Title: 2024 WIP-C Webinar 2
URL Source: blob://pdf/a2519e99-04e2-462f-8dce-cc86c082e662
Markdown Content:
Administration of SSA Benefits Eligibility: Disability Reviews, Appeals, and T2 Benefits Overview
2025 WIP-CTM Session 2
Work Incentive Support Center
Disability, Workplace, and Employment Support Practice Online Professional Programs 2
Information Screen
The Work Incentive Support Center (WISC) provides training, credentialing, and support to practitioners in the field of work incentive planning.
WISC is housed in the K. Lisa Yang and Hock E. Tan Institute on Employment and Disability. The institute, which is also known as the Yang-Tan Institute or YTI, is part of Cornell Universitys ILR School.
> Copyright 2025 Cornell ILR. All rights reserved. 3
## The WISC Team 4
## Todays Class
Title 2 and Supplemental Security Income (SSI)
Sequential evaluation process for disability determination
Special situations
Appeals
Title 2 Overview
Social Security Disability Insurance (SSDI)
Childhood Disability Benefits (CDB)
Disabled Widow(er)s Benefits (DWB) 5
## Title 2 and Supplemental Security Income (SSI)
The essentials of eligibility and appeals
Sequential evaluation process for disability determination
Special situations
Appeals 6
## Sequential evaluation process for disability determination
> Five steps 7
## Sequential Evaluation: Step 1
Is the claimant performing Substantial Gainful Activity (SGA)?
In 2025, SGA for a non-blind individual is $1,620 and for an individual with blindness it is $2,700.
But, SGA is much more than a number! 8
## Sequential Evaluation: Step 2
Does the claimant have a severe impairment or combination of impairments?
The impairment must impact the ability to work.
Intended as a threshold, de minimus test and should be used only to weed out groundless claims. 9
## Sequential Evaluation: Step 3
Does the claimants impairment, or combination of impairments, meet or equal the severity of a listing in the SSA Listing of Impairments?
The Listings are not intended to be complete, but all impairments in the Listings are per se disabling, according to SSA guidelines.
Adult Listings (age 18 and older) and Child Listings (age 17 and younger) are used.
The sequential evaluation process ends at this point for individuals who are found to be disabled based on a decision that they meet or equal the medical listing of impairments. 10
## Sequential Evaluation: Step 4
If the claimants condition does not meet or equal the severity of a listed impairment, does the claimant have the residual functional capacity (RFC) to do their past relevant work?
Past relevant work refers to any work the individual has performed at the SGA activity level within the past 5 years.
Past work is considered regardless of the country in which the work was performed. 11
## Sequential Evaluation: Step 5
If past relevant work is excluded, does the individual retain the residual functional capacity (RFC) to do any other kind of work that exists in significant numbers in the national economy?
Does the individual have the capacity to perform other work that exists in the national economy at the SGA level?
RFC is considered, along with age, education, and work experience. 12
## Special situations
Important to know 13
## SSA Policies to Know About
Presumptive Disability (SSI only)
Compassionate Allowance
Age-18 Redetermination (SSI only) 14
## Presumptive DisabilitySSI Only
Applicants for SSI benefits, including children, may request presumptive eligibility consideration.
SSI benefits may be paid for a period of up to 6 months based on presumptive disability or blindness, pending a disability determination.
These payments will not be considered an overpayment if SSA later finds that the individual is not disabled or blind. POMS DI 23535.001(D)(2) 15
## Compassionate Allowance
SSA may quickly identify diseases and/or medical conditions that clearly meet the Listings of Impairments with only minimal medical evidence and review.
There are 287 medical conditions that give rise to consideration for a Compassionate Allowance. POMS DI 23022.080 contains the current list. The list is very active with conditions added and deleted regularly.
As of now, SSA has approved over 1 million cases under the Compassionate Allowance provisions. 16
## Age-18 RedeterminationSSI Only
Each SSI recipient under age 18 who continues to receive SSI benefits upon turning age 18 must undergo an Age-18 Redetermination.
An Age-18 Redetermination is neither a new application nor a Continuing Disability Review (CDR).
An Age-18 Redetermination determines if the individual, now an adult, meets the adult disability standard. 17
## Appeals
Four levels 18
## Appeals Overview
The appeals process has four levels, each with certain time restrictions.
An individual generally has 60 days from when they receive a notice from the SSA to file an appeal.
Limited good cause exists for late appeals. 19
Appeals: Reconsideration
The application takes 39 months to process. If it is denied, appeal instructions are in the notice to the applicant.
The first appeal is a Request for Reconsideration.
Use Form SSA-561-U2.
Reconsideration takes 39 months. 20
Appeals: Hearing
If the Request for Reconsideration is denied, the claimant can file a Request for Hearing before an Administrative Law Judge (ALJ).
Use Form HA-501-U5.
