Frequently Asked Questions
The answer is yes, you might—so it is important to pursue the matter by talking with an attorney.
Not every injury that happens at work or on the clock is your employer’s responsibility, but just because you are off the employer’s premise or off the clock doesn’t automatically mean that your employer is not responsible. There are many factors that must be taken into account when addressing whether an injury is work related. Don’t fall for an insurance adjuster telling you that because your injury was not onsite or on the clock that it isn’t their problem.
1. The injury must have happened in the course of employment. This is the one most people believe is all that is needed. You are injured while on the clock, therefore it is work related; this is not the law.
2. The injury must also arise out of your employment. There must be some risk associated with the employment. Tripping over your own two feet generally does not constitute a risk peculiar to your employment unless your employer sets things up so you must rush.
View common workplace injuries >
A local employer provides a very short lunch period. Individuals only have 15 minutes within which to eat their lunch. Our client left his workstation and went to the vending machines to get some snack food to supplement his lunch. The vending machines were empty. At that point, he had two choices; go back to his workstation without finishing his lunch and get there in a timely fashion, or race to the next nearest vending machines. He chose to race and tripped over his own two feet, breaking his hand. The claim was denied.
The Illinois Workers’ Compensation Commission agreed that because the employer put such heavy rigid rules down and did not provide adequate time for an individual to get supplements for his lunch, that the rushing and tripping over his own feet were indeed work related.
For a fall at work to meet the two-prong test and be work related is very fact sensitive. What the injured worker may see as insignificant may be the fact which changes the event from being not work related to being work related. If you suffer a fall at work, give notice to your employer of the event and see legal counsel right away. Do not give a taped statement.
The value of a claim depends upon the extent of the injury and the individuals’ average weekly wage. There are many rumors about how much a case is worth. Most cases are settled without trial. However, it is the threat of trial that causes a case to settle. Attorney Tracy Jones maximizes the trial risk for the insurance company forcing them to offer top settlement dollars before trial.
Even if everything seems to be going well right now, you will inevitably need an attorney. Don’t wait to get one until after a problem occurs and risk a situation where an attorney cannot fix the harm that has been done. You need protection against an insurance company who cares more about their bottom line than an employee’s health and well-being. Don’t wait—get an attorney right away so that we can make sure you are protected, and can prevent and address issues before they become irreversible problems.
In Illinois, an insurance adjuster does not have an obligation to advise the injured worker of the law. In fact, the insurance adjuster’s duty is to the insurance company and the employer, not the injured worker. If you proceed without an attorney, you have nobody who is obligated to advise you and represent you. You are out on your own. This is never a good situation, so that is why 97% of the people who have workers’ compensation cases in Illinois hire attorneys. Learn more >
A workers’ compensation case generally is resolved shortly after the individual has finished treatment. Once the injury from work reaches a healing plateau, the attorney can start moving the case toward settlement. On average, a claim takes 1.6 years from the date it is filed to settlement. Learn more >
Section 8.1(b) of the Illinois Workers’ Compensation Act provides that disability would be based upon the AMA impairment rating, the age of the injured worker, the occupation of the injured worker, the impact an injury will have on an injured worker’s future earnings, and the medical records. No one factor carries greater weight, and it all must be taken into consideration. Do not let anyone say the AMA impairment rating does not count.
The answer is no. The employer does not have to pay you weekly or even on a set time schedule. This can be very frustrating and result in significant stress when you are dealing with a work injury. Section 8(b) of the Illinois Workers’ Compensation Act requires an employer to pay temporary total disability (TTD) benefits if your doctor has taken you off work for a work-related injury or if you have restrictions from the doctor that your employer cannot accommodate. Although those benefits must be paid in a reasonable amount of time, the Act does not state on what schedule or how often the employer is required to pay you.
Because the Act does not state the schedule for pay to be issued, the courts have had to interpret what is considered reasonable. Despite decades of case law, the courts still have not set forth a specific pay schedule that must be followed. However, if an insurance company does not pay benefits or withholds them for too long, we can file a petition for an emergency hearing to force the insurance company to trial over the nonpayment of benefits. If your benefits are not being paid, contact an attorney today.
Curious about how to increase your chances of being approved for benefits? Discover 5 tips from a trusted Rockford attorney here.
