Welcome to the Florida Social Security Law Guide. In this manual, we will explain what the Social Security program in the United States is, what it was designed to accomplish, who is eligible for it, what the different kinds of benefits are, and how to acquire them. We will also go over a few unusual scenarios that may come up when applying and receiving benefits. For the most part, the process for applying for and receiving benefits from the Social Security program is relatively smooth. That being said, there are plenty of times when an application is denied and reasons for this rejection.
In this guide, we will highlight what you, as an applicant and hopeful beneficiary of Social Security benefits, can do to appeal an initial rejection of benefits. Thankfully, there is much that can be done and we will offer some advice for how to begin this process. We at the Franco Law Firm have helped many people over the years and all across Tampa Bay fight for and win the Social Security benefits that they deserve. It is our hope that we can help you do the same and we will begin by explaining how the system works and what that means for your and your specific situation.
What is Social Security?
The Social Security program in America was designed with the purpose of assisting families and individuals that are either retired or unable to work by providing them with financial stability. The two kinds of situations make up the two different forms of financial benefits that are granted to individuals that qualify for the program. For retirees, the funding is granted based on how much the individual paid into the program over the course of his or her working career. This means that the longer a person works, the greater the benefits granted to them are. Age also plays a role in obtaining benefits, as beneficiaries must be of the minimum age of 62, or 66 for full benefits.
The Social Security disability side grants financial benefits to individuals that are physically or mentally unable to work. This program therefore grants them some kind of income that they would not otherwise be able to acquire and helps them to maintain a certain quality of life. These funds must be applied for and are granted on a need basis. If the qualifying conditions are met, the program grants funding based on the severity of the disability and cost of living for the area that the individual lives in.
What is the SSA?
The Social Security Administration, or SSA, is the government organization that oversees the Social Security program. An entity of the federal government, the SSA regulates all aspects of the program, including how much is taken from workers’ taxes, the processing of applications and credit earning, retirement benefit services, and the offshoots of the Social Security program, such as Medicare, SSI, and SSDI.
When an individual applies to receive Social Security benefits, it is the SSA that he or she will be filling out the application for and turning it in to. Consequently, it is also this organization that makes the determination as to whether or not the application is approved or denied. If an application is denied, it is also the SSA that will hear the appeal to overturn it and make a determination after listening to the case of the applicant. The SSA has its own judges that oversee such cases and therefore it is important to know how to go through the appeal process to give the hopeful applicant the best chance possible of winning the appeal and see benefits granted.
Social Security Disability Insurance
Social Security Disability Insurance, or SSDI, is the section of the Social Security program that specifically deals with protecting the financial stability of injured workers. If an individual contracts a disability, be it by injury or by disease, that renders him or her unable to work, this program provides financial benefits to the individual to help compensate for the lack of wages. Note that this is different that workers’ compensation, as it can be a disability caused by any circumstance, not necessarily one caused by a workplace injury. That being said, SSDI is meant to only cover those that are completely unable to work and does not include those that can work part time.
In order to receive benefits from the SSDI program, the individual must meet the conditions specified above. Additionally, it is a program that the individual must have paid into previous. This means that the beneficiary must have held a job that contributed to Social Security sometime in the past ten years leading up to when benefits are granted. The number of years that the person has had to have worked does vary depending on the age of the applicant, but for the most part, five out of the past ten years are necessary.
Supplemental Security Income
Supplemental security income, or SSI, is the facet of the Social Security program that is meant to give financial benefits to individuals that have limited income and resources. Similar to SSDI, the individual seeking benefits must be disabled in some capacity. Unlike the other Social Security programs however, SSI is need-based and therefore does apply to individuals that are able to work. The qualifying trait with SSI is a lack of sufficient financial security to maintain a certain quality of life.
The idea behind SSI is that if an individual is disabled, they may not be able to hold certain jobs and therefore are limited in the amount of income they can bring in. When applying for SSI, it is necessary to prove that there is a need for additional assistance beyond what that job can provide. There are however many individuals that receive SSI that are also unable to work and the SSI program does not require any payment into it in order to receive benefits from it, unlike the SSDI program. Therefore, it is open for application for anyone that has the need and meets all government requirements.
