Unfortunately, typically not. While a 504 plan or an IEP is good evidence and often contains useful information about the child’s disability, it is often not enough by itself.

There is no single formula for winning a disability case. There is a wide range of possible evidence that may be useful:

• Doctors records.
• Hospital records.
• Mental health provider records.
• Police reports.
• School disciplinary reports.
• Attendance records.
• School psychologist records.
• Any evaluations with
• Physical therapy / occupational therapy records.
• Teacher questionnaires.
• Special Education teacher reports.
• IQ test results.
• WJ-III test results.

This is just scratching the surface. If you can think of other evidence, do not avoid it just because it is not listed here. Tell me in the comments about the kind of evidence you found useful.

We have two adopted children that we have had since birth. One is now 14, but was born at 26 weeks weighing 1lb 14 ou. The other is now 12 but was born at 32 weeks at 3lbs 5oz.

Are they eligible for Social Security benefits now?

It is important to remember that Social Security benefits for disabled children fall under the Supplemental Security Income (SSI) program. Just as in adult SSI cases, children can only receive benefits as of their protected filing date (PFD); there are no benefits before the PFD.

That means Social Security will focus its attention on whether the child is disabled at present. There is actually a bit of wiggle room here as there can be an issue of disability starting before the PFD. However, the period of disability has to continue through the protected filing date. If you cannot show the child is disabled as of the date of filing a claim for Social Security child SSI benefits, while the child may have been disabled in the past, there are no benefits available to the child and there is no case.

Put another way, a child might have been eligible for disability benefits as an infant, or at some other time in the past, if someone filed an application. However, if no one did, you cannot file an application now based on a disability in the past.

The only exception, and it is a limited one, is when there was a prior claim filed in the past and it is still within the time period reopen the prior claim – two years from the date of the initial denial on the prior claim. If there was a prior claim, and it is within 2 years of the initial denial on that prior claim, it may be possible to try to reopen that case with a new application.

I understand that this is a harsh rule, and I find myself commiserating with parents who tell me about their children’s early hospitalizations and medical problems. However, the discussion always turns to the issue of whether there is a current claim and whether the child is disabled as of the protected filing date.

Whether a child qualifies for disability benefits depends on meeting the initial non-medical requirements and the severity of their conditions and how well the child’s medical conditions are documented. Working with a lawyer can help you get an idea of your child’s chances on a disability case. However, it is still only a guess. The only way to find out is to apply.

photo credit: limaoscarjuliet

Disabled children can apply for Social Security benefits under the Title 16 children’s Supplemental Security Income (child SSI) program. Children’s cases are considered differently than adult disability claims. However, after a child turns 18, Social Security applies the adult standard to decide disability. Note: children between 18 and 22 may be eligible for Disabled Adult Child benefits based on their parents’ contribution to Social Security.

What happens if a child turns 18 before Social Security decides if the child is disabled?

Here is what Social Security says on this (20 CFR 406.924):

If you attain age 18 after you file your disability application but before we make a determination or decision. For the period during which you are under age 18, we will use the rules in this section. For the period starting with the day you attain age 18, we will use the disability rules we use for adults who file new claims, in §416.920.

Put another way, Social Security will consider disability under the child standard for the portion of time the individual was under 18, and use the adult standard for the portion of time the individual was 18 or over. That means you, in effect, have to prove the case twice: once under the child standard and again under the adult standard.

This can get tricky as an individual can be disabled under the one standard but not the other.

Also, when a child was under 18 for only a short part of the total claim, there is an issue of whether it is worth doubling the analysis for the amount of amount of benefits potentially due.

Keep in mind that SSI back benefits can only be paid back to the protected filing date. Also, unless the claim was protectedly filed on the first day of the month, the benefits are rounded up to the next full month.

If a claim was filed on anything other than the first day of the month the child turns 18, there are no additional benefits available. However, the case will still be considered under both the child and adult standards of disability.

If the case was filed on the first day of the month in which the child turns 18, there is only one additional month of benefits. However, the case will be evaluated under both the adult and child standards. The same applies if the child was only under 18 for only a short period of time.

As a result, it is sometimes worthwhile to move the onset date to the date of the child’s 18th birthday. Of course I cannot give you a hard and fast rule describing when to amend the onset date. However, you should be aware of the costs and benefits so you can make an informed decision. In my Colorado disability practice, there have been times where the onset date was amended to age 18, and other times not.