Does my employer have to pay for my health insurance when I am off work for a work injury?
Unfortunately, the Illinois Workers’ Compensation Act does not require an employer to continue paying health insurance premiums even if you are off work for a work-related injury. If you are in a union, the collective bargaining agreement may contain a provision that dictates who is responsible for payment of your health insurance premiums while off work, so check there first. If it does not address the issue or if you are not a member of a union, look into your company’s policy.
The employer can choose whether to:
- Cover the entire premium for the insurance
- Cover the employer’s portion but require the employee to continue to pay the employee portion for the insurance
- Terminate coverage by not agreeing to pay the employer portion of the premium
In the third scenario, the employer may be required to offer you continuation of coverage (often called COBRA) which requires you to pay the entire premium yourself. In that situation, it might benefit you to look into alternative coverage that may be less expensive through a spouse’s employment, Medicaid or Medicare coverage, or another private health insurance policy.
Learn more about the types of benefits and how they are paid out.
Two weeks, sort of. The question often arises as to how soon weekly benefits must start after a person is injured. Technically speaking, the insurance company is supposed to pay within 2 weeks or state in writing the basis of their non-payment. Often they fail to do this unless someone is represented by an attorney.
Temporary total disability benefits are paid at 66 2/3% of your average weekly wage. Your AWW is the average earnings over the 52 weeks before your injury. Overtime, if it is regularly worked or mandatory is considered, but at straight pay. Some bonuses also count. Learn more >
In addition to that, if you work a second job and your employer or supervisor is aware of it, then your AWW should also include the wages from that other job. Calculating your AWW and TTD rate can be tricky. Insurance companies have an incentive to minimize that number since it would reduce what they must pay you. Don’t get taken advantage of. Black & Jones has decades of experience calculating AWWs, and we will fight to get you paid what you are owed.
When a doctor has taken you off work due to your injury or prescribed necessary medical treatment for your injury, the insurance company is to pay the injured worker temporary total disability benefits and to authorize treatment as prescribed. The insurance company often fails to meet these obligations. Black and Jones Attorneys at Law will file a Petition for Immediate Hearing/19b with the Illinois Workers’ Compensation Commission to get each client the benefits and treatment he or she is entitled to under the Illinois Workers’ Compensation Act. If you are not receiving your benefits or necessary medical treatment, call Black and Jones immediately to initiate the appropriate paperwork.
Yes, if you are back to work on a restriction but you are not getting your full and usual hours and wages, then the employer may owe you temporary partial disability (TPD) benefits. When you are working within your restrictions but not making your full average weekly wage (calculated pursuant to Section 10 of the Illinois Workers’ Compensation Act), then the insurance company is responsible for paying you 66 2/3% of the difference between what you would be earning in the full performance of your work and what your current gross pay is. Unfortunately, they are not liable for paying you the full 100% loss.
Some employers will bring someone back to work on restrictions but at a lesser hourly rate or for less hours. The law requires the employer to then pay TPD benefits to the employee so they don’t have to go without such a reduced income.
If you are working on restrictions and making less money, contact an attorney today to ensure you get the benefits you are entitled to.
No, under the Illinois Workers’ Compensation Act, any employer does not have to bring you back to work if you have restrictions. If your doctor puts you on restrictions—such as light duty or sedentary work only—while you are undergoing treatment for your work injury, the employer has the option of either offering you accommodating work within your restrictions or sending you home. If your employer does not offer you work, then you are entitled to temporary total disability (TTD) benefits to be paid to you while you are off work. These benefits would continue until either the employer brings you back to work or you are released to return to full-duty work by the doctor—whichever comes first.
If your employer offers you work within your restrictions, be careful not to do anything that exceeds those restrictions. An employer cannot force you to do anything outside your restrictions.
Keep a copy of the written restrictions on you at all times at work. If you are asked or expected to do a task that is outside the restrictions (for example: lift a 20-pound box when you are limited to only 10 pounds or use your right hand to hold a clipboard when you are on left-hand duty only), you should pull out the restrictions and respectfully refuse to do that task. Do not quit or voluntarily walk off the job if it is outside your restrictions. Next steps:
- Remind your supervisor that you have restrictions and that the task is outside that restriction
- Offer to do any other task as long as it is within the restriction
- Simply locate your supervisor or boss and notify them that the duty is outside the restriction
- Wait until they either give you alternative tasks or send you home
If you are sent home, contact your attorney immediately so that temporary total disability benefits can be demanded. Not sure how to pick the right attorney for you? Black & Jones has put together our top 5 tips for finding the best attorney for your case.