Social Security Credits Explained
When receiving Social Security benefits, with the exception of SSI, part of a person’s qualification into the program is contingent on Social Security credits. How exactly do Social Security credits work and how are they earned? In order to receive most kind of benefits, the applicant must reach a certain threshold of credits earned. The credits aren’t necessarily “spent,” they are simply a way of tracking if an individual has paid enough into Social Security in order to qualify for receiving benefits from it.
The number of credits needed for an individual to qualify for benefits is raised in correlation with the person’s age. For example, someone who is 44 must have 22 Social Security credits in order to receive benefits, while someone at age 60 must have 38.
Social Security credits are accrued by working in a job that pays into the program. With exceptions in certain types of jobs or in a military service job, one credit is granted every four years. These credits accrue automatically and are kept track of by the Social Security Administration, but it is not a bad idea for a person to be aware of thow many credits he or she may have to make the application process easier if benefits are sought after.
What is a Social Security Claim?
A Social Security claim is the action involved in requesting benefits from the Social Security Administration. The claim is made by filling out paperwork directly to the SSA and is normally a smooth process. Under normal circumstances, the claimant, the person seeking benefits, will complete the necessary application, it will be reviewed and, once accepted, the appropriate level of benefits will be granted on a schedule determined by the SSA.
There are many times however in which the SSA will reject a Social Security claim. When this happens the applicant can appeal to have the rejected claim overturned. When a claim is rejected, there is always a reason provided and knowing this can help the individual win the appeal and have benefits granted to him or her. During this process, it is always advised that the claimant have an attorney help them through the process, preferably one who is well-versed in Social Security law. If rejected again, the claimant must wait a certain amount of time before applying again, but if the claim is overturned, benefits are granted based on when the original claim was filed.
Who Can Get SSI Benefits?
Supplemental Security Income benefits are granted to disabled individuals that require extra financial assistance in order to have an acceptable quality of life. Due to the fact that SSI is a needs-based program, it is typically reserved for individuals that are financially struggling because of the disability that is preventing them from working or from working full-time. That being said, there are certain criteria that must also be in place in order to apply for SSI benefits.
Although there are some circumstances where children can receive SSI benefits, the individual normally must be between the ages of 18 and 65. People over 65 should apply for retirement benefits through the Social Security Administration. The applicant must also have never been married, not be blind, and must be a citizen of the United States, residing in one of the 50 states, District of Columbia, or the Northern Mariana Islands. If a person has received SSI benefits in the past, but no longer does or has been rejected twice, they are not eligible for benefits. Applications for SSI can be completed online through the SSA’s website or by visiting a local office of the SSA.
Who Can Get SSDI Benefits?
As discussed earlier, Social Security Disability Insurance grants financial benefits to individuals that are no longer able to work because of a disability. As such, the primary qualifying factor for getting SSDI benefits is that the individual must have a disability that inhibits him or her from maintaining a job. This disability must be medically documented and the individual must be able to prove that he or she is unable to work.
The second criteria for being eligible for SSDI benefits is that the individual must have a certain number of Social Security credits. Credits are granted to individuals automatically if they have worked in jobs that contribute to Social Security, which is compulsory for the majority of professions. Essentially, if the individual has worked for a long enough period of time and then has become disabled, he or she would be eligible for SSDI benefits. The amount of credits or time worked needed scales up based on age, but typically requires at least five years of working and contributing to Social Security out of the past ten. Applications for SSDI are usually filled out at a Social Security Administration office, as there is often a lot of paperwork and documentation required as part of the claim process.
Who Determines Eligibility?
When it comes to determining if someone is eligible for Social Security benefits, the jurisdiction falls completely to the Social Security Administration (SSA). When someone fills out an application to receive Social Security benefits, either online or at a local office, that application would be processed and reviewed by the SSA. It is then either approved, and benefits granted, or denied.
If an application claim is denied, the applicant may appeal to have it overturned. This is also overseen by the SSA, although it is done through a different branch of it. The Administration has its own judges that weigh over appeal cases and hold hearings with applicants to determine if the claim is eligible to be overturned. Either way, this judge will be the one to make the final determination as to whether or not an appeal is successful. There are no attorneys offered to appealing claimants, however it is highly recommended that each individual consults with an attorney of their own throughout the appeal process in order to achieve the best possible chance of success.
When Do You Need a Lawyer for a Social Security Claim?
