SSI and Brain Injury Claims in New York
Traumatic brain injuries can have devastating, long-lasting effects that prevent you from working and earning a living. If you have suffered a brain injury that limits your ability to work, you may qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits. Understanding how to navigate the SSI and SSDI systems is crucial for securing the financial support you need during recovery.
The process of obtaining disability benefits for a brain injury involves meeting specific medical criteria, providing comprehensive documentation, and understanding how any personal injury settlement might affect your benefits. This page explains everything you need to know about SSI and brain injury claims in New York.
Key Takeaways
- Two benefit programs available: SSI is needs-based for those with limited income and assets, while SSDI is based on your work history and Social Security contributions.
- Specific medical criteria: Brain injuries must meet SSA Blue Book listing 11.18 requirements or prevent you from substantial gainful activity for at least 12 months.
- SGA limits for 2026: You cannot earn more than $1,690 per month ($2,830 for blind individuals) to qualify for disability benefits.
- Settlement impact differs: Personal injury settlements do not affect SSDI benefits but can disqualify you from SSI unless properly structured through a special needs trust.
- Three-month waiting period: The Social Security Administration typically requires medical evidence from at least three months after your traumatic brain injury to evaluate your claim.
What Are SSI and SSDI Benefits?
The Social Security Administration administers two distinct disability programs that can provide financial assistance to individuals with brain injuries: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). While both programs provide benefits to people who cannot work due to disabilities, they have different eligibility requirements and funding sources.
SSDI is an insurance program funded through Social Security taxes. To qualify for SSDI, you must have worked and paid into the Social Security system for a certain number of years. The amount you receive depends on your earnings history and the amount of Social Security taxes you paid during your working years.
SSI, on the other hand, is a needs-based program designed to help aged, blind, and disabled people who have little or no income and limited resources. SSI is funded through general tax revenues, not Social Security taxes. To qualify for SSI, you must meet strict income and asset limits in addition to being disabled.
According to the Social Security Administration, under both SSDI and SSI, a disability is defined as the inability to engage in any substantial gainful activity due to a medically determinable physical or mental impairment that is expected to last at least 12 continuous months.
How Do Brain Injuries Qualify for Disability Benefits?
Not all brain injuries automatically qualify for disability benefits. The Social Security Administration has specific criteria that your traumatic brain injury must meet to be considered disabling. The primary question is whether your brain injury prevents you from engaging in substantial gainful activity.
For 2026, the substantial gainful activity limit is $1,690 per month for non-blind individuals and $2,830 per month for blind individuals. If you are currently earning more than these amounts through work, you generally will not qualify for disability benefits, regardless of the severity of your brain injury.
The SSA evaluates brain injuries under specific listings in the Blue Book, which is the agency’s manual of impairments that qualify for disability. Traumatic brain injuries are primarily evaluated under two listings:
Listing 11.18: Traumatic Brain Injury
This listing covers brain injuries resulting from skull fractures, closed head injuries, or penetrating injuries. Your injury must cause specific motor or mental impairments lasting at least three consecutive months after the injury.
Listing 12.02: Neurocognitive Disorders
If your brain injury primarily causes cognitive impairments such as memory loss, difficulty concentrating, or problems with executive functioning, your claim may be evaluated under the mental disorders listings.
Understanding SSA Blue Book Listing 11.18 for Traumatic Brain Injury
According to the SSA Blue Book, listing 11.18 specifically addresses traumatic brain injury. The listing defines TBI as damage to the brain resulting from skull fracture, collision with an external force leading to a closed head injury, or penetration by an object that enters the skull and makes contact with brain tissue.
To qualify under listing 11.18, your traumatic brain injury must meet one of two specific criteria:
Option A: Disorganization of Motor Function
Under this option, your brain injury must cause disorganization of motor function in two extremities (arms or legs), resulting in an extreme limitation in your ability to stand up from a seated position, balance while standing or walking, or use your upper extremities. These limitations must persist for at least three consecutive months after the injury.
