You may have heard of disability benefits, though you may have questions regarding the regulatory maze that disabled individuals must work through to obtain them. A major area of confusion is the distinction between Social Security Disability Insurance (SSDI) and Supplementary Security Income (SSI). Both programs are administered through the Social Security Administration and have different criteria and requirements. This blog is meant to help demystify these two important federal programs and help you understand whether you or a loved one qualify.
You have the right to appeal any decision Social Security makes as to your entitlement to Social Security benefits or Supplemental Security Income (SSI) payments.
The first step in the appeals process is called a reconsideration determination. You will receive a new decision by someone who had no part in the first decision. The Social Security Administration (SSA) will send you a letter explaining how they made the decision. It is very difficult to get SSA to change their minds in a reconsideration request unless there is substantial medical information that was not received or considered during the initial determination.
The childhood disability rules apply to children from birth to age 18, although under certain circumstances, it can apply up to age 21. In any event, the onset of a disabling impairment must precede a child’s 22nd birthday.
In order to obtain Social Security benefits for a child, you must be able to show a physical or mental impairment which results in ‘marked and severe functional limitations’ and which can be expected to result in death or which has lasted or is expected to last a continuous period of not less than 12 months.
For children from birth to 3 years old, a child has a ‘marked impairment’ if he/she is functioning at more than one-half but not more than two-thirds of the child’s chronological age; or, for a child age 3 to 18, a limitation which is more than moderate but less than extreme. Marked limitation may exist when several activities or functions are limited and interfere seriously with the child’s functioning
The Social Security Administration (SSA) has interpreted this standard to require that in order for a child to be eligible for SSI, the child must establish that he or she meets, or medically or functionally equals, a ‘Listing’. SSA has published a Listing of Impairments (conditions) for 14 body systems and the required medical proof to show that a listing is met. If a child meets or functionally equals a listing, this will be considered as conclusive proof of disability.
HIV infection (AIDS) is a listed impairment for both adults and children. The HIV listings, one for children and one for adults, are part of the new Immune System Listing, section 14.00. The final regulations also contain provisions regarding the particular conditions of women with HIV infections. Important factors to be considered in evaluating the functioning of children with HIV infection include, but are not limited to, symptoms, frequency and duration of manifestations of disorder, periods of exacerbation and remission, and the functional impact of treatment, including the side effects of medication. If the child’s impairment does not meet the criteria of this HIV, consideration must be given as to whether the child has an impairment that satisfies the criteria of a listing in another body system. For example, a child with HIV infection may show signs and symptoms of a mental impairment or of another physical impairment.
A continuing disability review is required for all childhood disability recipients once every three years if their impairment is likely to improve.
For additional information regarding Social Security Disability or Medicaid, please follow this link.
Social Security law is complex; at Hoffman, Larin and Agnetti, PA we offer a free consultation so that you can learn your rights. There are no fees for representation before the Social Security Administration in disability claims, unless we win. We have offices throughout south Florida in Dade, Broward and Monroe Counties for your convenience.