Social Security is a group of government programs administered by the Social Security Administration (SSA) which make payments to individuals. The rules governing the program may be found at 20 CFR 404 et. seq. Eligibility for most SSA programs is based upon the work history of the recipient or a family member.

Social Security is a group of government programs administered by the Social Security Administration (SSA) which make payments to individuals. The rules governing the program may be found at 20 CFR 404 et. seq. Eligibility for most SSA programs is based upon the work history of the recipient or a family member. They may be placed in the following general categories:

  • Retirement benefits;
  • Disability benefits;
  • Spousal benefits;
  • Dependent benefits; and
  • Lump sum death benefits.

Another SSA program is the SSI program. The rules governing SSI are found at 20 CFR 416 et. seq. Eligibility for those payments is based upon financial need, not work history.

RETIREMENT BENEFITS

Who is eligible to receive Social Security retirement benefits?
Generally, to be eligible a retiring individual must have worked for ten years during the worker's lifetime in employment covered by Social Security. To reach 10 years of coverage, one must work 40 quarters (three-month periods), which for 1998 equaled $700 of earnings. Since 1970, quarters of work have been based upon annual earnings, not the actual number of months worked. Therefore, a worker earning $2,800 in 1998 would receive 4 quarters of credit, even if all of the money was earned within one calendar month. No more than 4 quarters may be earned in any calendar year, however. 20 CFR 404, Subpart B.

At what age can I receive Social Security retirement benefits?
Eligible individuals may take "early retirement" at a reduced monthly benefit level starting at age 62. If you wait until age 65 (the "expected" age of retirement), you will receive a normal benefit. Taking a "late retirement" after age 65 will give you a higher than normal monthly benefit.

Due to increasing average life spans, the "normal" or "expected" retirement age will be increased in the future. For persons born between 1943 and 1959, the "expected" retirement age is gradually increased to age 66 and for persons born after 1959 it is increased to 67. These rules are covered at 20 CFR 404.310-325.

How are monthly retirement benefits currently calculated?
First, SSA calculates your average monthly earnings during your work history. The 40 year period concluding with the year during which you turn 61 is utilized. Your 5 lowest earnings years are discarded. Earnings are adjusted for inflation.

Second, SSA utilizes a complicated formula to determine your "Primary Insurance Amount".

Third, this "Primary Insurance Amount" is increased by cost of living increases beginning with the year you turn 62 (whether or not you retire at that age). For example, if Ms. X was born on 7-4-32, has a Primary Insurance Amount of $1,000, and retires on her 65th birthday which falls on 7-4-98, she would receive a first month's retirement check of $1,085. That check would include the cost-of-living increases for 1994 (when she turned age 62), 1995 and 1996. 20 CFR 404, Subpart C.

How can I obtain my Primary Insurance Amount?
If you submit the form " Request for Earnings and Benefit Estimate Statement" to your local SSA office, SSA will provide you with a free estimate of your Primary Insurance Amount. Obtain a form at your local office or call SSA at (800) 772-1213.

If I retire early, how will the amount of my benefits be affected?
Your retirement benefits are reduced by 5/9 of 1 percent for each month prior to age 65 for which you receive benefits. Individuals retiring at age 62 have their Primary Insurance Amount reduced by 20%, 13 1/3% at age 63 and 6 2/3% for retirement at 64. Again, in future years, the "expected" retirement age will be increased.

How much will my benefits increase if I take late retirement?
The amount of increase depends on your age. If you were born before 1917 your increase will equal 1/ 12 of 1% per month. If born between 1917 and 1925 you will receive an increase of 3 of 1 % per month. Those born after 1926 receive increases ranging from 3 1/2% to 8% per year. All persons born in 1943 or later will receive increases of 8% annually. At the present, these increases stop when you reach age 70. 20 CFR 404.313.

Will my retirement benefits be reduced if I work while receiving them?
Maybe. Persons under 65 currently may earn up to $8,280 annually with no reduction in benefits. Benefits will be reduced by $1.00 for every $2.00 earned in excess of that amount. Individuals age 65 and older may have unlimited earnings with no reduction in retirement benefits. 20 CFR 404, Subpart E.

