Supplemental Security Income (SSI) Common Questions
Here's a quick overview of common questions we get on the topic of Supplemental Security Income, a needs-based welfare program set up through the Social Security Administration. We've got even more free information on this topic at our website at https://www.ltlegalteam.com/faqs/.
What is SSI, and how does SSI differ from SSDI?Supplemental Security Income (SSI) serves as a needs-based welfare program. It is designed to provide benefits for disabled people who need help covering basic costs of living. Eligibility depends mostly on a person's income and resources. One can be eligible for SSI regardless of whether they have worked or paid taxes to Social Security. However, there are limits on the amount of assets or income a claimant possesses to be eligible for SSI.
Social Security Disability Insurance (SSDI) provides benefits to disabled people who have worked and paid sufficient taxes to Social Security for several years (generally 10) prior to being disabled. If a person is declared disabled and unable to work they will be provided SSDI benefits regardless of their previous income or assets.
How much does SSI pay?SSI pays monthly stipends based on the "federal benefit rate" (FBR). This amount is currently $733 per month for individuals, and $1,100 for couples. The FBR typically increases every year if there is a cost-of-living adjustment by Social Security.
The FBR is the maximum amount that a claimant can receive from the federal government. Claimants receive money based on how much they are earning, and what assets they possess. The less one makes, the higher FBR payment they are likely to receive.
Several states can supplement the federal SSI rate, though Texas is not one of them.
Do I qualify for SSI?There are a few steps in deciding whether you qualify for SSI:
1. Am I disabled?
Just like applying for SSDI, one must qualify as "disabled" to be eligible for SSI. Social Security defines this as having a severe impairment, either physical or mental, that prevents them from performing substantial gainful activity. The impairment must last for at least 12 months, or be expected to last at least 12 months. This process is managed by Disability Determination Services (DDS). DDS first determines whether your condition is severe. They then decide whether it matches one of their listed disability conditions (referred to sometimes as their "blue book"). Next they determine whether the claimant can perform the functions of their last job. If they determine that you cannot do your last job, they then decide whether you can perform any other type of job that fits your physical and mental limitations, age, education, and skills.
2. Do I have limited income or resources?
Because SSI is needs-based, one must make less than the threshold amount of countable income to be eligible for benefits. This limit is $733 per month for individuals and $1,100 for couples.
How do I know if I qualify as disabled?Meeting the criteria to qualify as disabled is a complicated multi-step process.
First, the Social Security Administration (SSA) will determine whether the claimant has been engaging in "substantial gainful activity." Basically this means they look to see whether the claimant's income meets a certain monthly amount. For 2016 this amount was $1,160 per month. If ones earns more than this amount per month, the SSA will not consider them disabled.
Next, the SSA will determine whether the claimant's condition qualifies as "severe," meaning that their condition is severe enough to prevent them from performing substantial gainful activity and earning a livable wage at their current job. It must also prevent the claimant from performing any of their past jobs from the last 15 years. Should the claimant be disqualified from working these past jobs, the SSA will then examine whether or not the claimant can perform any other jobs that fit their education, training, and age restrictions.
The easiest way to see if you qualify as disabled is for your condition or impairment to meet Social Security's disability listings (often referred to as the blue book) that contain many different conditions. A claimant must meet one (or better yet, several) of these specific conditions, based on documented medical evidence.
Additionally, the SSA must determine that your severe condition(s) will last for 12 months or longer. Any ailment or condition not expected to last that long will be denied.
How does the SSA evaluate my impairment, and what are the possible outcomes of this?1. Severe Impairment that matches blue book listing.
Should SSA find that your impairment matches the specific criteria for a blue book severe impairment listing, you will automatically qualify for disability benefits.
2. Severe impairment that does not match blue book listing.
If SSA finds that your impairment is severe but does NOT exactly match the blue book impairment listing, the disability claims examiner will send your file to be reviewed by a medical consultant. The medical consultant will assess your residual functional capacity (RFC), which determines how much functional ability you have when it comes to work, taking into consideration the effects of your impairment. The consultant will examine your medical records, doctors notes, and the results of any testing. They will specifically look at any notes from doctors regarding your functional ability and what restrictions your impairments cause. They will use this to decide whether your medical problems constitute a disability that would prevent you from working.
Once the medical consultant determines your RFC, they will determine what level of work you are able to perform: sedentary work, light work, medium work, or heavy work. For example, if your doctor has restricted you from standing more than 3 hours a day, the consultant will assess you as able to perform sedentary work.
The next step is for the claims examiner to decide what jobs you can perform given your RFC assessment and your past work history (going back 15 years). They will see if there is any work you performed in the past that you could still do today according to any functional restrictions.
If they decide that you cannot do any of these prior relevant jobs, they will next determine whether you can perform any less demanding work taking into account your age, education, and skills.
Should SSA find that you are unable to perform this less demanding work, they will consider you medically disabled and will grant you benefits under a medical-vocational allowance.
SSI denied my application. Can I appeal?Yes - The majority of SSI applicants are denied on their first try. The chances of a claimant being approved goes up as they move through the appeals process, especially if they get a hearing in front of an administrative law judge.
Denied claimants have 60 days to appeal a denial. There are 4 general steps to the appeals process:
1. Reconsideration - This is the first step of the appeals process. Unfortunately, the chances of winning a reconsideration appeal are relatively low - about 15 percent. This is because the reconsideration process is overseen by the same examiner who reviewed your initial claim. Most claims are denied unless there is new medical information regarding your condition. Most attorneys handling SSI appeals are fully aware that they have low chances of winning their appeal here - they are simply going through the reconsideration process so that they can move on to a hearing before an administrative judge.
2. Hearing before an administrative law judge - If your appeal is rejected after a reconsideration review, this is the next step. As with the previous step, there is a 60 day deadline for filing this appeal. Be sure to supplement any new evidence you may have regarding your disability, especially if it relates to your medical condition. Getting copies yourself of any recent records is very helpful, and will be much quicker to do yourself rather than waiting on Social Security to do it. Unfortunately it is often a long time before the hearing takes place, due to backlogs that are typically longer than a year.
3. Review by the Appeals Council - Should your appeal be denied by an administrative law judge, claimants have the chance to appeal again to a council consisting of over 50 administrative appeals judges and over 50 appeals officers who will determine whether the ALJ made an error in their appeals decision. The council does not evaluate the merits of your claim (meaning they don't consider the medical and vocational evidence) but rather they evaluate whether or not the ALJ made an error in the application of the law. An attorney is especially useful here in looking for possible legal errors made by the judge.
The appeals council can deny a request for review (which basically means that the ALJ decision stands), remand the case back to the ALJ and grant you another hearing, or issue a new decision and award you disability benefits.
4. File a lawsuit in federal court - should the appeals council refuse to review your appeal, or should your case be re-heard by the ALJ but end again in denial, then the next step will be to file a lawsuit in federal court. Here you will file an Opening Brief with the Court, analyzing the decision of the administrative law judge and persuading the federal judge that errors were made in the ALJ's review. the SSA can then file a Response Brief defending their position. After this, you can file a Reply Brief to the SSA's Response Brief. At this step a federal judge will consider all arguments and make their decision.