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Glossary

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A

activities of daily living (ADLs): Social Security will ask you about your daily activities. Your ADLs are one way in which Social Security gauges the severity of your disability.

actual knowledge: The direct and clear awareness or understanding that a circumstance probably exists

adjudicator: The adjudicator is a person assigned to evaluate your medical condition and issue the decision on your disability claim.

administrative law judge (ALJ): An ALJ is an independent judge who knows Social Security law. When you request a hearing, Social Security will assign an ALJ to your case. The ALJ will review your file, listen to your testimony, and make a decision on your claim.

admissible evidence: Evidence that a party or his/her legal representative can introduce in a court proceeding.

affidavit: Printed/written statement of facts an individual makes under oath.

alternative dispute resolution: Settling a case through arbitration, mediation, or other means without going to trial.

appeals council (AC): If your claim is denied by the ALJ, you have the option of filing another appeal. If you appeal the ALJ’s decision, your file will be sent to the Appeals Council in Falls Church, Virginia. The AC consists of a panel of judges who will review your file to determine whether the ALJ on your case made a mistake.

arbitration: Resolving a case outside of the court by presenting it to an unbiased third party. Their decision may or may not be final.

assumption of risks: when a person assumes the risk of potential danger both voluntarily and knowingly

at fault: The driver responsible for causing the accident; the driver whose insurance company may have to pay more for the accident.

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B

bellwether trial: A test trial in a mass tort case in which the verdict can influence the out-of-court settlements of hundreds or thousands of plaintiffs whose cases did not go to trial.

beneficiary: A term used to describe anyone who is receiving Social Security benefits.

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C

cessation: Sometimes after Social Security does a continuing disability review, they determine that a claimant is no longer entitled to benefits. When Social Security stops paying benefits, either due to medical or financial reasons, it is known as a cessation.

claim: A formal submission to an insurance company requesting compensation based on an existing insurance policy.

claimant: The person who has filed a claim for benefits.

claim number: Most Social Security offices track claimants by Social Security number. Therefore your claim number is generally your Social Security number.

collision coverage: Pays for damage to your car due to a collision.

comparative fault: The fault of both parties in an accident is compared in order to determine the amount of money each side will be awarded or responsible for.

complaint: Initial pleading in a civil action by the plaintiff/complainant

comprehensive coverage: Pays for damage to your car due to non-collision causes (theft, fire, etc.)

concurrent claim: When a person files a claim for both DIB and SSI at the same time.

constructive knowledge: Notice of fact that a person is, by law, presumed to have because such knowledge can be obtained by reasonable care.

consultative exam (CE): Many applicants are asked to see an independent doctor for a physical or psychological exam. Usually this is done if your own doctors’ medical records are not sufficient for Social Security to make a determination.

contingency fee: Working on the basis of only receiving payment if the client receives a settlement or award; a “We don’t get paid unless you do” policy.

continuing disability review (CDR): Every disability claim that is approved must eventually undergo a CDR. This is Social Security’s way of making sure that your medical condition has not improved. Normally CDRs are done every three to five years, but they can be done more often if your condition is expected to improve sooner than that. During a CDR, Social Security will collect your medical records to make sure that you are still disabled.

cost of living adjustment (COLA): Normally, Social Security benefits go up a small percentage each year to coincide with the increased cost of living caused by inflation. For years in which there is no inflation, Social Security does not administer the COLA.

counsel: May refer either to an attorney or the legal advice provided by an attorney in an injury case

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D

damages: Monetary compensation awarded to an individual who has been injured by the defendant’s actions or inaction.

date last insured (DLI): The DLI is the date a claimant’s work credits expire. You must prove that you became disabled prior to your DLI in order to qualify for DIB.

date of entitlement for DIB: This is the first month in which you are eligible to receive a disability payment. For those who are entitled to receive DIB, their date of entitlement is either the fifth full month after the onset date, or the twelfth month before the application for benefits, whichever is later.

date of entitlement for SSI: For those only entitled to SSI, the date of entitlement is the first month in which the financial and medical requirements are met, but it cannot fall before the application for benefits was filed.

deductible: The money you must pay first before the insurance company will start paying.

defendant: The person or company being sued in a case.

deposition: A statement made in court under oath. This can be used as testimony in a trial.