Advocacy is important in this critical step.
Depending on the Office of Hearings Operations (OHO), it can take 1830 months to obtain a hearing date. 21
Appeals: Appeals Council
If a claim is denied by an ALJ, the claimant can request a review by the Appeals Council.
Use Form HA-520-U5.
This review will focus on substantial evidence and errors of law. There is no right to a de novo hearing before the Appeals Council.
1 year for decision to be issued. 22
## Appeals: Federal Courts
Upon denial of a claim by the Appeals Council, a claimant can bring a claim before the Federal Courts within 60 days.
At this point in the appeals process, the claimant must proceed either with an attorney or on their own (called pro se by the courts).
The appeal is a review and not a new trial. 23
## Title 2 Overview
Benefits and eligibility
Social Security Disability Insurance (SSDI)
Childhood Disability Benefits (CDB)
Disabled Widow(er)s Benefits (DWB) 24
## Social Security Disability Insurance (SSDI)
> Insurance based on work 25
## Social Security Title 2 Programs
Title 2 of the Social Security Act provides benefits for several groups:
Retirement benefits
Survivors benefits
Disability benefits 26
## Retirement and Survivors without Disability
Retirement Insurance Benefits (RIB)
Worker
Dependents: Spouse, children
Survivor Benefits
Lump Sum Death Benefit
Survivors: spouse, children, parents 27
## Title 2 Disability Programs: Three Types
Disability Insurance Benefits (DIB)
Childhood Disability Benefits (CDB)
Disabled Widow(er)s Benefits (DWB)
Tip
Most people refer to all three programs as Social Security Disability Insurance, or SSDI. Even so, its important to know which of the three Title 2 benefits the person is receiving. 28
## Title 2 Disability Programs: Basics
The person must meet SSAs definition of disability.
A person can get more than one type of benefit simultaneouslyif so, work incentives apply independently to each benefit.
Monthly payments are determined by FICA contributions, not economic need. 29
## Title 2 Disability Programs: Eligibility
All the following must be true:
Medically disabled
Younger than full retirement age, or age 55 for certain blind individuals
Not working, or if working, earning less than the Substantial Gainful Activity (SGA) amount
Have insured status as a worker 30
## Insured Status for SSDI
One credit can be earned per calendar quarter, with a max of four per year at a rate of $1,810 in earnings per credit in 2025.
You always need half of the available credits for the base period.
Before age 24, the base period is the 3-year period before the disability began (you need 6 credits in that 3-year period).
Age 24-30, the base period is the number of years between age 21 and the age the disability began (if the disability began at age 30, you need 18 credits).
Age 31 and older, the base period is the 10 years before the disability began (you need 20 credits in that 10-year period). 31
## Childhood Disability Benefits (CDB)
> Essential overview 32
## Childhood Disability Benefits (CDB): Eligibility
All the following must be true:
18 years or older
Disabled by SSAs definition before age 22
Child of insured worker(s) who is either disabled, retired, or deceased (in certain cases, may be a dependent of a grandparent or step-grandparent; see POMS GN 00306.009)
Unmarried, but there are a few exceptions 33
## CDB: Need to Know
If marrying, to remain eligible for CDB, you must marry a person who gets a Title 2 benefit.
You can have been previously married, divorced, and then remarried to another Title 2 recipient if this all happened prior to being eligible for CDB.
If you are converting from SSI to CDB, then Medicaid continues Special Medicaid Continuation for Childhood Disability Beneficiaries.
SSA also uses the term Disabled Adult Child (DAC) for this benefit. 34
## Disabled Widow(er)s Benefits (DWB)
Understanding the start and end dates 35
## About Disabled Widow(er)s Benefits (DWB)
Must be age at least age 50
Must have a disability at the time the spouse dies or within 7 years of the spouses death.
At age 60, transition to a survivor benefit that does not require disability.
If you are already receiving SSI, you keep Medicaid even if you become ineligible for SSI based on your DWB eligibility 36
## Summary Slide
SSA uses a 5-step sequential evaluation in the disability determination process.
Most people must appeal to get approved for SSA disability benefits.
There are three different SSA Title 2 disability benefits, each with their own eligibility criteria.
The Title 2 work incentives apply to all three SSA Title 2 disability benefits.
If a person gets more than one Title 2 disability benefit, then the phases of work incentives that we will discuss in the next class apply to each benefit individually. 37
## Homework
Included in the Moodle platform
Covered at the beginning of the next class
Tip
Homework is neither corrected nor required, but it is a way to let your instructors know if anything is unclear. 38
## Contact Us
K. Lisa Yang and Hock E. Tan Institute on Employment and Disability
Cornell University
ILR School
201 Dolgen Hall
Ithaca, New York 14853
[email protected] Work Incentive Support Center Disability, Workplace, and Employment Support Practice Online Professional Programs