Do you qualify for Supplemental Security Income (SSI) benefits?

Disability Benefits Available through the Social Security Administration

The Social Security Administration offers two different programs that may provide funding sources for people with disabling medical conditions : the Social Security Disability (SSD) program and the Supplemental Security Income (SSI) program.

Both programs require that the disabled person establish, through competent medical evidence, that he/she is disabled. Disability is defined as the:

Inability to engage in substantial gainful activity, by reason of a medically determinable physical or mental impairment(s) which can be expected to last for a continuous period of not less than 12 months.

In simple terms, this means that to be found disabled you must prove three elements:

1. You can’t work
2. Because of an accident of illness, and that
3. Your illness, and disabling conditions have lasted, or are expected to last, for at least one year.

Generally, the older you are (especially over 50, 55 or 60) the less education you have, the more physical your work has been, and the less transferable your work skills, the easier it is to obtain benefits. At times, however, age doesn't matter at all. For example, if your disability is based on emotional problems, such as depression, then none of the above factors come into play. Bottom line - if you honestly believe you can't do a full time job and your doctor supports your application for disability, you should be successful.

SSI Eligibility

SSI eligibility is based on disability and income/resources - that is, a disabled person is entitled to receive these benefits if his/her household income and assets fall below a certain level, regardless of whether the individual ever worked. If eligibility for SSI is established, the program entitles the patient to Medicaid, and other social services administered through the state's Department of Public Welfare. SSI benefits are only available to the disabled individual and not family members.

SSI benefits can be compared to welfare benefits for the disabled. If you do not have the work history for SSD benefits, then you may qualify for SSI benefits. In addition to meeting the medical requirements which are the same as those needed for SSD benefits, your household income and resources must fall below the federal guidelines for this program. In general, you may not have more than $2,000.00 in resources individually, ($3,000.00 if a couple) and the limit to household income varies by the size of your household. If you qualify for state welfare and/or medical assistance, you will most likely meet the income and resource requirements. For example, in Pennsylvania, if you have no children and your spouse earns less than $1893.00/month, you would most likely qualify for some type of benefit.

In some instances, individuals may be eligible for both SSD and SSI benefits. An individual whose SSD benefits are less than the amount of the Federal SSI benefit amount can apply for SSI to increase the total benefits up to the level that would otherwise be paid by SSI. In these instances, household income and resources will be taken into account in determining whether SSI is payable.

The decision about when and to which program to apply is an important one. Generally, if there is medical evidence that the disability will continue for at least 12 months, you can apply immediately. If the medical evidence about the length of disability is unclear, then it might make sense to apply as soon as the medical evidence becomes available indicating that you will be out of work for more than one year.

With the proper medical documentation and guidance, many claims are now approved at the initial level. It is helpful to have an attorney prepare and review the application and medical documentation. It is important that the medical information submitted clearly indicate the individual's disabling conditions as well as his/her physical and mental limitations. Most claims, unfortunately, are still denied at the initial level. There is a lengthy administrative appeals process in the event of an initial denial and it is important to have an attorney who primarily deals with Social Security Disability law assist you.

There is no fee unless you are successful in your claim. Attorney fees for Social Security claims must be approved by Social Security and are calculated at 25% of back due benefits. In general, fees do not exceed $5,300.00 unless claims rise beyond the hearing level.

SSI for Children

Children with disabilities may be eligible for SSI. A child qualifies as disabled if the child has a medically determinable impairment (physical or mental) that causes marked or severe functional limitations for more than one year, or is likely to result in death. The Social Security Administration considers the overall affects of various impairments. Therefore, functional limitations in a few different areas will be considered cumulatively.

Whether or not benefits will be paid also depends upon household income. Generally speaking, the income level must be low enough to qualify for welfare and/or food stamps. Income eligibility is determined using a complex formula that accounts for many deductibles. Also, a parent's assets can operate to make the child ineligible for payments if the child lives with the parent. For example, in Pennsylvania, if a two parent family has 2 children, one of whom is disabled, then the monthly earned household income cannot exceed $3440.00 in order for the disabled child to receive some type of benefit.

We can help you get the benefits you deserve!

Do you qualify for Social Security Disability (SSD) benefits?