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There are two main Federal programs that provide income to individuals with disabilities, or who are disabled because of lymphedema. On is Social Security Disability, the other is Supplemental Security Income. Social Security Disability funding comes from Social Security itself, while the Supplemental Security Income program comes from general taxes and is only administered by Social Security.
Supplemental Security Income SSI pays monthly cash benefits to individuals who have both limited income and limited resources. The Social Security Administration administers this federal program. If eligible, individuals may receive both SSI and Social Security benefits. And, in most states, a person who receives SSI benefits is automatically eligible for health benefits under Medicaid.
Signed into law by President Nixon in 1972, the Supplemental Security Income program replaced a patchwork of state programs for the aged, blind, and disabled. A study conducted by the federal government of the implementation of SSI found that “the quality of life of the aged and disabled who are poor has improved greatly since they were transferred to SSI from former state programs.”
To qualify for SSI, individuals or couples must be age 65 or older, or blind, or disabled. Individuals or couples also must be U.S. citizens. There are certain exceptions for non-citizens.
Applicants' resources (cash and savings) cannot exceed:
$2,000 for an individual $3,000 for a couple The bottom line: SSI provides extra money for eligible low-income people.
Certain resources, such as a home, a small burial funds and plots , or one car usually do not count.
Monthly unearned income cannot exceed:
$870.33 for an individual $1160.83 for a couple These figures will be higher for people who have earned income (earnings from a job, for example).
The amount of the SSI benefit will depend on the income the individual or couple receives. The maximum federal SSI benefit is:
$850.33for an individual $1140.83 for a couple
Jnue 19, 2008
From - Disability Secrets.com
SSI, or supplemental security income, is a needs-based program. For those who have never worked, or those whose earnings in recent years have been low enough to result in a small Social Security benefit, or no benefit at all, SSI may be the only program they qualify for.
For those applicants whose social security disability benefit would be low, ssi does exactly what its name implies. It supplements.
For example, if an approved claimant received title II (aka ssd, rsdi) monthly benefits in the amount of $385.00, an ssi award could be used to guarantee that the claimant's total monthly benefits were equal to a certain minimum amount.
What is that minimum amount? The minimum is equal to the full monthly benefit amount for ssi, which is currently $623.00 per month.
Therefore, in the example above, a title II recipient who received $385.00 per month might also receive an additional $238.00 in ssi to bring their total monthly benefits to $623.00, a sum equal to the full ssi monthly benefit amount.
Of course, this scenario will not happen in every such case. Because ssi (unlike ssd-rsdi) has resource limits (currently, an individual cannot have more than $2,000.00 in disposable assets), many title II claimants will not be eligible to receive supplemental security income, no matter how low their ssd benefit amount is.
Whether or not an individual's disability application will be for SSI, or basic social security disability, is determined by the individual who takes the claim at the social security office.
Sometimes, in the case of a claimant whose earnings have been low, the application may be dual, or concurrent; that is, for both SSI and social security.
In some states, such as North Carolina, a recipient of SSI automatically receives medicaid, a program which allows for a certain number of physician visits and prescriptions each month. (1)
1. Regardless of what anyone tells you, it's good advice, if you are disabled and unable to work, to pursue a claim for Social Security disability, or ssi based on disability, and get it filed immediately. Reason: disability claims can take a very long time to process. This isn't true in all cases, but it is in most. Unfortunately, many claimants for disability benefits have experienced severe problems and hardship simply because they had no idea how long the process would be, and only realized when it was too late that they should have filed an application much much sooner.
2. If you are denied on your Initial Claim, it's good advice to get an attorney or non attorney Representative to provide representation and help you with your claim for continuing and past due benefits (back pay). Reason: the way the disability system works, a claimant will, typically, either be approved on an initial application…or will be forced to follow the appeal route, at least to the point where their case is brought before an Administrative Law Judge at a social security disability hearing. This is not always the case, but it is generally a predictable rule of thumb (*reconsiderations usually have a much higher rate of denial than initial claims–and initial claims are denied 60 to 70 percent of the time, depending on the state in which you filed. For this reason, most claimants will have to go to a hearing if they hope to be approved–and going to a hearing unrepresented is foolish).
