Supplemental Security Income Claims (SSI)
The Supplemental Security Income (SSI) program is a public income benefits program administered by the Social Security Administration (SSA) that began in 1974. Broadly, the SSI program provides monthly monetary benefits to disabled or aged people who meet certain resource and income limits as well as the particular medical eligibility conditions outlined by law. The creators of the SSI program intended it to provide a basic income assistance program for vulnerable individuals with minimum uniform benefit levels. The SSI program is funded by the U.S. Treasury using general revenues. In April 2016, SSA reports that over 5.5 million individuals were receiving SSI benefits in the country. As explained below, the SSI application process is complex. You should speak with an experienced Supplemental Security Income lawyer prior to submitting an application.
The Differences Between SSI and SSDI
There are two similar programs administered by SSA that often cause people some confusion: the SSI program and the Disability Insurance (SSDI) program. These programs are similar in that they are both Federally-administered programs that give monetary payments to individuals who meet certain medical eligibility conditions, such as having qualified disabilities. However, there are several significant differences between the two as outlined below.
· SSI is a means-tested benefit program, while SSDI is an entitlement-tested benefit program.
The SSA administers both SSI and SSDI programs, and both are intended to provide financial assistance, but the financial eligibility requirements are quite different between the two. The SSI program was created to provide basic income support to disabled and elderly people who would otherwise face enormous difficulties in obtaining necessities such as shelter and food. The SSI program’s focus is very narrow to the population described above, and therefore, applicants must satisfy a strict list of financial eligibility requirements. These conditions make the SSI program a means-tested program.
Because SSI is a means-tested program, SSA will require applicants to prove that their income falls within certain income limits provided by law. These limits specify that applicants are not allowed to have more than $2,000 in total calculable assets. If the claimant is married, then the limit increases to $3,000 jointly. Typically, SSA will consider as part of an applicant’s assets all property owned except for an applicant’s home and one vehicle. However, SSA may also consider most other property owned, including all bank accounts, other vehicles, valued life insurance policies, etc. For individuals who receive SSI program benefits and also receive support, such as shelter and food, from others, the SSA considers such additional support as income and will subtract its monetary value from the monthly SSI payment. Therefore, this type of support and maintenance that is in-kind in nature will likely reduce a recipient’s monthly SSI payout because the SSI program will account for that support in determining an individual’s total need. Financial eligibility is a complex question and applicants should consult with an experienced disability benefits attorney before proceeding with an SSI application to ensure that all of the requirements are met.
In contrast, the SSDI program is an entitlement-tested program. Individuals who wish to apply for SSDI must qualify by showing that they have earned sufficient credits by having a job and paying into social security for a minimum amount of years without regard to their current assets and income. SSA has different requirements for much younger beneficiaries and adult children of deceased or retired workers who have disabilities. In actuality, high-income earners may qualify for SSDI benefits as long as they meet the program’s requirements.
· SSI beneficiaries typically receive Medicaid, while SSDI provides its beneficiaries with access to Medicare.
Typically, an individual who applies for and receives SSI benefits will immediately qualify for Medicaid benefits. Medicaid is a joint federal and state health care insurance program and usually provides comprehensive insurance coverage for qualifying beneficiaries. Many individuals may qualify for SSI benefits primarily for the purpose of Medicaid health care insurance that comes with the SSI program.
In contrast, the SSDI program comes in tandem with Medicare. The Medicare program is a federal health care insurance program that provides coverage for routine hospital and other medical services and most primary medical care. However, Medicare is not as comprehensive as SSI’s Medicaid insurance program. As such, most Medicare beneficiaries will have to buy what is typically known as “gap insurance policies” to supplement what is lacking in their coverage under Medicare for primary medical needs.
· The Monetary Payouts from the SSI program are different from SSDI Payouts.
Finally, the payouts from the SSI program can vary widely from SSDI program payouts. For example, in 2015, the standard payouts from the SSI program were around $733 a month for an individual beneficiary (not taking into account potential state supplementary payouts). In contrast, the average SSDI payout for 2015 was $1,165 per month. Because the SSDI program is dependent on a beneficiary’s record of earnings, there will be some SSDI beneficiaries who receive more than the average payout. Additionally, SSI payouts may be reduced by other income that the beneficiary receives and, therefore, many SSI beneficiaries may receive less than the standard $733 payout.
An applicant for SSI benefits who meets the required income and disability criteria may also simultaneously qualify for SSDI benefits. Such an applicant will need to establish that he or she has a qualifying disability that and has earned sufficient work credits through adequate years of employment. SSI benefit applicants should investigate whether they qualify for SSDI benefits as well and consider applying for both programs, as the SSDI program may be a better alternative for those who may not meet the necessary income eligibility criteria for the SSI program. Applicants should consult with an experienced disability benefits attorney to obtain assistance with determining eligibility and submitting simultaneous applications.
