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Benefits
& Insurance
Social
Security Planner
Table
of Contents
Workshop: A Guide to Applying for SSI, SSDI and
Presumptive SSI.
The workshop will cover the
following areas:
- Medical
and financial eligibilities
- Supplemental
forms
- Payment
programs
- Sample
answers
- Step-by-step
application guide
- Medical
reports
- Interview
process
- Application
timeline
- COBRA/OBRA
notification requirements
Check Calendar listings for Social Security Workshops
For additional information contact APLA at 231.201.1600 and ask to speak with a Benefits Counselor.
Applying
for Social Security
The Social Security
Administration (SSA) oversees two disability payment
programs: Social Security Disability Insurance (SSDI)
and Supplemental Security Income (SSl). The application
process for both is essentially the same.
Who Can Apply?
You must have
a medical, or mental, condition that prevents you from
working for the foreseeable future (usually at least
a year). If you are working, you must stop, or be earning
less than $900 (2007) a month. Unearned income, such
as State Disability Insurance, General Relief, government
housing aid, and private income from disability insurance
will not necessarily interfere with eligibility.
Legal permanent
residents may be eligible if they were legally
in this country prior to August 22, 1996. Those
who came here after that date may not be eligible
for SSI unless they fall into an exempt category.
Undocumented residents are not eligible for SSI.
They may receive SSDI if they are in their countries
of origin. Non-citizens should consult a benefits
counselor to determine eligibility.
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Medical
Eligibility for HIV
- A
disabling HIV diagnosis must be based on infections
and symptoms, not T-cell counts or viral loads.
Social Security does not consider "under
200 T-cells" a disabling diagnosis.
- Social
Security approves or denies disability by reviewing
charts and files from all medical facilities
where you have received treatment.
- The
Medical Report (Form #4814) at the end
of this packet lists 41 infections or conditions
in Box C that meet the definition of a
disabling AIDS diagnosis.
- Box D on the #4814 outlines what Social
Security may consider a severe
HIV symptomatic diagnosis with "repeated
manifestations" of various
infections.
- HIV
symptomatic diagnoses
may be denied without
additional documentation
(see Documenting
Your Disability
Claim in this packet).
- Other
conditions (chronic
back pain, psychiatric,
etc.) may contribute
to an otherwise
weak HIV claim.
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Financial
Eligibility
Social Security
Disability Insurance (SSDI):
- You
must have paid into the Social Security Trust
Fund through F.I.C.A. payroll taxes.
- If in
your mid-thirties, you must have paid in for
at least five of the 10 years before you became
disabled; if younger, fewer years of pay-in
are required; if older, more than 5 years.
- Benefit
amounts are based on life-time pay in and
range from $1 to around $1,700 (2007) a
month.
- No
payment for first five months of
disability, but the start date
of disability can be backdated
(State Disability or Presumptive
SSI may cover the five-month period
before payments begin).
- SSDI
can be applied
for and collected
together with State
Disability; other "unearned" income
and assets are
not counted against
claimant.
- Dependents
and survivors'
awards are available.
- Legal residents who paid in are eligible; undocumented residents
may only be eligible in their home country.
Supplemental
Security Income (SSI)
- A
federal welfare program; no pay-in through taxes
required.
- Income
from any source must be under SSI's current
payment level of $856 (2007) for a single individual.
- Income
from friends, family, including help with
rent and food, will count against claimant;
loans from friends, family, etc., are not
counted.
- Assets
(bank accounts, pensions, etc.)
must be under $2,000 (single rate).
- One
vehicle and one
house are exempt
from assets limitations.
- "Spend-down" of
assets to qualify
is allowed.
- Undocumented
residents
are
generally
not
eligible.
Presumptive
SSl and Emergency Advance Payment
"Presumptive" eligibility
is a special category available to people with severe
HIV symptomatic or AIDS diagnoses. Under Presumptive,
Social Security can start paying SSI benefits immediately.
Some offices can hand-write same-day checks; these
are called "emergency advance payments." Social
Security can make Presumptive payments for up to six
months while your claim is being processed. If you
have no income, you should apply for Presumptive.
- Financial
eligibility is the same as for SSI.
- For
people in "dire need" who have no
money and whose health, nutrition or residence
will be endangered without immediate income.
- A
completed Medical Report (Form #4814, at
the back of this packet) is required for
Presumptive applications.
- Not
all offices readily offer Presumptive
and emergency advance payment;
check with the office where you
are applying first.
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THE
APPLICATION INTERVIEWS
Interviews with
claims representative can be done in person or over
the phone. Going in person is recommended. You won't
have to mail vital documents and can speed up the process.
During the
application process, Social Security's claims representatives
should investigate your eligibility for SSDI, SSI
and Presumptive. Make sure you ask about all three
payment programs.
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SSDI
INTERVIEWS:
The claims representative
needs to know about your condition, how it prevents
you from working, your work history, if you have been
married, or in the military, and whether you will be
collecting State Disability. SSDI does not pay for
the first five months of disability. Make sure you
back-date the start of your disability as close as
possible to when you last worked. Apply for Presumptive
SSI if you have no income during this period.
What
to take with you for an SSDI Interview:
- Original
or state-certified copy of your birth certificate,
or other childhood identification (baptismal
certificate, grade school records, etc.)
