1. Understanding Social Security & SSI Presented by Matthew Lane and Nancy Goodwin www.zieglerlane.com

2. Understanding Social Security & Supplemental Security Income Able to Work? Learn About Social Security Disability criteria for bleeding disorders and co-infections, Medicare waiting periods for recipients and rules for returning to work. Presented by Matthew Lane & Nancy Goodwin – www.zieglerlane.com

3. 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

4. Two Types of Disability Benefits The purpose of Disability Insurance Benefits (DIB; Title II of the Act) “is to provide the measure of economic security for program beneficiaries.” The purpose of Supplemental Security Income (SSI; Title XVI of the Act) “is to assure a minimum level of income for supplemental security income recipients who otherwise do not have sufficient income and resources to maintain a standard of living at the established Federal minimum income level.” See HALLEX I-1-2-57(A)(1) (available online at http://www.ssa.gov/OP_Home/hallex/)

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

6. Advantages of DIB Retroactive benefits available (1 year) Eligible for Medicare after 24 months of receiving benefits Auxiliary benefits available for spouse and children

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

8. 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 from spouse, etc.

9. Disability Evaluation Process 1.Are you performing substantial gainful activity (making over $1,000 per month)? 2.Do you have one or more severe impairments? 3.Do you meet or equal a listed impairment? 4.Can you return to your past work? 5.Can you perform any other work?

10. Bleeding Disorder Listings – Step 3 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

11. Bleeding Disorder Listings – Step 3 7.02 Chronic anemia (hematocrit persisting at 30 percent or less due to any cause) With: A.Requirement of one or more blood transfusions on an average of at least once every 2 months; or B. Evaluation of the resulting impairment under criteria for the affected body system. [e.g., orthopedic listings, Section 1.0]

12. Bleeding Disorder Listings – Step 3 7.06 Chronic thrombocytopenia (due to any cause), with platelet counts repeatedly below 40,000/ cubic millimeter. With: A.At least one spontaneous hemorrhage, requiring transfusion, within 5 months prior to adjudication; or B. Intracranial bleeding within 12 months prior to adjudication.

13. Most applicants do not meet Listings Most cases are decided at Step 5 of the evaluation process. Once you’ve proven you cannot return to your past work, the issue becomes whether you can perform any other work.

14. The Appeal Process Initial Denial by State Agency Reconsideration (where applicable) SSA Administrative Law Judge hearing SSA Appeals Council review Federal District Court *60 day appeal deadline at each step

15. Deciding to Apply Work and self-identity –How DIB is funded Financial consequences of going through SSA’s application process –Can you work while applying? Medical coverage concerns

16. Proving Disability Symptoms alone cannot prove disability Medical conditions must be documented with treatment records Infusion Logs Letter from last employer about why you could not do your job duties because of your medical problems

17. How Your Doctor Can Help The treating source rule – well supported opinions are given more weight –A letter stating “my patient is disabled” is not enough –“My patient is disabled because...” –What comes after the word “because” is what counts. –Medical opinions that you cannot perform job duties must be properly considered by SSA

18. How Your Doctor Can Help SSA is concerned with functional limitations (e.g., patient can stand no more than 30 minutes at one time). Doctor can validate and explain episodic problems and symptoms of disease (e.g., effect of joint bleeds, limited effect of infusions, etc.).

19. Mental Health SSA must consider the combined effect of all impairments, including physical and mental health problems (e.g., depression) Importance of seeking help for depression from a mental health provider

20. Returning to Work Substantial Earnings –Impairment Related Work Expenses (IRWE) SSA’s Ticket to Work program –SSA’s Trial Work Period –Extended Payment Eligibility Different rules apply for SSI

21. Selecting a Representative When to hire (well before ALJ hearing) Benefits of local attorney vs. national firm Advantages of a specialist vs. a generalist Seek a referral from National Organization of Social Security Claimants’ Representatives (NOSSCR; www.nosscr.org) Ask how the term “expenses” is defined. See http://tinyurl.com/d376xs6.

22. Attorneys’ Fees in DIB/SSI cases Attorneys’ fees are regulated by the Act Fees are contingent; thus, if you are not awarded benefits, there is no fee. Typically, at the administrative level (through the ALJ hearing), fees are limited to 25% of your past-due benefits (back pay) with the maximum fee being $6,000. For example, if your back pay is $12,000 ($1,000 per month for 12 months), then the attorney fee would be $3,000. The $6,000 cap can be removed if extended appeals become necessary.

23. Your Social Security Statement Enables you to confirm your earnings are properly reported, which is how insured status is determined Green & white paper statements are no longer mailed by SSA Obtain a copy of your Social Security Statement online at www.ssa.gov Look for SSA seal and the words “The Official Website of the U.S. Social Security Administration”

24. Attorney Matthew Lane Ziegler & Lane, LLC Social Security Disability Law is all we do. 1-800-451-0300 www.ZieglerLane.com info@zieglerlane.com