"Residual Functional Capacity" in Social Security Disability Evaluation

As a correlative step in its disability evaluation, the Social Security Administration examines an individual's residual functional capacity (RFC). The nature of the individual's impairment(s) will determine to what degree his ability to work is impacted. The bedrock of the RFC assessment is what is the most that an individual can do; not the least. An individual's RFC is that remaining functionality that the individual has despite the limitations caused by his impairment. An RFC assessment is made based on all the evidence, which may include the individual's own account of his limitations, observations by physicians, psychologists, friends, neighbors, and the like, work attempt records, and the individual's medical records.

Social Security Benefits

Though most states require that the injured worker be subject to a contract for hire to receive workers' compensation benefits, such benefits will usually be denied if the contract for hire is illegal. However, the illegality must arise from the nature of the employment and the worker's performance of illegal acts as opposed to the illegality that arises in the making of the contract itself.

Injury "By Accident"

For the recovery of workers' compensation benefits, many jurisdictions require proof of injury "by accident." While some states define accidental injuries in their workers' compensation statutes, others do not leaving the courts to sort out the meaning intended. Generally, "by accident" signifies that an identifiable, yet unexpected, event caused the injury. Whether an injury has occurred "by accident" has been heavily litigated among the applicable states with the result being a developing definition of the phrase. For example, one court defined an "accident" as an unanticipated occurrence as opposed to one that was expected. Another court has defined "accident" as an unexpected and precipitous event that happens suddenly and produces an injury based on objective findings.

Correlation Between Workers' Compensation and Social Security Disability Benefits

Workers' compensation and social security disability insurance (SSDI) benefits both aim to help disabled individuals by providing funds for income replacement. Though similar in purpose, the programs diverge in their criteria for the receipt of benefits. Eligibility for workers' compensation benefits requires that the individual be an employee who was injured on the job. In contrast, SSDI benefits are only issued to those individuals who are so severely disabled by a medically determinable impairment that they cannot engage in any substantial gainful activity. Additionally, to be declared eligible for SSDI benefits, an individual must have worked long enough to be "insured" and must not have reached a certain age.

Violation of Law or Commission of Crime

As a general rule, an employee is not necessarily withdrawn from workers' compensation eligibility if he is injured while violating a law or committing a crime in furtherance of his job duties. Most often, the violation of a law or commission of a crime will affect an employee's receipt of benefits if, in the applicable state, it constitutes "wilful misconduct" or is the subject of its very own statutory provision giving a defense to the employer. The violation of a statute does not ipso facto equal "wilful misconduct." Rather, flagrancy and knowledge on the part of the employee are generally required for an act to rise to the level of "wilful."