DISABILITY BENEFITS

Who is eligible to receive Social Security disability benefits?
If you are "disabled" and have worked a sufficient number of quarters during your work history, you may be eligible for Social Security disability benefits. You are considered "disabled" if you have physical or mental impairments which prevent you from engaging in "substantial gainful activity". Your "disability" must be expected to last for a minimum of 12 months or expected to result in death. These rules are covered at 20 CFR 404, Subpart P.

If you become disabled before age 24, you must have worked at least six quarters in the three years before the disability began in order to qualify. If you become disabled at any time from 24 to age 30, you must have worked at least 2 the quarters which passed between age 21 and the time your disability began. If you became disabled after age 31, you must have one quarter of work for each year after your 21st birthday and before the year in which the disability began. In addition, you must have worked at least 20 quarters in the ten years before the onset of your disability. 20 CFR 404.130-133.

How are monthly disability benefits calculated?
The calculation of disability benefits is almost identical to the previously explained formula to calculate retirement benefits. Under both programs you would receive your Primary Insurance Amount, adjusted by annual cost of living increases. Your disability benefit calculation ends with the year you become disabled (the retirement benefit calculation, on the other hand, ends the year you become 61). You exclude your five lowest earnings years to calculate your retirement benefits, while you exclude 0 to 5 of your lowest years depending on the age at which you became disabled to calculate disability benefits. 20 CFR 404.317.

How can I prove that I am disabled?
It will be necessary to submit written medical evidence from your physicians to document your "disability". Under revisions to N.R.S. 629.061, which were passed by the 2001 Nevada Legislature, a health care provider shall furnish one free copy of any records that are necessary to support a claim or appeal under the Social Security Act, to a patient, (or a representative with written authorization from the patient), who requests it, within 30 days after the date of receipt of the request. The request must be accompanied by documentation of the claim or appeal,

It may be necessary to take additional tests or be evaluated by Social Security physicians. You may also be required to document the limitations which your impairment places on your ability to perform basic work functions (sitting, standing, lifting, ability to understand and carry out routine instructions, etc.). If your application is initially denied, it is often wise to obtain the services of an attorney to help you gather and present your medical evidence. These rules are covered at 20 CFR 404, Subpart P.

When do disability benefits and Medicare began?
Payments for Social Security disability do not began until the sixth full month of disability. Individuals receiving Social Security disability benefits cannot qualify for Medicare coverage for two years after the onset of their disabilities. These rules are covered at 20 CFR 404.315.

FAMILY BENEFITS

If I retire or become disabled, can my family get benefits with me?
Yes. As you work you are also building up protection for your family. Subject to the limitation explained below, qualified family members may receive a check of up to 50% of your retirement or disability benefit. These rules are covered at 20 CFR 404.330-395. Benefits may be payable to:

  • your unmarried children under 18 (under 19 if in high school) or 18 and older if disabled before age 22.
  • your spouse, if 62 or older (or any age if carrying for qualified child who is under 16 or disabled).
  • your divorced spouse (who was married to you for at least 10 years) if 62 or older and unmarried.

Are my survivors covered when I die?
Your unmarried young or disabled children may qualify for monthly benefits. Moreover, your widow or widower, even if divorced (if you were married for least 10 years), may qualify for payments. Benefits can start at age 60 (or 50 if disabled) or at any age if caring for your qualified child who is under 16 or disabled. 20 CFR 404.350.

Is there a limit on the amount which my family and I may receive each month?
Yes. The total depends on the amount of your benefit and the number of family members who also qualify. The total varies, but generally is equal to about 150 to 180% of your retirement benefit (may be less for disability benefits). The family limit also applies to benefits for your survivors.

What it my spouse worked enough to qualify for benefits?
Your spouse cannot receive benefits on his/her record plus a full benefit on yours. The most which your spouse can receive is the larger of the two benefits. 20 CFR 404.331(e). To compare your spouse may request a Personal Earnings and Benefit Estimate Statement from SSA.

