Transcript What is SSI?

Disability Seminar
• Introductions
• Goals of the presentation
• © 2010, David F. Traver
• This slide presentation is provided free by
Attorney David F. Traver and may be
duplicated, changed, edited, and used for
public presentations. However, it may
not be sold or included in any published
work without permission of Attorney
Traver
• Questions? Call me at 262-594-2096
What is SSI?
• Supplemental Security Income (SSI)
(Title 16) (T-XVI)
• Disability Insurance Benefits
• Disabled Widow's and Widower's Benefits
• Disabled Adult Child Benefits
• SSI child's disability benefits
Social Security Disability
(DIB) (Title 2) (T-II)
• A disabled insured worker under 65.
• A person disabled since childhood (before
age 22) who is a dependent of a deceased
insured parent or a parent entitled to title
II disability or retirement benefits.
• A disabled widow or widower, age 50-60 if
the deceased spouse was insured under
Social Security.
Under title XVI, or SSI, there are
two basic categories
• An adult age 18 or over who is disabled.
• A child (under age 18) who is disabled.
Definition of Disability
• What does “disabled” mean?
Christopher Reeve
• Date of Birth: 9-25-52
(New York City)
• Occupation:
actor/director/producer
• Medical State:
Ventilator-dependent
Quadriplegic
• Annual Income: Estimated to be
over 1 million per year
Stephen W. Hawking
• Date of Birth: 1-8-42
(London, England)
• Occupation: Theoretical
Physicist and Author
• Medical State: Advanced ALS
• Annual Income: estimated to be
over 1 million per year
Definitions of Disability
• school programs
• hunting license
• fishing license
• handicapped parking permits
• insurance companies
SSA’s Definition of Disability
“Disabled" means the inability to do any
substantial gainful activity due to a medically
determinable physical or mental impairment.
A physical or mental impairment must be
established by medical evidence consisting of
signs, symptoms, and laboratory findings –
not only by the individual's statement of
symptoms.
SSA’s Definition of Disability
Duration requirement:
• Expected to cause death or
• Causes death or
• Lasts 12 months or
• Expected to last 12 months
SSA’s Definition of Disability
Alcoholism or Drug Addiction: The
passage of Public Law 104-121 prohibits
a finding that an individual is disabled if
drug addiction and alcoholism (DAA) is
material to the determination.
Non-Medical Requirements
SI payments are not based on prior work or a family
member's prior work.
SI is not an insurance program!
Non-Medical Requirements
• To get SSI, the claimant must have limited
income and resources.
• To get SSI, the claimant must be at least 65 years
old, blind, or disabled
Limited Income
Countable income must be:
• below $579 a month for single adult or child.
• below $869 a month for couple
• See http://dhfs.wisconsin.gov/ssi/benefits.htm
SSI Also Provides
• Medicaid (medical assistance) retroactively to
the date of the SSI award. (This is extremely
important).
• food stamps.
• $83.74 per month from the State of
Wisconsin, $132.05 for couple.
Not all income counts
Some exclusions are:
• $20 per month of most income
• $65 per month of wages and one-half of wages
over $65
• food stamps
• home energy/housing assistance
• impairment-related work expenses
• Income set aside or PASS
Limited Resources
(Property and other assets a person owns)
• $2,000 for single adult or child
• $3,000 for couple (limit applies even if only one
member is eligible)
Not all resources count
Some exclusions are:
• the home a person lives in
• a car, depending on use or value
• burial plots for individual and immediate
family
• burial funds up to $1,500
• life insurance with face value of $1,500 or less
Fugitive Felon
• Fleeing to avoid prosecution for a crime
that is a felony
• Fleeing to avoid custody or confinement
after conviction of a felony
• Violating a condition of probation or
parole imposed under State or Federal
law.
CITIZEN / NONCITIZEN
ISSUES
To get SSI, the claimant must be:
• a citizen of the U.S.; or,
• an alien who meets the alien eligibility
criteria under the 1996 legislation and
its amendments.
