Disability Seminar

• Introductions

• Goals of the presentation

• © 2010, David F. Traver

• This slide presentation is provided free by Attorney David F. Traver and may be duplicated, changed, edited, and used for public presentations. However, it may not be sold or included in any published work without permission of Attorney Traver

• Questions? Call me at 262-594-2096

What is SSI?

• Supplemental Security Income (SSI) (Title 16) (T-XVI)

• Disability Insurance Benefits

• Disabled Widow's and Widower's Benefits

• Disabled Adult Child Benefits

• SSI child's disability benefits

Social Security Disability (DIB) (Title 2) (T-II)

• A disabled insured worker under 65.

• A person disabled since childhood (before age 22) who is a dependent of a deceased insured parent or a parent entitled to title II disability or retirement benefits.

• A disabled widow or widower, age 50-60 if the deceased spouse was insured under Social Security.

Under title XVI, or SSI, there are two basic categories

• An adult age 18 or over who is disabled.

• A child (under age 18) who is disabled.

Definition of Disability

• What does “disabled” mean?

Christopher Reeve

• Date of Birth: 9-25-52 (New York City)

• Occupation: actor/director/producer

• Medical State: Ventilator-dependent Quadriplegic

• Annual Income: Estimated to be over 1 million per year

Stephen W. Hawking

• Date of Birth: 1-8-42 (London, England)

• Occupation: Theoretical Physicist and Author

• Medical State: Advanced ALS• Annual Income: estimated to be

over 1 million per year

Definitions of Disability

• school programs

• hunting license

• fishing license

• handicapped parking permits

• insurance companies

SSA’s Definition of Disability

“Disabled" means the inability to do any substantial gainful activity due to a medically determinable physical or mental impairment.

A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings – not only by the individual's statement of symptoms.

SSA’s Definition of Disability

Duration requirement:• Expected to cause death or

• Causes death or

• Lasts 12 months or

• Expected to last 12 months

SSA’s Definition of Disability

Alcoholism or Drug Addiction: The passage of Public Law 104-121 prohibits a finding that an individual is disabled if drug addiction and alcoholism (DAA) is material to the determination. 

Non-Medical Requirements

SSI payments are not based on prior work or a family member's prior work.

SSI is not an insurance program!

Non-Medical Requirements

• To get SSI, the claimant must have limited income and resources.

• To get SSI, the claimant must be at least 65 years old, blind, or disabled

Limited IncomeCountable income must be:

• below $579 a month for single adult or child.

• below $869 a month for couple

• See http://dhfs.wisconsin.gov/ssi/benefits.htm

SSI Also Provides

• Medicaid (medical assistance) retroactively to the date of the SSI award. (This is extremely important).

• food stamps.

• $83.74 per month from the State of Wisconsin, $132.05 for couple.

Not all income countsSome exclusions are:

• $20 per month of most income • $65 per month of wages and one-half of wages

over $65 • food stamps • home energy/housing assistance• impairment-related work expenses

• Income set aside or PASS

Limited Resources(Property and other assets a person owns)

• $2,000 for single adult or child

• $3,000 for couple (limit applies even if only one member is eligible)

Not all resources countSome exclusions are:

• the home a person lives in • a car, depending on use or value • burial plots for individual and immediate

family • burial funds up to $1,500 • life insurance with face value of $1,500 or less

Fugitive Felon

• Fleeing to avoid prosecution for a crime that is a felony

• Fleeing to avoid custody or confinement after conviction of a felony

• Violating a condition of probation or parole imposed under State or Federal law.

CITIZEN / NONCITIZEN ISSUES

To get SSI, the claimant must be:• a citizen of the U.S.; or,

• an alien who meets the alien eligibility criteria under the 1996 legislation and its amendments.

CITIZEN / NONCITIZEN ISSUES

• When in doubt, SUBMIT AN APPLICATION!

Sequential Evaluation Process

A PLACE FOR EVERYTHING, AND EVERYTHING IN ITS PLACE!

Sequential Evaluation Process - 1

The Social Security Administration considers:

• First, whether the claimant is engaged in a "substantial gainful activity."

1.) Is the person working?

If not, the Social Security Administration considers whether the claimant has an impairment or combination of impairments that "significantly limits [the claimant's] physical or mental ability to do basic work activities."

2.) Is there a disability?

Sequential Evaluation Process - 2

Sequential Evaluation Process - 3

If so, the Social Security Administration determines whether the impairment meets or equals any of the Listings found in the regulations. If the claimant's impairment is found to meet or equal one of the Listings, the claimant is found disabled.

3.) Is a listing met?

Sequential Evaluation Process - 4

If not, the Social Security Administration determines the claimant's residual functional capacity and determines if the residual functional capacity does not allow the claimant to perform past relevant work.

4.) Can the person do some past job?

If not, the burden shifts to the Social Security Administration to prove that in light of the claimant's age, education, job experience and functional capacity to work, the claimant is capable of performing other work and that such work exists in the national economy.

5.) Are there other jobs the person can do?

Sequential Evaluation Process - 5

Administrative Procedures - Appeals

•Why appeal?

•Because you want to win.

When to Appeal? IMPORTANT!!

• A claimant has 60 days to appeal from the date the claimant received any denial letter from SSI or the Social Security Administration.

• Add five days to the date on the letter, so usually, the time for appeal can be considered as 65 days.

Stages of Appeal

• There are many stages of appeal. They include reconsideration, a request for a hearing, Appeals Council review, and review by federal courts, all the way up to the United States Supreme Court.

Stages of Appeal

• Request for Reconsideration. Upon appeal of the first denial letter (the initial denial) and request an appeal, the case will be reviewed by staff psychologists or physicians. Usually such appeals are denied within 60 days in a rubber-stamp fashion.

Stages of Appeal

• Request for a Hearing. An Administrative Law Judge (ALJ) hearing is held six months to a year after the request a hearing.

• The assistance of an attorney is absolutely crucial at this stage.

• Appeals Council in Arlington Virginia. This appeal does not involve a hearing; the Appeals Council simply reviews the arguments and evidence mailed or faxed to the Council.

Stages of Appeal

• If an appeal to the Appeals Council is lost, the next appeal is to the District Court. This appeal too must be made within 60 days.

Stages of Appeal

The Players at the Social Security Administration

State of Wisconsin Disability Determination Bureau (DDS)

Initial applications and reconsiderations of those applications are handled by the at State of Wisconsin agency hired by the Social Security Administration:

Disability Determination BureauP.O. Box 7886Madison, WI 53707-7886(608) 266-1565(608) 266-8297

Wisconsin Social Security Administration office hours are 9:00 am to 4:00 pm, Monday through Friday. They are closed on weekends and national holidays.

Place your local DDS, ODAR, and SSA Office information here

Milwaukee, WI 53203-2286 (414) 297-1790 TDD (414) 297-3956 FAX (414) 297-

1460Place your local DDS, ODAR, and SSA Office information here

Milwaukee, WI 53203-2286 (414) 297-1790 TDD (414) 297-3956 FAX (414) 297-

1460Place your local DDS, ODAR, and SSA Office information here

Milwaukee, WI 53203-2286 (414) 297-1790 TDD (414) 297-3956 FAX (414) 297-1460

The Players at the Social Security Administration

Office of Hearings and Appeals (OHA)

The Office of Hearings and Appeals310 West Wisconsin Avenue, Suite 880Milwaukee, Wisconsin 53203

(414) 297-3141 FAX (414) 297-1993

The Players at the Social Security Administration