Disabled children under age 18 can receive Social Security disability benefits under the Supplemental Security Income (SSI) program, or “Child’s SSI.” In order to qualify for children’s disability benefits, Social Security requires that the child:

1. Is not working at a job that Social Security considers to be substantial work; and
2. Has a physical or mental condition (or a combination of conditions) that results in “marked and severe functional limitations.”  This means that the condition(s) very seriously limits his or her activities; and
3. The condition(s) has lasted, or is expected to last, at least 1 year or is expected to result in death.

Note: some conditions result in presumptive disability decision. If your child has one of these condition, he or she may be able to be instantly approved.

However, the majority of children’s disability cases focuses on the second part, the requirement of that a condition produces “marked and severe functional limitation.” There are several ways of doing this:

1. Just as in adult cases, a child may meet one of the Listing of Impairments. A listing of medical conditions, acceptable medical evidence, and the severity necessary for an impairment to be considered disabling. The children’s listings are available here.
2. An impairment may also “medically equal” a listing level impairment. Medically equaling an impairment means that the child’s impairment is not provided in the listings, however, the conditions produces the same or very similar symptoms and limitation as a listed impairment. Note: while you can certainly consider medically equaling a listing, as a practical tip, it is often better to consider meeting or “functionally equaling” a listing.
3. An impairment may also “functionally equal” a listing level impairment. This is another way of saying that the child’s condition is as bad as a listing level impairment. However, there are very specific rules for functional equivalence which are best discussed in their own article.

INCOME AND ASSET LIMITS APPLY:

Additionally, just like the adult SSI program, income and asset limits apply. One wrinkle in children’s SSI case is that Social Security looks at household income and assets (instead of just those of the child). Social Security has pages discussing how it decides whether parents’ and child’s income and resources are within allowed limits.

The household financial limits sometimes make children financially ineligible for children’s SSI benefits even though they might meet the medical requirements for disability.

If denied on financial grounds, parents sometimes wait to re-apply for Social Security benefits for their children until the child is 18. At 18, only the child’s income and resources are counted. However, the child is then evaluated under the adult standard for Social Security disability.

Another option parents are often not aware of when re-applying at age 18, is also apply for Social Security Disabled Adult Child (DAC) benefits.

• DAC provides benefits under the parent’s contribution to Social Security (which may allow for higher monthly benefits).
• As a Title II benefit program, DAC does not count non-compensation sources of income. Gifts, support, inheritance, settlements would not affect DAC eligibility.
• DAC benefits provide Medicare health insurance instead of Medicaid coverage provided with SSI.

Disabled Adult Child benefits have additional requirements. For example: one parent needs to have worked long enough paying into Social Security to qualify.

Here is the answer in a directly from Social Security:

No. At one time, SSA did pay benefits to eligible college students, but the law changed in 1981. Benefits stop when a child reaches age 18 unless he or she:

• Is disabled; or
• Attends a secondary (grade 12 or below) or elementary school full-time.

In general, benefits end when:

• The student graduates [high school]; or
• The student turns age 19 and two months, whichever is first.

Normally, benefits stop when a child reaches age 18 unless he or she is disabled. However, if the child is still a full-time student at a secondary (or elementary) school at age 18, benefits generally can continue until he or she graduates or until two months after he or she reaches age 19, whichever is first.

Here are the applicable regulations:

20 CFR 404.350 “Who is entitled to child’s benefits” states

(a) General. You are entitled to child’s benefits on the earnings record of an insured person who is entitled to old-age or disability benefits or who has died if

(1) You are the insured person’s child, based upon a relationship described in §§404.355 through 404.359;
(2) You are dependent on the insured, as defined in §§404.360 through 404.365;
(3) You apply;
(4) You are unmarried; and
(5) You are under age 18; you are 18 years old or older and have a disability that began before you became 22 years old; or you are 18 years or older and qualify for benefits as a full-time student as described in §404.367.

Subsection 5 concerns continuing benefits for those 18 or over, who are still full-time students. This section requires an individual to be either:

1. Under 18; or
2. A Disabled Adult Child (DAC); or
3. 18 or older and a full-time student under §404.367.

However, §404.367 only deals with primary and secondary school students. Part “e” specifically requires that “You are in grade 12 or below.

Keep in mind we are talking about auxiliary benefits for children due to the death or disability of a parent. How going to school affects a disabled child’s entitlement to disability benefits is discussed here.

Updated 04/07/11.

Social Security may approve Supplemental Security Income (SSI) benefits to children with a low birth weight (regardless or whether the child is premature).

According to the Social Security regulations, these cases are often reviewed by the child’s first birthday.