LUMP SUM DEATH BENEFITS

Does Social Security make a death benefit payment when I die?
Yes. Social Security pays a $255 lump-sum death benefit if you worked either (a.) 40 total quarters, (b.) at least one quarter for each year after your 21st birthday [excluding the year of your death] or at least 6 quarters in the 13 quarters preceding your death. The benefit is payable to your spouse, or if there is no eligible spouse, to a child. These rules are covered at 20 CFR 404.310-325. 20 CFR 404.390-395.

SUPPLEMENTAL SECURITY INCOME (SSI)

Does Social Security offer benefits to aged, blind and disabled individuals with little money and limited work histories?
Yes. The Supplemental Security Income (SSI) program pays benefits to individuals who are 65 and older, blind or disabled who are "needy". The rules governing SSI are found at 20 CFR 416. Persons are considered "needy" if they have limited income and resources. The limits on income vary from state to state. In Nevada an individual's monthly income may not exceed $512.00 if disabled, $534.40 if aged or $$603.30 if blind (assuming each is living independently). An individual's non-exempt resources may not exceed $2,000 in value.

A husband and wife can receive SSI benefits as a couple if they are both either 65, blind and/or disabled. A couple may not have over $3,000 in non-exempt resources. The income limits for couples living independently in Nevada are:

  • $815.46 Aged couple
  • $965.53 Aged person and blind spouse
  • $778.23 Aged person and disabled spouse
  • $1,115.60 Blind couple
  • $928.30 Blind person and disabled spouse
  • $769.00 Disabled couple

The income limits for both couples and individuals are affected by living arrangements. Those in domiciliary care may qualified despite higher incomes (and receive a higher benefit). Those living in household of another have lower income limits and benefits (receiving free rent is considered "in-kind" income).

The purpose of the SSI payment is to ensure a minimum subsistence income for aged, blind and disabled individuals with limited work histories. In Nevada, a disabled individual is currently (2000) determined to need a minimum income of $512.00 per month. If, for example, such as individual's Social Security monthly check was only $200.00 (due to a limited work history), the SSI program would supplement the Social Security check by an additional benefit of $332.00. The two checks together would total the minimum subsistence income amount of $532.00.

What assets are exempt from the SSI resource limits?
Most importantly, your home does not count against the SSI resource limit. The rules allow several other types of resources to be exempt. Exemptions include a car (if necessary for employment or medical treatment), clothing, household goods, jewelry, life insurance with a cash surrender value under $1,500 and burial plots. The rules covering assets are at 20 CFR 416, Subpart L.

How does the SSI program define "disabled"?
SSI uses the same definition used to determine eligibility for Social Security disability benefits. Essentially, you must show that you are physically or mentally unable to work for a period of at least 12 months. These rules are covered at 20 CFR 416, Subpart I.

If I receive SSI, will I be eligible for medical benefits?
Yes. SSI recipients are eligible for Medicaid. It is necessary, however, to file a separate application for Medicaid at your local Nevada State Welfare Division (NSWD) district office. To maximize coverage, file your application as near as possible to the date of your SSI application. Medicaid can pay for medical bills incurred up to 3 months prior to the date of your application.

If you transfer resources to another person without receiving fair market value in return within 30 months prior to applying for Medicaid, NSWD will presume that you transferred the resource for the purpose of qualifying for Medicaid. You will have the burden of proof to demonstrate that you had a different purpose for transferring the resource. If you can not prove an innocent reason for the transfer, you will be disqualified from receiving Medicaid until you spend the uncompensated value of the resource on nursing home care or 30 months passes, whichever is sooner.

PAYMENT DATES

When will I receive my checks?
SSI payments are usually dated and delivered on the first day of the month for which they are due. However, if the 1st falls on a weekend or holiday, they are dated and delivered on the first business day preceding the 1st of the month. For example, if the third is a Sunday, payments are delivered on the preceding Friday.

