Disability

Print Friendly, PDF & Email

Disability

Disability is the inability to engage in any substantial gainful employment by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

The Act provides that “every individual who is fully insured and is disabled and has been disabled for at least three full calendar months, upon filing an application for disability insurance benefits, shall be entitled to a disability insurance benefit for each month beginning with the first month of the waiting period and ending with the month preceding the month in which he dies or recovers from his disability‚Ķ” 53 FSMC 803(3).

1. In order to be eligible for disability benefits, a person must be:

  • fully insured with at least $1,500 in contributions to the FSMSSA. A person can pay of the difference in a one-time payment if his or her contributions are less than $1,500 to become eligible. Fully insured means that a person’s cumulative quarters of coverage is at least as great as the number of years calculated from the later of the date the worker turned age twenty one (21) or June 30, 1968, to the date the worker attains age sixty (60), becomes disabled or dies. Partial years shall be counted as whole years. For example, 37.25 years would be rounded up to 38 years. In any case, a person cannot be fully insured if he or she has less than 12 quarters.
  • Beginning January 1, 2010 and on, an individual requires at least 45 quarters along with at least $1,500 in contributions to be fully insured for disability benefits. Furthermore, beginning January 1, 2010 and on, an individual must also meet the definition of currently insured to qualify for disability benefits. To be currently insured, an individual must have at least 20 quarters in the 25-quarter period immediately preceding the quarter in which an individual becomes disabled.
  • disabled and has been disabled for at least three full calendar months

2. Evidence Needed. A claimant shall be required to provide FSMSSA proof of the following:

  • Eligibility fact – the individual is fully insured;
  • Medical fact – evidence proving that the claimant has the claimed disability;
  • Durational fact – proof that the disability has lasted for at least three full calendar months, and that it is expected to result in death, or to last not less than 12 months;
  • Vocational fact – proof that the disability prevents the claimant from engaging in substantial gainful employment.

3. The burden is upon the claimant to furnish the medical and other evidence needed for the processing of his disability claim. However, recognizing the fact that a number of people in the FSM are not experienced in filling out forms and securing information lodged in medical or Government offices, if requested to do so, SSA Employees shall assist claimants in filling out the disability claim form and report, securing the claimant’s medical record, and referring the record to the disability examiner for assessment, finding and recommendation.

4. The disability applicant has the right to request a hearing from the FSMSSA if the his/her claim is not favorable.

Medical Evidence means any written reports or other documentation prepared by a doctor or other medical personnel, as a result of examination or review of the applicant’s physical or mental condition, or oral testimony by a doctor before FSMSSA at any hearing or investigation of the matter. FSMSSA has the right to utilize its own medical examiner to review the medical records of the applicant, or to conduct his or her own examination of the applicant, and prepare a report or present oral testimony. In the event of a conflict of evidence concerning disability of the applicant, or any related issue, the FSMSS Administrator will make his own findings on the issue of disability based on the standard of a preponderance of the evidence presented.

Dependent’s Benefit. Every surviving child who is dependent upon an individual entitled who died fully insured, shall be entitled, upon filing an application, to a child’s insurance benefit for each month beginning with the month of death of such individual and ending with the month preceding whichever of the following first occurs:

  • Benefit are payable during the disability of a child who was disabled before the attainment of age twenty-two;
  • The child must prove that he/she was disabled before attainment of age twenty-two;
  • The child shall receive disability benefits for life except if he/she improves on his/her disability.

Disability Applications. Generally, the process takes longer than other applications for Social Security benefits. It is encouraged that the following information be made available upon visiting your branch office:

  • Proof of age;
  • Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and approximate dates of treatment;
  • Work activity report and employment history; summary of where you worked in the past 15 years and the kind of work you did;
  • Educational background if any;
  • If you are applying for surviving spouse benefits, the worker’s death certificate and marriage certificate;
  • If you are not a natural child of the deceased worker and you are applying for benefits as a surviving disabled child, proof of dependency and adoption.

Additional evidence may be needed depending on the FSMSSA medical examiner’s needs to satisfy each disability claim.

Disability Recipients. Your claim will be reviewed for verification purposes periodically; re-examination will be conducted to determine your continuing eligibility for disability benefits. A notice will be sent to your address when the re-examination is due and it is important that you respond within the given time period. If there is no response, FSMSSA will stop your monthly benefits until the re-examination is satisfied.