Disability Determination Bureau (DDB): The DDB is the state agency in charge of making decisions on initial applications. The DDB will also review your file if you have to file a Request for Reconsideration. Although the DDB is an agency of the state in which you live, it must abide by federal regulations. Therefore every state follows the same guidelines for determining disability.

disability insurance benefits (DIB): The type of disability benefit for which you work and pay taxes. In addition to meeting the work credit requirements, you must also meet the medical requirements for disability. Synonym for Social Security disability insurance (SSDI).

discovery: Evidence gathering before trial, which is disclosed to both sides.

disputed fact: A fact not agreed upon by the parties because there is evidence on both sides.

docket: A brief summary of the case and proceedings. May also describe a court’s schedule of cases.

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E

eggshell skull rule: The defendant cannot use the plaintiff’s pre-existing condition, weakness, or vulnerability to avoid responsibility for the plaintiff’s injuries, even if the condition made them more susceptible to injury.

exclusive control: Whenever someone has the sole control over a dangerous condition or property that led to an accident.

expert testimony: Testimony provided by an expert with experience and/or training in a particular topic or subject matter.

eyewitness: Person who provides firsthand knowledge of an event and testifies under oath.

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I

interrogatories: Form of the discovery process in which lawyers present written questions to the other side that are answered in writing under oath.

invitee: A person invited to the property by the person who owns the property.

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L

lawsuit: Legal action pursued by a plaintiff against a defendant whose negligent action (or inaction) led to injury or otherwise caused harm.

liability: Something for which one is financially responsible.

lien: A legal right to someone else’s assets.

listing of impairments: The Listing of Impairments (or “Listings”) describes, for each major body system, impairments considered severe enough to prevent an individual from doing substantial gainful activity. The Listings specify the medical criteria that must be met for a person to qualify for benefits based on a specific diagnosis.

litigation: The process of taking legal action.

local office (Social Security): Your local office is generally the field office closest to your place of residence. The local office is responsible for taking your application for benefits. They can answer any specific questions about your claim and will accept appeals.

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M

mass tort: A civil action involving numerous plaintiffs against one or a few companies.

maximum medical improvement (MMI): The point at which you are not expected to make any further medical improvement. This point may be 100% at what you were before an accident or injury, or it may be less.

mediation: Nonbinding intervention between parties to promote resolution of a grievance, reconciliation, settlement, or compromise.

medical expert (ME): MEs are generally used by judges during disability hearings. The role of the ME is to help the judge understand the medical records. The ME may also offer an opinion on whether or not your medical condition meets or equals a condition in the Listing of Impairments. The ME may also give testimony regarding your residual functional capacity.

medical malpractice: When a professional in the medical field neglects to perform his or her service at the level of ordinary skill or neglects his or her duty and the patient suffers from injury or death as a result.

multidistrict litigation (MDL): A federal procedure that transfers all like cases to one court to speed up the legal process with the goal of enabling more plaintiffs the opportunity to settle out of court.

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N

negligence: Failing to take reasonable care to protect others from foreseeable harm; acting in a careless or reckless manner.

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O

Office of Hearings Operations (OHO): Also known as the hearings office, this is the office where the judges work and hear cases. If you have to file a Request for Hearing, your file will be sent to an OHO office for a hearing to be scheduled. (Formerly known as ODAR, the Office of Disability Adjudication & Review.)

onset date: The date you first meet the disability criteria; the day you became disabled.

overpayment: When the Social Security Administration (SSA) pays you more than you have earned because your information is incorrect. Overpayments usually occur if you fail to report a change in your living situation, income, marital status, disability, or resources to the SSA in a prompt manner.

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P

past due benefits (PDB): This can also be known as back pay or retroactive benefits. Your monthly benefits accrue while you wait for Social Security to make a determination on your claim. When it is time for Social Security to pay for your benefits, you may receive a lump-sum check for the retroactive period.

past relevant work (PRW): Social Security considers any work that you did within the 15 years prior to your onset of disability as relevant work. They will gather information from you regarding your job duties and special skills you may have learned at these jobs.

personal injury: Physical or mental injuries or conditions as a result of negligence of some kind (car accident, medical malpractice, etc.).

phantom driver: Unidentified driver whose reckless driving causes you to crash into something other than their car (ie., a no-contact car accident)

plaintiff: The person accusing someone else of wrongdoing of some sort in a case; the person who brings forth a civil action against another party.

police report: Document written by police officers detailing a crime or incident (e.g., a car accident)

post-traumatic stress disorder (PTSD): A mental health condition in which a person struggles to recover after experiencing or witnessing a traumatic event.

premises: A house or building occupied by a person or business in an official context, in addition to all of its land and outbuildings

premises liability: When the owner of the premises is held responsible for the injury that occurred there.

premium:The amount of money you pay for insurance, typically monthly.

primary insurance amount (PIA): The term Social Security uses to describe your monthly benefit amount if you are entitled to DIB.

product liability: The legal responsibility of a company or manufacturer to ensure the safety and quality of its products.

property damage: When a person’s negligence causes damage to or the destruction of someone else’s personal property.

punitive damages: Extra financial obligations imposed on a defendant to deter them from engaging in the behavior of which they have been found guilty.

