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Archive for October, 2012

If you are able bodied and you suddenly become disabled, there are a couple different options.

WORKERS:

  • Injured while you are employed, you will probably get short-term disability insurance coverage which companies pay for – this will pay for a portion of your salary.  You will probably have to use your available sick days before eligible for the std to kick in.  You also get to keep your company health benefits.  That can last between 10 and 26 weeks.   You get better during that time, great, go back to work.  If you’re still unable to work when short term runs out, you may be eligible for long term disability.  Usually this is only the case if you have paid for that coverage through your employer.  It’s fairly inexpensive, but it’s optional coverage and a lot of people decline it.  If you declined the long term, skip to next paragraph.  If you elected that coverage, you will have to submit medical documentation to prove your disability, they must respond within 45 days.  They could ask for more information (lab tests, x-rays, exams), approve application or decline it, you have 30 days to reply with additional info or appeal.  Once you reply or appeal they have another 45 days.  (Keep in mind, during all this decision time, you have no income.)   But at least federal law due to ERISA mandates quicker response time than the federal government is held to.
  • If you have no long term disability insurance through work either because you declined coverage or because they denied your claim, you need to then apply for disability through Social Security- skip to next bullet point with non-workers.

NON-WORKERS: STUDENTS 18+, HOUSEWIVES, UNEMPLOYED

  • Without the private long term disability insurance one must turn to Social Security.  The process is as follows: A) fills out an online application for Disability that is approximately 8 pages with all doctor contact information for the past ten years. B) Social Security mails two large paper forms to the applicant to be filled out.  They are each in excess of 20 pages.  C)  Social Security mails questionnaires to each doctor and provider you listed in the online application for them to assess you. And then when they review all that information that comes back they can decide either A) they don’t have enough information and they need a Social Security doctor to evaluate you to make a decision. B) based on the information provided you do not fit the definition of disabled. OR C) they have enough information and you are disabled.
    • Problems with the 8 page online application:
      • It is incumbent on the applicant to track down  the current name, address and contact information of the doctors/providers as well as dates of service and to verify with those providers that they still have your records at their office.  It took me three full days to secure this information.
  • Problems with the 20 page forms that need to be filled out.
    • They are very complicated series of questions and documents.  Basically, these documents are what the applicant uses to make their case to the agency that they are disabled.  It took my father and myself over 20 hours to complete my paperwork as we did it together.  Dad has a masters and spent over 20 years reviewing contracts and legal documents as part of his job.  The issue is that you have to search on the website for the five things that the agency uses to determine if you’re disabled.  Then in a separate section of the web, it shows you what you need to establish to prove that you indeed suffer from a condition that is acceptable.  So, in those documents you need to make sure that you explain that you meet those five criteria for disabled and that your symptoms match those to qualify for an acceptable condition.  PEOPLE WHO HIRE A LAWYER HAVE A MUCH HIGHER SUCCESS RATE WITH DISABILITY APPLICATIONS BECAUSE THEY KNOW EXACTLY WHAT THE DOCUMENTS NEED TO PROVE.  Bottom line, people who don’t realize what they need to prove, don’t have money for a lawyer, perhaps are not as educated, don’t have a family member to help them when they’re incapacitated are screwed.  I really believe that a high number of applications are denied simply because they are not filled out correctly or well.
  • Problems with provider questionnaires.
    • Doctors don’t fill them out at all or don’t fill them out well.  If they haven’t seen you in a while or have incomplete notes, they may send nothing back.  I contacted all of my doctors, sent them letters to explain my situation and reminded them of our sessions.  I asked them to please fill out the paperwork for me as it was important to me in my current circumstance.  Almost all of them sent them in, which I considered a victory.
  • IT IS INCUMBENT ON THE APPLICANT TO MAKE SURE THE SSA HAS ALL THE TESTS, X-RAYS, LABS, DOCUMENTS, DOCTOR’S NOTES, INFORMATION THAT THEY NEED TO CHECK OFF ALL THE BOXES TO JUSTIFY A DISABILITY CLAIM.  SOMETHING MISSING OR SOMETHING NOT PROVED?  DENIED.  OH, AND YOU NEED TO KEEP A COPY OF EVERYTHING JUST IN CASE THEY LOSE IT – AND YES, YOU STILL SUBMIT THE APPLICATION IN PAPER.

