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Social Security

Social Security

Delaney & Melkonoff, P.C. is a Phoenix legal practice devoted to helping people receive all types of Social Security benefits and resolve other disputes with the Social Security Administration. With over 40 years of Social Security experience, we are able to assist with not only disability claims, but also Supplemental Security Income (SSI), retirement, and survivors’ benefits. Too often people do not realize how complex the claims process is until their valid claim has been fully or partially denied. We can help with the filing process, and also ensure that you receive the full amount of benefits available to you.

Please continue reading to learn more about Social Security benefits for disabled and injured workers, retirees, and survivors, and contact Delaney Melkonoff, P.C. today for a free consultation and straightforward answers to your specific questions.

Article

Impairment Meets Or Equals Listing Of Impairments For Social Security Disability Evaluation

General Social Security

Disability

Retirement

Survivors’ and Family Benefits

Medicare

General Social Security

What does Social Security mean to me?

The Social Security Act provides benefits to retired persons, survivors, and disabled persons and their families, as well as funding for many other programs that provide medical assistance, child support enforcement, assistance to pay energy bills and buy groceries, and assistance to the unemployed. Social Security benefits and Supplemental Security Income (SSI) are administered directly by the Social Security Administration. Applications for entitlement under these programs can be filed by telephone, online, or at any Social Security office.

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Who can get Social Security benefits?

All Social Security benefits, but not SSI (see below), are based upon the earnings record of a worker who has worked long enough in covered employment and/or self-employment to become insured. Benefits can be paid to the disabled or retired worker and the worker’s family or to his or her surviving dependents. Spouses, ex-spouses, children, step-children, adopted children, and in rare cases even grandchildren and parents of insured workers may qualify for benefits.

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How long must I have worked to be insured for Social Security benefits?

To be considered fully insured for Social Security retirement or survivor’s benefits, you must have worked for at least 10 years. To receive disability benefits you must also have worked for 5 out of the last 10 years before becoming disabled. These requirements are reduced for persons who die with surviving children or become disabled prior to age 31. Any worker can request a copy of his or her earnings record and a benefit estimate from Social Security in order to check insured status and potential benefits.

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What is SSI?

SSI stands for Supplemental Security Income. It is a cash assistance program for the aged, blind, or disabled who have very limited income and assets. The Social Security Administration manages the program and takes all applications for SSI. The main difference between SSI and Social Security benefits is that Social Security entitlement is based upon and paid out of Social Security taxes paid by a worker, while SSI is paid on the basis of need out of general tax revenues. Even disabled children can receive SSI if they meet the financial and special disability requirements.

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Who can get SSI?

Generally speaking, the SSI program provides a monthly payment to financially needy US citizens who are blind, disabled, or over the age of 65. The income rules and exclusions are different for unearned and earned income, but non-excluded monthly income over $674 per month (in 2011) or countable assets of over $2,000 ($3,000 for a couple) will make the applicant ineligible. Residence in a public institution or outside the US will cause payments to stop. In Arizona, an SSI recipient is also automatically eligible for healthcare under the AHCCCS Program.

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What if my claim is denied?

Certain appeal rights are provided with the denial of any Social Security claim. Every denial must be documented by a notice, and the notice must include appropriate language explaining appeal rights. It is important to file any appeal within the specified time limit, normally 60 days from the date you receive the denial notice. There are three levels of administrative appeal available to most claimants: reconsideration, hearing, and Appeals Council review. If a claimant is dissatisfied with the administrative results, further review can be sought through the federal court system. It is not necessary to have legal representation in order to pursue appeal rights, but statistics kept and published by the Social Security Administration show that represented claimants fare significantly better than unrepresented, especially at the hearing level and beyond.

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Disability

How is disability defined by Social Security?

Social Security uses a rather strict standard of disability. It is an inability to perform any type of regular work for a period of not less than 12 months caused by medical reasons. It could be based upon physical and/or mental impairments, but not drug or alcohol addiction and not impairments caused by the commission of or incarceration for a felony. The inability to find work, lack of availability of work, or the inability to be hired for some other non-medical reason does not constitute disability. An even stricter standard is applied to children seeking disability payments under the SSI program.

