2009 Conference Presetation provided by: Connie Valt and Bob Hunt Social Security Administration Connie DaValt [email protected] WI Disability Determination Bureau Bob Hunt [email protected] SSDI & SSI Disability Overview Both programs make payments to people with disabilities. Social Security Disability Insurance (SSDI) Provides benefits to disabled or blind people who are “insured” by workers’ contributions to the SSA trust fund. Supplemental Security Income Makes cash assistance payments to the aged, blind and disabled who have limited income and assets. Who Can Get Social Security Disability Benefits? Worker Must have paid into Social Security five out of last 10 years. Spouse At age 62 At any age if caring for child under 16 or disabled Divorced spouses may qualify Child Not married under 18 (under 19 if still in high school) Not married and disabled before age 22 SSDI When do benefits begin? The disability board determines a date of onset that the condition begins. SSDI can be paid retroactively up to 12 months prior to the date the claim was taken 5 month waiting period when no benefits are payable Checks are paid the month after they are due (Feb check paid in March) Who Can Get SSI? Age 65 or older Blind – any age Disabled – any age Limited income Limited resources Eligibility can begin the month after Social Security is contacted (but we still need to wait for a medical decision). Checks come on the 1st of the month for that month. SSI Financial Eligibility2009 Rates Have low income and savings “Countable” income: Less than $674.00 per month (individual) Less than $1011.00 per month (couple) “Countable” assets: $2,000.00 for single person $3,000.00 for couple Health Insurence SSDI Medicare coverage – after 24 months of benefits SSI Medical Assistance coverage – in Wisconsin, comes automatically with SSI federal benefits Method of Application Online at socialsecurity.gov telephone appointment (1-800-772-1213) Application Process Paperless, no claims signature Signature needed on medical release Prepare for claim Complete pre-interview guide – worksheet Enter disability info on internet Disability Determination Services Each State has its own DDS – a state agency that contracts with SSA to make disability determinations for SSDI and SSI. Each DDS applies the same rules for disability determination, based on SSA laws and regulations. Individual determinations are team decisions made by a disability examiner and one or more medical consultants (MDs and PhD Psychologists) The Disability Determination Sequential Evaluation steps: Are you performing substantial gainful activity (earning at least $980/month)? Is your condition “severe”? Does your condition meet a Listing? Can you still perform past relevant work? Can you perform other less strenuous or less stressful work? SSA’s Listing of Impairments Find them at: ssa.gov/disability/professionals/bluebook/ If a Listing is met (or equaled), and the applicant is not performing Substantial Gainful Activity, the finding will be “disabled” based on medical considerations alone. If no Listing is met/equaled, evaluation moves on to the past/other work steps. Listing 11.19 Syringomyelia Syringomyelia with: A. Significant bulbar signs; B. Disorganization of motor function (i.e., significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements or sustained disturbance of gait and station). When a Listing Isn’t Met/Equaled The disability examiner determines the applicant’s “residual functional capacity” (RFC), considering: the medical findings details about daily activities effects of pain and other symptoms the opinions of treating and examining doctors any other relevant information RFC is then used at the past/other work steps Capacity for Physical Work Exertional capacity – sedentary, light, medium, heavy Ability to stand, walk, sit, lift, carry, handle, reach, crawl, see, hear, communicate Endurance for a 40 hour work week Ability to perform work functions without frequent rest break Capacity for Mental Work Ability to understand, remember, and follow directions independently Ability to respond appropriately to supervisor, co-workers, and usual work situations Ability to cope with routine changes or stresses in the work setting Ability to concentrate and complete tasks in a timely manner Information the Applicant can Provide When and where treatment has been provided (at least during the past year) Details about how the condition affects daily activities (in SSA’s Function Report) Details about the impact of pain and other symptoms If possible, a letter from a treating doctor – listing specific limitations and the supporting medical findings Consultative Examinations If insufficient information is available from treating sources, a CE may be scheduled. If so, attendance is very important. Failure to attend will likely result in a denial of the claim for insufficient evidence. If unable to attend, contact the disability examiner right away so that other arrangements can be made. For More Information Visit Social Security’s website at: socialsecurity.gov/ While there, locate the nearest SSA office by clicking on the “Find a Social Security Office” link, then enter your ZIP code. Call Social Security’s toll free number: 1-800-772-1213 This entry was posted in Medical Article, Q and A by admin. Bookmark the permalink.
Posted on: Wed, 02 Jul 2014 03:56:28 +0000
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