Working while Disabled

Social Security Rules and Regulations encourage Claimants to attempt to work. You can work and receive your full benefits during a Trial Work Period and then continue to work after your Trial Work Period and keep your Medicare benefits, both for specific time periods.If you become disabled by the exact same condition, within specific time periods, your benefits can be reinstated. Your earnings will be reduced by disability related expenses that allow you to work. When you are able to return to work, be certain you know the Reporting responsibilities to Social Security and have documented proof of when you supplied that Notice. These time periods and reporting requirements are ABSOLUTE and just because you have exceeded those Trial Work Period months and have continued to get your full benefits, does not mean you have a right to keep the payments made in error. Be certain to have proof you notified SSA of your work and have written proof if some one at SSA tells you your benefits will continue after the Trial Work Period.

9/11/2001 Where were you?

We will always be drawn together by this date and each of us will remember what we were doing: I was having a second cup of coffee and watching the morning news show. I live about 5 miles, as the crow flies, from Tactical Air Command, Langley Air Force Base. The TV was showing the Twin Tower on fire, and the house shook with the sounds of a "scramble" from Langley; I stepped to the window to see as I heard the exclamations on tv as the second plane hit. I tried to reach my niece who was attending Columbia University ...no luck, but she was fine. And tears filled most of the next days.We will not forget.

Reopening Prior Applications greater than four years prior to current Application

The Rules of Social Security Administration allow for the reopening of prior Claims under specific circumstances up to four years prior.However, in the Fourth Circuit a special Ruling applies which allowed me to reopen a Claim that was Filed seven years prior and never Appealed providing 75 months of retroactive benefits after 16 months of representation in my office. This has been a wonderful case to have won for a client who has been cared for by a dedicated sister for many years with little or no help from other family members, financially or emotionally.

Delay in Filing an Appeal

Many Claimants do not meet the 60 day deadline for Filing an Appeal when they have received Notice of the Determination. There must be an overwhelming reason for the delay or your case must start again from th beginning: new appliction, new disability report AND A MOTION TO REOPEN THE PRIOR CLAIM. A new Claim Filed within a year of the prior Claim Denial, can be considered a Motion to Reopen but at some point in the new Claim you need to actually request that the prior Claim be reopened and that is with a Motion to Reopen with case citations and applicable Regulations, Statutes, SSR, or AR.
Some good reasons for missing the date could be:
you were hospitalized for the majority of the 60 day period
your Appointed Representative was hospitalized for the majority of the 60 day period
neither you nor your Represenative received the Notice of Determination
on the date you had an appointment at the SSA local office you became ill and had to go to the Emergency Room
on the date you had an appointment at the SSA local office, weather closed their office.
You can see, there must be a verifiable and serious reason to miss your date.
When a Claimant is mentally retarded or has significant psychiatric disease, and they were unable to adeqautely understand the Notice giving them only 60 days to Appeal, a Representative may be able to have those cases Reopened.

Earthquake in Mineral Virginia 08/23/2011

Hope everyone is doing OK; several of my clients who were either in the office or were coming into the office for appointments were not certain what was happening. Some even wondered if they were having medication side effects. Not to worry only an earthquake ...in Virginia... while we wait for a hurricane... well... don't worry anyway.
If you have an appointment and the Hurricane Irene has hit the area, please call the office before you come to the offfice; we may be unable to get to the office.

Trying to send Irene away ...play "Good night Irene" by clicking here:

How important are medical records to a Disability case before SSA?