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What does Social Security do for disabled people?

There are several types of direct and indirect assistance for disabled persons provided by the Social Security Act. Monthly benefits are provided to disabled workers insured under Social Security and their families. Monthly subsistence payments are paid under the SSI program to needy U.S. citizens who are blind or disabled. The Social Security Act provides a freeze period for disabled workers to protect their future retirement benefits from being disadvantaged by periods of disability. Disabled surviving spouses of insured workers may be entitled to monthly benefits. An adult child of an insured worker who became disabled before age 22 can be entitled to monthly benefits. The Social Security Administration also works with vocational rehabilitation programs and provides hospital and medical protection to disabled workers through Medicare.

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How do I apply for disability?

If you believe you may be unable to work for a year or more because of medical reasons, you should apply for benefits promptly. You may file a claim online, by telephone, or in person at any Social Security office. Social Security disability benefits will not begin until the sixth full month of disability. SSI disability payments can commence as early as the month of application. If the claimant is unable to make application for some reason, a legal guardian, spouse, or parent may apply for him or her. It may take several months for a disability claim to be processed, so interim assistance from the state and/or friends and relatives, if available, may be required.

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How is Disability determined?

The step-by-step regulatory process for determining disability involves five primary questions:

  • Question 1 – Is the claimant working? If the answer is yes, and the claimant is averaging more than (in 2011) $1,000 per month in earnings, the claim is denied. Otherwise, proceed to the next step.
  • Question 2 – Does the claimant’s medical condition impose significant limitations upon basic work related processes or activities? If not, the claim is denied. If so, proceed to the next step.
  • Question 3 – Is the claimant’s condition listed or equivalent to a medical condition listed in the Social Security regulations as presumptively disabling? If so, the claim is approved at this point. If not, proceed to the next step.
  • Question 4 – Does the claimant’s condition prevent the claimant from performing the duties of all of the jobs he or she has performed in the last 15 years? If not, the claim is denied. If so, proceed to the next step.
  • Question 5 – Based upon the claimant’s medical condition, age, education, and work experience, can he or she reasonably be expected to adapt to other less demanding work that exists in the national economy? If he or she has the capacity to adapt to and perform such other work on a sustained basis, the claim is denied. Otherwise, the claim is approved.

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Who decides if I am disabled?

The Social Security interviewer will help you complete your application and check to see that you meet the non-medical requirements, such as whether you have worked long enough and recently enough to be insured for Social Security disability benefits or whether your financial status meets the eligibility standards for SSI. But the interviewer does not make any disability decision. The application and other forms you have completed will then be sent to the Disability Determination Service Office in your state. In Arizona, this agency is part of the Department of Economic Security and maintains offices in Phoenix and Tucson. There, a Disability Examiner will collect medical records from the sources you have identified in your application papers and use this information, with the assistance of a staff physician or psychologist, to determine whether you meet the disability standard defined in the Social Security Act. You will receive a written notice from the Social Security Administration informing you if your claim is approved or not.

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What if I am blind?

Social Security defines statutory blindness as “central visual acuity of 20/200 or less in the better eye with the use of correcting lenses. An eye that has a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be” deemed to meet this requirement. There are a number of special rules under the Social Security Act for persons that are so identified as “statutorily blind.” The earnings limit for blind beneficiaries is higher than that for other disability beneficiaries, and under certain circumstances less work will make the blind worker insured. The state may also provide additional assistance to persons designated as blind under either Social Security or the SSI program.

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What can cause disability benefits to stop?

Disability benefits end when Social Security determines that the disability has ended. Generally, this can be due to either medical improvement or a return to work. The law requires that disability be reviewed periodically. It also requires that any work performed by a disability beneficiary be reported to Social Security. Unless the beneficiary experiences medical improvement, he or she should be entitled to nine months of trial work before benefits can be stopped for work activity (not applicable to SSI). Benefits can also be suspended for failure to cooperate or loss of contact. The beneficiary’s responsibility to report and cooperate should therefore be taken seriously.

