Social Security Disability / SSI : Application, …...SSD / SSI : Application, Cessation, and Re-evaluation Age 18 Redeterminations •At age or within one year of becoming 18, the
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Social Security Disability / SSI :Application, Cessation, and
Title II – 20 CFR 404.1520 - https://www.ssa.gov/OP_Home/cfr20/404/404-1520.htm#cTitle XVI - 20 CFR 416.0920 - https://www.ssa.gov/OP_Home/cfr20/416/416-0920.htm#c
• Sources of Law: CFRs, POMS (Program Operations Manual System), HALLEX (Hearings Appeals and Litigation Law Manual), SSRs (Social Security Rulings), Case Law, The Blue Book (Listing of Impairments), and Vocational Grids
• Disability is “all or none” in Social Security Programs. No partial or temporary disability benefits, but closed periods can exist.
• Defining Disability for Adults - “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”1
• Defining Disability for Children – “if you 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 not less than 12 months.”2
• Note the primary difference between adult and child cases highlighted in yellow above.
Title II – 20 CFR 404.1520 - https://www.ssa.gov/OP_Home/cfr20/404/404-1520.htm#cTitle XVI - 20 CFR 416.0920 - https://www.ssa.gov/OP_Home/cfr20/416/416-0920.htm#c
SSD / SSI : Application, Cessation, and Re-evaluationThe Essentials - Common Programs
• Title II Program
• DI (Disability) Benefits are funded through OASDI payroll deductions. It comes with delayed Medicare (ask about spend-down Medicaid!), and benefits are based on earnings history.
• Title II Derivative Programs (paid using the record of another)
• DAC (Disabled Adult Child) Benefits are based on a parent’s earnings and are for disabled individuals who are over 18 with disabilities that started before age 22, and whose parent is deceased or receiving retirement or disability benefits.
• Survivors Disability Benefits are Payable at age 50 and beyond to individuals who became disabled within 7 years of spouse’s passing and are even payable to divorced spouses if marriage lasted more than 10 years.
• Title XVI Program
• Supplemental Security Income (SSI) is a program for citizens (adults and children) with limited financial means (income and resource tested). SSI comes with Medicaid but pays a lower monthly benefit ($783 in 2020).
Medical records provided in support of disability filings are free in Georgia. O.C.G.A. §31-33-3 -https://medicalboard.georgia.gov/sites/medicalboard.georgia.gov/files/imported/GCMB/Files/Patient%20right%20to%20medical%20records.pdf
SSD / SSI : Application, Cessation, and Re-evaluationQuestions & Answers
Thomas O’BrienAttorney-at-Law
Download this presentation at:https://www.OBFlegal.com/files
The Law Firm of O’Brien & Feiler1.844.623.9467 x108
SSD / SSI : Application, Cessation, and Re-evaluation Appendix - Administrative Law Judge Hearings
• Takes place in a private courtroom, video at an SSA location and for now over the phone.
• Lasts about 45 minutes to an hour.
• Likely no decision on the spot.
• In the room will be the Judge (at a bench in black robes), Judge’s Assistant, Vocational Expert, Claimant, Claimant’s Attorney.
• In adult cases, witnesses are MOST EFFECTIVE where there are communication or reliability issues.
• Testimony may occur via video or phone and only an audio record is made.
• Not a job interview.
• Claimant is not required to be a medical expert. Simply be an expert on how their health affects them. What are the health problems that prevent work? What are negative symptoms from treatment? From medication?
SSD / SSI : Application, Cessation, and Re-evaluation Appendix - Administrative Law Judge Hearings
• Court proceeding – “Given Claimant’s age, education, work experience, and medical condition is there any work in the national economy that they can do full-time?
• Prove severe condition and erode capacity to work!
• Evidence is key to this process
• Medical records (review records prior to hearing!)
• Journals (migraines, seizures, panic attacks)
• Rx Records
• Not all evidence is created equal (school, EHR, etc.)
• Not meeting a listing is alright, and medical issues are additive (for example weight is a multiplying factor SSR 02-1p)!
• Skill level of prior work is very important, as are transferable skills.