When filling out the initial application to appeal for Social Security benefits, you need nothing more than what is noted on the application, which is usually only documentation of medical history, diagnoses, or income statements. While you may want to work with someone in the Social Security Administration if you need any help completing the application or confirming what kind of information you should provide, a lawyer is not necessary at this stage.
If your application is rejected however and you need to file a claim to have it overturned, then you should consult with an attorney. While having a lawyer is not a true necessity, it drastically increases your chances of successfully winning the appeal. Any attorney with enough experience in Social Security law and the appeal process will know how to guide you and can make recommendations specific to your situation that will help you counter the reasons the SSA rejected your application in the first place. As such, it is always a good idea to seek out a lawyer that is well-tenured and has many Social Security case wins.
Social Security Claim Verification
After a person has applied for Social Security benefits, how does he or she know if the application has been approved or not? Confirmation of the successful acquiring of benefits comes in the form of a benefit verification letter. This letter is an official document created by the Social Security Administration that indicates that the individual who receives it does indeed qualify for benefits. It also states on it which program from Social Security, either SSI or SSDI, the individual is receiving benefits from and how much money is being given.
A benefit verification letter from the SSA is meant to help the beneficiary keep track of earnings from Social Security. In addition to providing simple peace of mind, it provides proof of income, which is important for applications for Medicare, loans, mortgages, or other government benefit programs. A benefit verification letter will also contain on it information on the income given concerning taxes, retirement, and survivor benefits, if these become relevant. Letters are always given when new funding is dispensed, usually monthly, however additional copies can be requested at any time from the SSA, either at one of their offices or through their online website.
How to Calculate Benefits Payable
We’ve addressed how to begin collecting benefits from the Social Security program, but how exactly does one calculate the amount of money in each monthly package? There are a number of factors that play into the calculation of benefits payable, the first of which is the average indexed monthly earning, or AIME. This number is the average of the total amount of time in which the individual was paying into Social Security. By adding up each year’s total and dividing it by the number of years, adjusted afterwards for each year’s inflation, you would be able to find the AIME.
This AIME number is then used to find the primary insurance amount, or PIA. This figure is the representation of the averaged indexed monthly earning, rather than yearly, with percentages taken from it that represent the cost of living in the area where the beneficiary lives. Both the AIME and PIA are then applied to the Social Security benefit formula, which factors in inflation and other adjustments. This will give a base amount of benefits.
There is one other factor that plays into benefit calculation and is applied to the base amount at the end. If the person’s age is different than the full retirement age, it will be adjusted up or down depending on if the individual is older or younger, respectively.
Supplemental Security Income for the Blind and Disabled
You may notice, if you look at the requirements for the Supplemental Security Income (SSI) program that one of the qualifications for benefits is that the applicant not be blind. Does this mean that those that are blind are not eligible for SSI benefits? It is indeed the case that blind or low vision individuals cannot receive SSI, but it is because there are special stipulations for this kind of disability in the SSDI program.
If you are blind or of low vision, you do qualify for SSDI even though technically you may be able to find work or be self-employed. Under the guidelines of the SSA, these individuals can earn as much as $2,040 a month, as of 2019, and still collect SSDI benefits. Being blind or of low vision almost guarantees an approval for benefits for SSDI benefits under these rules, so it is a good idea to apply for them if you fall under this category, as there should be no fear of denial.
A subsidiary of the Social Security program, Medicare is the government assistance program that is meant to serve as health insurance coverage for individuals age 65 or higher or those with certain, chronic disabilities or diseases. While Medicare is not designed to cover every medical expense for these individuals, it does cover most of them. For those undergoing long term care, Medigap is a sub-program that is available that offers a major discount to private insurance plans to cover what Medicare initially cannot. Most forms of health care, including hospital stays, outpatient treatment, doctor visits, and prescription drugs fall under the coverage of Medicare.
In order to qualify for basic coverage under Medicare, the above stated conditions must be met. There are additional tiers to Medicare coverage that can be obtained as well if other conditions are met. Similar to SSDI benefits, if an individual worked for an extended period of time and paid into Social Security, they would receive additional benefits under Medicare relative to the amount of time working. Similar to SSI benefits, if an individual is in a low-income situation, additional benefits are granted as well to compensate. Under this circumstance, the State, rather than the Federal government, may step in and help provide benefit coverage as well.
