supplemental security income (ssi) for adults with disabilities
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Supplemental Security Income (SSI) for Adults with Disabilities. John S. Whitelaw , Supervising Attorney, Community Legal Services Rebecca Vallas , Staff Attorney, Community Legal Services. SSI Applications Project Pepper Hamilton, LLP January 2013. Purpose of this Project. - PowerPoint PPT PresentationTRANSCRIPT
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John S. Whitelaw, Supervising Attorney, Community Legal Services
Rebecca Vallas, Staff Attorney, Community Legal Services
Supplemental Security Income (SSI) for Adults with Disabilities
SSI Applications ProjectPepper Hamilton, LLP January 2013
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Purpose of this Project
Elimination of General Assistance (GA) Getting SSI applications approved quickly is
even more critical Unassisted applicants are much less likely to
be approved at initial level Overall approval rate: about 1/3
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What is SSI?
Signed into law in 1972 by President Nixon Provides minimum income to elderly/
disabled low-income Americans Must meet financial eligibility criteria and
medical disability standard Provides monthly benefit ($710 max for
2013) plus Medicaid (75% FPL)
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Who gets SSI?
1.2 million aged 6.7 million disabled & blind ~7.9 million total
Compare: 34.6 million retired workers getting Social Security
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Eligibility criteria
Medical eligibility Nonmedical eligibility
– Financial -- income & resources– Citizenship– Not discussed in this presentation
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Definition of disability
Unable to engage in substantial gainful activity (SGA) because of a medically determinable impairment(s) which is (are) expected to last 12 months or result in death.
PHYSICAL
MENTAL
COMBINATION Same for SSI and SSDI
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SSI vs. SSDI
SSDI (aka Social Security Disability Insurance (“Title II”)
– Insurance program for workers who have paid enough in FICA taxes to be covered
– Not a needs-based program
SSI (“Title XVI”)– Provides a minimum income to people who have not
worked enough to be covered– Or who are covered but receive less than $730 in SSDI
(“concurrent beneficiaries”)– Means tested
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Sources of Law
Statute – Title II of the Social Security Act (42 USC § 401 et
seq)– Title XVI of the Social Security Act (42 USC § 1381
et seq)
Regulations– 20 CFR § 401 et seq– 20 CFR § 416 et seq
Program Operations Manual System (POMS)
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Application Process
Individual submits application for benefits Local SSA office processes application, sends to
state agency that makes decision– Bureau of Disability Determination (BDD) (DOL)
BDD requests medical evidence from providers BDD sends forms to providers to complete BDD makes initial decision about whether individual
is disabled Average time: 3-5 months for initial decision
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Application Process, cont’d
If denied, individual has right to appeal– 60-day* deadline, from date of notice
Next step is hearing before SSA Administrative Law Judge
Year or longer delay before getting a hearing Representatives often involved at this stage ALJ makes decision on disability Additional levels of appeal
* 60 day deadline plus five days for mailing
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Individual files application
SSA determines non-medical eligibility
Applicant’s electronic record is returned to initiating SSA office
SSA notifies applicant of decision by letter
SSA sends medical information and releases to BDD, disability examiner is assigned
BDD processes claim & makes disability determination
SSA-3368 Disability Report SSA-3369 Work History Report(optional, can be included in Medical Summary Report)
SSA-827 Authorization to Disclose Information to SSA(one for each provider with medical information; use in conjunction with agency release form)
(Required, can be completed on-line)
IV - 2
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“Sequential Evaluation”
Five Steps 1. Is applicant working at SGA level? 2. Does the applicant have a medically determinable
impairment or combination of impairments that is/are severe?
3. Do(es) the applicant’s impairment(s):a. meet a listing; orb. medically equal a listing?
4. Can the applicant return to “past relevant work”?5. Is there other work that exists in significant numbers in
the national economy that the applicant can perform despite his/her impairments?
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Step One: SGA?
$1,040 per month for 2013 If applicant is working and earning this much
or more per month claim is denied at step one without further review.
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Step Two: Severe Impairment
De minimis test Not an issue in most cases Typically comes into play with “older” adults
55+
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Step Three: Listings
• Musculoskeletal• Hematological• Skin• Digestive• Respiratory• Oncology• Mental • Immune
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Step Four: Past Relevant Work (PRW)
What qualifies as PRW? Work performed in the last 15 years Determine applicant’s current “residual
functional capacity” (RFC) – what he can do physically and mentally on a sustained basis
Can applicant do PRW with his/her current RFC?
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Step Five: Other Work
Taking into account the applicant’s age, education, and PRW, is there work that exists in significant numbers in the national economy that the applicant can perform on a sustained basis?
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SSI Application Project: What You Will Be Doing
“Clinic in a box” Limited representation for duration of
application assistance Single meeting with each applicant No ongoing relationship, follow-up,
obligations
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SSI Application Project: What You Will Be Doing (Cont’d)
Completion of online “disability report” Completion of supplemental forms
– Work History report– Activities of Daily Living report – SSA’s medical release forms
Benefits– Front-loads the application to increase chance of
quick approval– Ensures greater completeness and accuracy
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https://secure.ssa.gov/apps6z/radr/radr-fe
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Part I: Online Disability Report
Basic info, medical history, work & education, functional information
– Note special education
Don’t stress over specific details of treatment– What’s important: provider name & contact info
Think creatively about where applicant may have received treatment (eg: prison, hospital, therapy from LICSW)
Print re-entry number (early on) and summary sheet (at end)
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Part II: Supplemental Forms
Activities of Daily Living report– Handouts
SSA’s medical release forms (827)– Handout– Get these signed and witnessed
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Skills Development
Interviewing skills Client contact Dealing with challenging clients Issue spotting and synthesizing facts into
helpful evidence in support of approval
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Interviewing Challenging Clients
Homeless Mental illness Unreliable historians Difficulty abstracting
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Questions?
We will be at clinic sessions to help!
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Contact us
John S. Whitelaw, Esq.(215) 227-2403, [email protected]
Rebecca D. Vallas, Esq.(215) 981-3797, [email protected]
www.clsphila.org