When you have an injury at work where your doctor says that you cannot return to work, your employer is required to pay you temporary total disability benefits (TTD). TTD benefits are equal to 66 2/3% of your average weekly wage. If you have a second, or even third, job that your employer is aware of and you cannot do those jobs due to the injury, you should also be compensated for those lost wages. This is called “concurrent employment.” Your average weekly pay would then be calculated based on the wages from all employment over the 52 weeks before the injury. If you are unable to work any of the jobs due to the injury, the employer must then pay you 66 2/3% of all those lost wages.
If the insurance company refuses to pay you TTD benefits for your concurrent employment, you should contact an attorney to get you the benefits you deserve.
Discover more about workers’ compensation and navigating your career while receiving benefits.
Under the law, the employer is not obligated to provide or facilitate medical treatment for a work injury. Section 8(a) of the Illinois Workers’ Compensation Act provides that an employer must pay for all charges for all the necessary first aid, medical and surgical services and all necessary medical, surgical and hospital services incurred which are required to cure or relieve the effects of an injury. This provision does not require the employer to call an ambulance, transport an employee to a medical doctor, nor even facilitate an employee to get into the doctor. It only requires the employer to pay the bill afterwards.
If you report an injury to your employer and they do not send you to the doctor, you must seek treatment directly on your own as soon as possible. Waiting for the employer to send you can result in large gaps in treatment which can hurt your case. It is advisable to get into a doctor on your own as soon as it is practical after an injury—especially if the employer does not send you to a doctor.
Witnessing or experiencing a work injury is frightening. Check out this step-by-step list of what to do if you or someone you know has been injured at work.
Section 12 of the Illinois Workers’ Compensation Act gives the insurance company the right to have an injured worker examined periodically by a doctor of its choosing. Learn more >
No! An insurance company does not have to offer settlement to any individual who is hurt at work. In fact, 97% of the cases that are settled involve attorneys for the injured employee. The 3% who receive offers from insurance companies usually do not receive a full and fair value for their claim. This is because under IL law, the insurance company is not obligated to make an offer. The insurance company may make an offer to keep someone from going to an attorney to get full value.
No! In fact, never sign such a release that allows the insurance company to discuss matters with your doctor without you present. You would have no control over what information the insurance adjuster or an agent would be giving your doctor. Most insurance adjusters and agents are honest but there are many of them out there that will give misleading information to the doctor that you would be unaware of which could greatly alter your treatment plan. Therefore, never allow this type of conversation to take place behind your back. If they want to talk to the doctor, it needs to be in writing and a copy sent to you or your attorney. Learn more >
No! In fact, if the investigator tricks you into giving a taped statement, the investigator may be guilty of a Class IV Felony. It is never advisable to give a taped statement to anyone, especially the insurance company investigator. If you recall, the person that controls the question, controls the answer. The investigator knows what the law is and can trick someone into giving an answer which gives the impression that the injury is not work related when in fact it is. Do not give taped statements.
Upon further investigation, it was determined that at the top of the stairs was a wastebasket that was overflowing with milkshake cups. It was more likely true than not, that what was viewed on the video tape was not some sort of personal problem with the knee giving out, but rather the individual’s foot slipping because of the milkshake caught on the bottom of his foot. The case was denied and ultimately resulted well into a six-figure payment at settlement.
Seldom does an insurance company make an offer to an individual not represented by an attorney. A pro se offer as they are called are generally far less than the case is truly worth. Of the fifty to sixty thousand cases filed each year before the IWCC, all but 3% have attorneys. The 3% who proceed without an attorney are at the mercy of the insurance company. It is not the insurance company’s duty to make a fair offer to the injured worker. The insurance adjuster’s job is to protect the insurance company’s dollars. Generally an injured worker must hire an attorney to get a fair offer.
