SOCIAL SECURITY DISABILITY
Social Security Supplemental Income (SSI) and Supplemental Social Security Disability Income (SSDI) are among the biggest Federal programs provided by our government. These programs are designed to provide help to individuals who are no longer able to work. The two categories of federal outlays work in decidedly diverse ways. Both programs are run by the Social Security Administration. The programs seek to help people who have various kinds of medical and economic disabilities with benefits so that they can survive. But like all government programs, getting those benefits can be a daunting and difficult task.
SSDI makes payments to individuals and their families if they worked long enough and acquired "insured status." Insured status means having paid sufficient Social Security taxes to be entitled to benefits. SSI is a program to meet the financial needs of individuals who have not paid sufficient Social Security tax to be insured under the SSDI program. Application for either program requires the submission of medical evidence and other information to the Social Security Administration for a decision on whether or not disability criteria has been met.
The SSDI program provides money to individuals who are unable to work as a result of a medical condition that will go on for at least a year or until death. The Federal government is very frugal with this program and qualifying for medical disability is oftentimes hard. If a worker is qualified for Social Security benefits oftentimes his family will also be qualified for benefits and possibly additional benefits.
If an applicant is insured he should seek benefits immediately after becoming disabled. The Social Security determination process can take three to five months or even longer. The application requires a Social Security number, birth or baptismal certificate, the names, addresses, phone numbers and location information of doctors, caseworkers, hospitals, clinics and other medical providers that have given the applicant care. Records of all prescriptions, records from all the medical providers for which you have an address (which will be acquired by the Social Security Administration if you have them), a list of all the places where the applicant has worked and the kind of work done, wage statements for the past year.
How does the government determine eligibility?
What other benefits are available?
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HOW THE SOCIAL SECURITY ADMINISTRATION MAKES DECISIONS FOR INSURED WORKERS
Social Security Administration is a five-step process to decide if an individual is disabled. The five steps are, (1) are you working, (2) is your medical condition severe enough, (3) is your medical condition on the list of impairments, (4) can you do the work you did before, and (5) can you do any type of work.
Qualification for the Supplemental Social Security Income program (SSI) rests on the income and resources (or lack thereof) of the applicant. The applicant has his real estate, bank accounts, cash, stocks and bonds analyzed the Social Security Administration. If an applicant has less than $2,000.00 or a married couple less than $3,000.00 SSI may be available. Surprisingly, however, assets that are not counted are the home of the applicant if lived in by the applicant, life insurance policies of face value of less than $1,500.00, a car and burial plots. The ringer of course is the house; the house can have an extraordinarily high value.
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If an applicant feels that the agency has made an incorrect determination on the application for Social Security benefits, the applicant must appeal within 60 days of the date upon which the applicant received the denial letter. There are four levels of appeal without considering United States Supreme Court. Representation by counsel is possible and may be advantageous for the applicant during any or all of these processes.
- Reconsideration: The agency examines all the evidence given to it in the original application and any new evidence that the applicant wishes the agency to consider. Reconsideration generally is done on the files that are already in the possession of the agency. The applicant is not present, but may be represented.
- Hearing: If the results of the reconsideration process are unacceptable, the applicant can ask for a hearing to be conducted by an administrative law judge. Hearings by administrative law judges are held within 75 miles of the home of the applicant. The applicant and the applicant's representative are allowed but not required to physically attend the hearing and put on their case in person. More importantly the applicant and the applicant's representative are allowed to review the entire contents of the matter on file with the agency.
- Appeals Council: If the applicant disagrees with the hearing decision, he may ask for a Social Security Appeals Council examination. At the Appeals Council matters of law are examined determining whether the hearing decision was correct. Appeals Council reviews are selected by groups of Appeals Council administrative law judges. The Appeals Council seldom reverses the administrative law judge.
- Federal Court Review: Upon the issuance of an Appeals Council decision or the decision of the Appeals Council not to review the applicant's appeal to the Appeals Council, appeal may be taken to the Federal District Court.
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Are you working: If you are working and earning more than the Social Security disability amount you are not considered disabled no matter what your condition. On the other hand if you are not earning the Social Security disability amount your earnings will generally not be considered and you may be eligible.
