Social Security Disability and Supplemental Security (disability); there is a difference!

One of the common issues that I must explain to clients is the difference between supplemental security income (SSI) and social security disability insurance benefits (SSD,SSDI or DIB). Simply saying one is an earned benefit program and the other is a safety net program, really does not work.



The Social Security Administration offers two different types of disability benefits, namely Social Security Disability Insurance Benefits and Supplemental Security Income for the disabled.



SSI or Supplemental Security Income: The program is a nationwide federal welfare program providing monthly cash benefits to eligible needy individuals or couples who are aged, blind or disabled. It is administered by the social security administration to help people who have not worked and who are in need of medical health insurance and supplemental income to survive.



To be eligible for SSI, a claimant must be either age 65 or older, blind, or disabled. In addition, there are additional requirements of citizenship or qualified alien status and legal residence, limited income, and resources. If found disabled under SSI, unlike having been found disabled under DIB, there is no five month waiting period. The only waiting period before payment of SSI disability benefits is the month is the month of application, i.e. SSI disability benefits are available from the month following the month of application.



DIB or Disability Insurance Benefits: This system is similar to the SSI system, but was originally created to help out disabled workers. The difference between SSI and DIB is you have to have worked 20 out of the last 40 quarters (essentially 5 our of the last 10 years) and paid into social security with your taxes to be eligible. SSA will calculate a DLI or date last insured to determine when you will last be eligible for DIB benefits. There are several big advantages DIB provides over what SSI provides. One advantage is that DIB benefit cash payments are based on your income and are often significantly more each month than SSI only. Income earned at a much lower level reduces the amount of SSI received and the receipt is also determined after your other non-income resources are counted.



Unfortunately for some claimant's caught in the disability process. They may apply for SSDI benefits and be denied and appeal the denial as far as District Court and lose. They later file a new application only to find that even though they had worked their whole life, now that over five years have elapsed since last day of work, they are no longer eligible for SSDI benefits and have only SSI benefits to support them in their disabled condition prior to reaching retirement age.

In this vein, consider the case of Collier v Barnhart,473 F.3d 444(2^nd Cir.2007) . Claire Collier had amyotrophic lateral sclerosis and on application for disability benefits was over 31 years of age. 20 CFR § 404.130(b). Ms. Collier had worked for 15 years from 1979 through 1994, she then left the work force to have and raise three children. During the period that she worked, she and her employer had contributed over $40,000.00 in Social Security and Medicare taxes. In 2003 she was diagnosed with ALS. Ms. Collier applied for disability benefits. She lost because she did not have sufficient work credits (an applicant above the age of 31 must have worked twenty of the previous forty quarters, i.e. 5 of the past 10 years). She brought a constitutional challenge to the recent work history requirements. She lost!

In summary consider the table provided in most part by the Social Security Administration.

	Social Security Disability Insurance	Supplemental Security Income
	A disabled or blind individual must have paid Social Security taxes for benefits.	A disabled or blind adult or child must meet all of the following categories: 1. Have limited income If you are an individual: you must have less than $2,000 in resources, can only own 1 automobile, can only own 1 home (must be your primary residence). If you are married: you must have less than $3,000 in resources, can only own 1 automobile, can only own 1 home (must be your primary residence). If you qualify for SSI benefits, you also qualify for Medicaid. SSI benefits can only be paid as far back as the month after you filed your application. So, if you filed an application in March 2008, your benefits can’t start until April 2008. 2.Be a U.S. citizen or national, or in one of certain categories of aliens; and 3.Live in the United States or Northern Mariana Islands.
	The monthly disability benefit amount is based on the Social Security earnings record of the insured worker.	The monthly payment is based on need and varies up to the maximum federal benefit rate. Some states add money to federal SSI payments.
	The worker will get Medicare coverage automatically after receiving disability benefits for two years.	In most states, beneficiaries are automatically eligible for Medicaid. (Not in Minnesota which imposes additional criteria. It is considered one of the (209(b) States.)

