Wednesday, May 30, 2012

What is the Difference Between SSI and SSDI?

In reality, Social Security Disability Benefits are governed by two separate programs: SSI and SSDI.  What is the difference between the two?
  • The Social Security Disability Insurance (SSDI) program pays benefits to you and certain family members, if you worked long enough and paid Social Security taxes.
·        Your adult child also may qualify for benefits on your earnings record if he or she has a disability that started before age 22.
·       The Supplemental Security Income (SSI) program pays benefits to disabled adults and children who have limited income and resources.
The definition of “disability” is the same under both programs and is determined by the same process.
          Who Qualifies for SSDI?
You must have worked long enough--and recently enough--under Social Security to qualify for SSDI.
Social Security work credits are based on your total yearly wages or self-employment income. You can earn up to four credits each year.

The amount needed for a credit changes from year to year.  In 2012, for example, you earn one credit for each $1,130 of wages or self-employment income.  When you've earned $4,520, you've earned your four credits for the year.

The number of work credits needed for disability benefits depends on your age when you become disabled.  Generally you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled.  However, younger workers may qualify with fewer credits.
The rules are as follows:
  • Before age 24--You may qualify if you have 6 credits earned in the 3-year period ending when your disability starts.
  • Age 24 to 31--You may qualify if you have credit for working half the time between age 21 and the time you become disabled.  For example, if you become disabled at age 27, you would need credit for 3 years of work (12 credits) out of the past 6 years (between ages 21 and 27).
  • Age 31 or older--In general, you need to have the number of work credits shown in the chart below.  Unless you are blind, you must have earned at least 20 of the credits in the 10 years immediately before you became disabled.

Born after 1929, Became Disabled At Age:

Number of Credits You Need:
31 through 42
62 or older
          Who Qualifies for SSI?
Whether you can get SSI depends on your income and resources (the things you own).

Income Limits:
Income is money you receive such as wages, Social Security benefits and pensions.  Income also includes such things as food and shelter.  A person who is not blind and is just now applying for SSI disability benefits and earns more than $1,010 a month probably will not be able to get SSI benefits.

Social Security does not count all of your income when it decides whether you qualify for SSI. For example, the SSA does not count:
  • The first $20 a month of most income you receive;
  • The first $65 a month you earn from working and half the amount over $65;
  • Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as food stamps;
  • Shelter you get from private nonprofit organizations; and
  • Most home energy assistance.
If you are married, the SSA also includes part of your spouse’s income and resources when deciding whether you qualify for SSI.  If you are younger than age 18, the SSA includes part of your parents’ income and resources.  And, if you are a sponsored noncitizen, the SSA may include your sponsor’s income and resources.
If you are a student, some of the wages or scholarships you receive may not count.
Limits on Resources:
Resources that the SSA counts 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, the SSA does not count:
  • The home you live in and the land it is on;
  • Life insurance policies with a face value of $1,500 or less;
  • Your car (only one car);
  • Burial plots for you and members of your immediate family; and
  • Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.

Wednesday, May 23, 2012

Age is an Important Factor in Your Social Security Disability Application

As a Social Security Disability Lawyer, I am particularly sympathetic to applicants who are forced to start over and learn a new career when --as a result of an illness or a condition-- they can no longer perform the duties of their old job.  I find that helping Social Security Disability applicants who are over 50 is very gratifying and would like to provide a brief explanation of some of the strategies used by competent Social Security Lawyers who work in these types of cases.   

Fortunately, the Social Security Administration acknowledges a basic precept of the human condition: the older we get, the harder it is for us to perform certain types of work and re-adapt to the requirements of a new job.  In fact, Social Security Disability law provides different guidelines for different age groups.  As a general rule, the older you are, the more likely you are to get Social Security Disability Benefits. 

Social Security Disability rules regarding age are contained in the Medical Vocational Guidelines, which are rules used by the Social Security Administration to determine whether an applicant can adapt to a new job.  Social Security Disability Lawyers commonly referred to these rules as: "the Grids". 

Once a person turns 50, the Grids play a pivotal role in the Social Security Disability Process.  In many instances, the Grids specifically establish that certain applicants qualify for Social Security Disability Benefits as a matter of law.  For example, if your condition limits you to sedentary work and you are over 50, Social Security assumes that you are no longer able to adapt to a new type of job.  Therefore, age makes a huge difference in determining disability.  Based on the Grids, a person that can only do simple sedentary work at 48, will loose, but would be able to obtain Social Security Disability Benefits at age 50.  Moreover, at age 55, the rules are even more favorable to the applicant.  Social Security assumes that a 55 year old person who is physically capable of performing light work, cannot transition to any other type of work. 