Is the applicant's medical condition severe enough? The medical condition or disability must dramatically restrict the applicant’s work activities. Basic activities like walking, sitting, remembering that are restricted are considered dramatic. Restriction must have been in place for at least a year. If the applicant's medical condition is not dramatic, the State of Nevada will not identify you as disabled and your application will be denied on this basis by the Social Security Administration.
Is the applicant's medical condition on the list of impairments? Nevada has a list of impairments generated by the Social Security Administration. The list outlines medical conditions deemed by the Social Security Administration severe enough that the condition alone, without any other impairment, allows you to be determined to be disabled. Therefore any individual whose condition is on this list is automatically disabled and eligible for Social Security benefits. If the condition is not on the list or it has not developed to the point where it is severe enough to be considered, the state agency will examine the applicant under the preceding test.
Can the applicant do the work he did before? Nevada decides if the medical condition of the applicant prevents the applicant from doing the employment he did before he got sick. If Nevada decides that the applicant is not so impaired that he cannot do the work he did before, Nevada will determine that the applicant is not disabled and the application will be denied. If the applicant cannot do the work he did before the final analysis is invoked.
Can the applicant do any other kind of work? If the applicant cannot do the work he did before, the State of Nevada will attempt to find out if the applicant can do any other kind of work. In its analysis, the state will examine the applicant's medical condition, age, education, other work history, academic and educational skills, and other ways that the applicant might be able to get employment. If Nevada determines that the disability prevents the applicant from getting other work, determination of disability will be made for the applicant and disability will be applied. There are special rules for blind people.
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More than 7 million people are currently enrolled in the Supplemental Social Security Income program. Numerous other people qualify but have not applied. Many homeless are eligible for this program.
A person applying for SSI who has a severe disability can be presumptively disabled or presumptively blind and get payment for up to six months while the state agency determines if the person is disabled or blind. These payments will not have to be paid back if the claimant is found not to be disabled to blind.
There are also additional special benefits for certain World War II veterans. Individuals who were in the service in the United States military from December 16, 1940 to July 24, 1947 are entitled to special supplemental SSI benefits.
Other benefits available to the disabled
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Many times a child is disabled. The families of such children depend on the help of Social Security for the rest of the child’s life. SSDI and SSI both pay benefits to disabled children. If a parent retires or becomes disabled or dies, Social Security may pay benefits to children who have reached the age of 18 who were disabled before the age of 22 and remain disabled. Social Security benefits for disabled children continue as long as the child is unable to work because of their disability. Other children lose their benefits at age 18. SSI payments are based on need, not prior work, and will be paid to children regardless of the parent's work status or if the parent is even living. The benefits are available as long as the child is disabled and has no income or resources.
Determination of disability is done by way of a test that the child has marked and severe functional limitations that will last more than a year or result in the child's death. Children over 18 meet the test if they meet the adult qualification for disability preventing them from doing any kind of work.
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MEDICARE AND MEDICAID BENEFITS
Individuals eligible for SSDI are also eligible for Medicare benefits, Medicare prescription coverage and other benefits after the elimination period qualification has run. This is a tremendous benefit for an individual who is truly ill. SSI recipients are eligible for Medicaid once the eligibility period has run and this can be a lifesaver for individuals who are suffering from horrible diseases. The medical coverage provided under the respective programs can be more valuable than the assistance money involved.
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HOW CAN A LAWYER HELP ME GET BENEFITS?
Individuals applying for Social Security need the help of a skilled professional to get the benefits that they are entitled to because the process is very complicated and time sensitive, and government bureaucracies are not especially helpful in showing individuals how to navigate the rocks and shoals that are put in front of them. Lawyers are allowed to assist Social Security applicants under both programs and earn fees that are capped by the Federal government. Lawyers who assist individuals who need these services are doing a great benefit to the community because they're helping those who can least help themselves.
Call Howard Roitman & Associates for help. We can help you put together the strongest case, appeal your claim, represent you at hearings, and get you the benefits you are entitled to.
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