How to Appeal a Supplemental Security Income Denial
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Another option that is open to those of us with disability is the Supplemental Security progam. This is a separate part of the Social Security Administration with its own guidelines, rules and benefits.
This section will focus on appealing a denial of Supplemental Security Benefits
Supplemental Security Income
SSI makes monthly payments to people who have low income and few resources and are:
If you are
applying for SSI, you also should get our publication, What
You Need To Know When You Get Supplemental Security Income (SSI)
(Publication No. 05-11011).
Disabled or blind children also can receive SSI. You can get more information about benefits for children by visiting our website at www.socialsecurity.gov or calling us to get a copy of the publication, Benefits For Children With Disabilities (Publication No. 05-10026).
The basic SSI amount is the same nationwide. However, many states add money to the basic benefit. You can call us to find out the amounts for your state.
Rules for getting SSI
Whether you can get SSI depends on your income and resources (the things you own).
Income is money you receive such as wages, Social Security benefits and pensions. Income also includes such things as food, clothing or shelter. The amount of income you can receive each month and still get SSI depends partly on where you live. You can call us to find out the income limits in your state.
Social Security does not count all of your income when we decide whether you qualify for SSI. For example, we do not count:
If you are married, we also include part of your spouse’s income and resources when deciding whether you qualify for SSI. If you are younger than age 18, we include part of your parents’ income and resources. And, if you are a sponsored noncitizen, we also may include your sponsor’s income and resources.
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 wages you use to pay for items or services that help you to work. For example, if you need a wheelchair, the wages you use to pay for the wheelchair do not count as income when we decide whether you qualify for SSI.
Also, Social Security does not count any wages a blind person uses for work expenses. For example, if a blind person uses wages to pay for transportation to and from work, the wages used to pay the transportation cost are not counted as income.
If you are disabled or blind, some of the income you use (or save) for training or to buy things you need to work may not count.
Resources that we count in deciding whether you qualify for SSI include real estate, bank accounts, cash, stocks and bonds.
You may be able to get SSI if your resources are worth no more than $2,000. A couple may be able to get SSI if they have resources worth no more than $3,000. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it.
Social Security does not count everything you own in deciding whether you have too many resources to qualify for SSI. For example, we do not count:
To get SSI, you must live in the U.S. or the Northern Mariana Islands and be a U.S. citizen or national. In some cases, noncitizen residents can qualify for SSI. For more information, ask for the publication, Supplemental Security Income (SSI) For Noncitizens (Publication No. 05-11051).
If you are eligible for Social Security or other benefits, you should apply for them. You can get SSI and other benefits if you are eligible for both.
If you live in certain types of institutions, you may get SSI.
If you live in a city or county rest home, halfway house or other public institution, you usually cannot get SSI. But there are some exceptions.
If you live in a publicly operated community residence that serves no more than 16 people, you may get SSI.
If you live in a public institution mainly to attend approved educational or job training to help you get a job, you may get SSI.
If you live in a public emergency shelter for the homeless, you may get SSI.
Supplemental Security Income (SSI)
See complete information and futher links: http://www.ssa.gov/ssi/text-understanding-ssi.htm
Supplemental Security Income Appeals
You can appeal the Social Security Administration's decision regarding your eligibility to receive Supplemental Security Income (SSI). Your can also appeal their decision regarding the amount you are eligible to receive.
You should file your appeal within 60 days of written notice from the Social Security Administration. You may extend this for up to two years if you can show that you had good reason to wait that long to appeal. You can write your request for appeal, or you can call your local Social Security office and ask for assistance.
There are four levels of appeal. They are:
Reconsideration - A complete review of your claim by someone who didn't take part in the first decision. All evidence submitted at the time of the original decision, as well as any new evidence will be considered.
Hearing by an administrative law judge - If you disagree with the reconsideration decision, you may request a hearing. The hearing will be conducted by an administrative law judge who had not part in the first decision or reconsideration of your case.
Review by the Appeals Council - If you disagree with the hearing decision, you may ask for a review by Social Security's Appeals Council. If needed, Social Security will help your request a review by the Appeals Council. The Appeals Council looks at all review requests, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council does decide to review your case, it will either decide your case itself or return it to and administrative law judge for further review.
Federal court review - Finally, if you disagree with the Appeals Council's decision or the Appeals Council decides not to review your case, you may file a lawsuit in federal district court.
If you are appealing Social Security's decision to stop your SSI payments based on their determination that you are no longer eligible or your payments should be reduced, you may still receive your SSI payments during the time you are appealing if you ask for it within ten days of receipt of the letter from Social Security. At an administrative hearing, a judge will determine whether or not you can continue to receive your payments during your appeal. Please be advised that if your appeal is turned down, you may have to pay back any money you were not eligible to receive.