Option B: Marked Limitation in Physical and Mental Functioning
Alternatively, you can qualify if your TBI causes a marked limitation in physical functioning plus a marked limitation in at least one of the following areas of mental functioning, persisting for at least three consecutive months:
- Understanding, remembering, or applying information
- Interacting with others
- Concentrating, persisting, and maintaining pace
- Adapting and managing oneself
Important Timing Requirement
The SSA generally needs evidence from at least three months after your traumatic brain injury to evaluate whether you have the required motor or mental impairments. If the SSA cannot make a determination within three months post-injury, they will defer the decision until they obtain evidence at least three months after the TBI.
What Medical Evidence Do You Need for an SSI Brain Injury Claim?
Comprehensive medical documentation is essential for a successful SSI or SSDI claim based on brain injury. The Social Security Administration will review your medical records to determine whether your condition meets the Blue Book listing requirements or otherwise prevents you from working.
You should gather the following types of medical evidence:
| Evidence Type | What to Include | Why It Matters |
|---|---|---|
| Hospital Records | Emergency room reports, admission records, discharge summaries | Documents the initial injury and immediate treatment |
| Diagnostic Imaging | CT scans, MRIs, PET scans showing brain damage | Provides objective evidence of structural brain injury |
| Neurologist Reports | Clinical examinations, neurological assessments, prognosis | Expert medical opinion on severity and limitations |
| Neuropsychological Testing | Cognitive function tests, memory assessments, IQ testing | Documents mental and cognitive impairments |
| Physical Therapy Records | Treatment notes, functional assessments, progress reports | Shows ongoing physical limitations and rehabilitation efforts |
| Treating Physician Statements | Detailed forms describing your functional limitations | Medical source opinion on your ability to work |
The more comprehensive and consistent your medical evidence, the stronger your disability claim will be. Make sure all your treating physicians document your symptoms, limitations, and how your brain injury affects your daily activities and ability to work.
Applying for SSI and SSDI Benefits in New York
Applying for disability benefits can be done through several methods, and starting the process as soon as possible after your injury is important. You can apply for SSI and SSDI benefits online through the Social Security Administration website, by phone, or in person at your local Social Security office.
The Application Process
When you apply, you will need to provide detailed information about your medical condition, work history, and daily activities. The application asks about your physicians, medications, medical tests, and how your condition affects your ability to perform basic work activities.
After you submit your application, the SSA will review your case and forward it to the Disability Determination Services office in New York. DDS is a state agency that works with the SSA to make medical determinations on disability claims. A disability examiner will review your medical records and may request additional information or examinations.
The initial review process typically takes three to five months, though it can take longer if additional medical evidence is needed. If your claim is denied at the initial level, you have the right to appeal through several levels: reconsideration, hearing before an administrative law judge, Appeals Council review, and federal court review.
High Initial Denial Rates
Many disability claims are denied at the initial application stage, even when the claimant has a legitimate disability. Do not be discouraged if your first application is denied. Many claimants who are ultimately approved for benefits must go through the appeals process, particularly the hearing stage before an administrative law judge.
How Do Personal Injury Settlements Affect SSI and SSDI Benefits?
If you suffered a brain injury due to someone else’s negligence and received a personal injury settlement, you need to understand how that settlement might affect your disability benefits. The impact differs significantly between SSDI and SSI.
Personal Injury Settlements and SSDI
Personal injury settlements do not affect SSDI benefit payments. SSDI is an insurance program based on your work history, not your current income or assets. You can receive a large personal injury settlement and continue receiving your full SSDI benefits without any reduction or termination.
The only factor that affects SSDI benefits is whether you return to work above the substantial gainful activity level. If your brain injury improves enough that you can work and earn more than $1,690 per month in 2026, your SSDI benefits may be suspended or terminated.
Personal Injury Settlements and SSI
SSI benefits, however, are significantly affected by personal injury settlements because SSI is a needs-based program with strict income and asset limits. According to disability benefits experts, without proper planning, a settlement can jeopardize SSI and Medicaid eligibility.