Children and Disability

Children and Disability

Children are to a parent the most precious thing in the world. Parents live, struggle and agonize with and over their children. When the child is disabled there may be a need to receive social security benefits on the child’s behalf. When parents make an application for benefits for their disabled child they are often mystified and confused when they receive a denial.

There are a couple situations that need to be discussed.  No discussion can do the subject justice because claims involving children are complicated.

If it is an adult child, who is disabled and not able to work, the child may be eligible for social security disability benefits (Title II) if:

1. The child has an insured deceased parent or an insured living parent who is receiving social security benefits for retirement, disability or blindness.
2. The onset of disability must precede the child’s 22^nd birthday.
3. An application is filed before the child attains the age of 23.
4. The disability is established for the child after age 18 but before attainment of age 22.

The situation is much different if dealing with a minor child. In almost all cases the child has no working history, benefits if available at all are payable under Title XVI – Supplement Security Income (SSI) benefits.

The history of benefits for minor children goes back to at least 1973. Prior to 1996, the standard defining childhood disability came out of the original 1973 SSI legislation. It defined childhood disability as “any medically determinable physical or mental impairment comparable in severity”…that would disable an adult. What that meant was that comparable severity, childhood disability/adult disability, was a condition that met or equaled a listed impairment, without any consideration to functional limitations (unless of course the functional limitations were part of a listings definition of a particular impairment).

In 1990 this definition of comparable severity was challenged. In Sullivan v. Zebley, 493 U.S. 521, 110 S.Ct. 885, 107 L.Ed. 2d 967(1990), the Supreme Court ruled that the Social Security Administrations narrow interpretation of comparable severity violated the Social Security Act. It violated the Act because the SSA did not take into consideration functional limitations for children.

In 1996 Congress passed the Personal Responsibility and Work Opportunity Act of 1996 (Act). The Act changed the statutory definition of disability for SSI eligible children. For a disabled child to be eligible for benefits, the child’s impairment must impose “marked and severe functional limitations.”

The Act eliminated the concept of “comparable severity”, and replaced it with the requirement that a child claiming benefits must now prove “marked and severe functional limitations, and that can be expected to cause death or that has lasted not less than 12 months.” § 416.906

A child alleging disability must show that an impairment or combination of impairments:

1. The impairment medically meets or equals a Listing, or
2. Functionally equals a listing.

SSA has interpreted the “marked and severe” language to mean a Listings level severity. § 416.911. Listing level severity is demonstrated when a child has marked limitations in two areas of functioning or extreme limitation in one area of functioning. § 416.926a

SSA will find that a child has a ‘marked’ limitation when the child's impairment(s) interferes seriously with his/her ability to independently initiate, sustain, or complete activities. It is a limitation that is “more than moderate” but “less than extreme”. An ‘extreme’ limitation is found when the child's impairment(s) interfere very seriously with the child's ability to independently initiate, sustain, or complete activities. § 416.926a(e)(2),(3)

SSA will look to six ‘domains’ to help determine disability. A domain is proposed as a method to show all of what a child can or cannot do. The six domains that are used are:

1. Acquiring and using information;
2. Attending and completing tasks;
3. Interacting and relating with others;
4. Moving about and manipulating objects;
5. Caring for yourself; and,
6. Health and physical well-being.

In applying the six domains, the regulations require that SSA consider the child’s age, effects of any treatment or medication, the structure or non-structure of his/her day to day living, chronic illness etc. § 416.924a

             To attempt to win such a case great reliance must be placed on testimony of care givers and medical/psychological records that show the extreme limitations required to obtain benefits.  In many case, interacting with the child on a one time basis, having one meeting and examination, does not demonstrate the limitation under which the child must live.  A treating physician, a treating psychologist who has seen and interacted with the child may in fact give the best evidence.  I have found that it is very difficult to get a ALJ to accept the treating physician rule when there is medical records in the file from 'independent' examiners.

          This the complexity of proving a disability case is difficult at best to explain to concerned parents.