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What happens if my claim is approved?

This information pertains only to Social Security disability benefits, not SSI. Retroactive benefits are payable beginning with the sixth full month of disability or the 12th month before you filed your claim, whichever is later. At approximately the same time as you receive such payment, you should receive an award notice explaining your ongoing benefits and a booklet explaining your rights and responsibilities. You should read this booklet carefully and keep it as a reference. Your award notice may also include information as to the date your Medicare coverage will begin and information about the date you can expect a medical review of your continuing disability.

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Retirement

When can (or should) I retire?

Social Security benefits based upon attainment of full retirement age, currently 66 and gradually rising to age 67, can be received as early as age 62, or age 60 for widows and widowers, but receipt of benefits before full retirement age will result in permanent reduction in the benefit amount payable. Postponing retirement until your full retirement age will increase your potential monthly benefit. Postponing it further (up to age 70) can further increase your monthly benefit rate through application of Delayed Retirement Credits. If your earnings from work exceed an annual limit adjusted each year, your retirement benefits will be reduced or eliminated until the month you attain full retirement age, but any earnings for work after that will not impact your benefits in any negative way. Although the full retirement age is rising, Medicare still starts at age 65, but remember that no Medicare entitlement can exist until an appropriate application has been filed with the Social Security Administration.

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What if I am disabled when I reach retirement age?

If you are receiving Social Security disability benefits at full retirement age, the benefits will automatically be converted to retirement benefits with no action required on your part and no change in the benefit rate. A person who is entitled to more than one Social Security benefit can receive only the higher of the two benefits, not both benefits added together.

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Survivors’ and Family Benefits

What am I entitled to as the spouse of someone who has worked long enough to be insured for Social Security purposes?

The spouse of an insured worker who is entitled to disability or retirement benefits, or who has died, is potentially entitled to monthly benefits as a spouse or surviving spouse even if he or she has never worked. Entitlement is based upon attainment of age (at least 62 for spouses of live workers and 60 for widows/widowers of deceased workers (50 if disabled)), or can be at any age if the spouse has in his or her care at least one child of the insured worker who is under the age of 16.

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What if I am divorced?

The spouse of an insured worker whose marriage lasted at least 10 years prior to divorce may still be entitled to benefits as the worker’s spouse or surviving spouse. If the worker is alive, the divorced spouse must be at least 62 years of age or have custody of a child of the worker under the age of 16. If the worker is deceased, the surviving divorced spouse must be 60 years of age or at least 50 and disabled. Remarriage prior to entitlement can eliminate entitlement, but if the subsequent marriage ends, the benefits may be yet available.

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What are my children entitled to?

Minor children of a disabled, retired, or deceased worker may be entitled to Social Security benefits until age 18. These benefits can continue or be resumed after age 18 if the child is disabled or becomes disabled prior to the age of 22. Such benefits can continue as long as the individual remains disabled, does not marry, and does not perform sustained and substantial work. Disabled children under age 18 may also be eligible for payments under SSI.

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Medicare

Who is entitled to Medicare?

Medicare accompanies many Social Security benefits, but is not available to those who are only eligible for SSI. SSI recipients are automatically eligible for Title XIX Medicaid coverage, which in Arizona is called AHCCCS. Generally speaking, Medicare is automatically given to every retirement and spousal (including surviving spouses) beneficiary at age 65, and to every disability beneficiary who has been entitled to benefits for at least 24 months. There are rare other bases for Medicare entitlement that are not common enough to list here. Medicare Part A (basically hospital insurance) is free to most; Parts B (supplemental) and D (prescription drug) require the payment of a premium. Now that full retirement age is 66, a separate Medicare application may be needed at age 65 if a worker or spouse is not a current beneficiary.

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