3. If you think you may have problems doing the paperwork for your social security disability Claim, take some advice and find qualified assistance immmediately. An extraordinary number of persons who apply for benefits, or file an appeal following a denial, fail to properly complete their paperwork, or fail to submit their forms in a timely manner (*all appeals for disability must be filed within 60 days of the date of the last denial).
4. Advice: Since your Social Security Disability or ssi claim will be evaluated completely on the basis of your medical records, the best advice is to get regular, ongoing medical treatment. Reason no. 1: even if your past medical records indicate that you are disabled, an examiner or judge will not be able to approve your claim for continuing benefits if current medical records are not available to substantiate your claim. Reason no. 2: if you attempt to get a supporting statement from your doctor (an RFC is much better–see the definitions page), you may have difficulty getting your physician to cooperate if he/she has not seen you recently. If you lose your medical coverage before your claim for benefits is approved, as is usually the case, try to be seen at a free clinic, county health department, or emergency room. While these treatment sources are not the best, they are, simply put, better than nothing. Another avenue to pursue may be with your state's Vocational Rehab department. Very often, VR can assist claimants in getting certain testing and examinations paid for. Though this is always for the purpose of developing a VR claim, vr counselors are usually willing to supply these records to a claimant's representative as well. Just remember this advice: as a general rule you cannot be approved for social security disability or ssi based on disability if you are not seen by a medical provider at least once every two months.
5. Advice: Try your best to stay compliant with your prescribed medications. In the end, whether you took your prescribed medicine or not may affect how your impairments are viewed. In fact, judges will often deny claims in which claimants did not take what was prescribed. The fact that the claimant had no means by which to obtain their needed meds is generally irrelevant to an ALJ at a disability hearing.
6. Stay friendly with the people working on your case, even if your case has experienced problems along the way (long waits, misplaced paperwork, etc). This includes the people at Social Security and Disability Determination Services, as well anyone who might represent you. The disability process can be anxiety-provoking at times, but maintaining good relations with the individuals working on your case is good advice to practice. The truth is: these individuals usually have very many cases to work on and literally hundreds of phone calls each week to deal with (this is absolutely true). How you last communicated with one of these individuals can make the difference as to whether or not your case gets more attention, or less.
7. Have your treating physician complete an RFC form on your behalf. RFC stands for residual functional capacity. RFC forms are used by DDS examiners (each examiner must have their unit physician or psychologist complete the appropriate physical or mental RFC form before a claimant's case can be closed) and carry great weight, particularly at hearings held by Administrative Law Judges. To learn more about RFC forms, click the “Disability Definitions” tab on the menu below and from that page read the definition titled “residual functional capacity form, or rfc”.
8. Never call the Social Security Administration's 1-800 information number to get updates on a disability claim. The information supplied by the call center reps at the 1-800 number is routinely and consistently incorrect. Speaking from experience, in the last couple of years, I have spoken with no less than forty or fifty disability claimants who had questions and were given blatantly wrong information regarding the disposition of their claims, causing them great anxiety as a result. To get updates on a disability case, call either the social security office where you filed, or the disability examiner at Disability Determination Services. And, if a hearing has been requested, call (or, better yet, have your representative call) the Office of Hearings & Appeals since, at that point, the social security office will know very little about the pending status of a disability claim.
9. Always (repeat: always) keep copies of everything you ever submit to either the social security office, Disability Determination Services, or the Office of Hearings & Appeals. Though items generally get where they should after being mailed, some social security field and district offices are notorious for losing mail or claiming never to have received mail (The Durham, North Carolina District Office is exceptionally well-known for this).
