1. Welcome to our Columbus Ohio Adult Congenital Heart Disease Patient Education Presentation Adult Congenital Heart Disease at Nationwide Children's Hospital To view past patient education sessions: http://www.nationwidechildrens.org/congenital-heart-educationhttp://www.nationwidechildrens.org/congenital-heart-education If you have questions about this presentation please email ACHD@nationwidechildrens.org. ACHD@nationwidechildrens.org Click page down to move through the presentation. Click page up if you need to go back.

2. SOCIAL SECURITY Presenter: Attorney Brandon Sewell Jeff Buskirk and Associates Grove City, Ohio 614-875-7220

3. What is Social Security Disability? Programs managed by the Social Security Administration which are designed to provide income supplements to people who are restricted in their ability to be employed because of a notable disability. Includes both SSDI and SSI.

4. What is Social Security Disability Insurance (SSDI)? Social Security Disability Insurance (SSDI) – Also known as Disability Insurance Benefits, and Title II Benefits A payroll tax funded federal insurance program of the United States government. – SSDI is an insurance program – Paid for with employment taxes To be eligible you must: – Be disabled according to Social Security – Be insured on the date you become disabled

5. What is Supplemental Security Income (SSI)? Supplemental Security Income (SSI) – Also known as Title XVI Benefits A welfare program designed to help low-income individuals who are unable to work to meet their needs. – SSI is paid for with general tax revenues To be eligible you must: – Be disabled according to Social Security – Have little income or resources

6. Am I eligible for Social Security (SSDI or SSI)? Two considerations – Financial Eligibility – Disability

7. Financial Eligibility for SSDI - Part 1 You Gotta Have the Credits – In the year 2016, 1 Credit = $1,260 earned during 1 year 4 Credits = $5,040 earned during 1 year If you have questions please email ACHD@nationwidechildrens.org.ACHD@nationwidechildrens.org

8. Financial Eligibility for SSDI - Part 2 Must meet two tests: – Recent credits test For age 31 or older – you must have 20 credits in the 10 years prior to you becoming disability – Lifetime credits test As you get older the number of credits required over your lifetime increases – At age 21 – 6 credits or 1.5 years – At age 62 – 40 credits or 10 years

9. Financial Eligibility for SSDI - Part 3 Bottom line: For the majority of people, you must have worked 5 of the last 10 years. To put it another way, you must have worked and earned more than $5,040 in 5 of the last 10 years

10. Financial Eligibility for SSI – Part 1 Financial Eligibility Includes: – Income – Assets

11. Financial Eligibility for SSI – Part 2 Income Limits – No more than $733 countable income for individuals – No more than $1,100 countable income for married couples But…what is income? And…what is countable income?

12. Financial Eligibility for SSI – Part 3 What is income? – Earned income – such as money you earn as a result of performing work. – Unearned income – such as payments you receive from Social Security, veterans benefits, a pension, alimony, or child support – In-kind income – such as any type of free rent/shelter or food benefits you are receiving from a nongovernmental source. Living rent free with friends or relatives is an example. – Deemed income - A portion of income earned by other people in your house (like your spouse).

13. Financial Eligibility for SSI – Part 4 What is countable income? – $20 per month of income other than wages (unearned income) – $65 per month of wages (earned income) and one-half of wages (earned income) over $65 – wages that go toward special impairment-related work expenses (IRWE) for disabled persons or blind persons (BWE) – the first $30 of infrequent or irregularly received earned income in a quarter – the first $60 of infrequent or irregularly received unearned income in a quarter – medical care – reimbursement of expenses from a social services agency – food stamps, and – housing or home energy assistance.

14. Financial Eligibility for SSI – Part 5 Asset limits – $2,000 for singles – $3,000 for marrieds But…what are assets? And…what are not assets? If you have questions please email ACHD@nationwidechildrens.org.ACHD@nationwidechildrens.org

15. Financial Eligibility for SSI – Part 6 What are assets? – cash – money in a checking or savings account – cash value in life insurance policies (over $1,500) – stocks and bonds – household goods and personal effects (over $2,000) – motor vehices (except for one), and – real estate (other than the home in which a claimant resides).

16. Financial Eligibility for SSI – Part 7 What are NOT assets? – Your home. To be excluded from the SSA's asset limit, your house must be your principal residence. The exclusion includes your home, the land it's built on, and any adjacent buildings. – Your car. You may have one car excluded from the asset limit if you need it for transportation; otherwise, the value of a car will be excluded from the limit up to $4,500 (that is, any value in the car over $4,500 counts as an asset). – Wedding rings. A wedding ring and engagement ring (of any value) will be excluded from the resource limit. – PASS savings. Income set aside for an SSI “plan for achieving self- support” (PASS) is not counted. – IDA savings. Money saved in an individual development account. individual development account – Burial savings. Burial funds up to $1,500 in value, plus burial plots for your immediate family, are not counted.

17. AND NOW FOR THE GOOD NEWS…

18. YOU DON’T HAVE TO CALCULATE YOUR FINANCIAL ELIGIBILITY… JUST APPLY AND SOCIAL SECURITY WILL CALCULATE IT FOR YOU

19. Disability according to Social Security Social security uses a 5 step process to determine disability 1.Substantial gainful activity 2.Severity 3.Listing level 4.Ability to do previous work 5.Ability to do any other type of work If you have questions please email ACHD@nationwidechildrens.org.ACHD@nationwidechildrens.org

20. Step 1: Substantial gainful activity Are you making more than $1,130 per month? There is a more sophisticated analysis but, generally if you are making more than this amount you won’t qualify for disability.

21. Step 2: Severity Severe impairment – 12 months or more? – Are you seeking treatment? – Are you compliant? – Does your impairment still significantly limit your ability to work? If the answer to all 4 is yes, you have a severe impairment

22. Step 3: Listing Level Does your impairment match the listings in terms of diagnosis and severity? Is your impairment equivalent? Is your combination of impairments equivalent?

23. Step 4: Previous work – Part 1 First, the decision maker will assign you and RFC (Residual Functional Capacity) – An RFC is essentially an judgment based on the evidence about your ability to work. It is primarily divided by strength level into: Sedentary, light, medium, heavy If you have questions please email ACHD@nationwidechildrens.org.ACHD@nationwidechildrens.org

24. Step 4: Previous Work – Part 2 Second, the decision maker will compare this RFC to your prior jobs Third, if your RFC indicates you can do your prior work you will be denied.

25. Step 5: Any other work – Part 1 If you are under 50 years old - the decision maker will compare your RFC to jobs available in the national economy to determine whether you are disabled If you are 50 or older (or have special circumstances) – the decision maker will look to a grid rule to determine whether you are disabled

26. Disability according to Social Security The takeaway? The ultimate question is: Can you do ANY JOB full-time? – Not one that you have done previously – Not one that you have trained for – Not one that will pay your bills – Not one that you will definitely be hired for To put it another way, is there ANY job in the national economy that you can do given your impairments?

27. How long will this take? Part 1 There are four administrative levels – Application: 90-120 days for decision – Reconsideration: 60-90 days for decision – Request for Hearing: 12 months + – Appeals Council: 13-18 months The bad news…if you go all the way through Appeals Council this could take 3 years!

28. How long will this take? Part 2 The good news…you may not have to go all the way to Appeals Council. There are four administrative levels – Application: approximately 30% win – Reconsideration: approximately 5% win – Request for Hearing: 44% win – Appeals Council: 14% remanded for new hearing If you have questions please email ACHD@nationwidechildrens.org.ACHD@nationwidechildrens.org

29. How long will this take? Part 3 The takeaway? – Up to 2/3 of applicants have to go through request for hearing – Some wait more than 2 years…

30. Will I win? Part 1 Ultimately, it is impossible to know beforehand… Attorneys are hired to present the best case they can. – Some things are in their control – Other things are not…

31. Will I win? Part 2 Things that are not in their control… – Judges Columbus ODAR as an example – Judge Timothy Keller – 29% approval rate – Judge John Shailer – 80% approval rate

32. Do I need a lawyer? No. It’s not required.

33. Do I want a lawyer? YES! Statistics suggest that those who have a lawyer at hearing level are almost twice as likely to win benefits. Nearly 90% of those at hearing level have a lawyer or representative. Here’s why: – Gathering medical records Little to no effort by social security – Advice as to treatment needed – Gathering medical and mental health opinions – Pre-hearing brief and other motions – Presenting your case before the judge Your burden; the judge will often say “present your case”.

34. Questions?

35. Thank you for viewing our Columbus Ohio Adult Congenital Heart Disease Patient Education Presentation Adult Congenital Heart Disease at Nationwide Children's Hospital To view past patient education sessions: http://www.nationwidechildrens.org/congenital-heart-education http://www.nationwidechildrens.org/congenital-heart-education If you have questions about this presentation, please email ACHD@nationwidechildrens.org.ACHD@nationwidechildrens.org