Supplemental Security Income is the program for people who are disabled and have almost nothing to fall back on. It is also the program with the most ways to be turned down for reasons that have nothing to do with your health.
Marc Whitehead & Associates represents SSI claimants whose applications have been denied, whose benefits have been reduced, and whose payments have stopped after a review. An SSI attorney reads the notice, works out which of the two tests your claim actually failed, and handles the appeal.
Ask for a free review of your SSI claim. No fee unless benefits are awarded.
What Is SSI and Who Qualifies?
Supplemental Security Income is a federal needs-based benefit for people who are disabled, blind, or 65 and over, and who have very limited income and resources.
Two tests have to be satisfied at the same time, and each one denies claims independently.
The medical test. The same disability standard used for Social Security Disability Insurance. The agency asks whether your condition prevents work at a substantial level and has lasted or will last at least twelve continuous months, the duration requirement at 20 C.F.R. § 404.1509.
The financial test. Countable income below a limit, and countable resources below a separate limit. Work history is irrelevant. So are work credits.
Because the two tests are independent, a person can be plainly disabled and still be denied for having too much in a savings account. That combination is what makes SSI claims different from every other disability claim, and it is why so many denials in this program are not medical at all.
The Social Security Administration publishes the current income and resource figures, which change annually.
For a free legal consultation with a Disability lawyer serving Nationwide, call (800) 562-9830
SSDI or SSI: Which One Applies to You?
SSDI is earned through work. SSI is based on need. Applying under the wrong one is one of the most costly mistakes in this area.
| SSDI | SSI | |
|---|---|---|
| What qualifies you financially | Work credits from covered employment | Limited countable income and resources |
| Work history required | Yes | No |
| Medical standard | Same five-step test | Same five-step test |
| Does a spouse’s income count | No | Yes, through deeming rules |
| Time limit on eligibility | Yes, insured status can expire | No insured-status deadline |
| Benefits for family members | Possible | No |
| Health coverage that usually follows | Medicare, after a waiting period | Medicaid, in most states |
Some claimants qualify for both at once, which is called a concurrent claim. The SSI payment is then reduced by the SSDI benefit, and the combination frequently affects which health coverage you end up with.
Our page on SSDI benefits covers the work-credit side of this in detail.
Which one should you apply for?
Usually both, if there is any chance either applies. The agency will sort out which you qualify for. Choosing one on your own and being wrong costs months.
Nationwide SSI Disability Lawyer Near Me (800) 562-9830
What Counts as Income and Resources for SSI?
More than people expect, and some of the most important items do not count at all.
Income
The agency divides income into categories, and they are not treated equally.
Earned income is wages and net earnings from self-employment. A portion is excluded before the rest reduces your payment, which means working a small amount does not necessarily disqualify you.
Unearned income is everything else. Social Security benefits, unemployment, pensions, workers’ compensation, interest, and support from family.
In-kind support and maintenance. Food and shelter someone else provides. Living rent-free with a relative can reduce an SSI payment, which surprises nearly everyone.
Deemed income. Part of a spouse’s income, or a parent’s income for a child under 18, is treated as available to you whether or not you see any of it.
Resources
Resources are what you own rather than what you receive. Countable resources include bank accounts, investments, and property you do not live in.
Several significant things are excluded:
- The home you live in
- One vehicle, where it is used for transportation
- Household goods and personal effects
- Certain burial funds and burial spaces
- Property essential to self-support, within limits
Resource denials frequently involve a joint account opened for convenience, an inheritance nobody expected, or a vehicle valued incorrectly. All three are answerable with documents.
Denied over income or resources? Ask for a review. That denial is often reversible.
Why Do SSI Claims Get Denied?
For medical reasons, financial reasons, and procedural reasons, and the letter does not always make clear which one applies.
Medical denials
Insufficient evidence of functional limitation. The most common reason across all disability programs. Treatment records describe care. Adjudicators need to know what you cannot do.
