John S. Whitelaw, Supervising Attorney, Community Legal Services

Rebecca Vallas, Staff Attorney, Community Legal Services

Supplemental Security Income (SSI) for Adults with Disabilities

SSI Applications ProjectPepper Hamilton, LLP January 2013

Purpose of this Project

Elimination of General Assistance (GA) Getting SSI applications approved quickly is

even more critical Unassisted applicants are much less likely to

be approved at initial level Overall approval rate: about 1/3

What is SSI?

Signed into law in 1972 by President Nixon Provides minimum income to elderly/

disabled low-income Americans Must meet financial eligibility criteria and

medical disability standard Provides monthly benefit ($710 max for

2013) plus Medicaid (75% FPL)

Who gets SSI?

1.2 million aged 6.7 million disabled & blind ~7.9 million total

Compare: 34.6 million retired workers getting Social Security

Eligibility criteria

Medical eligibility Nonmedical eligibility

– Financial -- income & resources– Citizenship– Not discussed in this presentation

Definition of disability

Unable to engage in substantial gainful activity (SGA) because of a medically determinable impairment(s) which is (are) expected to last 12 months or result in death.

PHYSICAL

MENTAL

COMBINATION Same for SSI and SSDI

SSI vs. SSDI

SSDI (aka Social Security Disability Insurance (“Title II”)

– Insurance program for workers who have paid enough in FICA taxes to be covered

– Not a needs-based program

SSI (“Title XVI”)– Provides a minimum income to people who have not

worked enough to be covered– Or who are covered but receive less than $730 in SSDI

(“concurrent beneficiaries”)– Means tested

Sources of Law

Statute – Title II of the Social Security Act (42 USC § 401 et

seq)– Title XVI of the Social Security Act (42 USC § 1381

et seq)

Regulations– 20 CFR § 401 et seq– 20 CFR § 416 et seq

Program Operations Manual System (POMS)

Application Process

Individual submits application for benefits Local SSA office processes application, sends to

state agency that makes decision– Bureau of Disability Determination (BDD) (DOL)

BDD requests medical evidence from providers BDD sends forms to providers to complete BDD makes initial decision about whether individual

is disabled Average time: 3-5 months for initial decision

Application Process, cont’d

If denied, individual has right to appeal– 60-day* deadline, from date of notice

Next step is hearing before SSA Administrative Law Judge

Year or longer delay before getting a hearing Representatives often involved at this stage ALJ makes decision on disability Additional levels of appeal

* 60 day deadline plus five days for mailing

Individual files application

SSA determines non-medical eligibility

Applicant’s electronic record is returned to initiating SSA office

SSA notifies applicant of decision by letter

SSA sends medical information and releases to BDD, disability examiner is assigned

BDD processes claim & makes disability determination

SSA-3368 Disability Report SSA-3369 Work History Report(optional, can be included in Medical Summary Report)

SSA-827 Authorization to Disclose Information to SSA(one for each provider with medical information; use in conjunction with agency release form)

(Required, can be completed on-line)

IV - 2

“Sequential Evaluation”

Five Steps 1. Is applicant working at SGA level? 2. Does the applicant have a medically determinable

impairment or combination of impairments that is/are severe?

3. Do(es) the applicant’s impairment(s):a. meet a listing; orb. medically equal a listing?

4. Can the applicant return to “past relevant work”?5. Is there other work that exists in significant numbers in

the national economy that the applicant can perform despite his/her impairments?

Step One: SGA?

$1,040 per month for 2013 If applicant is working and earning this much

or more per month claim is denied at step one without further review.

Step Two: Severe Impairment

De minimis test Not an issue in most cases Typically comes into play with “older” adults

55+

Step Three: Listings

• Musculoskeletal• Hematological• Skin• Digestive• Respiratory• Oncology• Mental • Immune

Step Four: Past Relevant Work (PRW)

What qualifies as PRW? Work performed in the last 15 years Determine applicant’s current “residual

functional capacity” (RFC) – what he can do physically and mentally on a sustained basis

Can applicant do PRW with his/her current RFC?

Step Five: Other Work

Taking into account the applicant’s age, education, and PRW, is there work that exists in significant numbers in the national economy that the applicant can perform on a sustained basis?

SSI Application Project: What You Will Be Doing

“Clinic in a box” Limited representation for duration of

application assistance Single meeting with each applicant No ongoing relationship, follow-up,

obligations

SSI Application Project: What You Will Be Doing (Cont’d)

Completion of online “disability report” Completion of supplemental forms

– Work History report– Activities of Daily Living report – SSA’s medical release forms

Benefits– Front-loads the application to increase chance of

quick approval– Ensures greater completeness and accuracy

https://secure.ssa.gov/apps6z/radr/radr-fe

Part I: Online Disability Report

Basic info, medical history, work & education, functional information

– Note special education

Don’t stress over specific details of treatment– What’s important: provider name & contact info

Think creatively about where applicant may have received treatment (eg: prison, hospital, therapy from LICSW)

Print re-entry number (early on) and summary sheet (at end)

Part II: Supplemental Forms

Activities of Daily Living report– Handouts

SSA’s medical release forms (827)– Handout– Get these signed and witnessed

Skills Development

Interviewing skills Client contact Dealing with challenging clients Issue spotting and synthesizing facts into

helpful evidence in support of approval

Interviewing Challenging Clients

Homeless Mental illness Unreliable historians Difficulty abstracting

Questions?

We will be at clinic sessions to help!

Contact us

John S. Whitelaw, Esq.(215) 227-2403, jwhitelaw@clsphila.org

Rebecca D. Vallas, Esq.(215) 981-3797, rvallas@clsphila.org

www.clsphila.org