Do You Know the Difference in SSI and SSDI?

Legal Issues

Do You Know the Difference in SSI and SSDI?

Social Security programs for People with disabilities

Two government programs that provide payments to people with disabilities are the Social Security Disability Income (SSDI), (also known as Disability Income Benefits), and Supplemental Security Income (SSI).  Many people do not realize that these are two different programs.  The SSDI application is an insurance claim.  The SSI application is a welfare application. An individual must first meet basic eligibility requirements and then they must be declared disabled according to the Social Security Administration.  The eligibility requirements for each program are different, however, the disability criteria are the same.

 

Basic Applicant Eligibility

 

For SSDI an individual is eligible to apply for payments if they are fully insured and currently insured.  A worker is fully insured if they have worked a minimum of 10 years (40 quarters), or if an individual is less than 32 years old has worked for at least half the quarters between age 21 and the age the applicant was at the time they became disabled. To be currently insured an individual must have become disabled while working in the recent past.  SSDI is considered an earned benefit and does not have a financial need requirement.

 

For SSI an individual must meet certain income, resource, and residency requirements. An individual must not have a countable income more than the current Federal Benefit Rate. In 2012 this is $698/month for an individual and $1048/month for a couple.  The individual must also have countable resources of less than a given amount.  For 2011 this limit was $2000 for an individual and $3000 for a couple. There are many exclusions for the income and resource calculations that require much analysis.  An individual must also 1) be a resident of the US, 2) be a citizen or qualified long term resident, 3) not be a resident of a public institution, 4) not be absent from the US for a calendar month unless they meet other requirements, 5) have applied for other benefits they are eligible for, 6) not refused vocational rehabilitation if disabled, 7) accept appropriate treatment, if available, for drug addiction or alcoholism, 8) not be a fugitive felon, and 9) not be violating a condition of parole or probation.

 

Disability Requirement

 

The second requirement, that the person is disabled, is the same for these programs The SSA considers an adult disabled if they are unable to engage in substantial gainful activity (SGA) due to any medically determinable physical or mental impairment or combination of impairments that can be expected to result in death, or that has lasted (or can be expected to last) for a continuous period of at least 12 months.

 

For people with diabetes whose disability is diabetes the following criteria are used by the SSA for determining whether an individual with diabetes is disabled:

 

The Applicant has been diagnosed with diabetes mellitus and has at least one of the following conditions:

 

A. Neuropathy demonstrated by significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movements, or gait and station that significantly interferes with walking or arm movement that lasts for a long time and is unresponsive to medical treatment.

B. Acidosis occurring at least on the average of once every 2 months documented by appropriate blood chemical tests (pH or pC02 or bicarbonate levels) on a continuous basis that is unresponsive to treatment over several months.

C. Retinitis proliferans with significant visual impairment..

 

In addition to the above criteria if an applicant has had more than one limb amputated that causes difficulties moving around then an individual is disabled according to the SSA.

 

The SSA uses a five step process to analyze information provided by an applicant’s doctors.

 

(1) Is the applicant doing substantial gainful activity? 

(2) Is the medical severity of the impairment(s) rather minor taking into account the duration of the condition and the need for bed confinement?

(3) Is the disability not on the list of presumptive impairments (e.g., total blindness, longstanding confinement to a bed, and longstanding confinement to a wheelchair)?

(4) Is the individual unable to return to any type of work the individual has performed in the past 15 years?

(5) Given an assessment of the individual’s residual functional capacity, age, education, and work experience, is the individual unable to make an adjustment to other work?

Older applicants (over 50 years of age) have an easier time being declared disabled because the SSA presumes that an older worker has more difficulty learning a new job.

 

It is very important to obtain a doctor who is willing to work with you on this process.  They must be willing to write multiple medical documents to support your claim.  This is sometimes a very frustrating experience for the applicant and the doctor.  The eligibility and disability determinations may appear simple and straightforward, however, there are many exceptions and conditions that need consideration.  There is an art to using the correct language in supporting documentation.  As with other government benefit programs I have written about, it is prudent to consult with counsel before attempting to complete an application.  There is an appeal process if the first decision is not good, however, it can be expensive and drawn out.  Providing the information the correct way the first time may save you money in the long run.

 

If you are a person with diabetes where the condition has significantly negatively affected your life you may be eligible for payments under SSI or SSDI.  Consult with an attorney to determine your chances of success and obtain guidance on how to proceed.

 

Note: This is not legal advice.  I'm not your attorney.  This provides general information and a start in deciding what to tell your lawyer.