When we will conduct a continuing disability review. … we will start a continuing disability review …

By your first birthday, if you are a child whose low birth weight was a contributing factor material to our determination that you were disabled; i.e., whether we would have found you disabled if we had not considered your low birth weight. However, we will conduct your continuing disability review later if at the time of our initial determination that you were disabled.

That last sentence from 20 CFR 416.990 is a bit unclear. While not legally binding on Social Security, the publication Benefits For Children With Disabilities provides a better explanation.

By age 1 for babies who are getting SSI payments because of their low birth weight, unless we determine their medical condition is not expected to improve by their first birthday and we schedule the review for a later date.

In other words, unless Social does not expect improvement, a low birth weight baby approved for Social Security SSI benefits will usually have his or her case reviewed by age 1.

If you have a child or grandchild with a disability, you may be thinking about applying for Social Security disability benefits for the child. The most common type of children’s disability benefits is Supplemental Security Income (SSI).

However, proving disability in only half of a SSI case. All SSI cases have two parts:

1. The individual (adult or child) has to be medically disabled (this includes psychological disabilities).
2. The individual has to be financially eligible to receive SSI benefits.

It is quite possible for Social Security to decide that a person is disabled, but then deny that individual on financial grounds. See my article about financial eligibility in adult SSI cases.

Children’s SSI cases can be even tougher.  In adult SSI cases, Social Security considers the individual’s and their spouse’s income. In children’s SSI cases, Social Security considers then entire household income in deciding financial eligibility. The household finances test continues until the child turn 18. On the child’s 18th birthday, Social Security only considers the child’s income (which in many cases is zero).  However, once the child turns 18, he or she is considered an adult and evaluated under the adult standard of disability.

What often happens is the parents’ income makes the child financially ineligible for children’s SSI benefits. If this happens to you, there are a couple of limited options.

• Look into the possibility of DAC benefits.
• Reapply once the child turns 18 or if the household income decreases.

Has your child been financially denied children’s SSI benefits? How did you handle it? Tell me in the comments.

I was asked to address some of the issues parents should consider when deciding whether to start an application for Social Security disability benefits (typically children’s Supplemental Security Income – SSI – benefits) for their disabled child.

Many parents worry that if their child receives Social Security disability benefits, they will be labeled as “disabled,” and carry that for the rest of their lives. Even beyond being on disability, the child may be diagnosed with a socially stigmatizing condition such as mental retardation.

I want my child to have a normal life.  I want my child to overcome this. Will being “disabled” make my child stop trying?

I believe that disability can largely remain a private matter. It is possible for a child to be on Social Security disability benefits and not have other students, their parents, or even the school know. Of course, this depends on the nature of the disability and medical practicalities. In many cases, the school should be aware of disabling medical conditions to allow the child to have access to medications at school and to let the school take appropriate action in case of a medical emergency. Also, you may want the school to know so an appropriate Individualized Educational Plan (IEP) or 504 Plan can be put into place.

Parents should consider what receiving Social Security benefits might provide and weigh that against the potential negatives. Children’s Social Security benefits usually consist of a monthly benefit amount plus Medicaid benefits. Medical benefits provided by Medicaid are often the main reasons parents apply for their children. Medicaid helps many parents getting out of the local clinic, and opens new treatment possibilities such as seeing a specialist, and obtaining speech, occupational, physical, and cognitive therapies.

Ultimately, I believe it comes down to this, if you feel that the treatment options possible under Medicaid can help your child, it may be time to consider applying for Social Security benefits.

Social Security has a fact sheet answering common questions about Supplemental Security Income (SSI) benefits for disabled children:

• How does Social Security decide if a child is disabled?
• How can I get ready for the disability interview?
• How does Social Security decide if a child can get SSI?
• How will I know what Social Security has decided?
• Will my personal information be kept safe?
• What if I am more comfortable speaking in a language other than English?

The fact sheet also has information about:

• Medicaid.
• State Children’s Health Insurance Program (SCHIP).
• Other Health Care Services.
• Work Opportunities for Young People Who Are Getting SSI.

You can get the factsheet as a pdf here.

Social Security has two different benefit programs for individuals who are disabled.

• Disability Insurance Benefits (DIB, also known as SSDI, or Title 2 benefits); and
• Supplemental Security Income (SSI or Title 16 benefits).

Because of its name, it is a common misconception that must apply for “Disability Insurance” if you are disabled. Actually, both programs provide disability benefits.  

What is Disability Insurance Benefits (DIB)?

