Monday, April 7, 2014

Who Qualifies and What are the Benefits?

Who Qualifies and What are the Benefits? Financial 1
There are two basic Social Security programs: Social Security Disability Insurance (SSDI) which is what it says: Insurance - If you qualify, so do minor children you support.

A typical benefit is $1,100 per month, and additional amounts for minor children in your household who you support. If you win, you can get benefits as far back as a year before the date you first filed. But, every case is different.

Whether you qualify for SSDI or not depends upon how long you worked and when. You can ask your local Social Security Field Office – but be skeptical of their answer.

You need to know what your “Date Last Insured” is.

Just like with car insurance, when you stop paying the premium, your coverage will stop.

Say your coverage ended in January, but you had an accident in November of the preceding year. You could still go to your insurance company about the claim even if you are no longer covered.

The same is true in SSDI cases.

Say you were employed full time, and got hurt in 2004 and stopped working. But, you didn’t file a claim until 2013. You would not be covered in 2013 – but, you probably would have been covered up to December 31, 2010.

So you would be covered, if Social Security Agency finds your disability started any time before December 31, 2010 – but not after.

This happens all the time in Workers Compensation cases when people live off of their WC payments and so aren’t working. When that money is gone, they decide to file for SSDI. The Social Security Field Office could very well tell you when you call that you are not eligible. That is true – but only if your condition happened after December 31, 2010.

So, you need to know 1) Were you ever covered; and, 2) When did coverage stop.

Financial 2:

Supplemental Security Income (SSI) provides a very small amount of money (less than $850 per month) to people who live at or below the poverty level. If you win, you do get paid for the time you have been waiting to get your case heard, but not for any time prior to that.

Prior Claims: How far back the government will pay you could depend on whether you filed prior claims – too complicated to explain here.

Medical: Once you know your financial status, there are five steps to a determination.

Step 1. Are you working? You don't have to be bed-ridden to qualify. This is why so many people who get Social Security benefits may not look like they should qualify if you see them on the street. Only you know how you feel and what you can do. Don't give up hope just because someone else doesn't believe you.

Step 2. Do you have a medical impairment? Basically this means a diagnosis of something that limits your ability to work. Here, unlike Workers Compensation cases, they don't look at just one injury, illness or consequence. Everything counts. Does pain or pain medication limit your ability to concentrate? Are unscheduled breaks necessary for you? Are you out of breath or fatigued because you can't sleep? It is the combination of things and what a medical professional says about them that matter.

Step 3 Listed Impairments: There are special rules for some conditions (blindness, some cancer, some heart conditions, etc.). These cases may be processed more quickly. There is a long list of these conditions. Every case is different.

Step 4: Past Work. Can you do the easiest job you have done in the past 15 years? They don't just look at the most recent job you have had. If you have had a sit-down job in the past 15 years, it is legally significant even if you have done heavy labor for the past 10 years.

Step 5: Other Work If you can't do your past job, other factors (age, education, job skills and difficulty with English) will make it harder for you to go back into the work force. It does not matter whether you could actually find a job. It is your "vocational profile" and what the medical professionals say your maximum physical capacity that count.

CASE EXAMPLE: The young man with diabetes I mentioned earlier. He could easily lift 50 pounds. He could sit, stand and walk on an unlimited basis. So, why was he disabled? He was denied at the first two levels because the decision makers at that point did not look at the ravages of the disease.

He was approved by the Judge because we proved he could not do those things on a competitive and sustained basis long enough to maintain full time employment. In his case, the Agency will do a medical review in about a year. Hopefully, he will get the right medication and be better enough that he can go back to work – which he really wants to do. His benefits will end at that point.

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