10. Never presume that something you have mailed to either the social security office, disability determination services, or the office of hearings and appeals…actually arrived. In other words, several days after mailing documents (an application, appeal, medical records, etc), make a followup call to verify that the recipient agency actually received what was sent.
11. Prepare financially. Many, if not most, disability claimants do not realize how long the process may literally take. In the majority of instances, it may take as long as 2 years or more to win an approval (simply because most claimants will be denied at the initial and reconsideration levels and will then have to request, and wait for, a hearing to be scheduled).
Therefore, claimants should never rely on the time estimates offered by the social security offices where they have filed. Why? Because CR's (social security claims reps) do not process disability claims. They simply take disability applications, which are then forwarded to DDS and assigned to examiners. Once a case is at DDS, it may stay there for 30 days, or 230 days. There is simply no way to know how long a case will take to process (though a claimant can potentially speed up this process by assisting in the gathering of medical records).
With this in mind, then, claimants should be extremely careful regarding their finances. In fact, claimants with mortgages may wish to consider restructuring their debt load to “ride out” the disability process. (2)
Yes. But you must be very careful in this regard.
The Social Security Administration will allow both claimants for benefits, as well as recipients of social security or ssi benefits, to work and receive their benefits as long as their monthly earned income does not exceed the s.g.a. limit.
Sga stands for substantial gainful activity and it is SSA's determination that those who are unable to earn at least the sga amount each month, pretax, may be considered eligible to receive benefits, provided their medical evidence supports an approval of benefits.
The sga amount for 2007 is $900.00 per month. Claimants must bear in mind, though, that this earnings threshold is based on gross income, not net. (3)
How good are the approval chances for disability?
Most disability cases get denied at the initial claim level. And most claims get denied on the first appeal, the reconsideration, as well. There's no denying these realities. The denial rates in some states, in fact, are as high as seventy percent on an initial application and eighty-five percent on a reconsideration.
Nevertheless, the approval chances for a social security claim based on disability can go up in your favor if you simply get regular medical treatment from doctors (hopefully, physicians with whom you have a good relationship) and supply copies of your medical records when you submit your application for disability.
That's not to say that doing either of these things will dramatically improve your approval chances for disability, but they can definitely make a difference. How so?
Think of it this way. Up to seventy percent of all claims for disability get denied, yet over fifty percent of cases heard by Administrative Law Judges get approved.
Why is there such a large statistical disconnect? There are several reasons. Sometimes, it is simply because some medical conditions will get worse over time…so, by the time a hearing is held, a social security claim simply looks stronger. Other times, it is because a claimant “ages into an allowance” (for example, turning from age 49 to age 50—the rules at 50 are more favorable for approvals).
Many times, however, the difference in approval rates is due to this fact: for cases that are heard by ALJ's, a representative is involved more often than not and, as a natural result, more hearing preparation is done on such cases.
Representatives, of course, want very much want to win their cases (no mystery there; that's how they get paid) and, therefore, do everything possible to maximize those cases, particularly when it comes to gathering medical records and physician statements.
However, there's no reason why a claimant can't follow that same principle of preparedness before a case gets to a hearing with a judge, assuming it ever has to.
Remember: to better your approval chances for disability (and get awarded your monthly and past due benefits), get regular medical treatment AND include your records with your disability application when you file at the local social security office. (4)
How does the social security administration define the concept of disability as it applies to ssdi (social security disability insurance) and ssi benefits?
The definition of disability used by SSA is quite a bit more stringent and restrictive than others (for example, the VA). SSA's definition demands that an individual's disabling condition: must be severe enough to last for at least the length of a year (or be projected to last that long)
must prevent a person from being able to work during that time at one of their former jobs or engage in any other type of work (suitable other work will be determined, to some extent, by a claimant's age, work skills, and physical or mental functional restrictions.
