WHAT IS SSI (SUPPLEMENTAL SECURITY INCOME)?
Supplemental Security Income (SSI) is a Federal program administered by the Social Security Administration (SSA). The SSI program was established to provide cash assistance to individuals who:
Have limited income and resources;
- Are age 65 or older;
- Are blind; or
- Are disabled.
Disabled and blind children are also included in the SSI disability program.
WHEN ARE YOU ENTITLED TO DISABLED WORKER’S DISABILITY BENEFITS?
If you are a disabled worker, you are entitled to monthly cash benefits if you meet the following conditions:
- Are under a disability as defined by the Social Security Administration;
- Have filed an application for disabled worker’s benefits for the period during which an application is effective;
- Have disability insured status;
- Have completed a five-month waiting period, unless you are exempt from this requirement; and
- Have not reached full retirement age.
- Your disability benefits begin with the first month that you meet all of the conditions above.
WHEN ARE YOU CONSIDERED “DISABLED”?
You are considered “disabled” and entitled to disabled worker’s benefits if you meet the following conditions:
- You cannot engage in any substantial gainful activity because of a physical or mental impairment. You must not only be unable to do your previous work, but also any other type of work considering your age, education, and work experience (Note: It does not matter whether such work exists in your immediate area, whether a specific job vacancy exists, or whether you would be hired if you applied for work);
- Your impairment(s) must be established by objective medical evidence;
- It is expected that your impairment(s) will either result in death or last for at least 12 months in a row; and
- Your impairment(s) must be the primary reason for your inability to engage in substantial gainful activity.
HOW MANY APPEAL LEVELS ARE THERE?
There are four levels of appeal. They are (1) reconsideration, (2) hearing by an administrative law judge, (3) review by the Appeals Council, and (4) federal court review.
A reconsideration is a complete review of the claim by someone who did not take part in the first decision. Disability Determination Services will look at all the evidence submitted when the original decision was made, plus any new evidence. Most reconsideration requests involve a review of the files without the need for the applicant to be present. But when the applicant appeals a decision when they are no longer eligible for disability benefits because his or her condition has improved, they have a choice between a file review or meeting with a Social Security representative to discuss their case. The applicant can meet with a disability hearing officer and explain why they believe they still have a disability.
If the applicant disagrees with the reconsideration decision, they may ask for a hearing. The hearing will be conducted by an administrative law judge who had no part in the first decision or the reconsideration of the applicant’s case. The hearing is usually held within 75 miles of the applicant’s home. The administrative law judge will notify the applicant of the time and place of the hearing. The applicant and his or her representative, if one is appointed, may come to the hearing and explain his or her case in person. The applicant or his or her representative may look at the information in the applicant’s file and give new information.
The administrative law judge will question the applicant and any witnesses they bring to the hearing. The applicant or his or her representative also may question the witnesses.
It is usually to the applicant’s advantage to attend the hearing. If the applicant does not wish to do so, he or she must notify the representative in writing that they do not want to attend. Unless the administrative law judge believes the applicant’s presence is needed to decide the case, he or she will make a decision based on all the information in his or her case, including any new information given. After the hearing, SSA will send the applicant a letter and a copy of the administrative law judge’s decision.
- Appeals Council.
If the applicant disagrees with the hearing decision, he or she may ask for a review by Social Security’s Appeals Council. The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review the applicant’s case, it will either decide his or her case itself or return it to an administrative law judge for further review. SSA will receive a copy of the Appeals Council’s decision or order sending it back to an administrative law judge.
- Federal Court.
If the applicant disagree with the Appeals Council’s decision or if the Appeals Council decides not to review the case, the applicant may file a lawsuit in a federal district court.
WHEN DOES YOUR IMPAIRMENT MEET THE 12-MONTH DURATION REQUIREMENT?
Unless your impairment is expected to result in death, it must last or be expected to last for a continuous 12-month period. This is called the duration requirement. Even if your recovery is expected after the 12-month period, you may still meet the duration requirement that your impairment last for at least 12 months in a row. The 12-month requirement may also be met even if you file the application for disability benefits after you have recovered. This is provided your impairment keeps you from engaging in substantial gainful activity for at least 12 months in a row.
Austin personal injury law firm Bemis, Roach & Reed provides legal services to individuals throughout the State of Texas. Our board certified insurance attorneys also assist individuals and families nationwide with their Social Security Disability benefits claims. If you or someone you know has been denied disability benefits, call toll free (866) 433-4979 or contact us for a free personal consultation. Call 512-454-4000 and get help NOW.
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