Now, I want you to imagine that you have just gotten a diagnosis of hodgkins lymphoma, it’s bad, you are 38, with three kids between 8-13, you can’t work anymore, you need to go to treatment.  Your husband works and he needs to keep working to pay the bills and so you have medical coverage.  Even with his medical coverage, you have high prescription costs and out of pocket costs and the family will miss your salary.  You have worked, paid into Social Security, can get SSDI, could use the money, but have to apply.  The doctor’s give you a prognosis of two – three years, but say there might be a new treatment soon.  So, while you’re feeling really bad, taking care of three kids, going to treatment – you have to collect all the information, tests, labs, MRIs etc.  prepare a complicated document that proves the issues in the link below and that your condition meets the definition of a disabled condition.  But nowhere on the application do they tell you that you need to prove these things, unless you do your own research or pay a lawyer, you’re flying blind.

http://www.socialsecurity.gov/dibplan/dqualify4.htm

http://www.socialsecurity.gov/dibplan/dqualify5.htm

This whole complex application procedure explains the story of Mr. Perry with colon cancer that became stage 4, who was first denied, appealed then denied for more medical records, appealed again and then the agency wanted more accurate documentation to determine whether he was able to work.  He died before they approved his claim.

ONCE YOU HAVE BEEN FOUND TO BE DISABLED….

They determine whether you are eligible for SSDI or SSI.

SSDI – Based on what you have paid into social security trust fund, they see if you are eligible for a payment and calculate what it is.

If your payment is more than $690 per month, you receive ONLY SSDI.

If your SSDI payment is less than $690 per month, you receive that amount and then SSI will make up the difference to make your total benefit $690 per month as long as you are financially eligible.

If you haven’t paid enough in to Social Security and are not eligible for an SSDI payment, and if you have less than $2000 in assets, you are eligible for the SSI program which pays you $690 per month based on financial need.  The people who have been disabled for most of their lives usually get SSI category because they were never able to work and pay into the system.

FOOD STAMPS IN PA:

If you’re on disability and your payment is less than $700 a month, you are entitled to $200 a month in food stamps.  These can only be used for food – no toilet paper, toothpaste, shampoo.  If your disability payment is more than 700 but less than 900, they prorate your food stamps.  If your disability is more than 900, you get no food stamps.

MEDICAL COVERAGE:

Once you are disabled for 24 months, you are eligible for Medicare, a federal program.

Until then, in PA, if your disability payment is more than $1000 per month and you can work at least 1 hour a month, you can get Medical Assistance(Medicaid) and pay a premium for it based on your income.  So, you can do things like babysit or walk a dog and it counts.  (Income includes your disability payment)

If you are so disabled that you can’t even do that kind of work and your disability payment is more than $1000 per month, you would have to get private insurance until the 24 month period expires for Medicare.  And this, of course, is where the lovely pre-existing condition rule kicks in and a person can’t get private insurance.

If your disability payment is less than $1000 per month, you don’t need to work to qualify for Medical Assistance.

PROGRAMS TO GET YOU BACK TO WORK –

SSDI has more programs to train you to go back to work and accommodate your disability.  It also allows you a trial work period, where you can work and keep your benefits for a little while to see if it is a good fit.  Also, if your benefits end because you’re fully employed again, if your condition recurs within 3 years, your benefits will automatically be re-instated without applying.

SSI has fewer programs and funding.  They do not have a trial work period.  They don’t have the auto re-instatement.

VETERANS BENEFITS

The VA administers pensions for WWII vets, surviving spouses as well as disability claims for Vietnam vets, Iraq vets and Afghanistan vets.  Not only do they have to determine if the vet is disabled, they have to determine whether the injury happened while serving (not an old football concussion or from a car accident stateside), but then they determine the level of disability.  For example a single veteran who is 60% disabled receives a benefit of $1009.  If the disability is 100%, then the benefit increases to $2769.

If the VA stopped receiving new disability claims today and just processed all the backlogged pending claims, it would take them 301days to clear them all at current staff levels.

USE THIS MAP TO SEE THE BACK LOG BY OFFICE:

http://www.baycitizen.org/veterans/interactive/map-disabled-vets-stuck-backlog-limbo/

FOR DEPENDENT CHILDREN:

The process is the same of proving the child is disabled.  Up until they’re 18, their benefits go through their parents.  When they turn 18, they then are put on SSI and get the $690/month payment.  I believe if a working parent dies who has paid enough in to the social security system, then the dependent disabled child would inherit that benefit.  I don’t know as much about how this works as for adults.

Services are also administered differently by state.  NY uses the school districts to administer vocational and physical therapy, while it seems like that type of thing is administered through medical assistance in PA.

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