SOCIAL SECURITY DISABILITY AND
SUPPLEMENTAL SECURITY INCOME BENEFITS

PART ONE:
WHAT BENEFITS ARE AVAILABLE?

Introduction

There are two disability benefit programs administered by the Social Security Administration that provide financial assistance to persons unable to work because of a disability. The first is the Disability Insurance Benefits (DIB) program and the second is the Supplemental Security Income (SSI) program. While both programs are concerned with a person's disability, DIB is an insurance benefits program while SSI is a need-based program.

Test for Disability Benefits

In order to receive disability benefits under DIB and/or SSI, the individual must be totally disabled. To be considered disabled, the individual must be unable to engage in ANY substantial, gainful work activity by reason of a physical or mental impairment which can be expected to result in death or has lasted (or is expected to last) for one year or more. In addition, an individual may qualify for disability benefits if he or she is blind (minimum of 20/200 vision with corrective wear). The individual must prove that he or she is disabled by presenting reports from doctors, hospitals, or clinics providing treatment. The worker might be asked to undergo additional examinations or tests at the government's expense in order to determine the severity of the disability.

"Substantial" work activity involves the performance of significant physical or mental duties or a combination of both which are productive in nature. "Gainful" work activity is activity for profit (or intended for profit) to the individual performing it or to persons, if any, for whom it is performed.

Work activity need not be performed on a full-time basis to be considered "substantial". (As far as what does not constitute substantial gainful work activity, according to current Social Security guidelines, as of January 1, 2002 you can earn up to $780.00 per month and still be considered disabled. That amount is expected to increase in subsequent years. Therefore, you should contact the local Social Security Administration district office to determine how much you can earn and still be considered disabled.) Lastly, "physical or mental impairment" results from anatomical, physiological or psychological abnormalities which are demonstrable by medically acceptable tests.

A person must not only be unable to do his or her previous work or work similar to the previous work, but must also be unable to engage in any other kind of substantial, gainful work which exists in the national economy. It is immaterial whether such work exists in the immediate area, or whether a specific job vacancy exists, or whether the worker would be hired if he or she applied for work.

These standards for determining disability are very stringent. A doctor's opinion that a worker is "disabled" is not binding on the Social Security Administration. The Social Security Administration will examine the doctor's medical findings to determine whether the disability is so severe that the person cannot engage in any substantial, gainful work activity. The Social Security Administration will also consider the person's age, education, work experience, and physical and mental abilities.

Disability Insurance Benefits (DIB)

The DIB program provides disability protection in the form of monthly cash benefits to disabled workers and their families for the duration of the disability, depending upon their eligibility to receive such benefits. In order to qualify for DIB, the worker must prove the existence of a disability as defined above and must also be insured. A worker becomes insured by working long enough and recently enough under Social Security to earn sufficient credits for disability benefits. These "credits" are earned when the individual pays taxes that are normally deducted for Social Security from the worker's paycheck by the employer. The amount of credit that a worker needs to become insured depends on the age of the worker at the time the disability begins. In addition, to qualify for DIB, the worker must not have reached retirement age, and must complete an application for benefits. There is a mandatory waiting period such that the worker may not receive DIB until 5 months after the disability is determined to have begun.

To briefly sum up the eligibility requirements under DIB, the worker must:
(1) be "disabled" as defined in the Act;
(2) have the appropriate amount of disability insurance, or work credit;
(3) not have reached age 65; and,
(4) have filed an application for DIB benefits.

Dependent Benefits Under DIB

The dependent children of a disabled worker are also eligible for disability benefits. Those who qualify as "dependent children" are those unmarried children under 18 years of age, as well as unmarried children over 18 years of age who become disabled before age 22 and continue to be disabled. The worker's spouse who is 62 years old or older, or who cares for a disabled child or a child under 16 years old, is also eligible.