Social Security payments are usually dated and delivered on the 3rd day of the month following the month for which the payment is due (payments for January are delivered on February 3rd, etc.). If the 3rd is a weekend or holiday, payments are dated and delivered on the first business day preceding the 3rd.

Persons filing for Social Security benefits on May 1,1997, or later are assigned one of three new payment days based on the date of birth of the person on whose record entitlement is established (the insured individual).

Birth date of insured Payment day

1st through the 10th 2nd Wednesday of the month

11th through the 20th 3rd Wednesday of the month

After the 20th 4th Wednesday of the month

With a few exceptions, no beneficiaries filing for benefits on May 1,1997 and later will receive payments on the 3rd of the month. The exceptions are beneficiaries who:

  • Receive SSI and those entitled to both Social Security and SSI,
  • Receive income which is deemed to an SSI recipient,
  • Have their Medicare premiums paid for by their home state,
  • Are living in a foreign country,
  • Are paid on the 3rd and later become entitled on another's record,
  • Receive Black Lung or Railroad Retirement payments,
  • Are garnished check or tax levy cases, or
  • Receive payments made via the critical payment system.

Beneficiaries paid on the 3rd can voluntarily change their payment day to the schedule above if all beneficiaries receiving benefits on the record agree. Once changed, the payment date becomes permanent.

DIRECT DEPOSITS

May I have my Social Security or SSI check deposited directly to my bank account?
Yes. Request forms for direct deposit are available at any Social Security office.

After December 1998, with limited exceptions, all Federal benefits, including Social Security and SSI, must be paid through some form of direct deposit. Payments are sent electronically to an account in a financial institution, which can be a bank, trust company, savings and loan association, or credit union. You may sign up for direct deposit through the financial institution or the Social Security Administration.

Social Security has an international direct deposit (IDD) in certain countries outside the USA. To the extent that IDD exists in a country, mandatory IDD will apply. If you live in a country were no IDD program exists, you will be exempt until an IDD becomes available. You may have direct deposit to an account in the USA or any IDD country.

REPRESENTATIVE PAYEES

If I become the physically or mentally unable to handle my financial affairs, may a friend or family member receive my check?
Yes. The Social Security Administration may appoint a "representative payee" who may receive a check may payable to, for example, John Doe as representative payee for Sue Smith. The representative payee is accountable to the Social Security Administration for spending the check on the needs of the recipient. Social Security rules for representative payees are covered at 20 CFR 404, Subpart U and SSI rules at 20 CFR 416, Subpart F.

APPEALS

If I disagree with a decision made by the Social Security Administration, may I appeal?
Yes. The appeals process contains four possible steps:

  • Reconsideration by a second SSA eligibility worker,
  • Hearing before an Administrative Law Judge (ALJ)
  • Appeals Council review of the record, and
  • Federal court judicial review.

The Social Security Administration must first give a written notice of its decision (for example, to deny benefits). The notice must state the reasons for the decision and explain how an individual can request a reconsideration. A reconsideration must be requested within sixty days of the date of the written notice.

When appealing from a decision to terminate SSI benefits once you qualify, you may continue to receive your check while the appeal is pending. To do so you must request a reconsideration within 15 days of the date of the written notice. You may call in to request that SSA calendar the request if you cannot file a written appeal on time (but must file it within 10 days of the call). If you wait longer than 15 days, you may still appeal within sixty days but your benefits will not be restored until after hearing if you win.

If reconsideration is unsuccessful, the Social Security Administration must send you another notice of decision. Within sixty days, you may request an administrative hearing before an ALJ. It is unnecessary, but usually helpful, to be represented by an attorney at this hearing. After hearing, the ALJ will send you a written notice of decision.

If administrative hearing is also unsuccessful in may request review by the Social Security Appeals Council within 60 days. This request is made in writing and the review is on the record. No hearing is held. If you receive an unfavorable decision, you may appeal to federal District Court within 60 days. Social Security appeals procedures are covered at 20 CFR 404, Subpart J and SSI at 20 CFR 416, Subpart N.

