Supplemental Security Income (SSI) (Title XVI)

Maybe you never worked, have not worked in the last 4 years, or never had earnings greater than substantial gainful activity (for 2012, the substantial gainful activity amount was $1010, gross, per month). Now you are unable to work. Many people think that they have no options. But, Social Security has a benefit program that you should apply for.

Supplemental Security Income (SSI) payments are made on the basis of financial need to adults and children who are disabled, blind, or have limited income and resources. Whereas SSDI is funded from the Social Security tax, SSI is financed by general tax revenues.

Do you qualify for SSI?

  1. There are several criteria to qualify for SSI: you must be age 65 or older, be legally blind, or be disabled under the definition provided by the SSA. You must also live in the United States, be a US citizen or an eligible noncitizen.
  2. SSI is a needs-based program; therefore you must financially qualify for benefits. To financially qualify, you will be evaluated based on income and resources.
    1. Income is defined as any money that a person receives from wages, other benefits programs, food assistance programs (food stamps), pensions, retirement benefits, etc.
    2. Resources refer to the value of any assets held by an individual, such as cash, savings, equity in land, stocks, second vehicles, or real estate.
  3. Your household income and resources will be considered when you apply for SSI, and the total resources must be less than $3000. If you are unmarried, your income and resources must be less than $2000.

Once you meet the financial qualifications for SSI, Social Security will then consider whether or not you qualify for benefits based on the medical rules. To meet the medical rules, you must have a qualifying medical condition. Social Security defines a qualifying medical condition as a permanent condition that prevents you from working. In other words, your disability must have lasted, or be expected to last, a minimum of twelve months and you must be unable to earn an income greater than the "substantial gainful activity" amount that is regulated by Congress and readdressed annually. You must meet both the medical and nonmedical rules before you may receive SSI benefits.

Once you meet all of the qualifications for SSI, one would think that all they would have to do is apply and they automatically get awarded these benefits. However, that is not exactly how the process works. Often times, Social Security will deny you benefits for multiple reasons. Below is a list of reasons why someone may be denied SSI:

  • Too Much Income. If you are working and earning more than the substantial gainful activity (SGA) amount, Social Security will assume that you are "working" and therefore not disabled. If you can work, then logically Social Security will assume you are not disabled. You cannot work (defined as earning more than the SGA amount) and be disabled at the same time.
  • Your medically disabling condition is not expected to last 12 months. In order for Social Security to consider a medical condition disabling, that condition must last at least 12 months. Therefore, even a severe injury may not qualify a person for Social Security benefits. This seems to be a very common issue for clients of the Sellers Law Firm. Fortunately, we have experience in overcoming this obstacle for most clients.
  • The Social Security Administration cannot find you. In order for a claim to be determined, SSA will want you to complete many forms, interview you in person or by telephone, and perhaps see a doctor that they refer you to. If they cannot reach you, they cannot pay you. Fortunately, with an experienced attorney, Social Security will rely on the attorney to stay in contact with the client; which will reduce the amount of contact Social Security must have with you. However, you must remember to stay in contact with your attorney!
  • You refuse to cooperate with the Social Security Administration. This is perhaps the second leading cause for denial of SSI benefits. Social Security will want to verify every piece of information you provide to them. This includes employment records, medical records, and perhaps independent medical opinions provided by a doctor that they send you to. If Social Security cannot contact you, which means they cannot verify a piece of information, you will be denied for failure to cooperate. Fortunately, the Sellers Law Firm can and will gather the information needed by Social Security and provide that information to them. Therefore, the chance of being denied by Social Security for failure to cooperate is substantially reduced simply by having an attorney.
  • Non-Compliance. This is a very difficult hurdle for many people attempting to get any type of Social Security benefits. Non-Compliance can encompass many things. However, the most common issue for a Social Security claimant is failure to follow prescribed therapy. If a doctor prescribes you medication, you are expected to take that medication. If you are prescribed counseling sessions on a regular basis, you are expected to attend these sessions. The Sellers Law Firm recognizes there are many reasons why someone may not be compliant with medical treatment. Primarily, Non-Compliance is due to financial barriers. If you have no medical insurance, it may be extremely costly for you to attend doctor appointments or to have your prescriptions filled. There are ways to overcome this barrier to benefits and we have the knowledge and experience to do so.
  • DA&A (Drug Addiction and Alcohol). If you are a drug addict or an active alcoholic and your drug or alcohol use is a direct contributor to your disability, you will not be eligible for Social Security benefits. If, however, even if you quit using drugs or stopped drinking, your medical condition would still be disabling, then Social Security must find that your addiction and abuse is non-material to your disability. Each case involving DA&A is different and must be discussed on an individual basis.
  • Pending Felony, Confined to Prison, or Injury Sustained During the Commission of a Felony. If you are in prison, you may not draw Social Security benefits. If your medical condition that disables you was acquired during the commission of a felony, you may not draw Social Security benefits. And if you have a current warrant for a felony that is currently pending, you may not be eligible for Social Security benefits.
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