Do you qualify for benefits?

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

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

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 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 twoparent 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.

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Do you qualify for Social Security Disability (SSD) 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.

In order to qualify for SSD benefits (disability benefits based upon your earnings record), in addition to meeting the medical requirements for disability, you also must have worked 5 out of the 10 years (20 out of 40 quarters) prior to the start of your disability. If you were younger than 31 at the time your disability started, the work requirement is reduced. For example, if you became disabled at age 23, you would need 6 quarters (a year and a half of work) to qualify for benefits. A quarter of coverage is equal to earnings of $920.00 for 2005. Someone who is disabled prior to age 31 needs to have accumulated 1/2 the number of quarters between the age of 21 and the age at onset of disability, but not less than 6 quarters.

The amount of one's SSD benefits is based upon his/her earnings history. This amount is generally the amount that an individual would have received at the normal requirement age based upon the existing work history. However, SSD benefits may be reduced if an individual is receiving or has received (in the recent past) workers' compensation benefits, or if an individual is receiving benefits under a pension resulting from non-covered earnings (i.e. earnings for which Social Security taxes were not paid).

Family members who are dependents of an individual receiving SSD benefits may also be eligible to apply for benefits. The maximum amount that a family can receive is approximately 150% of the Primary Insurance Amount (PIA) amount. Children are eligible for benefits under this program until the age of 18, or 19 if still in high school. Disabled children over age 19 may be eligible for SSD benefits on the parent's account as well. A spouse caring for the children up to age 16 may also be eligible for benefits.

SSD benefits have a waiting period of five full calendar months from the date of onset established by the Social Security Administration and are retroactive up to one year from the date of application. If you apply for benefits before the five-month waiting period and are awarded benefits, the benefits will not begin until after the five-month waiting period has expired. Recipients of SSD are eligible for Medicare, but only after they have received SSD for two years, or if they are over 65. Medicare premiums are automatically deducted from the monthly benefits.

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, 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 generally calculated at 25% of back due benefits. Fees do not exceed $5,300.00 unless claims are decided upon beyond the hearing level.

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