A finding that you can still work. Made at step four or step five of the sequential evaluation, both of which turn on the agency’s assessment of your remaining capacity.
Duration. The condition is treated as not expected to last twelve months.
Failure to attend a consultative examination. Very often because the notice went to an address that was out of date, which is a particular problem in a population that moves frequently.
Financial denials
Countable resources over the limit. Including money that is not really yours, such as a joint account with a relative.
Income too high. Including in-kind support and deemed income you never touched.
Living arrangement. Where the agency concludes someone else is paying for your food and housing.
Procedural denials
Unreturned paperwork. SSI generates a great deal of it, and a form that never came back can close a claim without anyone looking at the medical file.
Non-medical eligibility. Residency, citizenship or qualified alien status, or an unresolved overpayment from an earlier period.
Our page on a denied Social Security disability claim covers the medical denial reasons in more depth.
Can a Child Get SSI Benefits?
A child under 18 can qualify, and the disability standard is different from the adult one.
For adults, the question is whether the impairment prevents work. Children are not expected to work, so the test asks instead whether the impairment causes marked and severe functional limitation in age-appropriate activities. The agency looks at how the child functions across domains such as learning, attending and completing tasks, interacting with others, moving about and manipulating objects, caring for themselves, and health and physical well-being.
Two things drive most childhood SSI denials.
Parental income and resources are deemed to apply to the child. A household that seems modest can still be over the limit, and this is where a large share of these claims fail before the medical question is reached.
School records are treated as evidence and are frequently missing. Individualized education programs, evaluations, therapy notes, and teacher questionnaires often say more about function than a clinic note does. Files without them tend to look thinner than the child’s actual situation.
At 18, the rules change. The agency redetermines eligibility under the adult standard, which is a different test, and benefits can end at that point even though nothing about the child’s condition has changed.
What If You Received a Notice Reducing or Stopping SSI Payments?
Every one of those notices is an appealable determination, and the deadline is printed on the letter itself.
A notice reducing the payment cites a change the agency recorded in income, resources, or living arrangement. That finding is often a reporting error or a misclassification, such as treating help from a family member as in-kind support when the arrangement was actually a loan.
A notice stopping payments for medical reasons follows a continuing disability review. It is a determination with full appeal rights, and there are provisions that allow payments to keep running while the appeal is decided. Those provisions carry a separate election deadline that runs shorter than the appeal deadline itself.
An overpayment notice says the agency believes it paid more than it should have and wants the money back. Reconsideration and waiver are both available, and waiver is worth pursuing where the overpayment was not your fault and repaying it would leave you unable to meet basic expenses.
None of these are letters to wait out. Each carries a deadline, and the shortest ones are attached to keeping payments running while the appeal is pending.
What Does an SSI Attorney Do on a Denied Claim?
Separates the medical problem from the financial one, then answers whichever it actually is.
That sounds obvious and it is the step almost nobody takes. SSI denials arrive in the same envelope whether the agency decided you can work or decided your countable resources were over the limit, and the two need completely different answers.
Read the file rather than the letter. The notice summarises. The file shows the reviewer’s assessment, any consultative examination report, and which records were and were not obtained.
Establish which test failed. Medical, financial, or procedural. A financial denial answered with medical records is months spent going nowhere.
Develop function, not volume. Where the denial is medical, what the file needs is a treating provider quantifying limitation, not another four hundred pages describing treatment.
Answer a financial denial with documents. Bank statements, account ownership, lease agreements, statements about who pays for what in the household. This is paperwork, not medicine.
Meet the deadline. The one part of an SSI claim that cannot be repaired afterward.
How Do You Appeal an SSI Denial?
Within 60 days of receiving the notice, through the same four-level ladder used for every Social Security disability claim.
Reconsideration first, then a hearing before an administrative law judge, then the Appeals Council, then federal district court. Our page on how to appeal an SSI denial covers the mechanics and the deadlines at each level.