- Two years of W-2 forms or tax returns
- Military discharge papers (DD-214)
-
Social Security card or number
- State Disability check stubs
- Completed Social Security Disability Report, Function Report and, depending on diagnosis,
Vocational Report
- Proof of residency status if not a citizen
- Marriage license, proof of child support
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SSI
INTERVIEWS:
SSI interviews
are more involved. You will be asked about any current
income and your assets, including bank accounts, stocks,
bonds, pension plans, saleable life insurance policies,
etc. You will also be asked about your living arrangements.
You must be paying your "fair share" of rent,
food, utilities, etc. If someone gives you money for
your expenses, or if you are living rent-free, it may
be deducted from your benefit. But, if someone loans
you money for rent, etc., it will not count against
you. You may be asked for signed loan statements indicating
you must pay the money back. Government and non-profit
assistance for rent or food are not held against you.
SSI applications are valid from date of application
only and you cannot back-date the start of your disability.
What to
take to an SSI interview:
- Everything
required for an SSDI interview except W-2's or tax returns
- Proof
of any other income -- General Relief, State Disability, Unemployment, earned income, etc.
- Three months of bank statements
- Signed loan statements if someone is loaning you money
- A copy of your lease, or rental agreement (if you rent a room, a note from
your landlord will do)
- Proof of government housing assistance
- Proof of your spouse's income if married and living together
- Documentation from Immigration for eligible non-citizens
For Presumptive
SSI:
- Same as for regular SSI.
- The Medical Report, #4814, completed by your physician,
is required for all Presumptive applications.
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Documenting
Your Disability Claim
Your claim will
be won, or lost, on your medical files. If possible,
take a complete copy of your medical files to your
interview. This includes records from your main HIV
doctor, from any other doctor you've seen for your
conditions, and from hospitals, psychiatrists, therapists,
chiropractors, and all other health care providers.
Records of
any major opportunistic infections, as listed on
the Medical Report at the end of this packet, along
with any lab tests, blood cultures, biopsies, sputum
tests, etc., are the best documentation you can
provide.
If you have
not had any major opportunistic infections, you
should add the following to your documentation:
- A
detailed disability statement from your doctor(s),
listing all of your symptoms and stating how
these symptoms keep you from working. Call the
Benefits & Insurance Department for a packet of sample disability
statements.
- Third
party testimony, or letters from friends, co-workers,
former employers, family, or any one who knows
about your condition and its effects on day-to-day
functioning. The Benefits Department has sample
third party letters, but you should avoid copying
the samples word for word.
- All
the Supplemental Disability forms in this
packet. Where space allows, write about
your condition and how it keeps you from
being able to work.
- Include
your own "log" of your
symptoms and medications.
- Go over your medical charts with your doctor. Make sure
every infection, symptom, ache and pain is thoroughly documented.
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STEP
BY STEP APPLICATION GUIDE
- Call Social
Security for an appointment through the 800.772.2213
number, or call a local office directly (you
will have to get numbers from a benefits counselor,
they aren't listed). Ask for a confirmation letter
which protects your filing date.
- Keep
a log of your application (write down names,
phones numbers, dates of contact, etc.). Make
copies of everything you submit.
- Tell
Social Security you are filing an AIDS
or HIV-related claim for Social Security
Disability Insurance (SSDI) or Supplemental
Security Income (SSI) or both.
- If
you have no income, ask about Presumptive
SSI and whether the office can
make "same day" or emergency
advance payment.
- Social Security will send you forms to be
completed by your appointment. Ask Social Security
what to bring in the way of vital documents and ID.
- You will meet with a claims representative
at your appointment. Ask for a "receipt
of claim" before you leave. This is proof you
applied.
- Take a complete set of medical records to your appointment if possible.
If not, Social Security will write to your doctors and request your records.
They will also pay for copying and postage.
- Your claim goes to a Disability
Analyst about two or three weeks
after your appointment. The analyst
is the person who reviews your medical
files. Call Social Security, get the
phone number for your analyst, and ask
if records, other information, etc.,
are coming in on time.
- If your diagnosis is not conclusive, get the analyst a disability statement
from your doctor. Ask APLA's Benefits & Insurance Department for sample letters.
- Continue sending the disability analyst new
medical charts, lab reports, etc., until a decision
is made. The analyst should come to a decision within
three months. You will be notified by letter.
When disability
analysts cannot make a decision, based on your
medical files, or have not gotten your file, they
may send you to a consultative exam with
doctors and psychiatrists paid for by Social Security.
If you are ordered for a consultative, call the
analyst and ask if any additional information from
your doctor, or from a private psychiatrist , would
be sufficient.
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AWARD
LETTERS: COBRA/OBRA NOTIFICATION
You will be
notified via Award Letter if you have been approved.
Keep a copy of this letter. If you are on COBRA, you can apply
for an extra 11-month OBRA extension. To qualify, Social
Security must decide you were disabled when you left
work, and before you took your COBRA option. To apply, you
must mail a copy of your Social Security Award letter
to your COBRA administrator within 60 days of receiving
the letter. Failure to do this could result in
the loss of your health insurance after 18 months.
If you are
denied by Social Security, contact the Benefits
Department for help with your appeal. Appeals must
be filed within 60 days of getting a denial letter.
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If you have questions
about APLA, becoming a client or about
any of the services we offer, call
us at 213.201.1600 during normal business
hours or send
an e-mail. We are happy
to help.
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