For 2024, the SSI asset limit for individuals is $2,000 in countable resources. If you receive a personal injury settlement that pushes your assets above this limit, you will lose SSI eligibility. Additionally, settlement payments can be counted as income in the month received, which also affects eligibility.
Protecting SSI Benefits with a Special Needs Trust
The solution to protecting your SSI benefits after receiving a personal injury settlement is to establish a special needs trust, also called a supplemental needs trust. By transferring settlement funds into a properly structured special needs trust, the money is not counted as your asset for SSI purposes.
According to the Special Needs Alliance, there are two main types of special needs trusts:
First-Party Special Needs Trust
Funded with the beneficiary’s own assets, such as a personal injury settlement. The trust must be established before the beneficiary turns 65 and must include a Medicaid payback provision requiring any remaining funds to reimburse Medicaid upon the beneficiary’s death.
Third-Party Special Needs Trust
Funded with assets belonging to someone other than the beneficiary, such as an inheritance from family members. This type does not require a Medicaid payback provision and can be established at any age.
For personal injury settlements in New York, you will typically establish a first-party special needs trust. The trust can pay for many expenses that improve your quality of life without affecting SSI eligibility, including medical expenses not covered by insurance or Medicaid, rehabilitation services, education, recreation, and personal care attendants.
Consult an Experienced Attorney
Special needs trusts have strict compliance requirements regarding their structure and how funds can be disbursed. Working with an attorney experienced in both personal injury law and disability benefits is essential to properly protect your SSI eligibility while maximizing the benefit you receive from your settlement.
What Happens If You Are Already Receiving SSI When You Get a Settlement?
If you are currently receiving SSI benefits and then receive a personal injury settlement, you must report the settlement to the Social Security Administration immediately. Failure to report the settlement can result in overpayment of benefits that you will have to repay, plus potential penalties for fraud.
When you notify the SSA of your settlement, your SSI benefits will likely be suspended or terminated unless you have already established a special needs trust to receive the funds. You have a limited time to set up the trust after receiving the settlement to avoid losing months of SSI benefits.
In New York, Medicaid’s asset limit is $30,182 for individuals in 2024. If your settlement exceeds this amount and you do not establish a special needs trust, you will lose both SSI and Medicaid coverage, which can be devastating for someone with a serious brain injury who requires ongoing medical care.
Can You Work While Receiving SSI or SSDI for a Brain Injury?
The Social Security Administration recognizes that some people with disabilities may be able to work part-time or at reduced capacity. The agency offers several work incentives to encourage beneficiaries to attempt to return to work without immediately losing their benefits.
Trial Work Period for SSDI
According to Social Security disability resources, the SSA allows people on SSDI to engage in trial work for up to nine months. During these months, which do not need to be consecutive and can be spread out over a five-year period, you can receive your full SSDI benefit regardless of your income.
In 2026, a trial work period month is any month in which you earn more than $1,110. Once you have used nine trial work months, the SSA will evaluate whether you are engaging in substantial gainful activity. If you are earning above the SGA limit, your SSDI benefits will be suspended, but you enter an extended period of eligibility during which you can restart benefits without a new application if your earnings drop below SGA.
Work Incentives for SSI
For SSI beneficiaries, the work incentives are different. The substantial gainful activity test applies to SSI applicants but not to ongoing recipients. This means you can be denied SSI if your work income exceeds the SGA threshold when you file for benefits, but that limit does not apply once you are receiving SSI.
Instead, SSI has income exclusions and reductions. The first $65 of earned income per month is not counted, and after that, your SSI benefit is reduced by 50 cents for every dollar you earn. This allows SSI recipients to work part-time and still receive some SSI benefits.
How Long Does It Take to Get Approved for SSI or SSDI?
The timeline for disability benefit approval varies considerably depending on several factors, including the complexity of your medical condition, the completeness of your medical evidence, and whether your case requires appeals.
Initial applications typically take three to five months for a decision. If your claim is approved at this stage, you will begin receiving benefits relatively quickly. However, many brain injury claims are denied initially, particularly if the medical evidence does not clearly show that your condition meets a Blue Book listing.
