Disability Terms and Definitions

PD Presumptive Disability. Only for SSI claims. Enables an early (presumptive) allowance of benefits for 6 months based on a substantial probability of a final allowance when all required documentation is obtained. A PD can be reversed to a denial, but the claimant does not return the PD benefits. Ticket to Work program The Ticket to Work program provides disabled beneficiaries with expanded options for access to employment services, vocational rehabilitation services, or other support services. Windfall Offset A provision to prevent a person from receiving monthly SSI and OASDI benefits in excess of the total amount which would have been paid if the OASDI benefits had been paid when they were due rather than retroactively. Outcome Payment System The system providing a payments under the Ticket to Work program to an employment network for each month, up to a total of 60 months, during which Social Security disability benefits and Federal SSI cash benefits are not payable to a beneficiary because of the performance of substantial gainful activity (SGA) or by reason of earnings from work. Benefit Year The 52 consecutive weeks for which you are eligible to receive unemployment benefits. The benefit year begins on the day that you file for unemployment benefits. Benefit Percentage The benefit payable is usually determined as a percentage of the insured's pre-disability income up to an overall maximum benefit amount. Own Occupation (Own Occ) Under this definition, an insured will be considered disabled only if he or she is unable to perform the duties of his or her occupation. Indexing Indexing is designed to provide some protection against inflation. After the first year of disability, a disabled employee's pre-disability earnings are usually increased (or indexed) by a certain percentage on an annual basis. Partial Conservatorship This type of Conservatorship/Guardianship generally applies to the developmentally disabled and restricts the areas in which the Conservator/Guardian may act on behalf of the individual. SSI State Supplement A cash benefit authorized by Ch. 49.77 and 49.775, Wis. Stats. This benefit is intended to supplement the federal SSI benefit payment. Eligibility is based on current receipt of federal SSI benefits or special "grandfathered" status as a recipient of the state supplement only.

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	Did You Know?
	SHMO means Social Health Maintenance Organization A managed system of health and long-term care services geared toward an elderly client population. Under this model, a single provider entity assumes responsibility for a full range of acute inpatient, ambulatory, rehabilitative, extended home health and personal care services under a fixed budget which is determined prospectively. Elderly people who reside in the target service area are voluntarily enrolled. Once enrolled, individuals are obligated to receive all SHMO covered services through SHMO providers, similar to the operation of a medical model health maintenance organization (HMO).