CITIZEN / NONCITIZEN
ISSUES
• When in doubt, SUBMIT AN
APPLICATION!
Sequential Evaluation Process
A PLACE FOR EVERYTHING, AND
EVERYTHING IN ITS PLACE!
Sequential Evaluation Process - 1
The Social Security Administration considers:
• First, whether the claimant is engaged
in a "substantial gainful activity."
1.) Is the person working?
Sequential Evaluation Process - 2
If not, the Social Security Administration
considers whether the claimant has an
impairment or combination of
impairments that "significantly limits
[the claimant's] physical or mental ability
to do basic work activities."
2.) Is there a disability?
Sequential Evaluation Process - 3
If so, the Social Security Administration determines
whether the impairment meets or equals any of the
Listings found in the regulations. If the claimant's
impairment is found to meet or equal one of the
Listings, the claimant is found disabled.
3.) Is a listing met?
Sequential Evaluation Process - 4
If not, the Social Security Administration determines
the claimant's residual functional capacity and
determines if the residual functional capacity does
not allow the claimant to perform past relevant work.
4.) Can the person do some past job?
Sequential Evaluation Process - 5
If not, the burden shifts to the Social
Security Administration to prove that in
light of the claimant's age, education, job
experience and functional capacity to
work, the claimant is capable of
performing other work and that such
work exists in the national economy.
5.) Are there other jobs the person can do?
Administrative Procedures - Appeals
• Why appeal?
• Because you want to win.
When to Appeal?
IMPORTANT!!
• A claimant has 60 days to appeal from the
date the claimant received any denial letter
from SSI or the Social Security
Administration.
• Add five days to the date on the letter, so
usually, the time for appeal can be considered
as 65 days.
Stages of Appeal
• There are many stages of appeal. They
include reconsideration, a request for a
hearing, Appeals Council review, and
review by federal courts, all the way up to
the United States Supreme Court.
Stages of Appeal
• Request for Reconsideration. Upon appeal
of the first denial letter (the initial denial)
and request an appeal, the case will be
reviewed by staff psychologists or
physicians. Usually such appeals are denied
within 60 days in a rubber-stamp fashion.
Stages of Appeal
• Request for a Hearing. An Administrative
Law Judge (ALJ) hearing is held six
months to a year after the request a
hearing.
• The assistance of an attorney is absolutely
crucial at this stage.
Stages of Appeal
• Appeals Council in Arlington Virginia. This
appeal does not involve a hearing; the
Appeals Council simply reviews the
arguments and evidence mailed or faxed to
the Council.
Stages of Appeal
• If an appeal to the Appeals Council is lost,
the next appeal is to the District Court.
This appeal too must be made within 60
days.
The Players at the
Social Security Administration
tate of Wisconsin Disability Determination
Bureau (DDS)
itial applications and reconsiderations of those applications are
handled by the at State of Wisconsin agency hired by the Social
Security Administration:
isability Determination Bureau
O. Box 7886
adison, WI 53707-7886
08) 266-1565
08) 266-8297
The Players at the
Social Security Administration
Wisconsin Social Security Administration office hours
are 9:00 am to 4:00 pm, Monday through Friday.
They are closed on weekends and national holidays.
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Place your local DDS, ODAR, and SSA Office information
here
Milwaukee, WI 53203-2286
(414) 297-1790 TDD (414) 297-3956 FAX (414) 2971460Place your local DDS, ODAR, and SSA Office
information here
Milwaukee, WI 53203-2286
(414) 297-1790 TDD (414) 297-3956 FAX (414) 2971460Place your local DDS, ODAR, and SSA Office
information here
Milwaukee, WI 53203-2286
(414) 297-1790 TDD (414) 297-3956 FAX (414) 297-1460
The Players at the
Social Security Administration
Office of Hearings and Appeals (OHA)
The Office of Hearings and Appeals
310 West Wisconsin Avenue, Suite 880
Milwaukee, Wisconsin 53203
(414) 297-3141 FAX (414) 297-1993