Many people handle their own Social Security appeals with free help from Social Security. However, the steps to the appeal process can be complex and confusing. Therefore, Social Security does allow you to choose a lawyer, a friend or someone else to help you act as your representative. If you would like more information about having a representative, contact Social Security or talk to a knowledgeable attorney or advocate to assist you through the appeals process.
For more information, contact the Social Security Administration at 1-800-772-1213.
What do I do if I am denied disability benefits?
If your initial claim is denied, you may appeal at the reconsideration level. At the reconsideration level, you will be able to submit new evidence and your case will again be reviewed. Claims at the initial and reconsideration levels are handled by DDS.
If you are denied a second time, at the Reconsideration level, you can request a hearing through the Office of Disability Adjudication and Review (ODAR). You will get a notice of hearing, which should say whether they plan to have any experts (medical or vocational) testify at your hearing. If they plan to have experts, and you do not already have legal representation, you should reconsider getting a lawyer at this time.
At this level, your case will be heard by an Administrative Law Judge. A hearing before an Administrative Law Judge is an informal process. The judge will ask you questions about your past work, medical conditions, limitations, treatment, medications, and daily activities. It is important to give straightforward answers that explain all of your limitations. If possible, you should try to give real life examples of how your impairments limit you. The chances of success are highest at this level, but are much higher if you have legal representation.
Following a hearing, the judge will usually issue a written decision. A decision can either be fully favorable, partially favorable, or unfavorable. If you get a decision that is not fully favorable, you will want to consider appealing to the Appeals Council. At the Appeals Council level, your case will be reviewed to see if any errors were committed previously. Both ODAR and the Appeals Council are run by the Social Security Administration. If you are denied at the Appeals Council level, you may appeal your case to federal court (a system that is not associated with SSA or bound by its policies). Representing yourself at this stage, however, is very difficult, and may be best left to an experienced representative. If you have any questions about handling an appeal on your own or any other disability-related question, you can call LSNJ-LAW™, Legal Services of New Jersey’s statewide, toll-free legal hotline, for advice at 1-888-LSNJ-LAW (1-888- 576-5529), Monday through Friday, 8:00 a.m. to 5:30 p.m. The hotline does not charge for its services, but certain eligibility rules apply.
Where can I go if I need more help?
This article is from the April 2008 issue of Looking Out for Your Legal Rights®.
Supplemental Security Income
|SOCIAL SECURITY ADMINISTRATION|
|Social Security Act of 1935, Title XVI, as amended; 42 U.S.C. 1381-1383f|
|To ensure a minimum level of income to persons who have attained age 65 or are blind or disabled, and whose income and resources are below specified levels|
|TYPES OF ASSISTANCE|
|Direct Payments with Unrestricted Use; Direct Payments for Specified Use|
|USES AND USE RESTRICTIONS|
|Supplemental security income payments are made to persons who have attained age 65 or who are blind or disabled and meet the means-tested and other requirements of the program. Generally, there are no restrictions on the use of benefits received by beneficiaries, although the right to future benefits is not transferable or assignable. The Federal government gives the States funds, in advance or by way of reimbursement, for necessary costs in making disability determinations under 20 CFR 404 subparts P and Q and part 416 subparts I and J. Necessary costs are direct as well as indirect costs as defined in 41 CFR 1-15, subpart 1-15.7 of the Federal Procurement Regulations System for costs incurred before April 1, 1984; and 48 CFR 31, Subpart 31.6 of the Federal Acquisition Regulations System and Federal Management Circular No. A-74-4 as amended or superseded for costs incurred after March 31, 1984|
|To be found disabled for SSI purposes: an individual age 18 or older must be unable to perform any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least 12 months; an individual under age 18 must have a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of at least 12 months. An individual under age 18 who files a new application for benefits and is engaging in substantial gainful activity will not be considered disabled. To be found blind for SSI purposes, an individual of any age must be "statutorily blind." This means central visual acuity of 20/200 or less in the better eye with use of a correcting lens. The eligibility of an individual who has attained age 65 or who is blind or disabled is determined on the basis of an assessment of the individual's monthly income and resources, citizenship or alien status, U.S. residency, and certain other eligibility requirements. In determining a month's income, the first $20 of Social Security or other unearned income is not counted. An additional $65 of earned income ($85 if the person had no unearned income) received in a month plus one-half of the remainder above $65 (or $85) also is not counted. If, after these (and other) exclusions, an individual's countable income, effective January 2004, is less than $564 per month ($846 for a couple, both of whom are aged, blind or disabled) and countable resources are less than $2,000 ($3,000 for a couple), the individual may be eligible for payments. The values of household goods, personal effects, an automobile, life insurance, and property needed for self support are, if within limits set out in regulations, excluded in determining value of resources. Burial spaces for an individual and immediate family and burial funds, up to $1,500 each for an individual and spouse, are excluded from resources. The value of a home which serves as the principal place of residence is also excluded in resource valuation|