As an attorney, I use these legal presumptions contained in the Grids to help persons over 50 win their Social Security Disability Benefits.  If you are considering filing for Social Security Disability Benefits or would like to know how your age might impact the possibility of obtaining benefits, feel free to call me at (860) 338-5619 and ask for a free case evaluation.  You may also fill the brief questionnaire at the top right corner of this page and submit it to my office.  I will try to get back to you within 24 hours.          

Wednesday, May 16, 2012

Can people with lupus qualify for Social Security Disability benefits?

May is Lupus awareness month.  For this reason, I figure that this is a perfect opportunity to write about the process of applying for Social Security benefits when suffering from this disease.

First, it is important to keep in mind that lupus affects everyone differently. Therefore, not two Social Security Disability benefit cases involving lupus are alike.  Don't expect your Social Security Disability Lawyer to make the same argument, as the lawyer of the person that you met at the waiting room of your rheumatologist’s office. 

Second, bear in mind that not everyone is disabled by lupus. A diagnosis of lupus does not automatically entitle a person to disability benefits.  The Social Security Administration recognizes systemic lupus erythematosus as a potentially disabling illness and includes SLE in their listing of impairments. Nonetheless, if you have been diagnosed with lupus and the disease is affecting your activities of daily living, it is a good idea to be proactive and schedule a consultation with a Social Security Disability Lawyer.   I'm always available for free consultations and don’t mind learning about a person’s case well in advance of the actual date of the “onset of disability” (the date when you can no longer work).   I believe that a conscientious disability attorney should be willing provide you with a free consultation, particularly when you suffer from a serious condition such as lupus. 

One of the reasons why I like to talk to clients well in advance of filing for Social Security Disability Benefits, is that, in order to successfully obtain social security benefits, an applicant must have the support of his or her doctor(s).  Consequently, I urge my clients to ask their doctors if they are willing to fill up social security questionnaires and provide letters in support of their patient’s applications for social security benefits.  Unfortunately, many doctors don’t cooperate with their clients and refuse to fill up these forms regardless of the severity of their patient’s condition. 

There are two basic ways that a person can qualify for Social Security benefits due to lupus.  An individual can meet the requirements of a listing set out in Social Security's list of qualifying impairments or show that he or she is unable to work. 

The list of impairments is essentially a "Blue Book" used by the Social Security Administration to determine whether an individual meets the Social Security definition of disability.  If a person’s condition “meets or equals” the listing, then that person is automatically deemed to be disabled.  The listing for lupus is contained in Section 14.02 of the listing.  However, this listing does not intend to cover all aspects of the disease.  In many instances, Social Security lawyers are able to prove that that a person with lupus is eligible for Social Security Benefits even when the applicant’s condition does not resemble the description contained in the lupus listing.  One way to prove that a person with lupus is entitled to Social Security Disability Benefits is to show that the person’s condition resembles the condition of a listing other than lupus.  Remember, lupus is known as “the great masquerader”.  If the type of lupus that you are afflicted with has been masquerading itself as a heart condition, then you should look at the listing for cardiovascular conditions and see whether you can prove that you meet that section of the listing.  Likewise, if your lupus has characteristics similar to crohn’s disease then, you should consider arguing that you equal listing 5.00 of digestive disorders.
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then the Social Security Administration must determine if it interferes with your ability to do the work you did previously (during the last 15 years). 

If you cannot do the work you did in the past 15 years, the Social Security Administration will see if you are able to adjust to other work.  The Social Security Administration will consider your medical conditions and your age, education, past work experience and any transferable skills you may have.  If you cannot adjust to other work, your claim will be approved.  If you can adjust to other work, your claim will be denied. 