Medicaid is also a branch of the Social Security program and one that is slightly different than the others. Whereas Medicare helps retired individuals with medical expenses, Medicaid offers coverages for long term care services that would not normally be covered under Medicare or private health insurance policies, such as nursing home or personal home care services. Unlike its counterparts, Medicaid is not funding completely by the federal government, but also operates jointly with state governments to dispense benefits.
Medicaid is a needs-based program, which means that it is meant to support low-income individuals and families. As such, applicants seeking coverage under Medicaid must prove that they are of a low enough income to qualify for the program. There must also be a proven need or disability that requires the medical treatments or care that the program covers. There is no age requirement for Medicaid, which also helps it stand out from Medicare and SSDI. Similarly to the other programs, however, if the initial application for benefits is rejected, the individual may appeal the denial and work to have it overturned.
Can My Family Receive Benefits?
For most SSI benefits, individual need determines if benefits are granted, so it is mostly concerning that individual the amount of benefits granted. For any Social Security program involving retirement however, there is the potential that the family of the person receiving benefits could receive additional benefits as well. If the family member meets the qualifying conditions, he or she could receive up to half of the monthly amount for full retirement with no penalty to the original beneficiary. This is true for both spouses and children. If a family member also qualifies for benefits, there is a maximum amount total that may cap these additional benefits.
If the spouse of the Social Security beneficiary is also of full retirement age, he or she would receive half the benefits of other. If he or she is not, this amount decreases in correlation to that person’s age. For children of the beneficiary, the child must be either under the age of 18 or under the age of 19 and a full-time student. If the child works, this will limit the amount of benefits. Finally, a divorced spouse may also receive benefits if the ex-spouse is now unmarried, the marriage lasted ten years or longer, and the ex-spouse is of age 62 or older.
What Happens When Your Claim is Approved?
After filling out an application to receive benefits from the Social Security Administration, in whichever program you choose, you will receive a letter in the mail indicating whether or not your application was approved or denied. If your application was approved, then there is nothing further that you need to do unless otherwise indicated as such on the approval letter. Within at least two months, you should begin receiving checks in the mail that contain your financial benefits.
If your approval was indeed the overturning of an original denial, then you may also be eligible for backpay. This occurs if the appeal process took over a month to complete and grants compensation for the time in which the appeal was going on. For example, if the appeal took three months, you would receive three months of the normal benefits that you now qualify for. This happens frequently in situations where an appeal was necessary, as the process itself is usually drawn out, even in the best scenarios where you and your attorney know exactly how to handle the case.
What Happens if Your Claim is Denied?
When you file an application for Social Security benefits, regardless of which individual program you are seeking benefits from, you will shortly thereafter receive a letter in the mail either approving or denying your application. Obviously, the hope is that the application will be approved and you can proceed with the expectation that a check will be arriving shortly, but what happens if your claim is denied? Does that mean that there is no chance at all of your receiving Social Security benefits?
Thankfully, a denial of benefits does not necessarily mean that all hope is lost. Any time that an SSI or SSDI application is denied, you have the opportunity to file an appeal claim to have the denial overturned. While you certainly can do this on your own at your local SSA office, it is highly recommended that you first consult with an attorney that has experience in Social Security law. A skilled and experienced attorney will be able to guide you through every step of the process, including how to file an appeal claim and how to give yourself the best possible chance of seeing the rejection overturned.
We at the Franco Law Firm hope that this guide has helped you better understand the Social Security program, it’s Administration, the various kinds of benefits that are available, how to apply for them, and what your options are in the event of a denial. While the information provided here does indeed give you the basics of Social Security, there are many idiosyncrasies and details that would be too lengthy to explain. Furthermore, when it comes to your own individual circumstances, certain factors may or may not come into play that could influence the determination of whether or not you receive benefits.
That is why it is always advisable to work with an attorney if you are trying to overturn a denial of benefits from the Social Security Administration. We at the Franco Law Firm have helped many people across Tampa Bay and beyond with their Social Security claims and have seen many of them find victory and the benefits that they need. We would be honored to help you through your appeal process as well and advise that you schedule a free consultation with us whenever it is convenient for you. To take advantage of this offer and for more information regarding Social Security, please feel free to call us anytime at (813) 872-0929, available in either English or Spanish.