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Q

quarter of coverage (QC): When you work and pay Social Security taxes, you earn QCs. If you accumulate enough QCs, you become insured for disability benefits under the Disability Insurance Benefit Program.

question of fact: An issue to be decided by a jury.

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R

recall: a company’s request for consumers to return a defective product.

representative payee: Sometimes Social Security determines that a person needs help managing his benefits. In these situations, Social Security will assign a payee to handle the funds. Usually it is a family member, friend, or institution such as a mental health provider.

request for hearing: If your request for reconsideration is denied, you have the option of filing a second appeal called the request for hearing. When you request a hearing, Social Security sends your file to the Office of Disability Adjudication and Review (ODAR) where it will be assigned a judge and scheduled for a hearing date.

request for reconsideration: If your initial application for disability benefits is denied, you have the opportunity to file an appeal. This first appeal is called a request for reconsideration.

residual functional capacity (RFC): The most you can do in spite of your physical/mental impairments. It is defined in terms of specific work restrictions such as sitting, standing, lifting, or remembering.

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S

sequential evaluation: This is the five-step process by which Social Security determines whether or not a person meets the medical requirements of disability. The process begins by determining whether you are preforming substantial gainful activity and ends with determining whether you can perform any work activity in spite of your impairments.

services level: If a claimant is working but making under SGA, he may still qualify for disability benefits. If the earnings exceed the services level (which is $720 per month gross in 2010), a trial work period may be triggered.

settlement: Agreement reducing/resolving differences between litigants that concludes the litigation.

settlement conferences: When the two parties of a lawsuit meet in an attempt to come to a settlement without going to court.

Social Security Administration (SSA): A government administration that provides financial assistance to people unable to work because of age, disability, or unemployment.

Social Security Disability Insurance (SSDI): Another term for DIB (disability insurance benefits), referring to the type of Social Security disability benefit for which you work and pay taxes.

statute of limitations: A law that establishes the time period in which a person may file a claim, starting at the time or discovery of an injury and ending a certain amount of time later depending on the type of claim statute.

subrogation: Allows your insurance company to recover what it spent on your injuries and/or repairs from the at-fault driver’s insurance.

substantial gainful activity (SGA): In order to qualify for disability benefits, a person cannot be performing SGA. A person who is earning more than a certain amount is generally considered to be performing SGA. In 2010, the SGA amount is $1,000 per month (gross).

supplemental security income (SSI): SSI is a needs-based disability program. In addition to meeting the medical criteria, you must also meet strict financial criteria regarding income and assets. You do not need any work credits to qualify for SSI.

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T

testimony: Evidence provided by witnesses under oath during a deposition or trial.

third party: Social Security often asks for reports from a third party, such as friends and family members, regarding a claimant’s daily activities.

traumatic brain injury (TBI): Neurological dysfunction resulting from outside force to the head.

trial work period: Social Security allows claimants to test their ability to work and still receive benefits. If you go back to work and earn over the services level of income ($720 per month in 2010), you will start a trial work period. The trial work period rules are complicated, but normally you can receive your benefits for up to nine months of a trial work period.

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U

unsuccessful work attempt (UWA): Many people make unsuccessful attempts at returning to work. For a work attempt to qualify as an UWA under Social Security regulations, you must first have a period of no work activity related to your disability. Your work attempt must last a short period of time (typically no longer than six months) and your work activity must end because of your medical condition. If your work attempt meets all of the requirements, it will not be counted against you.

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V

vocational expert (VE): VEs are often used by Social Security to provide testimony regarding the exertion and skill level of a person’s past work. Social Security may also use a VE to determine whether or not there are any jobs a claimant with certain restrictions could perform.

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V

wage earner: Some people qualify for benefits on another person’s record (a deceased spouse, for example). The wage earner is the person on whose record you are filing if not your own.

work credits: What the SSA uses to determine whether a person has the minimum amount of work time to qualify for disability insurance benefits (DIB). In 2016, you receive one credit for each $1,260 of earnings, up to a maximum of four credits per year.

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