Back in April, I gave a presentation about Social Security Disability Benefits to the Hartford Chapter of the Lupus Foundation.  I enjoy giving these types of presentations to all different kinds of advocacy and support groups.  I can make these presentations live or via conference call.  If you would like me to give a talk to your organization, please, don’t hesitate to give me a call at (860) 338-5619 or send me an email to


Tuesday, May 15, 2012

Walk for Lupus On Sunday, May 20, 2012 9:00 A.M., Blue Back Square, West Hartford

The Connecticut Chapter of the Lupus Foundation is having its biggest walk this Sunday and I plan to be there. Its a great opportunity to spread awareness and help improve the lives of those living with this terrible disease. Over the past several months I have had the pleasure of working with the Connecticut Chapter on several projects. Its a great group of people; full of energy and enthusiasm.
The West Hartford walk is one of the most important fundraising events for the LFA in the State. Your donations support important programs and services that provide help to people living with lupus today.
To volunteer for the walk contact Corrianne Gagliardi (860) 416-5250 at the Connecticut Chapter of the LFA or friend:!/LupusFoundationofAmericaCTChapter

Monday, May 14, 2012

Who is Considered "Disabled" by the Social Security Administration?

The definition of disability under Social Security is different than other programs. Social Security Administration (SSA) pays only for total disability. No benefits are payable for partial disability or for short-term disability.
"Disability" under Social Security is based on your inability to work. The SSA considers you disabled under Social Security rules if:
• You cannot do work that you did before;
• The SSA decides that you cannot adjust to other work because of your medical condition(s); and
• Your disability has lasted or is expected to last for at least one year or to result in death.
This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments.

Saturday, May 12, 2012

A Brief Explanation of "the Five Step Sequential Process" Used by Social Security to Determine Whether a Person Qualifies for SSI or SSDI

To decide whether you are disabled, the SSA uses a step-by-step process involving five questions.  They are:

1. Are you working?  If you are working in 2012 and your earnings average more than $1,010 a month, you generally cannot be considered disabled.  If you are not working, the SSA moves to Step 2.
2. Is your condition "severe"?  Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, the SSA will find that you are not disabled.  If your condition does interfere with basic work-related activities, the SSA then moves to Step 3.
3. Is your condition found in the list of disabling conditions?  For each of the major body systems, the SSA maintains a list of medical conditions that are so severe they automatically mean that you are disabled.  If your condition is not on the list, the SSA has to decide if it is of equal severity to a medical condition that is on the list.  If it is, the SSA will find that you are disabled.  If it is not, the SSA then will go to Step 4.
Many common disabling conditions appear on the listing.  For example, the listing for Systemic Lupus Erythematosus is contained in Section 14.02:

14.02 Systemic lupus erythematosus. As described in 14.00D1. With:
A. Involvement of two or more organs/body systems, with:
1. One of the organs/body systems involved to at least a moderate level of severity; and
2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).
B. Repeated manifestations of SLE, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
1. Limitation of activities of daily living.
2. Limitation in maintaining social functioning.
3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

4. Can you do the work you did previously?  If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then the SSA must determine if it interferes with your ability to do the work you did previously (during the last 15 years).  If it does not, your claim will be denied. If it does, the SSA will proceed to Step 5.
 5. Can you do any other type of work?  If you cannot do the work you did in the past, the SSA will see if you are able to adjust to other work.  The SSA will consider your medical conditions and your age, education, past work experience and any transferable skills you may have.  If you cannot adjust to other work, your claim will be approved.  If you can adjust to other work, your claim will be denied.

Tuesday, May 8, 2012

Checklist of Things to do Before you File a Long Term Disability Appeal

When a claim is denied, there is a very short period of time in which to submit an administrative appeal to the insurance company that denied the claim (typically 180 days).  If the appeal is not filed within this time period, it may be impossible to later challenge the denial in court.  This is why you must take certain steps immediately in order to protect your rights.  Here is a check list of some important things that you must do before you file the appeal.  If you call (860) 338-5619 and retain our legal services, the Law Office of Iván A. Ramos, LLC will assist you in completing the items mentioned in the check list.

            1.         COUNT THE DAYS AND CALENDAR YOUR APPEAL DEADLINE:   On a calendar, you need to count the days that you have to file the appeal.  Write down a reminder of the date on your cell phone calendar and on a regular calendar.  Also, ask a friend or a relative to remind you of the date.  Make another reminder in the calendars, several weeks before the date that it is due.  You should never wait until the last day to mail the appeal.  It is usually advisable to mail it, via overnight mail, several weeks ahead of the deadline. 

            2.         MAKE DOCTORS APPOINTMENTS AND UPDATE YOUR MEDICAL   CONDITIONS:  You need to make appointments with all the doctors that have been treating you, particularly those that know the most about your disability.  The purpose of the visit is to make sure that the medical files are updated with the status of your condition.  Sometimes conditions have worsened but the medical files do not reflect your current status accurately.  You should also ask the doctor if he or she would be willing to write a letter detailing your limitations. 

