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SSI BENEFITS FOR LOW BIRTH WEIGHT INFANTS

WHAT IS LOW BIRTH WEIGHT FOR AN INFANT?

Low birth weight infants are eligible to receive SSI payments as soon as you apply for the benefit. The SSA will begin monthly payments and pay for up to six months while they make a decision on your application. They do this because the SSA considers low birth weight to be a presumptive disability.

Many low birth weight babies are also born prematurely. However, prematurity is not needed to prove that your infant should be paid SSI benefits. Instead, the SSA only looks at the birth weight of the newly born baby. The SSA considers low birth weight in infants from the time they are born to the age of 1. Low birth weight is 2000 grams or less. They also look at failure to thrive in infants and toddlers from the time they are born up until the age of 3.

Having a child with low birth weight or failure to thrive can be very challenging. As a parent, you are worried about your baby’s health and their future. In addition to needing to adjust to taking care of a new baby, you must also file for SSI benefits. Find more information here about SSI benefits for children. Therefore, you should get help from us. If you need help, then contact Cannon Disability today for help filing your child’s SSI claim.

Low birth weight (LBW) and SSI benefits

HOW DOES THE SSA EVALUATE DISABILITY FOR LOW BIRTH WEIGHT?

The SSA uses an infant’s birth weight as it is written down on the original or certified copy of the birth certificate. They can also use a medical record that shows the birth weight if it is signed by a physician. Birth weight means the first weight recorded after birth.

Next the SSA will look at the babies gestational age. Gestational age is the infant’s age based on the date of conception as recorded in the medical record.

The SSA considers both the birth weight and the gestational age of the infant.

The following listing shows you that you will be paid SSI benefits if your infant’s birthweight is less than 1200 grams.

If the infant’s impairment meets the requirements for listing 100.04A or 100.04B, the SSA follows specific rules found in the Code of Federal Regulations § 416.990(b)(11).

LOW BIRTH WEIGHT IN INFANTS FROM BIRTH TO AGE ONE

The SSA has specific rules that they follow to figure out if you baby should be paid SSI benefits. For example, under the childhood listing, if you baby weighs below 2000 grams at birth, then they automatically qualify for SSI benefits. See the chart below:

100.04 Low birth weight in infants from birth to attainment of age 1.

A. Birth weight (see 100.00B) of less than 1200 grams.

OR

B. The following gestational age and birth weight:

Gestational Age (in weeks) Birth Weight
37-40 2000 grams or less
36 1875 grams or less
35 1700 grams or less
34 1500 grams or less
33 1325 grams or less
32 1250 grams or less

DOES THE SSA PAY SSI BENEFITS FOR FAILURE TO THRIVE?

The SSA will pay SSI benefits if you baby has “failure to thrive” (FTT). FTT can occur with or without a known cause. When the infant or toddler fails to grow at the common rate, then your doctor may state they have FTT. The SSA will accept the medical opinion of a doctor about whether or not your child has growth failure or a developmental delay.

For example, under listing 105.08, you child may have a growth failure due to a digestive disorder. If that is the case, the SSA will apply the following rule:

105.08  Growth Failure due to any digestive disorder (see 105.00G), documented by A and B: 

A. Chronic nutritional deficiency present on at least two evaluations at least 60 days apart within a consecutive 12-month period documented by one of the following:

1. Anemia with hemoglobin less than 10.0 g/dL; or

2. Serum albumin of 3.0 g/dL or less

AND

B. Growth failure as required in 1 or 2:

1. For children from birth to attainment of age 2, three weight-for-length measurements that are:

a. Within a 12-month period; and

b. At least 60 days apart; and

c. Less than the third percentile on Table I or Table II; or

TABLE ONE & TABLE TWO

Third Percentile Values for Weight-for Length
Length   (Centimeters) Weight   (kilograms)
Table I – Males Birth to Attainment of Age 2 Table II – Females Birth to Attainment of Age 2
45.0 1.597 1.613
45.5 1.703 1.724
46.5 1.919 1.946
47.5 2.139 2.171
48.5 2.364 2.397
49.5 2.592 2.624
50.5 2.824 2.852
51.5 3.058 3.081
52.5 3.294 3.310
53.5 3.532 3.538
54.5 3.771 3.767
55.5 4.010 3.994
56.5 4.250 4.220
57.5 4.489 4.445
58.5 4.728 4.669
59.5 4.966 4.892
60.5 5.203 5.113
61.5 5.438 5.333
62.5 5.671 5.552
63.5 5.903 5.769
64.5 6.132 5.985
65.5 6.359 6.200
66.5 6.584 6.413
67.5 6.807 6.625
68.5 7.027 6.836
69.5 7.245 7.046
70.5 7.461 7.254
71.5 7.674 7.461
72.5 7.885 7.667
73.5 8.094 7.871
74.5 8.301 8.075
75.5 8.507 8.277
76.5 8.710 8.479
77.5 8.913 8.679
78.5 9.113 8.879
79.5 9.313 9.078
80.5 9.512 9.277
81.5 9.710 9.476
82.5 9.907 9.674
83.5 10.104 9.872
84.5 10.301 10.071
85.5 10.499 10.270
86.5 10.696 10.469
87.5 10.895 10.670
88.5 11.095 10.871
89.5 11.296 11.074
90.5 11.498 11.278
91.5 11.703 11.484
92.5 11.910 11.691
93.5 12.119 11.901
94.5 12.331 12.112
95.5 12.546 12.326
96.5 12.764 12.541
97.5 12.987 12.760
98.5 13.213 12.981
99.5 13.443 13.205
100.5 13.678 13.431
101.5 13.918 13.661
102.5 14.163 13.895
103.5 14.413 14.132

2. For children age 2 to attainment of age 18, three (BMI)-for-age measurements that are:

a. Within a consecutive 12-month period; and

b. At least 60 days apart; and

c. Less than the third percentile on Table III or Table IV

TABLE THREE AND TABLE FOUR FOR LOW BIRTH WEIGHT

See table three and four under 105.08B2.

THE SSA CONSIDERS A CHILD’S DEVELOPMENTAL DELAY

Using reports from your doctor, the SSA can figure out whether or not your child has a developmental delay. The SSA determines how severe the delay is by measuring your child’s standardized test results against results from other children of the same age.

If your child was born prematurely, the SSA may use the corrected chronological age (CCA) for comparison. CCA is the chronological age adjusted by a period of gestational prematurity. CCA= (chronological age) – (number of weeks premature). Normally, the SSA will accept reports and testing about the developmental delay from your doctor. They also accept reports from a physical therapist or an occupational therapist.

If you don’t have results from standardized testing, then the SSA will need a narrative report from your child’s doctor. This report should discuss your child’s developmental delay. The doctor’s narrative report should be based on clinical observations, progress notes, and well-baby check-ups.

To meet SSA’s rules, the report must include a number of items. Firstly, the report should have the child’s developmental history. Secondly, the report should contain any examination findings. Also, abnormal findings should be noted on repeat exams. Third, the report should have an overall assessment of the child’s development by the doctor.

Some reports may include results from developmental screening tests. These type of tests can  identify a child who is not developing or achieving skills within expected timeframes. Although doctors may refer to test results as supporting evidence in their report, screening test results alone cannot establish a diagnosis or the severity of your child’s developmental delay. Instead, all of the above is necessary to prove SSI benefits should be paid.

THE SSA’S RULES ABOUT DEVELOPMENTAL DELAY

Failure to thrive requires low birth weight, as well as either Part B or Part C of listing 100.05.

Part B requires the following:

B. Developmental delay established by an acceptable medical source and documented by findings from one current report of a standardized developmental assessment that:

1. Shows development not more than two-thirds of the level typically expected for the child’s age; or

2. Results in a valid score that is at least two standard deviations below the mean.

OR Part C:

C. Developmental delay established by an acceptable medical source and documented by findings from two narrative developmental reports that:

1. Are dated at least 120 days apart (see 100.00C1); and

2. Indicate current development not more than two-thirds of the level normally expected for the child’s age.

HOW DOES THE SSA DETERMINE DISABILITY IF THE CHILD DOES NOT MEET THEIR RULES?

Even if your child does not meet the rules for low birth weight, the SSA can still pay SSI benefits for other conditions. For example, the most common disorders of prematurity and low birth weight include retinopathy of prematurity, chronic lung disease of infancy, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and periventricular leukomalacia (PVL). Other disorders include poor nutrition and growth failure. Additionally, your child may have hearing disorders or seizure disorders. Also, your child may have cerebral palsy and developmental disorders. The SSA looks at these disorders under the affected body systems.

If an infant or toddler has a severe medical condition that does not meet any of SSA’s rules, then the SSA can consider whether the child’s condition medically equals a listing. If the child’s condition does not meet or medically equal a listing, then the SSA will decide whether the child’s condition functionally equals the listings.

MEETING SSA’S LISTINGS FOR LOW BIRTH WEIGHT

There are also several listings that those who are born premature or with a low birth weight may meet. Below are the listings that children born prematurely or at a low birth weight may qualify for.

  • Listing 103.02- Decreased lung function
  • Listing 100.00- Growth impairment
  • Listing 102.02/04- Vision loss
  • Listing 102.10- Hearing loss
  • Listing 103.03- Asthma
  • Listing 104.04(D)- Congenital heart disease
  • Listing 105.08- Malnutrition caused by a digestive tract disorder
  • Listing 105.10- Need for a feeding tube to get nutrition
  • Listing 109.08- Diabetes
  • Listing 111.06/09- Motor dysfunction or communication problems caused by a neurological disorder
  • Listing 111.07- Cerebral palsy
  • Listing 112.00- Mental disorders
  • Listing 114.07- Immune deficiency disorder

In order to meet a listing, your child’s condition must meet all of the listing’s rules. Medical evidence must support the meeting of each element under the listing. Alternatively, if your child’s condition doesn’t meet a listing, but your child’s condition is similar to those found in a listing, then they could equal a listing.

WHAT SSI BENEFITS ARE DUE TO YOUR LOW BIRTH WEIGHT CHILD?

Supplemental Security Income (“SSI”) benefits are different than Social Security Disability (“SSD”) benefits. SSI benefits are a “supplement” to SSD benefits, paid to you if your monthly SSD benefit is a low amount of money. It is also the type of benefit that children receive because they have never worked.

In order to win SSI benefits you must meet SSA’s rules. SSI benefits also come with Medicaid benefits. Medicaid is an insurance benefit that pays for your visits to the doctor and medication. Also, find out more about garnishment of SSI benefits here.

The issue with getting SSI benefits is that your child must be disabled and also qualify financially. You qualify financially by not having significant assets (a cabin, a boat) or money (more than $2000 saved in the bank). The financial rules that govern SSI are complex. Therefore, you need the help of an attorney to help you understand if you can get SSI benefits.

Many parents wish to qualify for SSI benefits simply to obtain Medicaid. This makes sense considering that medical bills cost so much. Unfortunately, in order to qualify for Medicaid you usually must also qualify for SSI benefits. However, this is not true in all circumstances. So, make sure that you apply for Medicaid. If you qualify for even one dollar of SSI benefits, then you usually receive Medicaid benefits too.

HOW DOES SSA DETERMINE IF A CHILD FUNCTIONALLY EQUALS LISTING 107.05 FOR LOW BIRTH WEIGHT?

Children whose condition does not meet or medically equal a listing may have a condition that functionally equal the listings under the childhood SSA rules. When the SSA determines whether a child’s condition functionally equal the listings, they use the six domains of functioning.

The SSA considers how the child functional abilities compare to children in the same age group who do not have a medical condition. SSA recognizes that each child is different. They also know that conditions and symptoms vary in each child. That is why they look at six different domains and compare the your child to other children in their age group.

THE SIX DOMAINS OF CHILDHOOD FUNCTIONING

When the SSA looks at whether a child with a disability equals a listing, they look to six domains of functioning. For example, the six domains of functioning are:

1) ACQUIRING AND USING INFORMATION.

Some children may have problems acquiring and using information. For example, they may experience a delay in the child’s ability to learn and concentrate. Also, they may have trouble with speak and memory.

2) ATTENDING AND COMPLETING TASKS.

Frequent pain or developmental delay can limit a child’s ability to attend and complete tasks at school and at home. For example, if a child does not feel well, it may be difficult for her to stay focused on activities long enough to complete them in an age-appropriate manner. A child may also have problems paying attention to details and might make mistakes on homework or at school.

3) INTERACTING AND RELATING WITH OTHERS.

Developmental delay can also cause problems interacting with others. This may also create anxiety and difficulty maintaining relationships. Additionally, children with a delay may become withdrawn from others. They might also not be cooperative.

4) MOVING ABOUT AND MANIPULATING OBJECTS.

Low birth weight can inhibit a child’s ability to move and manipulate objects. For example, low birth weight or failure to thrive, may cause problems with walking, running, and climbing up and down stairs.

5) CARING FOR YOURSELF.

Caring for yourself involves a child’s basic understanding of her body. This includes emotional health for carrying out self care tasks. A child with failure to thrive may avoid taking medication. Also, they may avoid eating. Likewise, they may ignore symptoms out of frustration.

6) HEALTH AND PHYSICAL WELL-BEING.

