The Social Security Administration (SSA) administers several benefit programs for Americans. Most people know about the SSA because they contribute a share of their income toward their Social Security account with every paycheck. When they become eligible (usually by reaching a particular age after working a particular number of years), they can draw a monthly Social Security payment.
The SSA also administers multiple disability programs, including the Social Security Disability Insurance (SSDI) program. Americans who have paid Social Security taxes for a sufficient number of years — and have worked in sufficiently recent years — are “insured” by SSDI. The SSDI program pays benefits to “insured” individuals who are unable to work because of a medical condition that meets the SSA’s strict definition of a “disability.”
A third SSA program is less well known than Social Security and SSDI. The Supplemental Security Income (SSI) program is funded by general revenues, not by payroll taxes. Eligibility does not depend upon the applicant’s employment history. Rather, individuals are eligible for SSI if they meet the SSA’s criteria for financial need and are over the age of 65, blind, or disabled.
Unfortunately, like many federal agencies, the SSA is not always quick to process applications for SSI. When the SSA turns down an application, it can be slow to process an appeal. Hiring an attorney can have an impact on the speed with which the SSA processes an SSI claim.
SSI Benefit Eligibility
Applicants are eligible to apply for SSI if they are citizens or lawful permanent residents who are not in deportation status. Applicants must have a residence in one of the 50 states, the District of Columbia, or the Northern Mariana Islands, and must not be absent from the US for more than one month each year.
In addition to being older than 65, blind, or disabled, an eligible applicant for SSI must have limited income and resources. The means-tested program is intended for people who do not have substantial earnings, savings, or property.
The exact combination of income and resources that disqualifies an applicant for SSI depends on several factors and can vary from year to year. An SSI lawyer can help people understand whether they are eligible, or whether there might be steps they could take to become eligible in the near future.
For the purpose of SSI eligibility, a disability is a physical or mental impairment that will probably continue for at least 12 months or will end in death. A qualifying disability is one that makes the applicant unable to perform any substantial gainful activity. As a general rule, someone who can work full-time for at least minimum wage is capable of substantial gainful activity. When a disabling condition greatly limits the ability to earn income, a lawyer can review medical records and investigate the facts to determine whether an application for SSI benefits has a reasonable chance of success. A lawyer can also help applicants appeal from a denial of SSI benefits.
Making an SSI Claim
Applicants for SSI must provide evidence of their entitlement to benefits. Evidence of age (and often of blindness) is easy to supply, but evidence that an applicant is disabled can be more difficult to assemble.
A few very serious medical conditions (including certain cancers) should result in a prompt and nearly automatic approval of an SSI claim. Still, it is important to fill out the application correctly and to provide medical evidence that the disability exists.
Most disabilities do not receive a presumption of eligibility. It is therefore necessary to provide full medical records that document the nature and extent of the disability, its anticipated duration, and its impact on the applicant’s ability to work and function.
Some applications for SSI can be filed online, depending on the reason for which the claim is made. A claim based on age must usually be made in person or over the telephone. However, as the SSA continues to respond to the challenges of the pandemic, the rules for applying are subject to change.
Advantages of Legal Representation
Research shows that SSI applicants who are represented by an attorney have a greater likelihood of having a claim approved. Experienced lawyers understand what the SSA is looking for in an application. If the facts simply do not support a meritorious claim, a lawyer will advise the applicant to look for some other source of benefits. Since SSI is available only to people with limited income, for example, a lawyer might advise a client who is not financially eligible that it would be a waste of time to process the application.
Whether an applicant is capable of substantial gainful employment is not always obvious. When the medical records do not contain a functional capacity evaluation, an SSI lawyer might advise a client to obtain one. When reasons for the applicant’s unemployment are unclear, a lawyer might need to assemble evidence to demonstrate that the applicant is not shirking work. In some cases, an evaluation by a vocational expert might strengthen the application.
When the claim has merit, a lawyer will help the applicant avoid common mistakes, including incomplete applications or ambiguous medical records, that cause claims to be rejected. Providing proper documentation is critical. When documents need to be supplemented after the initial application is submitted, applicants experience stressful delay. Getting it right the first time assures that the claim will be processed with minimal delay.
A substantial number of SSI claims that are rejected are overturned on appeal. Appeals can take various forms. A request for reconsideration must be filed within 60 days and usually takes 6 to 12 weeks to decide. A request for a hearing must also be filed within 60 days and can easily take a year to process. However, when SSI applicants are represented by an attorney, they have historically had a success rate of about 50% on appeal.
Appeals can be complicated. An experienced lawyer can do everything possible to expedite the hearing, but it is essential to present a full and substantial case. Presenting the best evidence is the key to winning an SSI appeal.