If denied at the initial level, the reconsideration stage typically takes another two to four months. If denied at reconsideration, you can request a hearing before an administrative law judge, which currently has wait times of 12 to 18 months in many parts of New York due to backlogs in the hearing system.
At the hearing stage, your chances of approval improve significantly, especially if you are represented by an attorney who can present medical evidence and testimony effectively. Many claimants who were denied at the initial and reconsideration stages are ultimately approved at the hearing level.
Initial Application
3 to 5 months for initial review and decision. Approval rate is lower at this stage as decisions are made based on medical records alone.
Reconsideration
2 to 4 months for reconsideration review. Different examiner reviews your case but no hearing is held at this level.
ALJ Hearing
12 to 18 months wait for hearing date. Highest approval rate as you can present testimony and have legal representation.
What Are the Benefits Amounts for SSI and SSDI in 2026?
The amount you receive from SSI or SSDI depends on which program you qualify for and, in the case of SSDI, your earnings history.
For SSI in 2026, the maximum federal benefit rate is determined annually and adjusted for cost of living. New York provides a small state supplement to federal SSI benefits. The exact amount you receive depends on your living situation, other income sources, and whether you have countable resources.
For SSDI, your benefit amount is based on your average lifetime earnings before you became disabled. The SSA calculates your benefit using a formula that considers your highest-earning years. The average SSDI benefit in 2024 was approximately $1,537 per month, though individual amounts vary widely.
If you are approved for SSDI, you will also become eligible for Medicare after receiving SSDI benefits for 24 months. This is true regardless of your age. For SSI recipients, you are generally automatically eligible for Medicaid, which in New York provides comprehensive health coverage.
Common Reasons Brain Injury SSI Claims Are Denied
Understanding why disability claims are denied can help you avoid common mistakes and strengthen your application. The most frequent reasons for denial of brain injury claims include:
| Reason for Denial | Explanation | How to Avoid |
|---|---|---|
| Insufficient Medical Evidence | Lack of documentation showing the severity and duration of your brain injury | Obtain comprehensive medical records, imaging studies, and neuropsychological testing |
| Income Above SGA | Currently earning more than the substantial gainful activity limit | Reduce work hours or stop working before applying if medically necessary |
| Condition Not Expected to Last 12 Months | Medical evidence suggests brain injury may improve within a year | Provide physician statements about long-term prognosis and permanent limitations |
| Non-Compliance with Treatment | Failure to follow prescribed medical treatment without good reason | Attend all medical appointments and follow treatment recommendations |
| Lack of Work History | Insufficient work credits for SSDI eligibility | Apply for SSI instead if you do not have enough work history for SSDI |
Do You Need an Attorney for an SSI Brain Injury Claim?
While it is possible to apply for SSI or SSDI benefits without an attorney, having legal representation significantly increases your chances of approval, particularly if your case goes to the appeals stage. Attorneys who specialize in Social Security disability law understand the medical and legal requirements for approval and can help you gather the necessary evidence and present your case effectively.
Disability attorneys work on a contingency fee basis, meaning they only get paid if you win your case. The fee is limited by federal law to 25% of your past-due benefits, with a maximum cap. This arrangement makes legal representation accessible to claimants who may not have the resources to pay hourly attorney fees.
An experienced attorney can help you in several ways: gathering complete medical evidence and obtaining detailed physician statements, preparing you for the administrative hearing, cross-examining medical experts hired by the SSA, presenting legal arguments about why you meet the disability criteria, and coordinating with your personal injury case to protect your benefits.
Coordinated Legal Representation
If you have both a personal injury claim and a disability benefits claim arising from the same brain injury, working with a law firm that handles both types of cases ensures coordinated representation. This coordination is crucial for properly structuring any settlement to protect your SSI eligibility while maximizing your overall recovery.
What If Your Brain Injury Gets Better?
Some brain injuries improve over time with treatment and rehabilitation. If you are receiving SSI or SSDI and your condition improves to the point where you can return to work, you must report this to the Social Security Administration.