Should I seek legal representation when appealing a Social Security Administration decision?
Legal advice may be very helpful at any stage of the appeals process. If you are not represented prior to requesting an ALJ hearing, it is generally advisable to seek to services of an attorney at that point. You may agree to pay an attorney fee approved by the Social Security Administration from funds which you receive if you win your appeal.

If you are no longer able to work because of a disability, you might consider applying for Supplemental Security Income and/or Social Security Disability Insurance. However, if you wait too long to file, you might jeopardize the type of disability you are eligible for. The process of filing for both types of disability is the same.

What is the difference between SSI and SSDI?
SSI (Supplemental Security Income) pays benefits based on financial need, even if you have never worked, or if you have not worked enough. SSDI (Social Security Disability Insurance) is paid to people who have worked and paid Social Security taxes and have obtained sufficient quarters to qualify for benefits. You can call Social Security at 800-772-1213 or visit them online at www.ssa.gov to start the application process. You may also visit one of the local offices.

Stages of a Social Security Claim

  1. Application – If you are denied, you may file a Request for Reconsideration.
  2. Request for Reconsideration – If you are denied, you may file a Request for Hearing.
  3. Hearing – If you are denied, you may request a Review of the Decision by the Appeals Council.
  4. Appeals Council – Your claim may be approved, sent back to the judge for another hearing or denied.
  5. Federal Court – If you are denied again by the Appeals Council, you can file an appealin Federal District Court.

All appeals should be done within 60 days of the denial date.

How Do I Know That I am Disabled?
Social Security’s rules for disability are different than other agencies (like Workers’ Compensation or the VA). Social Security law defines disability as: The inability to engage in any substantial gainful activity, because of a physical or mental impairment, that will last longer than 12 months. This means you are not necessarily disabled just because you cannot return to your previous job(s). It also means you should be getting current medical treatment for your disaiblity. (If you have no insurance, you may contact Clark County Social Services at 702-455-4270 to apply for temporary medical assistance care.)

In your daily life you will want to pay attention to how your disability affects:

  • Your daily living activities (for example, grocery shopping, doing household chores, cooking).
  • Your ability to participate in social activities (for example, being with friends, getting along with other people).
  • Your concentration, persistence and pace (your ability to concentrate or remember things, follow through with tasks or complete tasks at a reasonable pace).

Supporting Your Disability Claim

  • Get current medical treatment and keep a complete list of doctors with addresses and phone numbers.
  • Every time you go to the doctor, report all of your symptoms.
  • If you have substance abuse issues, get help (it could affect your claim).
  • Keep a simple log/diary of the side effects of medications, doctor’s appointments and how you feel from day to day.
  • Fully explain any answers on forms you fill out. (For example, if you can do dishes but have to rest while doing so, explain that.)

CALL US WHEN YOU:

  1. Don’t understand something Social Security said or sent to you or you have questions about Social Security.
  2. Need assistance completing forms.
  3. Have been on Social Security benefits and are being cut off after a review of your disablity or because of an oustanding felony warrant.
  4. Receive a denial of the Request for Reconsidation or have filed a Request for Hearing.

At the Hearing Level We May:

  • Help you file a Request for Hearing.
  • Obtain medical records and update Social Security’s file.
  • Evaluate the merits of your case.
  • Prepare you for and represent you at the hearing.

Compassionate Allowances Program

Michael J. Astrue, Commissioner of Social Security, today announced the national rollout of the agency's Compassionate Allowances initiative, a way to expedite the processing of disability claims for applicants whose medical conditions are so severe that their conditions obviously meet Social Security's standards.

"Getting benefits quickly to people with the most severe medical conditions is both the right and the compassionate thing to do,"

Commissioner Astrue said. "This initiative will allow us to make decisions on these cases in a matter of days, rather than months or years."

Social Security is launching this expedited decision process with a total of 50 conditions. Over time, more diseases and conditions will be added. A list of the first 50 impairments -- 25 rare diseases and 25 cancers -- can be found at Social Security (Compassionate Allowances)

The following websites may provide additional information or assistance: