A Basic Guide to Social Security Disability Benefits Presented by Matthew Lane and Nancy Goodwin of Ziegler & Lane, LLC

Definition of Disability As defined under the Social Security Act –Unable to consistently perform full-time work –Due to medically-determinable physical or mental impairments –Or a combination of impairments –That will last one year or result in death

Disability Insurance Benefits Must be disabled and have insured status Insured status obtained by payment of payroll taxes for enough quarters Insured status expires

Advantages of DIB Retroactive benefits available Eligible for Medicare after 24 months of benefits Auxiliary benefits available for spouse and children

Your Social Security Statement Insured status based on reported earnings Obtain a copy of your Social Security Statement online at Look for SSA seal and the words “The Official Website of the U.S. Social Security Administration”

Supplemental Security Income Must be disabled and have limited income and resources SSI benefits available only from date of application Concurrent Medicaid eligibility

SSI Resource Guidelines Very detailed requirements Generally speaking, $2,000 for an individual and $3,000 for a couple Excluded assets: home and one car Deeming of income

SSI for Children Standard: a physical or mental condition, or combination of conditions, that cause “marked and severe functional limitations” The whole child standard Household resource limits apply

Disability Evaluation Process 5 step sequential evaluation process If not disabled at any step, evaluation ends You have the burden of proof

The 5 Steps 1.Are you working and performing substantial gainful activity? 2.Do you have one or more severe impairments? 3.Does your condition meet or equal a listed impairment? 4.Can you return to your past work? 5.Can you perform any other work?

Listing for Coagulation Defects Listing 7.08: “Coagulation defects (hemophilia or a similar disorder) with spontaneous hemorrhage requiring transfusion at least three times during the 5 months prior to adjudication.” –Found at 20 C.F.R. Part 404, Subpart P, Appendix 1, Part A, Section 7.00: Hematological Disorders

Listing for Children Listing : Inherited coagulation disorder Requires repeated spontaneous or inappropriate bleeding; or Hemarthrosis with joint deformity. –Found at 20 C.F.R. Part 404, Subpart P, Appendix 1, Part B, Section : Hematological Disorders

The Application Process Initial application –Online, by phone, in person –Be specific in your application paperwork –65% of applicants are initially denied –Takes 4-8 months –Appeal vs. reapplication –60 day appeal deadline

The Administrative Appeal Process Administrative Law Judge hearing –6-12 month wait for hearing –Approval rates vary widely –Benefits of legal representation –Appeal of ALJ decision v. new application Appeals Council review –6-12 month wait –75% denial rate

Federal Court Final SSA decisions may be appealed by filing suit in Federal District Court Must demonstrate application of improper legal standard or that decision is not supported by substantial evidence You need an experienced attorney month process

Proving Disability Medical problems must be documented –Must have records to support allegations –Discuss side effects of medication with doctor –Ensure recurrent problems are recorded at every visit Symptoms alone cannot prove disability SSA must consider combined effect of all impairments, both physical and mental (e.g., depression and anxiety) Significance of mental health treatment Document reasons for loss of employment

How Your Doctor Can Help Why “my patient is disabled” is not enough The treating source rule – well supported opinions are given more weight Obtain a narrative statement explaining diagnosis, basis of diagnosis (lab tests, x- rays, signs), frequency and duration of symptoms, and resulting functional limitations

Frequent Problems Gaps in medical treatment Non-compliance Drug and alcohol abuse that materially contributes to disability Work activity Financial hardship and the benefits of planning ahead

Ziegler & Lane, LLC Social Security Disability Law is all we do