As discussed above, SSDI program beneficiaries may also qualify for SSI program payouts. However, if a beneficiary receives a payout from the SSDI program that is higher than the maximum possible SSI payment, that beneficiary will likely not be eligible at all for SSI program benefits. On the other hand, for those SSDI recipients who receive small SSDI payouts, the SSI program will supplement such payouts. For instance, if an SSDI recipient only receives monthly payouts totaling $396, the SSI program may supplement such payouts to ensure that the beneficiary will receive benefits not exceeding the minimum possible SSI program payout, which currently equals to $733 per month. As a result, the beneficiary in this example will receive an additional SSI benefit payout of $337 to bring the total monthly payout to $733, which is the full minimum SSI monthly benefit amount.
The SSI Program Application Process
Applicants for SSI program benefits face a complicated process governed by multiple federal regulations. Applicants should ask for assistance from an experienced SSI benefits attorney. In South Florida, Englander Peebles can provide such services.
· Submitting an Initial Application
Individuals who wish to apply for SSI program benefits can begin the process by contacting any of the SSA field offices in Florida. There is a total of 54 field offices across the state. Alternatively, interested individuals can complete an SSI application online through the SSA website. The SSA field office that receives the application is responsible for verifying eligibility requirements that are non-medical in nature, which may include employment, age, marital status, or coverage under SSA. The office then forwards the completed application to the Florida Department of Health’s Division of Disability Determinations (DDD). The DDD is responsible for collecting and evaluating medical evidence and making the first decision regarding whether an applicant has a qualifying disability under the law. Notably, Florida’s DDS allows its disability examiners to conduct medical assessments to determine the severity of, and limitations caused by, variously claimed disabilities except mental disorders which are reviewed by a psychiatrist.
SSA collects statistics regarding approval of SSI applications, and in Florida, only 26.8 percent of applicants receive approvals during the initial application stage. In contrast, the national average rate of approval of disability at the same stage is 31 percent.
· The DDD’s Determination of Disability
SSA utilizes a similar medical determination process for both SSI and SSDI programs, which is a five-step sequential evaluation process. The steps in the SSI evaluation process are outlined below.
1. Substantial Gainful Activity Determination: The first step of the process is SSA’s determination of whether an applicant is still employed and earning at income levels that count as substantial gainful activity (SGA). The SGA is a level of employment earnings defined by the SSA as the amount of money a person must make to be self-sustaining under the SSI program. If the SSA determines that a person is employed and earning at the SGA limit or more, SSA will deny the claim before sending it to a DDD for disability determination. This means that an applicant’s claimed disability will not be further examined, and as long as the applicant earns at or more than the SGA limitation, SSA will deny the application for SSI or SSDI benefits.
2. Evaluation of Disability: If a claimant is not employed and earning at the SGA limits, then SSA will forward the application to the DDS to evaluate the applicant’s disability. At this stage, the DDS must evaluate if the applicant has a medically verifiable mental or physical impairment. Such impairment must be supported by documentary evidence generated by generally accepted diagnostic and clinical procedures. The DDS has to consider the severity of the impairment, and will take into consideration laboratory findings, symptoms, and other signs of the impairment’s severity.
3. Evaluation of Criteria for Severity: As part of the DDS evaluation of the disability of the applicant, it must consider whether an applicant’s impairment equals or meets the criteria for severity listed with the SSA’s listing of medical impairments. These impairments are contained in SSA’s manual more commonly called the Bluebook. The Bluebook lists the medical impairments that SSA considers to be qualifying disabilities for the purpose of qualifying for its benefit programs. If an applicant does satisfy the requisite severity level of a listed impairment, then the DDS will likely approve the applicant’s claim for benefits. If not, then the application will proceed to the fourth and fifth steps that pertain to applicant’s ability to engage in work activity considering their residual functional capacities, which are more fully described below.
4. Evaluation of Past Employment Activity and Residual Functional Capacity: The question that the DDS will next consider is whether an applicant can perform any of their past employment activities. If SSA finds that a claimant can carry out the employment duties of any job held within the last 15 years for at least three months before filing an SSI application, such a finding is relevant to approval or denial of the claim. This information is particularly important if such past employment entailed earnings at SGA levels, and the applicant had the necessary time to learn the job. If the applicant’s residual functional capacity keeps the applicant from performing any past employment activities, then SSA must further evaluate the application to determine if the applicant can perform alternative employment activities considering the limitations caused by the impairment.
