Social Security Disability Insurance (SSI) Benefits Eligibility
Social Security Disability Insurance (SSI) is wage replacement income for individuals who have worked and paid FICA taxes and who now have a disability meeting Social Security disability rules. SSI provides a variety of benefits to family members when a primary wage earner in the family becomes disabled or dies. SSI is financed with Social Security taxes paid by workers, employers, and self-employed persons. SSI benefits are payable to disabled workers, widows, widowers, and children or adults disabled since childhood who are otherwise eligible.
To be eligible for the SSI program, Social Security's definition of disability must be met. To meet medical eligibility requirements, an individual must be unable to engage in any Substantial Gainful Activity (SGA) for at least 12 months. This is the same medical definition used in the Supplemental Security Income (SSI) program.
Social Security's Definition of Disability
To be considered medically disabled according to Social Security rules, an individual must be unable to engage in any "Substantial Gainful Activity" (SGA) due to any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. In addition to being unable to perform his or her previous work, the person cannot, considering age, education, and work experience, engage in any other kind of SGA that exists in the national economy (1967 Amendments).
Substantial Gainful Activity (SGA) means any significant activity, physical or mental, which is performed for remuneration or profit over a reasonable period of time. To qualify, an individual's monthly-earned income must be less than $980, the SGA amount for 2009. SGA dollar amounts are adjusted every January, a process called indexing.
Social Security has separate rules for those who are eligible for benefits because they are blind. SGA limit is $1,640 in 2009 for blind beneficiaries.
An individual may be able to support their disability claim and meet the above definition by:
1. Qualifying under the "Listing Level of Impairments
" outlined in SSA's "Blue Book
2. Qualifying under SSA's Sequential Evaluation Rules for determining disability.
: To qualify for benefits, you must first have worked in jobs covered by Social Security. Then you must have a medical condition that meets Social Security's definition of disability. In general, SSI pays monthly cash benefits to people who are unable to work "in any kind of gainful employment" for a year or more because of a disability. The recipient must be unable to do ANY KIND OF WORK - regardless of whether the work is comparable to the 'kind of work' you previously engaged in before the disability. It means any kind of work whatsoever. Once determined eligible - Benefits usually continue until you are able to work again on a regular basis. Not everyone receives the same size disability check. "The amount (of benefits) you receive is actually based on your average lifetime earnings" up to the point of disability.
There are also a number of special rules, called "work incentives," that provide continued benefits and health care coverage to help you make the transition back to work. If you are receiving Social Security disability benefits when you reach full retirement age, your disability benefits automatically convert to retirement benefits, but the amount remains the same. SSA does have an initiative designed to expedite the processing of new disability claims. 'Compassionate Allowances
' provides that certain cases that usually qualify for disability can be allowed as soon as the diagnosis is confirmed. Examples include acute leukemia, Lou Gehrig's disease (ALS) and pancreatic cancer.
What Happens When Benefits Denied
When benefits are denied, the person applying (Claimant) has the right to appeal that decision. Typically, that is the first juncture in the process that Claimants consider hiring an attorney. Sometimes, mistakes made up to this point haunt the case later on, when the attorney is trying to correct those mistakes. The appeal process starts at the local administrative level and then works its way up to the regional administrative level (Appeals Council) and can ultimately reach the Federal District Court level. Due to enormous backlogs on these appellate dockets, the appeals process can be long and drawn out. Therefore, it is highly advisable and advantageous for Claimants to hire an attorney at the earliest possible stage of the application process.
The Plight of the SSI Benefits Applicant in the Appeal Process
Once SSI Benefits have been denied, the Applicant (Claimant) is typically thrust on the horns of a serious Catch-22 dilemma. On the one hand, the Claimant is rapidly descending into a condition of dire destitution and poverty because they are unable to obtain Substantial Gainful Employment. They cannot earn a living. On the other hand, if they should make any kind of a 'shear desperation' effort to earn some kind of income, the Social Security Administration is likely to cite that work effort as 'PROOF' (Evidence) that the Claimant does NOT qualify for SSI Benefits because they CAN
engage in Substantial Gainful Activity (SGA). It is a real double-bind conundrum that makes the hiring of an attorney highly advisable -- at the earliest stage of the disability application process - NOT just after the application has been denied.
Attorney Guidance Through the Application & Appeal Process
SSI Benefits Attorneys guide the Applicant (Claimant) through the daunting bureaucratic maze which is the application and appeals process of today. The SSI attorney knows the procedures, knows the rules and is adept at dealing with the SSA agency. The SSI attorney also knows and understands the medical jargon that is profusely embedded in SSA determinations. The SSI attorney is adept and adroit in dealing with the various experts such as Physicians and Occupational Therapists, who are indispensable in helping the SSI attorney prove the Claimant's eligibility.
CBS Documents Erronious Denials
Below is a hard-hitting, blunt CBS documentary disclosing dishonest practices within the Social Security Administration (SSA), in routinely denying an enormous number of Social Security Disability claims each year . . . about 67-68% of all claims. Of course there's going to be 'some' illegitimate claims, malingering non-disabled freeloaders looking for a free ride. But it's not going to be 68% of the applicant pool. Nothing even close to that percentage. The average wait time for an SSI Hearing is seventeen (17) months. Between 2006 and 2007 an incredible number of Social Security Disability applicants - over 16,000 - DIED while waiting to have their claims approved.
Obviously . . . those people genuinely were disabled. But they never received the benefits they were entitled to . . . benefits they desperately needed BEFORE they died. Most SSD attorneys have seen cases where SSA had reliable, authenticated 'confirmed' medical proof that a person had "terminal cancer" - yet SSA denied them benefits despite those medical facts.
Social Security Administration (SSA) Under Pressure To Reform
Because the media is finally giving the plight of wrongfully denied SSI disability claimants the attention they deserve, SSA is under greater pressure to reform its less than honest denial practices. As every SSI disability claimant attorney well-knows - it is very rare to see the U.S. Media projecting this level of candor and honesty regarding the profound defects in the operation of the SSA and its often unfair, dishonest treatment of SSI disability claimants. If you have not yet seen this CBS Special Report you are going to appreciate this documentary. Don't wait until YOUR "ox is getting gored
" before you become outraged at these wholesale corrupt government practices! Now is the time to express your outrage to your elected representatives.