Social Security

Why Am I Considered Disabled for Workers’ Comp but Not for Social Security?

By E.A. Gjelten, Author and Editor
Workers’ comp laws and Social Security use different standards and definitions for “disability.”

This kind of confusion is understandable. Most people would think “disabled” means the same thing, whatever the context. But the definitions of disability are actually quite different for the purpose of workers’ compensation than they are for Social Security disability. (Other programs like VA disability have still other rules for deciding who’s disabled.)

Defining Disability Under Workers’ Comp

State workers’ comp laws define what’s considered a permanent disability for injured employees. Generally, you may receive permanent disability benefits if a work-related injury has left you with a lasting physical or mental limitation (or “impairment”). You don’t have to be completely disabled to get these benefits; permanent disability can be partial (less than 100%). In fact, most permanent disability awards are for a partial disability.

States have different ways of calculating total and partial permanent disability awards under workers' comp. Typically, your treating doctor will assign an impairment rating based on medical guidelines. In many states, permanent disability benefits are based on a schedule. In some other states, they’re based on how much less you’re able to earn as a result of your permanent partial disability. Whatever the method for calculating benefits, the goal is generally to compensate workers with permanent impairments for their loss in earning capacity.

Social Security’s Definition of Disability

Whether you apply for benefits through Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), the definition of disability is the same. But it’s different from the meaning under workers’ comp. For purposes of SSDI and SSI—but not workers’ comp—your medical condition must be so severe that you can’t do any kind of “substantial gainful employment,” which generally means earning a certain amount each month.

The determination of eligibility for Social Security disability is complicated and involves several steps. Essentially, however, the medical requirements boil down to this: Unless you meet the criteria for certain listed impairments, you’ll need medical evidence showing that you can’t perform specific movements or tasks, like standing for a certain time or paying attention. These movements or tasks must be required for your former job—or for any other work you could do, considering your age, education, and experience.

Social Security is known for denying many applicants by saying that they could work simple jobs that often aren’t readily available, such as mail sorter or surveillance monitor. So it’s not uncommon for applicants with severe limitations to be denied benefits.

You aren’t necessarily out of luck. Depending on the specifics of your situation, you may have several options.

Requesting a Disability Hearing

If you haven’t already done so, you can appeal the denial of your SSDI application. Our survey showed that your chances of success would be significantly greater at a disability hearing. A disability attorney can guide you through this process, including helping you gather the kind of evidence you need to convince a disability judge that you deserve SSDI benefits.

It’s true that it can take a very long time to get through the appeals process for Social Security disability. (Most readers who responded to our survey waited more than a year just to get a hearing date.) In the meantime, however, you should speak with an experienced workers’ comp attorney to see if you could get more benefits through workers’ compensation, either by reopening your old case or filing a new claim.

Reopening Your Workers’ Comp Case

Depending on the laws in your state, you might be able to reopen your workers’ comp case based on the change in your condition. If your case is reopened, you’ll have the opportunity to show that you need more medical treatment and wage-loss benefits. You should look into this possibility sooner rather than later, because you don’t want to miss your state’s deadline for making this request. A workers’ comp attorney can explain the time limits and any exceptions that might apply to your case.

Filing a New Workers’ Comp Claim

While you’re speaking to a workers’ comp lawyer, you should also discuss the possibility of filing a new workers’ comp claim. Your injury could be considered new and work related if something you were doing at your most recent job aggravated your back condition. In that case, you might be entitled to additional workers’ comp benefits for the new injury.

Social Security disability and workers’ compensation are complicated systems with different rules. Also, each state has its own workers’ comp rules. That’s why it’s a good idea to speak with both a disability lawyer and a workers’ comp lawyer when you’re applying for benefits under both systems.

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