Friday, August 12, 2011

Help! I Just Received a Technical Denial!

When applying for both Supplemental Security Income (SSI) and Disability Insurance Benefits (DIB) in San Diego at the same time in a concurrent claim, it is common for a claimant to receive a technical denial for one of the benefits. Technical denials—unlike medical denials, which are based on Social Security’s definition of disability—vary greatly between SSI and DIB. While DIB technical requirements are based on how much a claimant has worked and paid into the system, SSI requirements are welfare based—or based on the client’s income and resources. Claimants have to meet both medical and technical requirements in order to qualify for benefits under Social Security’s rules. However, you do not need to meet both sets of technical requirements- being eligible for one or the other is enough.

The technical requirements for DIB are based on work credits. For 2011, one work credit amounts to $1,120 worth of wages, and it is possible to earn a maximum of four work credits a year. The amount of work credits necessary to qualify for DIB varies with age; for example, while a 31 year old only needs a total of 20 work credits, someone who is 62 or older needs 40 in order to qualify. In general, 20 of these 40 work credits need to be earned in the last ten years; therefore, one must have worked 5 out of the last 10 years in order to meet the technical requirements for DIB. The applicant also must be found disabled within their date last insured (DLI), which is the end of this ten year period.

In contrast, SSI is a need-based benefit which bases its technical requirements on the income and resources of the applicant. When calculating income, Social Security includes not only income you earn from working, but also food and shelter; however they do not count income such as food stamps or home energy assistance. The income limits vary from state to state and are based on the Federal Benefit Rate. In the case of resources, a claimant is individually allowed to have resources worth no more than $2,000, while the resource limit for a couple is $3,000. SSI does not count the home in which the applicant lives or the primary vehicle, among other technicalities. Only those who live in the US or the North Mariana Islands are eligible, and these applicants also must be US citizens or nationals to qualify.

While a medical denial can be appealed, it is most often very difficult to appeal a technical denial. If a claimant is denied DIB due to a lack of work credits, the application cannot be appealed. If the denial is due to a DLI issue, the applicant must furnish relevant records that prove disability before the DLI. SSI, on the other hand, can be re-filed when the resources and income dip below the required limits. Unless proof of disability before the DLI or proof that income and resources have been significantly depleted, it is not generally possible to appeal a technical denial.

The best way to ensure that your claim is handled properly is to hire an attorney. Your disability attorney will stay on top of all paperwork and requests from Social Security and make sure that all your medical records have been received. For more information, visit us at www.socialsecuritylaw.com.

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