Social Security requires that you provide medical documentation of your disabling condition(s). If you were getting regular medical care and then lost your insurance and had no means of obtaining medical care, SSA Regulations require that DDS  obtain a Consultative Examination(s) of your conditions. During the most recent years, these have increasingly been performed at "mills" by medical care providers who do not see you in their practice, many do not have a practice and only perform DDS and Workers Compensation evaluations. It is my opinion that Claimants are not served well by these evaluations when done by these groups. I have numerous clients who say that they were not even touched by the examining clinician. There is no way that I am aware of that a clinician can comment accurately about muscle spasms if they do not touch the patient! With this  in mind, it is essential that you have consistent medical records.
FIND a free clinic or a sliding fee scale clinic; APPLY for Medicaid so those medical care providers who do provide treatment and evaluations during this determination period, will be able to bill Medicaid/Medicare for your services when you win. Major medical centers and medical school clinics provide exceptional documentation of disability cases.
The Social Security Administration Regulations require that your medical records meet certain standards. These are not my standards; these are the Rules: generally very little evidentiary weight is given to the records of an LCSW who is not having their records and case work supervised by a PhD in psychology, a LPC (Licenced Professional Counselor), or a MD with a psychiatric specialty; SSA usually will give little weight to the medical opinions of a Nurse Practitioner unless counter signed by a physician. A General Practitioner or Family Practice physician's opinions of mental disease or some other highly specialized disease process, such as anxiety and depression, cancer, diabetes, neuropathy, stroke, cardiac conditions,etc, are given little weight if the symptoms do not require the referral to a specialist You must recognize these limitations when you are seeking medical documentation of your condition(s). I cannot tell you the number of Claimants who have to accept a much later onset date than when they first became disabled by a condition because the Claimant continued to be seen by a physican/medical care provider that SSA does not consider to be adequate to provide treatment and/or diagnosis. Many times, once referred ot the specialist, the Family Practiiotner "supervises" the care prescribed by the specialist, and SSA will accept those records.

Sample case from contact to review

Ideally, you will be referred to us prior to your last date employed so that we can review what your options are prior to leaving work. This happens in less than 2% of the cases we agree to represent.
Of course, many times you are disabled suddenly rather than a gradual onset of disease.
The sooner in the process that we can review your case, the more assistance we are in helping you avoid financial disaster.
We will give you an example of a case where we entered the case by making application for DIB online with our new client:

The client calls our office by referral from their physician’s office when we set an appointment to make the online application; we will mail directions to the office and a list of information that we will be required to have in order to complete the application and disability report; your appointment is usually within 7 days of your initial call and will generally take 1.5 to 2 hours. DIB application for benefits can cover retroactive benefits for as much as 12 months prior to the month of application, however you should apply as soon as you are unable to work to avoid possible loss of monetary benefits. There are certain forms that must be completed after printing and submitted to the local SSA office. If there is any information that was not completely provided, SSA will send a letter asking for correction or clarification, then the case is sent to DDS.
Usually within 30 days you will begin receiving correspondence from DDS such as work history reports, activity of daily living questionnaires, fatigue questionnaire, pain questionnaire, or referral for independent consultative examinations. We will meet with you and complete these forms.
Usually, within 60 days of the last request for information, DDS will make their determination of disability in writing. IF you are approved, you are a member of a very rare group. The American Bar Association conducted a detailed  analysis of the SSA statistics and found that approximately 20% of initial applicants are approved and most of those are catastrophically ill claimants. If you are denied, you will have 60 days from the date the Determination was written and mailed to you (60 days after you receive the Determination, estimating that you received the letter 5 days after it was mailed). Keep all envelopes!! We feel there is rarely a reason to delay the Request for Reconsideration so we will get you into the office to file the Reconsideration as soon as possible. Even if medical treatment is scheduled, do not delay. As soon as the Reconsideration is filed, the local SSA office will send your case file to DDS and you will not have access to the case file information. We suggest that you obtain a copy of the case file so we can review the medical records IMMEDIATELY after getting the Denial. This must be done before your Request for Reconsideration is filed in the local SSA office and before it is sent to DDS.
Occasionally, Reconsideration cases are placed in a hold status because the number of initial applications are so high and take a priority for the DDS staff allocation however when they are not being held, the process will begin again with the same forms and the same time period for a response. Again the chances of being approved are low however the next step, a Hearing by an Administrative Law Judge, has over an 80% chance of getting an Approval. The time to wait for a Hearing can vary from about 9 months to over two years, depending on the ODAR office where your case is located. Some cases can be expedited and a Favorable Decision can be made without a Hearing.

Our Philosophy

We believe that a disabled individual needs to have their disability determination completed as soon as possible.