            3.         REQUEST A FULL UP-TO-DATE  COPY OF YOUR DISABILTY PLAN AND OF THE CLAIM FILE:  Pursuant to Federal Law, you have a right to obtain a copy of your disability plan and of all the documents that the insurance company has in  your claim file.  Obtaining these documents is important because it gives you the reasons why you have been denied benefits.  From these documents, you will get sense of the   theories and strategies that the insurance company will rely on to continue to deny your benefits.  You should also check to see if the company has included all the necessary medical documentation in the file       
            4.         REQUEST COPIES OF ALL YOUR MEDICAL RECORDS:  Medical  records are an essential part of all Long Term Disability Appeals.  In your appeal, you  must present a full picture of your medical conditions.  Once your administrative appeal  is filed, you are not allowed to introduce any new evidence in your case.  For this reason,  it is always a good idea to err on the side of caution and gather as much medical information about your condition as possible.  You should also review your medical records and make sure that all the information is accurate.  If any information in the      records is inaccurate, you can ask your doctor to correct it.

You should keep detailed notes of all telephone conversations that you have with the insurance company and keep copies of all correspondence in your case.  This will also give you a better understanding of the strategies and theories that the insurance company might use justify their denial.

            6.         CHECK YOUR POSTINGS IN FACEBOOK AND OTHER SOCIAL NETWORKS:  Insurance companies will go into Facebook, Linkedin, Twitter and other social media in search of information that might weaken you disability case.  In many instances, information contained in social media is misconstrued and used by insurance  companies to contradict your claim that you are unable to perform certain activities.  For this reason, it’s a good idea to remove any pictures or postings that could weaken your case.  The bottom line is that should always be careful with what you post the internet.

            7.         READ YOUR POLICY:  Take time to read your long term disability policy carefully.  It’s important that you obtain a good understanding of how the provisions in your policy apply to your particular case.

            8.         BE CAREFUL WHEN YOU SIGN MEDICAL AUTHORIZATION FORMS:  Insurance companies have the right to request your medical records.    However, on some occasions insurance companies ask claimants to sign authorization  forms that cover more than just medical information.  You don’t have to allow the insurance company to talk to previous employers or give them permission to obtain financial documents.  You should read all medical authorization forms carefully and redact from it any language allowing the company to obtain non-medical information.

            9.         UNDERSTAND WHY YOUR CLAIM WAS DENIED:  The ancient Chinese warrior-philosopher Sun Tzu encouraged his troops to "know your enemy" before going into battle.  Likewise, you need to read your denial letter and understand the reasons why your disability benefits were denied.  Before you advocate on your own behalf, you need to have a good understanding of your opponents’ argument.  If the denial letter is unclear, you might want to write a letter to the insurance company asking for clarification. 

            10.       GATHER INFORMATION THAT DESCRIBES THE NATURE OF YOUR WORK:  You need to gather documentation that adequately describes your job duties.  You may need this information because in many instances job titles don’t reflect the  actual duties performed by an employee.  You must also consider obtaining letters from  your previous employer stating the difficulties that you had performing your job. 

            11.       OBTAIN DOCUMENTS FROM THE SOCIAL SECURITY   ADMINISTRATION:  If you are receiving social security disability benefits, it is important that you obtain a copy of your complete file at the Social Security Administration.  Although the definition of disability used for awarding SSDI benefits is usually different for the definition used by your insurance company, the information contained in SSA documents is highly persuasive evidence that you are unable to work as a result of your condition.

          12.       IDENTIFY A FRIEND OR A RELATIVE THAT CAN HELP YOU IN THE PROCESS:  Finally, it is always a good idea to have a close friend or a relative help you during this difficult process.  Find someone who can help you gather all the information  needed to file the appeal and who can keep track of your medical appointments and deadlines.

The Law Office of Iván A. Ramos, LLC strongly recommends that you contact us as soon as you encounter problems with the granting of your benefits.  We will provide you with a free initial consultation.  If we represent you and you do not get benefits or payments from the insurance company, we will not charge you for our legal fees.  You will only be responsible for the costs associated with pursuing the appeal.   

Call (860) 338-5619

Our firm will not charge you legal fees, unless we get payments for you.