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Social Security Benefits: SSI and SSDI

NOTE: The following information is general information only, and is to explain major issues in getting Social Security's disability related benefits.  It is not legal advice.  The Social Security Administration can be reached through their website or at (800) 772-1213 for further information.  The following includes NAMI's short fact sheet that provides an overview of the applcation process, and then information by NAMI of Southwestern Wisconsin.

Social Security Benefits (from NAMI National's Website)

Note:  Amounts are not current.  See Social Security for the correct amounts.

Are you or your relative entitled to Social Security Benefits?

Mental illness, like a physical illness, can be disabling. Persons with a serious mental illness are just as entitled to disability payments as persons with a serious physical illness. If you or your relative has a mental illness such as schizophrenia, obsessive-compulsive disorder, manic depression, or another disabling brain disorder (mental illness), you may be entitled to benefits from the Social Security Administration. For all inquiries, call the Social Security Administration at 1-800-772-1213.

Who receives disability payments?

More than 8.6 million Americans receive disability benefits from Social Security programs each year. The Social Security Administration defines disability in terms of ability to work. Persons who cannot work for a year or more, or whose condition is likely to result in death, may qualify for benefits. Doctors and disability examiners at state agencies determine disability examiners based on clinical evidence and examinations.

What specific disability program might I be eligible for?

You could be entitled to receive payments from one, or both, of two Social Security programs: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). SSI is for persons who are disabled, poor, and unable to work. SSDI is for persons who are disabled and unable to work, but who have worked in the past, or whose parents have worked and paid into the social security trust fund. The standard SSI rate for 2000-2001 pays individuals $512 a month, $769 for a couple and more if there are children. About half the states supplement SSI, which increases cash benefits. The amount you may be entitled to from SSDI can be much larger, depending on work history.

How do l apply for social security benefits?

Applicants must generally apply in person at their local Social Security Administration (SSA) field office. Family members or guardians may apply when the disability is so severe that it prevents the individual from applying. Family members or guardians should call SSA to find out what procedure they should follow.

If it's clear I have a disability, will I automatically receive benefits?

The Social Security Administration has four basic standards for determining disability.

• Earnings - Generally, If you make $700 a month or more, you will not be considered disabled.
• Severity - If your condition does not interfere with basic work-related activities, your claim will be denied.
• Checklist - If your condition is not on a list of disabling impairments maintained by Social Security, SSA would have to decide if your condition has the same disabling effect as a condition on the list in terms of ability to perform work.
• Type of work - If you cannot do the work you did previously, SSA looks to see if you can do any other kind of work taking into account your age, education, past experience and transferable skills. If you cannot work, you will be considered disabled.

What does the application involve?

A field representative will conduct an in-depth interview with the applicant and complete a variety of application forms. The SSA representative will ask about the applicant's disability, medical history, leisure time activities, and financial status. This process can be difficult particularly if the applicant is experiencing symptoms or if the interviewer is not skilled. You may want a relative or friend to accompany you for support

After the Interview is complete, what's the next step?

A caseworker from SSA and a caseworker from the state Disability Determination Service (DDS) share responsibility for determining eligibility for disability programs. The SSA caseworker will focus on financial eligibility while the DDS caseworker will focus on medical and functional information. A decision should be reached within three months from the application date. This happens rarely, however. The process will more likely take six months. It's a good idea to call and check on the status of the application.

What are the chances of receiving benefits?

Good, if you are willing to be persistent. Two out of three persons who apply for disability benefits are initially rejected. These applications are often rejected for what appear to be arbitrary reasons. If you appeal an initial rejection, your chances of obtaining benefits improve. In 1999, over half of disability cases that were appealed to an administrative law judge were won by beneficiaries. Appeals must be filed within 60 days of receiving a notice of determination.

If the application for benefits is turned down, what can be done?

Four levels of appeal exist. You can:

1. Ask for reconsideration by another DDS caseworker to determine if the initial decision was proper. These reviews rarely result in overturning the initial decision.
2. Ask for an administrative hearing-a formal hearing before an administrative law judge. You may request a hearing before an Administrative Law Judge if you disagree with the reconsideration decision. Such judges try hard to remain objective. In 1999, 55% of disability cases appealed to these judges were decided in favor of beneficiaries.
3. Ask for a review by the SSA Appeals Council. This council reviews decisions by administrative law judges. The council usually leaves judges' decisions unchanged.
4. Appeal a denial of disability benefits to a U.S. Federal District Court. Relatively few claimants get their case heard at this level, and the chances of a favorable ruling are only slightly better than the previous level.

If I have other questions, where do I go for answers?

Call the Social Security Hotline at 1-800-772-1213 between 7 a.m. and 7 p.m. EST weekdays. The best times to call are early in the morning and early in the evening.

Updated July 2000
Permission is granted for this fact sheet to be reproduced in its entirety, but it must include the NAMI name and logo.

INFORMATION FROM NAMI OF SOUTHWESTERN WISCONSIN FOLLOWS

SSI is a means-tested program.  If you receive money from other sources, you need to report it, and your SSI benefits may be adjusted.  The State of Wisconsin supplements SSI benefits by a small amount with state funds.  You automatically qualify for Medicaid (Medical Assistance) if you receive SSI.

SSDI is not directly means-tested.  "Unearned" income does not reduce your benefits.  You need to have a sufficient work history to receive benefits,.  How much work history is required depends on your age.  Young people can sometimes qualify through their parents' work histories if their parents are deceased or collecting social security benefits.

It is extremely common to be denied when you first file an application.  It is important to file your appeal on time when you are denied.  You can hire an attorney to assist you with your application, especially if you need to go before an adminstrative law judge.  Social Security places a limit on how much your attorney can charge you.  It is not uncommon for Social Security to schedule an appointment with a doctor of their choice to evaluate you.  The interview with the field representative may take place over the phone.

When you answer questions about your abiities on their applications, it is important to be honest, even about ways your disability limits your social activities and daily life.  It can be difficult to admit you are having some types of problems, especially psychiatric problems that do not appear to relate to your ability to work.  Financial constraints can force you into completing these forms when you are still in denial about some aspects of your illness.  It is easier for Social Security to understand why you are unable to work if you also have problems in other areas of your life, and if you cover up how badly you do in these situations, they will think those situations reflect your real abilities.

You will be asked to have someone who knows about your disability complete a checklist about you.  You should choose the person who will complete the checklist about you carefully.  They should be aware of how hard your disability makes life for you, and not think you could simply "snap out of it" if you wanted.  If some of your friends and family think you are doing better than you think, and some think you are doing worse, choose one who thinks you are doing worse.  You do not have to agree with them.  If you are asked to complete a checklist about someone else, it is important to list their problems honestly, even if they are not always willing to admit them.  They will not receive a copy of your checklist without making a special request.  You can mention that you think they are in denial about some of the problems you see if you like.

You can work part-time while receiving SSDI or SSI benefits.  The information about both programs is complex.  It is summarized in a short booklet,  The "red book" is a detailed documentation of all of the applicable rules. 

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