefits might increase?

There are very few ways that your Social Security Disability benefit can be increased. One is a cost of living increase. Most years, Social Security Disability beneficiaries receive a slight increase in their benefits to account for inflation. For example, the most recent increase of 2.0% became effective as of January 2018.

The only other way that benefits can be increased is by recalculating your PIA to give you credit for previously un-credited earnings, a process called the Automatic Earnings Reappraisal Operation (AERO) recalculation. Your PIA was originally calculated based on the earnings information the SSA had available at the time. Later, the money you earned during the year your disability began and your prior year’s earnings, if they were not available previously, can be reviewed to see if the amounts you earned will increase your PIA.

AERO recalculations are done automatically twice a year, once in March and once in October. If you are eligible for an increase after an AERO calculation, you will be notified by mail. Your increase will be retroactive to the January after the income was earned. Other than those two types of increases, your PIA – and correspondingly your benefits amount – will remain the same.

If you receive workers compensation for a period of time, you may see what appears to be an increase in your Social Security Disability payment when the workers compensation ends. However, this is not an increase. The reason is that you were not receiving your full PIA due to a workers compensation offset. When the offset ends, your benefit will increase to your full PIA amount.

What if I go back to work?

What if I want to try going back to work?

Part of the definition of Social Security Disability eligibility is that you need to have a medical impairment that prevents you from working or earning. This means that if you have the ability to go back to work regularly, the SSA may determine that you no longer qualify for benefits and may suspend or terminate your payments.

But while many people assume this means you cannot earn any income when receiving Social Security Disability payments, that is not necessarily the case. Recipients can receive income as long as it does not exceed $720 per month. Additionally, the SSA has special rules that can help if you want to try going back to work. For example, if you report your work activity, you may have unlimited earnings during a trial work period of up to nine months without losing your benefits. These months do not necessarily need to occur in a row.

If you’re interested in going back to work, ask your Social Security office for more information about programs that can help with work expenses, training, and rehabilitation.

Navigating SSI

What about Supplemental Security Income (SSI)?

Supplemental Security Income (SSI) is a separate governmental program for disability benefits. While medical eligibility is determined the same way for both programs, SSI benefits have nothing to do with work history. Instead, SSI benefits are based on financial need.

To meet the SSI income requirements, you must have less than $2,000 in assets (or $3,000 for a couple) and very limited income. If your Social Security Disability benefit is less than the maximum income allowed to get SSI and your total resources are within SSI limitations, you may qualify for SSI disability payments to supplement your Social Security Disability benefit.