The definition of disability used by the social security administration does not in any sense include the concept of short-term or temporary disability benefits.
Is the SSA definition of disability fair to claimants? As it is currently written, the argument can be made that it is. And, as it is currently written, an ssd or ssi disability claimant does not actually have to be disabled for a year or more, as long as a person's medical records can indicate that the disability will eventually last that long.
The unfairness of the social security administration's disability system has more to do with the fact that chronic understaffing plagues the disability system. This understaffing, particularly as it regards hearing office staff, contributes heavily to a backlog of disability hearing cases that, essentially, forces applicants to wait more than a year for a hearing. (5)
Disability Secrets.com (1) (2) (3) (4) (5)
When applying for disability is Lymphedema the primary reason for claiming or the damage it does?
Disability determination is addressed in SSA Publication No. 64-039 “Disability Evaluation Under Social Security” (also known as the 'Blue Book')
Lymphedema is not recognized in the Blue Book as a malfunctioning of the lymphatic system that will result in an automatic determination of disability. I would suggest therefore that time be spent in seeking disability due to “disorders of the musculoskeletal system”. See Part A Section 1.00 of the Blue Book. Loss of function from any cause is discussed in this section, and it is my opinion that your lawyer should read this section and discuss an approach with you based on your situation.
It will be a difficult fight to establish disability for lymphedema, but I believe it meets all the requirements.
Bob Weiss LymphActivist Not a lawyer or licensed to give legal advice. These are my observations.
SSI is short for Supplemental Security Income. It pays monthly cash benefits to people who are age 65 or older, those who are blind, or those who have a disability and who do not own much or have a lot of income. SSI is not just for adults. Monthly benefits can go to disabled and blind children, too.
The amount of cash benefits you can receive depends on the state in which you live. The basic SSI amount is the same nationwide. However, many states add money to the basic benefit. Call the Social Security Administration at 800-772-1213 to find out the benefit amount for your state.
Qualifying for SSI benefits
To qualify for SSI benefits, you have to meet a variety of eligibility requirements, including an income and resource test. The amount of income you can have each month and still get SSI depends partly on where you live. Call the Social Security Administration at 800-772-1213 to find out the income limits in your state. Social Security does not count all of your income when they decide if you can get SSI. For example, SSA does not count:
The first $20 of most income received in a month The first $65 a month you earn from working and half the amount over $65 Food stamps Shelter you get from private nonprofit organizations and Most home energy assistance If you are a student, some of the wages or scholarships you receive may not count.
If you are disabled but work, Social Security does not count any wages you use to pay for items or services you need to work because of your disability. For example, if you need a wheelchair, the wages you use to pay for the wheelchair will not count as income.
Also, Social Security does not count any wages a blind person uses to pay expenses that are caused by working. For example, if a blind person uses wages to pay for transportation to and from work, the transportation cost is not counted as income.
Additionally, if you get SSI, you may also be able to get other help from your state or county. For example, you may be able to get Medicaid, food stamps or some other social services. For information about all the services available in your community, call your local social services department or public welfare office.
SSDI is short for Social Security Disability Insurance. In general, SSDI pays monthly cash benefits to people who are unable to work for a year or more because of a disability. After a 24-month waiting period, SSDI eligibility allows you to receive Medicare benefits even if you are under age 65.
Qualifying for SSDI
To qualify for benefits, you must first have worked in jobs covered by Social Security. You must also have a medical condition that meets the Social Security Administration's (SSA) definition of disability. In addition to meeting the definition of disability established by SSA, you must have worked long enough – and recently enough – under Social Security to qualify for disability benefits. Social Security work credits are based on your total yearly wages or self-employment income. You can earn up to four credits each year.
The number of work credits you need to qualify for disability benefits depends on your age when you become disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.
How the Social Security Administration determines if you are disabled The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.