|Individuals who have attained age 65 or are blind or disabled, who continue to meet the income and resources tests, citizenship/qualified alien status, U.S. residence, and certain other requirements. Eligibility may continue for beneficiaries who engage in substantial gainful activity despite disabling physical or mental impairments.|
|Proof of age, marital status, income and resources, establishment of blindness or disability, proof of residence in the U.S. and citizenship, or alien status is required|
APPLICATION AND AWARD PROCESS
|None. This program is excluded from coverage under E.O. 12372|
|Call toll free at 1-800-772-1213 or telephone or visit the local Social Security Office|
|The individual (and representative payee, if any,) will be notified by mail of award or denial|
|None. Benefits are not paid prior to the month following the month of application. However, an emergency advance payment may be available in the month of filing the application|
|Range of Approval/Disapproval Time|
|Call toll free at 1-800-772-1213 or telephone or visit the local Social Security Office. The appeal process ranges from a case review or field office conference to a review by the Federal Courts. An appeal must be requested within 60 days of the date on which a written notice of SSA's initial determination is received by the applicant. The 60 days start the day after you receive the notice|
|A redetermination of a person's benefit amount and continuing eligibility will be made on a scheduled basis at periodic intervals. Unscheduled redeterminations are made when changes in circumstances are reported. The length of time between scheduled redetermination varies depending on the likelihood that the beneficiary's situation may change in a way that affects payment amount or eligibility|
|Formula and Matching Requirements|
|This program has no statutory formula. Some mandatory State supplements are required by supplemental security income law to maintain former State recipients' December 1973 payment levels at pre-supplemental security income levels, increased by cost-of-living adjustments, where such payments were higher than the initial supplemental security income standards. States also have the option of paying supplements. The Social Security Administration will administer for a fee under agreements with States both mandatory and optional State supplements. States paying supplements are required by supplemental security income law to maintain either their State supplement expenditures or their payment levels when Federal standards are increased|
|Length and Time Phasing of Assistance|
|Benefits are paid monthly. Accrued benefits are paid in a lump sum unless they exceed a specified amount in which case they are paid in up to three installments at 6 month intervals. In the case of a disabled child, accrued payments over a certain amount must be retained in a dedicated account and used only for certain approved expenditures|
POST ASSISTANCE REQUIREMENTS
|Any change of address or any event affecting eligibility or benefit amount (such as an increase in resources or income or improvement of disabling condition) must be reported to the Social Security Administration when the event occurs|
|(Benefit Payments - These figures represent benefits actually paid, or expected to be paid.) FY 03 $32,535,000,000; FY 04 est $34,285,000,000; and FY 05 est $38,363,000,000|
|Range and Average of Financial Assistance|
|Monthly Federal cash payments range from $1 to $564 for an aged, blind, or disabled individual who does not have an eligible spouse, and from $1 to $846 for an aged, blind, or disabled individual and an eligible spouse. These rates became effective January 2004. The average Federal monthly benefit payment for January 2004 was $393|
|In fiscal year 2003, an average of 6,553,000 persons per month were Federal Supplemental Security Income recipients. It is estimated that in fiscal year 2004, an average of 6,711,000 recipients will receive monthly cash benefits. During fiscal year 2005, the average number receiving payments is estimated to be 6,867,000 per month. Not included are those persons who receive only State supplementary payments, some of which are administered by the Social Security Administration for the States as part of the SSI program|
|REGULATIONS, GUIDELINES, AND LITERATURE|
|Code of Federal Regulations, Title 20, Parts 401, 416, and 422. "SSI for Aged, Blind, and Disabled People" and other publications are available from any Social Security Office without charge. The Social Security internet address is www.ssa.gov and it includes copies of all disability-related laws, regulations, rulings, and free publications, as well as other information about Social Security programs|
|Regional or Local Office|
|Consult Appendix IV of the Catalog|
|Office of Public Inquiries, Room 4100, Annex, Social Security Administration, Baltimore, MD 21235. Telephone: (410) 965-2736. Use the same number for FTS|
Web Site Address
Supplemental Security Income - 2008 Edition
HOW TO APPEAL SOCIAL SECURITY DETERMINATIONS
Social Security and Supplemental Security Income
Supplemental Security Income (SSI): Frequently Asked Questions
How to Fight Termination of Supplemental Security Income
Supplemental Security Income (SSI)
Appealing a Decision by the Social Security Administration for Disability Benefit Eligibility
Supplemental Security Income
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