Low birth weight and failure to thrive often affect a child’s health and physical health. In this domain, the SSA looks at the frequency and duration of the child’s symptoms. Also, they examine to what extent the pain and weakness affects the child’s ability to function physically.

PRESUMPTIVE DISABILITY 

Social Security knows that there are some medical conditions that are almost always found to be disabling. Because of this presumption of disability, the SSA will begin monthly payments as soon as you apply for SSI. These SSI payments will last for up to six months while a decision is made on your application. Children who have any of the following conditions may qualify for presumptive disability payments.

WHAT WE DO TO HELP YOU WITH YOUR LOW BIRTH WEIGHT BENEFITS CASE

You do not need to obtain SSI benefits for your child on your own. Cannon Disability Law can help file your disability application for your infant. Also, we can help you file an appeal after every denial from the SSA. If we take over filing your SSI application, then you can focus on taking care of your child’s health. For example, our attorneys and staff can:

  • Send you the paperwork you need to become our client
  • Help you file your application for SSI benefits
  • Contact SSA as soon as you file your application to explain that your child’s low birth weight is a Compassionate Allowance
  • Request reconsideration if you receive an initial denial from Disability Determination Services
  • Help you confirm your attendance at a Consultative Examination
  • Request a Hearing with an SSA judge
  • Prepare you to be a good witness at your SSA hearing
  • Represent you at your hearing and also question the vocational and medical witnesses.
  • Read more about vocational experts here.
  • Learn more about medical expert testimony here.
  • Request review of an unfavorable decision with the Appeals Council
  • Request review of an Appeals Council denial in Federal Court

If you file your application for SSI benefits online at Social Security’s website, then you have 6 months to finish the application. Once you submit your application, the SSA sends you a summary in the mail. You must sign the summary and mail it back. Additionally, once you receive a denial from the SSA, you have 60 days to file an appeal. Unless you call and get an extension of time, you must file an appeal. Therefore, appeal and meet the time limit set by the SSA. If you do not, then you will lose any benefits you could receive on an old application.

WHAT ARE THE COSTS OF YOUR DISABILITY CLAIM?

The costs of an SSI case are not high. However, if there are costs in your case, then you pay those. Normally those costs are less than $100. You must pay the bill when your doctor charges for a copy of your medical records. Other than that, we can keep your costs to a minimum. For example, we have an office fee charge of $75 that covers your office costs for the two years you are our client. That is the only fee we charge for stamps, copies, faxes, and telephone charges.

Once we win your SSI case, the payment of your attorney fee comes from your back benefit. This is unusual, because to hire most lawyers, you have to pay the attorney fee upfront. We don’t do that. Instead, we are paid when you win your SSI benefits. If we don’t win your SSI benefits, then you do not owe an attorney fee.

Also, we represent clients in many states. For example, we have clients in Nevada, Utah, and Idaho. You can learn about Idaho disability benefits here. We also represent clients in Colorado and California. Likewise, find out more about Nevada disability benefits here.

Utah disability benefits information can be found here. Additionally, we have information about California disability benefits here.

No matter where you live, we will answer your questions about your SSI benefits. We want to be your legal team. If you have questions about SSI benefits and winning childhood benefits, then contact us today.

HIRE CANNON DISABILITY TO WIN YOUR BENEFITS FOR LOW BIRTH WEIGHT

In the past 30 years, we have won millions of dollars in SSI benefits for our clients. If you want to win SSI benefits, then you need to hire an attorney with the experience to win your case. Also, you need a lawyer to show the SSA that your infant should be paid SSI benefits. We can do that. Contact us today.

If you want to learn more about Cannon Disability’s representatives, then read our About Us page. For instance, Andria Summers is an amazing advocate. Because she has an insurance license, she can help you with your Medicare plan. She has also won thousands of SSI cases.

Dianna Cannon has been representing SSD and SSI clients for thirty years. Additionally, she is rated as one of the top three disability attorneys in Utah and one of the top three SSD attorneys in Las Vegas, Nevada.

Brett Bunkall also has significant experience helping people obtain their SSI and SSD benefits. We are experts. You can trust us to help you win SSI benefits.

In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. If you win SSI benefits, then you also get Medicaid benefits. Also, we help our clients with their Medicare benefits. Our specialists, for instance, can help you apply for SSI benefits using the SSA’s website.

Likewise, if you need an appeal, we can help you do that too. There are also many forms you will need to fill out. But, don’t worry. If you have questions about forms, then we will answer them. You can also learn more about SSA’s appeal forms here. Call us for a free consultation about your SSI case. We can help you if you have a child with low birth weight or failure to thrive.

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