Disability under Social Security is based on your inability to work. SSA considers you disabled under Social Security rules if you cannot do work that you did previously and you cannot adjust to other work because of your medical condition(s). Your disability must also last or be expected to last for at least one year or to result in death. This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments.
To decide whether you are disabled, SSA uses a step-by-step process involving five questions. They are:
1. Are you working?
If you are currently working and your average earnings are more than the minimums established by SSA, you generally cannot be considered disabled. Check with SSA to determine their income standards.
2. Is your condition “severe”?
Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, SSA will not consider you disabled. I f your condition does interfere with basic work-related activities, SSA goes to Step 3.
3. Is your condition found in the list of disabling conditions?
For each of the major body systems, SSA maintains a list of medical conditions that are so severe they automatically mean that you are disabled. If your condition is not on the list, SSA has to decide if it is of equal severity to a medical condition that is on the list. If it is, they will find that you are disabled. If it is not, they then go to Step 4.
4. Can you do the work you did previously?
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then SSA must determine if it interferes with your ability to do the work you did previously. If it does not, your claim will be denied. If it does, the SSA proceeds to Step 5.
5. Can you do any other type of work?
If you cannot do the work you did in the past, SSA looks to see if you are able to adjust to other work. They consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.
For additional questions about Social Security Disability Insurance, please visit the Social Security Administration's Web site.
SSI makes monthly payments to people with low income and limited resources who are 65 or older, or blind or disabled. Your child under age 18 can qualify if he or she meets Social Security’s definition of disability for children, and if his or her income and resources fall within the eligibility limits. The amount of the SSI payment is different from one state to another because some states add to the SSI payment. Your local Social Security office can tell you more about your state’s total SSI payment.
SSI rules about income and resources When we decide if your child can get SSI, we consider your child’s income and resources. We also consider the income and resources of family members living in the child’s household. These rules apply if your child lives at home. They also apply if he or she is away at school but returns home from time to time and is subject to your control.
If your child’s income and resources, or the income and resources of family members living in the child’s household, are more than the amount allowed, we will deny the child’s application for SSI payments.
We limit the monthly SSI payment to $30 when a child is in a medical facility where health insurance pays for his or her care.
SSI rules about disability Your child must meet all of the following requirements to be considered disabled and therefore eligible for SSI:
The child must not be working and earning more than $940 a month in 2008. (This earnings amount changes every year.) If he or she is working and earning that much money, we will find that your child is not disabled.
The child must have a physical or mental condition, or a combination of conditions, that results in “marked and severe functional limitations.” This means that the condition(s) must very seriously limit your child’s activities.
The child’s condition(s) must have lasted, or be expected to last, at least 12 months; or must be expected to result in death.
If your child’s condition(s) results in “marked and severe functional limitations” for at least 12 continuous months, we will find that your child is disabled. But if it does not result in those limitations, or does not last for at least 12 months, we will find that your child is not disabled.
Providing information about your child’s condition When you apply for benefits for your child, we will ask you for detailed information about the child’s medical condition and how it affects his or her ability to function on a daily basis. We also will ask you to give permission for the doctors, teachers, therapists and other professionals who have information about your child’s condition to send the information to us.
If you have any of your child’s medical or school records, please bring them with you. This will help speed up the decision on your application.
What happens next? We send all of the information you give us to the Disability Determination Services in your state. Doctors and other trained staff in that state agency will review the information, and will request your child’s medical and school records, and any other information needed to decide if your child is disabled.
If the state agency cannot make a disability decision using only the medical information, school records and other facts they have, they may ask you to take your child for a medical examination or test. We will pay for the exam or test.
Benefits For Children With Disabilities Social Security Online
SSI State Supplements (2008)
Social Security Disability (SSI) Benefits - Disability Secrets.com
My Disability Blog Tim Moore
Supplemental Security Income: Supporting People with Disabilities and the Elderly Poor By Eileen P. Sweeney and Shawn Fremstad
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Updated Jan. 17, 2012