Some cases must be tried especially those that are disputed. It is the threat of trial that moves a case to settlement. If an insurance company is afraid of losing at trial, they will settle. If there is no chance of going to trial, the insurance company will not make a reasonable settlement offer. Black and Jones advance cases to trial to force the insurance company to make a fair settlement offer.
Unlike television, the judge does not make the decision at the end of the trial. The judge has 45 days within which to issue their decision. Their decision is then sent to both attorneys who have 30 days within which to file an appeal. A little over half of the cases that go to trial are appealed. If appealed, it generally takes one to one and a half years more to resolve the claim. For this reason it is best to use the threat of trial rather than an actual trial to resolve the case. Learn more >
If you work around chemicals and develop lung problems or rashes, it is very important to get the name of the chemical that you work around and, if available, get the MSD sheet. The MSD sheets should be available to you. If they are not, you can get them online from the name of the chemical. More likely than not, you will need an expert witness or an attorney to help tie this case up. It would certainly help if you have the MSD sheets.
Both employers. If someone is working for a temporary agency and is injured while working at the company that the temporary agency sent the person to for work, both are technically responsible. This is called “joint and several liability”. However, the temporary agency usually has a contract with the company where the worker is injured where the temporary agency will assume responsibility for all work injuries.
Possibly. If you smoke and you have to go outside to smoke during your break and are injured while outside, most likely, this injury is work related under the Personal Comfort Doctrine.
Yes! Even after you punch out, you may be covered by workers’ compensation laws. The law states that for an injury to be work related, the injury must arise out of and in the course of your employment. “In the course of” usually means that you are on the clock, but not always. A person can be asked to stop at the hardware store on the way home from work to pick up some tools needed at work and have an accident. This would be work related because the accident was in furtherance of the employer’s business. Therefore, it is not necessary that you be technically on the clock for an injury to be work related.
The injury also has to “arise out of”. This is a very confusing concept. “Arising out of,” means that the injury must come from a risk peculiar to one’s employment. These are very difficult questions to answer. Many people mistakenly believe that if they are at work and they get hurt, that is all that is needed. This is often how people get trapped by insurance companies during taped statements. For example, the mere act of bending over at work is not work related. If a person herniates a disk while bending over, the Illinois Appellate Court says that the herniated disk is not work related. An insurance investigator could take a taped statement and ask the individual how they got injured. The individual could honestly respond “I was bending over at work when I hurt my back.” The investigator most likely would not ask follow up questions because he or she had enough to deny the claim. The individual may have been simply bending over at work in an awkward position with a 50 pound box in their hands and failed to mention these very critical aspects of the event. Therefore, be very careful when talking to anybody from the insurance company.
Yes! Employees who have to travel have special protection. This is because most of their time spent away from home base is in the furtherance of the employer’s work, including some recreational activities while away from the actual tasks. For example, a traveling employee who slips and falls in a hot tub may have a viable workers’ compensation case for the slip and fall because they are a traveling employee.
Two pending cases involve staring at lights or working in the bright sun. A doctor has tied up these work activities as placing an individual at greater risk causing eye injury. These cases are proceeding to the Illinois Workers’ Compensation Commission.
If you've tested positive for COVID-19, you should not go to work. Now, under the Families First Coronavirus Response Act, if you test positive, then you need to notify your employer, and you need to self-quarantine for whatever period of time your doctor has said. Now, if you work for an employer that has less than 500 employees, you may be entitled to up to 2 weeks of pay during that time under the Emergency Sick Pay Act. After that, if you need to be off longer, you could be entitled to some additional benefits or even unemployment benefits, so if you test positive, you should notify your employer and stay home. Learn more >
If you work for an employer who's requiring you to come into work, but you don't think that they're an essential business, then if you don't show up, you're not going to get paid, and you might jeopardize your job.
The better approach to this would be every local government at the city and county level has established a way for you to contact them and to make a complaint about whether your employer is considered essential or not.
For example, here in Winnebago County, the Winnebago County Health Department has set up an email address, and you can actually email them or call them to make a complaint that your employer is operating when you don't think they're essential. According to the governor's shelter order, the county then will investigate, and if they agree, they'll issue what's called a cease letter telling the employer they need to shut down. If the employer then shuts down, you don't have to report to work.