The SSA conducts periodic continuing disability reviews to determine whether beneficiaries still meet the medical requirements for disability. The frequency of these reviews depends on whether your condition is expected to improve. If your brain injury is expected to improve, you may have reviews every six to 18 months. If improvement is possible but not expected, reviews occur every three years. If improvement is not expected, reviews may occur every five to seven years.
If the SSA determines through a continuing disability review that your condition has improved and you can now work, your benefits will be terminated after a trial work period. However, if you attempt to return to work and find that you cannot sustain employment due to your brain injury, you can request expedited reinstatement of benefits without filing a new application.
Frequently Asked Questions About SSI and Brain Injury Claims
Can I apply for both SSI and SSDI at the same time?
Yes, you can apply for both programs simultaneously if you meet the basic eligibility requirements for each. Some people qualify for both SSI and SSDI, receiving what is called concurrent benefits. In these cases, SSDI is paid first, and if the SSDI amount is below the SSI maximum, SSI supplements it to bring your total benefit up to the SSI level.
How much can I have in assets and still qualify for SSI?
For SSI eligibility in 2024, you can have no more than $2,000 in countable resources as an individual or $3,000 as a couple. Not all assets count toward this limit. Your home, one vehicle, household goods, and certain other assets are excluded. Funds held in a properly structured special needs trust are also excluded from the resource limit.
Will my family members receive benefits if I am approved for SSDI?
Yes, certain family members may be eligible for benefits based on your SSDI record. Your spouse, children under 18, children aged 18-19 who are still in high school, and adult children who were disabled before age 22 may qualify for dependent or survivor benefits. The total family benefit is subject to a maximum family benefit cap.
What happens to my disability benefits if I move out of New York?
Your SSI or SSDI benefits continue if you move to another state, though SSI amounts may change because state supplement amounts vary. You should notify the Social Security Administration of your address change promptly. If you move outside the United States, SSDI benefits may continue depending on the country, but SSI benefits will stop if you are outside the U.S. for 30 consecutive days or more.
Can I get disability benefits for a brain injury caused by medical malpractice?
Yes, you can receive SSI or SSDI for a brain injury regardless of how the injury occurred, whether from medical malpractice, a car accident, a workplace injury, or any other cause. The source of the injury does not affect your eligibility for disability benefits. However, if you receive a settlement or award from a medical malpractice case, you need to structure it properly to protect SSI benefits.
How long do I have to wait to apply for disability benefits after my brain injury?
You can apply for disability benefits as soon as you believe your brain injury will prevent you from working for at least 12 months. However, the Social Security Administration typically requires medical evidence from at least three months after the injury to properly evaluate claims under listing 11.18. Applying early ensures you get in the system, but be prepared that the SSA may defer a decision until sufficient time has passed to assess your permanent limitations.
What is the difference between SSI and workers’ compensation for brain injuries?
SSI and workers’ compensation are completely different programs. Workers’ compensation is insurance that employers provide for work-related injuries, paying medical expenses and wage replacement. SSI is a federal needs-based disability program available regardless of how you were injured. You can receive both workers’ compensation and SSI simultaneously, though your SSI payment may be reduced if your combined benefits exceed certain limits. Workers’ compensation settlements must also be carefully structured to avoid affecting SSI eligibility.
Get Help with Your SSI Brain Injury Claim in New York
Navigating the Social Security disability system while recovering from a traumatic brain injury can be overwhelming. The application process is complex, the medical evidence requirements are strict, and the appeals process can be lengthy. If you are also pursuing a personal injury claim for your brain injury, coordinating these cases to protect your disability benefits requires careful legal planning.
If you or a loved one has suffered a brain injury and needs assistance with SSI or SSDI benefits, or if you need to structure a personal injury settlement to protect your eligibility for benefits, contact an experienced brain injury attorney who understands both personal injury law and Social Security disability law.
Protect Your Rights and Your Benefits
Our New York brain injury attorneys provide comprehensive representation for both personal injury claims and disability benefits. We understand how to maximize your recovery while protecting your eligibility for SSI and Medicaid through properly structured special needs trusts.
