Social Security pays five main types of benefits – Retirement, Disability, Spouse’s/Dependent Children, Survivors, and Medicare. For disability lawyers, the social security disability benefits determination process depends on a medical chart review, which helps establish the extent and legitimacy of disability claims. Because the Social Security system is complex, accurate medical record review is critical for fair and timely benefit evaluation.
Attorneys and medical review professionals must also understand the essential Social Security terms and definitions used by the Social Security Administration (SSA). Below is a simplified glossary that explains important terms related to Social Security benefits.
Key Social Security Terms Explained
Advance Designation
Under the Strengthening Protections for Social Security Beneficiaries Act of 2018, SSA allows advance designation to capable adults and emancipated minors who apply for or receive Social Security benefits, Supplemental Security Income (SSI), or Special Veterans Benefits.
Beneficiaries can designate up to three individuals to serve as representative payees, if needed. This is optional, and individuals can update or withdraw their designations anytime.
AIME (Average Indexed Monthly Earnings)
The SSA calculates Social Security benefits using a worker’s average indexed monthly earnings. It summarizes up to 35 years of indexed earnings. The 35 highest years of earnings (up to age 60) are totaled and divided by the number of months worked during those years.
Appeal (Appeal Rights)
If a beneficiary disagrees with a benefit decision, they have the right to appeal. The process includes:
- Reconsideration by an SSA official not involved in the original decision
- Hearing before an Administrative Law Judge
- Appeals Council review, and finally
- Federal court review, if needed
Benefit Verification Letter
An official letter from the SSA that states the monthly benefit an individual receives (or is entitled to receive). Also called a benefits letter, budget letter, proof-of-award, or proof-of-income letter, this serves as evidence of Social Security or SSI benefit status.
Cost-of-Living Adjustment (COLA)
SSA may increase benefits annually to offset inflation. If inflation is minimal, there may be no COLA in a given year. COLA ensures beneficiaries maintain their purchasing power despite changes in the cost of living.
Computation Years
These are the highest-earning years from a worker’s base years used to calculate Social Security benefits. The total earnings for these years are averaged to determine the Average Monthly Earnings (AME) or AIME.
For disabled or deceased workers, the number of computation years may be reduced depending on age at disability or death.
DRCs (Delayed Retirement Credits)
Workers who delay retirement beyond their full retirement age (FRA) can earn delayed retirement credits, increasing their future monthly benefit amount until age 70.
Early Retirement
Workers can claim early retirement benefits as early as age 62, but the monthly benefit will be permanently reduced. The reduction depends on how many months before the full retirement age the benefits are claimed.
FICA Tax
The Federal Insurance Contributions Act (FICA) tax funds Social Security and Medicare.
- The Social Security portion is 12.4% of gross wages (split between employee and employer).
- The Medicare portion is 2.9% of all earnings, with no income cap.
FRA (Full Retirement Age)
Full Retirement Age is when an individual becomes eligible for their full Social Security benefit amount. The exact age depends on the year of birth. SSA’s Retirement Age Calculator can help determine FRA and estimate reductions for early claims.
Lifetime Earnings (Earnings Record)
A worker’s earnings record is the complete history of their annual earnings. It forms the foundation of all SSA benefit calculations. Credits remain on the record even if the worker changes jobs or has years with no earnings.
PIA (Primary Insurance Amount)
The Primary Insurance Amount (PIA) is the benefit a worker receives at full retirement age. It’s calculated as the sum of three percentages of portions of the AIME, adjusted each year according to the national average wage index.
Social Security Credits
Employed people pay Social Security taxes, they earn credits toward benefit eligibility.
- A worker can earn up to four credits per year.
- 40 credits (typically 10 years of work) are required for most benefits.
- Younger workers may qualify for disability or survivor benefits with fewer credits.
The Role of Medical Records in Determining Disability Benefits
When determining disability eligibility, the SSA relies heavily on medical evidence. A detailed and well-organized medical record review helps establish:
- The severity and duration of the disability
- Whether the condition meets the SSA’s medical criteria
- The applicant’s residual functional capacity (RFC)
Professional medical review companies specializing in disability evaluation help attorneys obtain and interpret medical records accurately. By partnering with such experts, disability lawyers can:
- Ensure all relevant medical documentation is included
- Strengthen the claimant’s case with clinical clarity
- Reduce delays in benefit approval
The process of securing social security disability benefits is deeply rooted in both medical accuracy and legal precision. Understanding key SSA terms helps attorneys navigate the system confidently, while professional medical record review transforms complex data into clear, defensible evidence.
In today’s data-driven legal environment, the partnership between attorneys and medical review experts – enhanced by AI and automation – ensures that disability claims are not only well-documented but also justly represented. Ultimately, accuracy and clarity are the connectors between medical facts and fair benefits for those who truly need them.