Now, keep in mind if you don't have to report to work, you might actually be entitled to up to two weeks of emergency sick pay under the Families First Coronavirus Response Act. If you aren't entitled to that because it only applies to some employers, you are able to use your accrued vacation or sick time or other paid time off, and after that, you may be entitled to unemployment benefits, as well. So, the best approach is not simply to not go into work, but instead file a complaint if the business is shut down because they're not essential. You might be entitled to get paid during that shutdown.
A lot of employees are going to be exposed to coronavirus or COVID-19 while working. If that happens, you should contact an attorney if you test positive. Sometimes, if you're exposed, you may have a compensable workers’ compensation claim. For employees who are our frontline workers—our medical providers, staff at hospitals and medical facilities, firemen, policemen, or anybody on the front line. They're at a high risk of getting COVID-19, and if they do get it, obviously they can't work. But, they may have a compensable workers’ compensation claim because their exposures most likely happened while they were working. Learn more >
Beyond those people, let's say you're not one of the frontline workers, but you're working for an essential business that's still operating. Well, if you get COVID-19, you may also have a compensable workers’ compensation claim here in Illinois. It's going to depend on what level of risk you are at, so there's a high risk for frontline workers. There's also medium risk. This would be people who are working for essential businesses who are exposed to the public. So, our grocery store workers, our gas station attendants, our public transportation people—these workers are having contact with the general public as required by their work. If they are exposed and contract COVID-19, they also likely have a compensable workers’ compensation claim.
Now, the last category of workers would be what would be considered a low-risk worker. These are people who are working in a job where they really aren't having any contact with the public. They're going into a secure environment where they're not having a lot of contact with their co-workers. For those employees, we're going to have to ask the right questions because, yes, they may have a compensable workers’ compensation claim, but we're going to have to show that their risk of exposure was higher than the average public. This means if you had the same exposure as going to the grocery store once every few weeks, it might not be compensable. That's where it's most important to talk to an attorney who's going to ask you the right questions to determine whether, in fact, you have a compensable claim.
There are two federally administered disability programs-Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). To receive SSDI a person must be disabled while insured through payroll deduction. A person’s assets do not determine if you are eligible for SSDI. SSI is available to those with little or no work history who have few assets. Learn more >
Yes, possibly. When you are found disabled and you have earned enough work credits to be eligible for SSDI, you would begin receiving those benefits. If your monthly benefit is less than the allowed SSI benefit amount and you meet other income and asset eligibility requirements, it is possible to also receive SSI benefits. That is why it is important to apply for both SSI and SSDI benefits if you do not have many assets or additional income.
Insured status is based upon payroll deductions, FICA. A person may be insured for years into the future. If a person can show that they are disabled on, or before the date last insured, the person would be eligible for SSDI.
You can apply for Social Security Disability at any local Social Security office, over the telephone, online or at the office of Black & Jones Attorneys at Law. Learn more >
You do not need to be off work for an entire year before you apply for Social Security Disability. You do need to have a disability that is likely to last a year. Learn more >
The process can vary greatly in how long it will take from the initial application to resolution. Generally it is about one year. Learn more >
For almost all of those who apply there are three stages with two denials. The initial application is usually denied. A reconsideration is then filed. Generally, this is also denied. Lastly, one applies for a hearing before an administrative law judge. It is at this stage that the claim is tried. Learn more >
This is a question that we are often asked. In today’s economy, a person must have some income to afford the basic necessities of housing and food. To be entitled to Social Security Disability (SSD) or Supplemental Security Income (SSI), you must show that you are unable to work or likely will be unable to work over substantial gainful activity (SGA) for a full 12 months. Unfortunately, because of the way the law is written, working and earning even a small income can impair your ability to qualify for SSD or SSI benefits.
In the ideal scenario, short-term and long-term disability policies bridge the income gap for a person who goes from working to being disabled before they are able to get Social Security Disability benefits. Oftentimes, the process can take 12 to 24 months. In the best-case scenario, a person would work for an employer that offers short-term and long-term disability policies. When the person is then taken off work by their doctors for a medical (either physical or mental) condition, they would first begin receiving their short-term disability policy payments. These can vary but usually pay between 50% and 100% of their income. The policies also vary in length and can be as short as 30 days, or as long as 26 weeks. When the short-term disability policy is exhausted, the person then transitions over to their long-term disability policy. Those policies can vary greatly on the amount of the benefit and the duration of time it pays for.