5. Evaluation of Residual Functional Capacity and Alternative Employment Activities: The final step in the evaluation process is for the DDS to determine whether the applicant can perform alternative employment activities when his or her work activity, residual functional capacity, education, or age is considered. If the applicant’s residual functional capacity is very limited and their existing employment abilities are not readily transferable to other types of employment, then the DDS may determine that the applicant is qualified for SSI benefits through some form of vocational allowance. Such an allowance is based on an applicant’s residual functional capacity, age, transferability of skills, and education.
Each step in the sequential evaluation outlined above ensures that all SSI applicants receive the appropriate analysis for SSI program benefits.
Applicants are often discouraged upon receiving a denial letter from SSA in response to an SSI application. However, SSA denies most claims initially because applicants have the burden of proving that they have met the required eligibility requirements and possess a qualifying medical impairment. Additionally, most applicants who initiate the SSI application process without the assistance of an experienced SSI disability attorney may miss crucial steps or evidence and find their application initially denied. Gary Englander of Englander Peebles can assist SSI program applicants in South Florida with collecting the necessary evidence and providing the necessary information for the examiners.
Applicants for SSI benefits who have received a formal denial from SSA have the right to appeal that decision. There are four parts to the appeal process:
- Reconsideration stage: When an applicant who has received a formal denial from SSA requests reconsideration, the DDD will assign a new reviewer to the case who did not participate in the initial determination in the case. The new reviewer will evaluate the entire application and any new evidence the applicant may have submitted. Therefore, reconsideration is a second opportunity for the DDD to examine an application, and at this stage in Florida, SSA approves, on average, about 8.9 percent of initially denied applications.
- Hearing stage with an SSA Administrative Law Judge (ALJ): If an SSI application is denied at the reconsideration stage of the process, the applicant has the right to request a hearing before an ALJ with the SSA. The ALJ will review the application and any additional evidence that the applicant may have submitted. Unfortunately, waiting times for a hearing is relatively extensive. In Florida, the average waiting time for a hearing before the ALJ is 367 days. Nationally, the average waiting period for an SSA hearing is 342 days. Notably, around 48.3 percent of applications that reach the hearing stage in Florida are eventually approved by the ALJ. The national approval rate at the hearing stage stands at approximately 50 percent.
- Appeals Council: If an ALJ renders a decision denying an SSI application, the applicant then has the right to appeal to the SS Appeals Council. The SS Appeals Council will re-examine the case and make a decision depending on its determination on whether the ALJ decided the case incorrectly, the decision was not supported by the factual record, or there were procedural issues with the outcome of the case.
- Federal Court Lawsuit: Alternatively, if the SS Appeals Council does not review the case or affirms the decision of the ALJ to deny the application, then the applicant may choose to file a federal legal action in one of Florida’s federal district courts. Applicants who wish to pursue this avenue of appeal must exhaust all other possible means of appeal before doing so.
Evidence to Support SSI Applications
There are extensive evidentiary requirements that applicants must satisfy to qualify for SSI program benefits. For example, applicants have to be able to prove inability to acquire gainful employment. Gathering adequate evidence to meet this burden of proof is a difficult task because applicants have to be able to reach back further in time to past employment beyond the time that the qualifying disability took place. Applicants often have to turn to various vocational and medical experts to successfully establish that mental or physical impairments render him or her unable to get gainful employment in an alternative job. Another example is showing residual functional capacity, which requires significant medical evidence and documentation. Applicants should seek the assistance of experienced disability benefits attorneys to determine what evidence is relevant to a particular application.
Florida Supplemental SSI Payments
States across the country have recognized that, even with the maximum possible SSI payout, qualifying individuals may still not have the income they need to be able to afford the necessities. Therefore, under the SSI program, states have the option to be able to provide additional monthly payouts to people in their states. In Florida, supplemental SSI payments are available only to SSI program recipients who live in community assisted care programs or care homes, and nursing care facilities in which Medicaid pays for more than 50 percent of the total cost.
Individuals who are pursuing federal benefits under either SSI or SSDI programs should speak with an experienced disability benefits attorney before initiating the application process. A Fort Lauderdale or South Florida lawyer experienced with the SSI program can guide potential applicants through potential pitfalls that often result in denials for those who are unaware, help applicants gather evidence to prove a claim for benefits, and provide advocate on your behalf at the hearing stage before an SSA administrative law judge.
How Englander Law Can Help You
Englander Peebles is an AV-rated law firm located in the Fort Lauderdale area. Contact Englander Peebles by calling (954) 500-4878 or by completing our online form to schedule a free and confidential initial consultation. During the initial consultation, we will help you determine your eligibility for benefits, complete all of the necessary SSA paperwork, and will answer any questions you may have regarding any of SSA’s benefit programs.