Two things are worth knowing before you file.
An appeal without new evidence usually produces the same result. Particularly at reconsideration, where the same agency reviews the same file.
Financial denials need documents, not medical records. Bank statements, account ownership documents, lease agreements, and statements about household arrangements. Sending more treatment notes to answer a resource denial accomplishes nothing.
What Does an SSI Lawyer Cost?
Nothing up front, and nothing unless benefits are awarded.
An SSI attorney works on contingency. Payment, where there is any, comes from past-due benefits after the Social Security Administration has approved the amount. Every agreement goes through that review, and the ceiling is the agency’s rather than the representative’s. The fee rules are published.
Because SSI past-due benefits are generally smaller than SSDI past-due benefits, the amounts involved are smaller too. The structure is the same.
Free consultation, whatever stage your SSI claim has reached.
SSI Questions People Ask
I did some part-time work. Did that cost me my SSI claim?
Not necessarily, and the answer depends on which rule the agency applied. Earnings above the substantial gainful activity level end a claim at step one of the evaluation, which is a medical-side problem. Earnings below that level are a financial-side problem instead, where a portion of what you earned is excluded before the rest reduces the payment. Denials often confuse the two, and a notice citing work activity is worth reading closely before you accept it.
The agency says my living arrangement counts against me. Can that finding be challenged?
Often, yes. Food and shelter provided by someone else is treated as in-kind support and maintenance, and the agency records it as income. The finding turns on how the household was described on the paperwork, which is not always how the household actually works. Where a genuine rental or loan arrangement exists, documenting it can change the determination.
What happens to my child’s SSI when they turn 18?
The agency redetermines eligibility under the adult disability standard, which asks whether the impairment prevents work rather than whether it causes marked and severe functional limitation for a child. Benefits can end at that point even with no change in the condition. The redetermination has full appeal rights, and the notice that follows it is appealable like any other adverse determination.
Was my claim denied because of my spouse’s income?
It may have been. For a married applicant, part of a spouse’s income and resources is treated as available to you under the deeming rules, even where you never had access to any of it. Deeming is arithmetic, and arithmetic can be wrong. A financial denial is worth checking against what the household actually received before you treat it as settled.
Can I get SSI and SSDI at the same time?
Yes, and it is called a concurrent claim. It happens when someone has a limited work history producing a small SSDI benefit that still leaves them below the SSI income threshold. The SSI payment is reduced by the SSDI benefit. It also affects health coverage, since SSDI usually leads to Medicare after a waiting period while SSI usually brings Medicaid.
The agency says I was overpaid and wants the money back. What can I do?
Two things, and they are not the same. Reconsideration challenges whether the overpayment happened or how much it was. Waiver asks the agency to forgive it, and is available where the overpayment was not your fault and repaying it would prevent you from meeting basic living expenses. Both have deadlines, and requesting one promptly can stop collection while it is decided.
I was denied for missing a consultative examination. Is that fixable?
Sometimes. The agency schedules a consultative examination when it decides the medical file is too thin to rule on, and not attending can produce a denial that reads as a failure to cooperate rather than a decision about your health. Where the appointment notice went to an old address, or where the reason for missing it was a good one, that is worth raising on appeal rather than starting the claim over.
The Program for People With the Least Margin
SSI exists for people who have run out of other options. The rules that come with it are unusually intrusive, unusually detailed, and unusually easy to fall foul of by accident.
That is not a reason to accept the first answer. A denial over a joint bank account, an inheritance, a living arrangement, or a school record nobody requested is not a finding about your health. It is a finding about a file.
Send us the notice and we will tell you which kind of problem you have.
Marc Whitehead & Associates, SSI attorneys. Free review of your SSI notice.
Our Main Houston Office
403 Heights Blvd
Houston, TX 77007
(713) 929-2856
Call or text (800) 562-9830 or complete a Free Case Evaluation form