The reality is that many employers do not offer short-term or long-term disability policies. An alternative would be for a worker to secure their own private policy. Again, these policies can vary in benefit rates and duration, but are available for people to pay a premium similar to how one would for health insurance or car insurance premiums. If you are taken off work by a doctor, you would apply to start receiving that benefit. If you are able to afford it or have access to it, it is advisable that you consider getting a short-term and/or long-term disability policy.
Unfortunately, most people do not have short-term or long-term disability policies. In this scenario, when a person becomes unable to work, their life can be abruptly interrupted and thrown into financial hardship. While there may be resources available for financial assistance, the reality is that those resources are limited.
Options in Illinois when hardship strikes:
- Apply for SNAP benefits or food stamps
- Seek assistance from your local township for assistance with housing and rent
- Check out civil service organizations or churches that offer help with living expenses and food
A lot of people feel forced between choosing their health or a roof over their head. It’s a difficult choice: either follow the doctor’s advice and stay off work to prevent their condition from worsening, but risk going hungry or homeless, or force themselves back to work just to put food on the table. That is why it is crucial to talk to an attorney about what options may be available in your particular case and to make sure that your disability claim is presented correctly to optimize the chances of a favorable outcome.
Yes, you are allowed to work some hours if you are pursuing Social Security Disability. To be eligible for SSDI, you must prove you have a medical condition that prevents you from working and earning over SGA (substantial gainful activity). SGA is a dollar amount which changes yearly. If you work and earn over SGA, then you do not meet the definition of disabled. But if you earn less than that, you may still be found disabled.
However, earning any income may impact the amount of SSDI or SSI benefits you are owed. There is a risk associated with working and earning an income—even under SGA—when pursuing benefits. So, it is important to talk to an experienced attorney who can advise you as to what the law requires so that you can make the best decisions for yourself. Learn more >
Generally, the Social Security Administration determines if the person’s physical abilities meet the physical demands of jobs within the economy. If one’s physical abilities fall short of meeting the physical demands of jobs within the economy, one is disabled. If one does have the physical ability to meet the physical demands of the job market, one is not disabled. It does not matter that no one will hire you, nor does it matter that the job does not exist. The standard changes, as one gets older.
An attorney can counsel an applicant for social security disability about the law and the process, gather the necessary evidence and present the evidence before the Administrative Law Judge. Learn more >
Attorney’s fees are 25% of one’s back benefits, not to exceed $6,000.00.
Disabled is defined as the inability to engage in substantial gainful activity because of a physical or mental impairment which is expected to last 12 months or more or result in death. Substantial gainful activity is generally defined as the inability to earn a certain amount of money per month, which currently is $900 gross per month. Learn more >
An SSDI applicant may be entitled to back benefits up to one year prior to the date of the initial application. SSI applicants may be entitled to back benefits to the date of the initial application.
Doctors do not find a person disabled. This is a legal question, not a medical one. Doctors offer an opinion about what a person can do physically because of physical impairments. The judge, or adjudicator, then applies the law to determine if the person, given these physical restrictions, is disabled or not. Learn more >
The bottom line is: the more medical evidence there is, the better. It is vital that we demonstrate that you have a medical condition that is so severe that you require regular follow up with your doctors. Sometimes, a condition can be severe but stable such that the doctors don’t need to see you frequently, sometimes even as little as once a year.
However, when seeking disability benefits, the lack of regular treatment can be interpreted as though you have improved. It is strongly encouraged that you seek treatment at least once every 30 to 60 days while your claim is pending. We want to ensure that the judge has sufficient medical evidence to determine that you are unable to work.
In order to prove that you are unable to work due to a physical or mental disability, you must produce evidence of that disability. The best evidence of your disability is in your medical records.
This is where a neutral medical professional comes in and:
- Records your subjective symptoms
- Documents what your objective physical and mental health examination demonstrates
- Outlines what your diagnostic tests show
- Offers written evidence of what the diagnoses are, the severity of those conditions is, the impact the diagnoses have on your ability to work, and whether there is any treatment that has been or could be helpful
When you have made the choice to refuse all medical treatment, there is very little by way of neutral evidence that you can offer to show the severity of your condition. It is not impossible, but it is very difficult to prove you are disabled without medical records to support the same.