Generally, Disability Insurance Benefits are based on your payroll contribution to Social Security.  To qualify for DIB, you have to have earned enough Social Security credits, in the right time frame, by paying into Social Security through payroll taxes.  

There are several circumstances in which you may not have enough credits for Social Security Disability Insurance:

• If you have never worked.
• You worked so long ago that you are past your date last insured.  
• Instead of paying into Social Security, you paid into a state program (such as PERA). 

In each of these cases, you might not be eligible for Disability Insurance (DIB).
Please note that this is just an overview.  There are several circumstances in which you may still be eligible for Social Security Disability Insurance (DIB) even if you do not have not have enough credits under your own earnings, including:  

• Social Security Disability Insurance (DIB) based on a spouse’s, or former spouse’s, earnings.
• Widow/er’s benefits and Children’s benefits when a spouse/parent dies.
• DAC (Disabled Adult Child) benefits.

It is often a good idea to speak with Social Security if you think you may qualify for one of these other types of Social Security Disability Insurance Benefits (DIB).

What is Supplemental Security Income (SSI)?

Even if you are not eligible for DIB, you may still be able to apply for SSI.  

Supplemental Security Income is a Social Security program which provides disability benefits to the following groups:

• Children, 
• Adults who have never worked; and 
• Adults who do not have enough quarters of coverage, or are past their date last insured.

Between a Rock and Hard Place:

Is it possible to not be eligible for either Disability Insurance Benefits (DIB) or Supplemental Security Income (SSI)?

Sadly, yes.

If you cannot prove your disability prior to your date last insured, and your spouse makes too much money (or you have another problematic source of income), it is possible that you may not qualify for either DIB or SSI.  This is the proverbial between a rock and a hard place.

Which Program Should I Apply For?

In my opinion, apply for both.  Do not rule out your eligibility for a particular Social Security program. When you apply, Social Security will determine which benefit program(s) you are eligible for and will help you file the application. However, if you want to know if you will qualify for either program, Social Security has a website where you can see what benefits you may be eligible for.

But, Wait!  There’s More.

Once again, this is just a quick overview of DIB and SSI.  There are differences between Social Security Disability Insurance (DIB) and Supplemental Security Income (SSI) which I will address in other articles.

One of the best tips I can give about building a child’s Social Security (Supplemental Security Income) case is to hold on to any disciplinary report, office notes, write ups, teachers notes, detention or suspension notices, etc.

This includes notes for:

• Talking out of turn
• Not following instructions
• Not sitting down
• Fighting
• Yelling
• Being disruptive 
• Cursing
• Throwing things

These documents are an important source of independent evidence about the child’s problems at school.

“Independent evidence” is key.  Social Security looks for  corroboration of the problems the family will tell them about.  Reports from teachers, counselors, administrators, coaches, can be extremely valuable in proving the type and severity of the child’s problems.

Unfortunately, based on my experience in Colorado, a lot of schools do not keep these write-ups in the student’s permanent file.

So, if you do not hold on to these documents, they may not be available when you are trying to prove your child’s disability claim.

Children can be entitled to receive Social Security child’s benefits if the deceased parent was fully insured by Social Security and if they meet 5 tests:

1. The child is the insured person’s child. See §§404.355 through 404.359;
2. The child is dependent on the insured. See §§404.360 through 404.365;
3. The child applies for benefits;
4. The child is unmarried; and
5. The child is under age 18; – OR – 18 years old or older and has a disability that began before the child became 22 years old; – OR – the child is 18 years or older and qualifies for benefits as a full-time student in a primary or secondary school as described in §404.367.

See 20 CFR 404.350 for more information.

Updated 04/30/09.

California Blogging has a story about surviving a four year Social Security Audit(!)

During the audit they inspect every account, every dime I make and spend.   I am allowed some money from some sources. Services from other government or social programs are not counted against Zachary.  Even though it’s immaterial it’s still audited.  Child support is counted against Zachary and people wonder why I don’t really go after his dad?  During the audit if you are missing a receipt for anything, your worker will make up an amount higher than the average number you have shown.

You can read the entire story on story on California Blogging.

If you have a child on Supplemental Security Income, Social Security looks at the entire household income to determine if the child is financially eligible to receive SSI benefits.

In some cases, this means even if the child is disabled, the family cannot receive any SSI benefits because the household income is too high. I have had cases where the parents wait until the child is 18 to apply, because at 18, Social Security only looks at the child’s income (often zero), not the household income.

But even if your household income is not too high at the beginning, you have to regularly prove to Social Security that your income is below the allowed amount. This results in audits.

 photo credit: Phillip