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Case Considerations: SSDI And SSI

BASIC SOCIAL SECURITY DISABILITY (SSDI or SSI) CLAIMS PROCESSING CONSIDERATIONS

  1. SSDI and SSI GENERAL ELIGIBILITY CONSIDERATIONS
    1. Citizen or Qualifying Legal Immigration Status – Lawful Permanent Resident & Some Other Limited Exceptions
    2. Adult -18 or over +must be totally disabled for all substantially gainful forms of employment
    3. Child –under 18–must be “blind” or have functional limitations that are marked or severe as defined by regulations
  2. SSDI Specific Eligibility Considerations
    1. Must be “currently insured” at time of Disability onset
      1. Determination of “current insurance” – must have certain number of quarters of coverage in proximity to date disability began – generally20 out of last 40 calendar quarters must have tax withholdings
        1. Caveat – exception for younger worker in terms of acquiring insured status
  3. SSI Specific Eligibility Considerations
    1. Must have very limited financial resources – generally cannot have $ 2000 or more in assets at any point in time
  4. 5 Step Inquiry by Social Security Administration- burden of proof in on claimant during steps one thru four below; at step 5 burden shifts to SSA to establish claimant can do work which exists in the economy
    1. Step 1: Is the claimant currently performing substantial gainful activity (i.e. earning income over a specified amount) ?
      1. If so, claim is denied
    2. Are the claimant’s alleged impairments severe enough to significantly limit his or her physical or mental ability to do basic work activities?
      1. If not, the claim is denied. Otherwise, proceed to step 3
    3. Does the claimant have an impairment which meets one of the specified listings found in 20 C.F.R. Part 404, Appendix 2?
      1. If so, the claim will be allowed and benefits will be awarded
        1. The listings generally require severe or marked impairments supported by very substantial medical evidence
    4. Considering all of the claimant’s impairment and their effect on his or her ability to perform work-related activities, can the claimant do his or her past relevant work?
      1. If so, the claim is denied. Otherwise, proceed to step 5
    5. Step 5 – Considering all of the claimant’s impairments and their effect on his or her ability to perform work-related activities, and also considering the claimant’s age, past education and work experience, can the claimant be expected to perform any other work in the national economy?
      1. Judge will consider vocational factors – jobs available in the economy and claimant’s ability to perform those jobs
      2. If yes, the claim is denied. If no, benefits will be awarded
  5. Favorable Factors in Regulations that can Work in Claimant’s Favor
    1. Older or Advanced age – 50 or over 54
    2. Lack of education
    3. Lack of English Literacy
    4. Objective medical evidence proving substantial impairment
    5. Lack of transferable skills
      1. Skills compatible with jobs in economy
      2. Physical restrictions are not compatible with jobs available in economy
  6. Procedural Time Limits
    1. Request for Reconsideration Must Generally be filed with SSA within 60 days of receipt of initial denial of claim
    2. Request for Hearing By an Administrative Law Judge Must Generally be filed with SSA within 60 days of receipt of denial of reconsideration from SSA
  7. VI. Attorney’s Fees
    1. Generally – 25% of any retroactive award of benefits or $ 6000 whichever is less

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