Additionally, if your doctors have made recommendations for treatment which may help your symptoms, and you refuse to try the treatment, it may lead to the impression that your disability would improve but you might be stopping it from getting better. This is seen often when medication is prescribed for mental health conditions. Where the records simply state that the doctor has recommended medication but the patient refuses to try it, Social Security will view that evidence as unfavorable to you. On the contrary, if the records demonstrate that treatment, such as medication, has been recommended and the patient tried it but it failed to work, that is powerful evidence about how disabling the condition is.
To increase the likelihood of a favorable finding that you are disabled, it is strongly advised that you seek consistent medical treatment and follow the recommendations of your doctors. If you are concerned about a particular form of treatment, speak to the doctor about it. If the records demonstrate that you decided it was not the best course together, your claim will not be impacted.
Long gaps in treatment are nearly as negative as refusing treatment. If you only see a doctor a couple times a year or you have had several years with no treatment, your chances of prevailing can be hurt. Usually, a lack of treatment is due to lack of health insurance. In this case, it is recommended that you apply for insurance through your state or seek treatment at providers that offer services to uninsured persons. At the end of the day, it is vital to have strong, frequent medical records proving that you’ve followed treatment, even if it has not been successful in getting you back to work.
Social Security benefits are taxable. I encourage you to speak to a tax preparer to find out what, if any, tax liability you may have. More about benefits >
Substantial Gainful Activity (SGA) is a term used by Social Security Administration (SSA) which refers to work that is both substantial—or otherwise considered productive and gainful—meaning able to earn income from which exceeds a specific threshold amount each month. To get Social Security Disability (SSD) benefits, you must prove that your disability prevents you from doing substantial gainful activity. You must prove that your disability either prevents you from working and earning any income at all or that it results in you being unable to earn income that exceeds the limits the SSA sets each year. This does not mean that you cannot work at all and cannot earn any income. Learn more about working while receiving benefits here.
Income earned passively, such as from investment growth or rental income, does not normally count as SGA. However, work done from making crafts and selling them may count as SGA. Certain income earned from working for a business— like a gas station attendant—or for a person, like making home deliveries or daycare, would count as SGA. Income earned while working as an independent contractor for companies such as DoorDash, Uber, Instacart or other gig-type employment counts as income for SGA purposes.
When a person is engaging in gainful activity, the SSA looks at how much the person is earning. If the monthly income the person earns from their work is under a certain threshold, it does not preclude benefits or count as SGA. However, if their earnings exceed this monthly threshold, it may make someone ineligible to receive disability benefits. This monthly amount increases each year.
If you are unable to earn income that exceeds SGA due to your disability, you may be entitled to benefits.
SGA is defined as a monthly amount because it is calculated monthly. In 2024, the maximum monthly SGA amount for non-blind individuals is $1,550.00. For blind individuals, it is $2,590.00. This means that if a person is able to engage in SGA over this amount, they are not entitled to benefits.
The rate is not calculated based on an average over a 12-month period. It is calculated on a month-by-month basis, so you must be careful and watch your earnings closely. For example, if you are working a job where you are paid biweekly $550, your earnings most months would only be $1,100 which is under SGA. However, two months out of every year, you would receive three pay stubs at $550 each. This means that for two months every year you would earn $1,650 which would put you over SGA two out of every 12 months. This can severely hurt your efforts to qualify for Social Security Disability Insurance (SSDI) benefits and, if receiving benefits, can quickly affect your continued eligibility for benefits.
Furthermore, if you receive bonus or extra pay from your employment during a particular month, that will likely be included in the calculation of your SGA. If the employer in the example above gives the worker a production bonus of $400 two months a year, it would result in them earning over SGA two months a year. This could likely disqualify someone from receiving benefits.
If you are working and earning any income while trying to pursue Social Security Disability (SSD) benefits, then you should consult an attorney without delay. Your earnings, even if significantly smaller than you used to receive, could be preventing you from qualifying for benefits. If you are pursuing Supplemental Security Income (SSI), additional rules apply which can affect your eligibility if you are earning any income.