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What is a Social Security "Disability?"

A "disability," as far as the receipt of social security benefits is concerned, is not defined the same as for other programs. Social security disability benefits are only paid for total disability; the complete inability to work is the benchmark. At its essence, a person is disabled under the Social Security Act if he is unable to engage in any substantial gainful activity due to a medically determinable physical or mental impairment that has lasted or is expected to last for twelve months or that results or is expected to result in death. A disability can result from either a physical or mental impairment, or a combination of impairments.

Necessity of Payment for "Employee" Designation

To qualify for workers' compensation benefits, an individual must be an "employee." An important consideration in the determination of "employee" status is whether or not the individual receives payment for his labor. Workers' compensation is meant to provide the injured employee with a portion of his lost wages. If there is no payment for the worker's labor, he is not an employee for hire and has no "lost wages" that workers' compensation benefits can help replace.

Disfigurement

Though not universal, awards for disfigurement are allowed in the majority of states. Usually, disfigurement awards are arbitrary in nature in that there is a somewhat fixed sum allocated, which can vary by jurisdiction. Unlike other awards, those for disfigurement are not normally based on the employee's loss of wages. However, the language in some state statutes is such that compensability will only be found when the disfigurement would impact the employee's earning capacity or general employability.

Course of Employment and the Personal Comfort Doctrine

An employee injured in the course of employment is entitled to workers' compensation benefits. However, compensability may remain unaffected even if the injury occurred when the employee deviated from his specific job duties to engage in an activity that was purely personal in nature and solely for his own comfort. The personal comfort doctrine allows employees to slightly deviate from their job duties, within the usual time and space parameters of their employment, without losing workers' compensation protection. It is generally understood that employees should be able to tend to their physical needs, such as using the restroom, getting a drink of water, or even taking a break to smoke, during the course of their employment.

Adult Consultative Examination Reports

When an adult Social Security Disability Insurance claimant fails to provide, or provides inadequate, medical information to make a "disability" determination, the Social Security Administration (SSA) will request that a consultative examination (CE) be performed. The claimant's treating physician or an independent medical source may perform the CE. When the CE has been completed, a report must be provided to the SSA that meets the minimum requirements specified by the SSA.