Supplemental Security Income (SSI)

The Supplemental Security Income (SSI) program is designed to guarantee a minimum level of income to disabled persons 64 years old or younger, or to persons who are blind or disabled and who do not have sufficient resources to maintain a minimum standard of living. Persons 65 years old do not have to be disabled. The definition of "disability" and the standards for evaluating medical impairments are the same for SSI and DIB. However, SSI limits eligibility to persons who are also financially needy as defined by federal regulations. The Social Security Administration examines benefit guidelines which dictate how much the person can receive based on his or her income level. Because SSI is a need-based program, persons who earn more income will receive less in SSI benefits. Unlike DIB, SSI does not have a mandatory waiting period. As such, benefits may begin either on the date of application or the date the person first meets the eligibility requirements.

For an appointment to discuss any Social Security issue, call Ron Slater, Ed Betza or Ken Vasil, at the Elderkin Law Firm, (814) 456-4000.

Part Two:
How to Obtain Disability Benefits

Procedure to Obtain Benefits Under DIB and SSI

Disabled workers may be eligible for both DIB and SSI benefits. However, the receipt of Social Security disability benefits is not automatic. If you believe that you are entitled to receive Social Security disability benefits, you should do the following:

(1) File an application with the nearest Social Security Administration district office which, in Erie, is located at 823 Peach Street. The telephone number is 1-800-772-1213 or 452-6696. Previously, if you were denied benefits at this stage in the process, you then had the right to request a reconsideration of the decision within 60 days from the date you received the notice of denial. This procedure is now somewhat different for Pennsylvania and several other states.

(2) For claims filed after October 1, 1999, Pennsylvania is one of ten prototype states in which the reconsideration phase is built into the initial claim procedure. Essentially, the local Social Security Administration district office assembles the file and then forwards it to the Pennsylvania Bureau of Vocational Rehabilitation, Disability Determination Service, which then gathers and reviews your medical information and makes a decision based upon the applicable Social Security rules and regulations. If the claim is going to be denied, the Disability Claims Examiner will conduct a Claimant Conference providing you with the opportunity to present additional information/evidence for the Examiner’s consideration. The Claimant Conference will generally be conducted over the telephone, unless you request an in-person conference, in which case the Examiner will schedule a meeting with you. Once the Claimant Conference has been concluded, you will be notified orally and in writing of the Examiner’s decision. If the claim is denied, you can then request a hearing before an Administrative Law Judge.

(3) File a request for a hearing before an Administrative Law Judge (ALJ). The ALJ makes an independent determination of the application. You may present new evidence, question witnesses, and present your argument for benefits. If you disagree with the ALJ’s decision, you may appeal within 60 days of receiving the ALJ’s decision.

(4) File a request for a review by the Appeals Council which is located in Washington, D.C. If the Council decides to review the matter, you may file a written statement and you may make a request to present your case in person. Most reviews by the Appeals Council are decided without a personal presentation. If you disagree with the Appeals Council decision, or if the Council chooses not to review the case, you may appeal within 60 days of receiving notice by filing suit in federal court.

All the necessary forms you need to file the initial application, as well as the forms that you would need to complete for the appeals (except for filing in federal court), are available at the Social Security Administration Office. If you think that you may be eligible for disability benefits, you should not delay in inquiring with the Social Security Administration Office because there are important time restrictions in applying for benefits. There are no charges during the appeal process, except if you choose to file suit in federal court. The administrative procedure detailed above applies to workers applying for DIB and/or SSI.

It is recommended that you consult an attorney early in the application process, but no later than before proceeding to a hearing before the ALJ. Many times the ALJ hearing involves the presentation of complicated medical evidence. It is also important that the hearing is properly handled in the event that you choose to appeal the case at a later date.


Conclusion

This article is intended to serve as a broad source of information. Each individual’s case may have different factual circumstances which might require a different legal approach. If you have any concerns about your eligibility for DIB and/or SSI, you should consult with one of our attorneys.


For an appointment to discuss any Social Security or personal injury issue, call Craig Markham or Ed Betza, at the Elderkin Law Firm, (814) 456-4000.