We believe that a Client deserves to have their case processed as rapidly as we possibly can and under whatever exceptions might apply to their case to request that the case be accelerated by Social Security.
We believe that each Client has the right to be informed of each benefit they could apply for and be assisted in making those applications.

Disability Benefits-SSA:DIB, SSI, Medicare; DSS: Medicaid

From the Social Security Administration there are two basic benefits based in Disability: Supplemental Security Income and Disability Insurance Benefits We also specialize in obtaining Medicaid benefits for the disabled, which is administered through the Department of Social Services of the various localities. Our assistance with Medicare coverage, comes through DIB eligibility or End Stage Renal Disease.

DISABILITY

The definition that the Social Security Administration uses for defining disabled is the same for these three benefits: you must not be able to do the work you have done as your primary past relevant work, there are no transferable skills, there are no jobs in the national economy that those transferable skills transfer to that you can do without 18 months of training or more, and your disability is anticipated to last for twelve months, or end in your death. A Representative assists with cases which don’t seem to meet that definition. Very few cases meet that definition when first evaluated by SSA.

SSI

Supplemental Security Income is available to the disabled population who meet certain income and resource limitations. SSI eligibility creates eligibility for many services from the Department of Social Services, such as food stamps, Section 8 housing, and Medicaid. There is no earnings record requirement for this benefit.

DIB

Disability Insurance Benefits is not a resource or income dependent benefit which provides monthly benefits based on the highest five consecutive earnings years or the last full year earnings, if that is highest, as well as benefits to eligible dependents after six full months of a disability anticipated to last at least twelve consecutive months. If you are also drawing Worker's Compensation, your DIB benefits will be "coordinated" with your Worker's Compensation amounts.

EARLY RETIREMENT PENDING DISABILITY DETERMINATION

If you have attained the age of 61 years and 6 months, you can apply for early retirement benefits to be paid to you while you are seeking Disability Insurance Benefits. Generally, Early Retirement benefits are substantially less than your DIB monthly benefit therefore you will receive additional funds when you are approved for DIB.

MEDICAID

Medicaid is administered through the Virginia Department of Medical Assistance Services and provides medical coverage for the disabled who meet the same income and resource limits as set for SSI. 

MEDICARE

Medicare is available to End Stage Renal Disease patients who meet specific medical guidelines, and DIB  recipients after 24 months of benefit eligibility.

Early Retirement Pending a Determination of Disability

If you have an Application for Disability Insurance Benefits pending with the Social Security Administration, when you become 61and ½ years of age you can request that you be paid under the early SSA Retirement Program pending the Determination of your Disability.

Early Retirement Benefits are substantially lower than your SSA Retirement benefits would be if you retired at the maximum age, however Disability Benefits are generally greater than Early Retirement benefits or Benefits for retirement at age 65.  

Many Claimants are unable to meet the COBRA payments for continuing their health insurance after leaving work without this added income. This is the only benefit that you can obtain from SSA to assist during this period of Disability Determination unless you are the Mother of an Adult Disabled as a Child and you are needed in the home to care for them.

Medicaid will reimburse your COBRA or insurance payments if you are found eligible under the Health Insurance Premium Payment Program. Be aware that many DSS employees do not know about HIPPP. File an Appeal if they do not process you immediately.

When your Disability Insurance benefits are determined, your Early Retirement benefit amount will be “offset”, SSA will reduce the amount they owe you for the DIB period by the amount they have already paid to you under Early Retirement. If you have a Representative, the fee that you will owe your Representative, based on a fee agreement meeting the statutory requirements, would normally include the Early Retirement Benefits paid as part of the Back Award.

After you have Notice that your Disability has been proven, your eligibility for Medicare will be determined by your Disability Onset date, not by your age as under Early Retirement.

If you are Eligible for Medicaid because your household income is below the income limits set, when you become 62 and you have SSA Retirement Benefits that you could apply for, your Medicaid will usually be terminated if you do not apply for the early Retirement Benefits. Virginia Medicaid requires that you Apply for all benefits for which you COULD be eligible. Your Medicaid may be stopped due to excess income after you begin your Early Retirement Benefits or it may continue under a Medicaid spend down.

What do you need to win your Disability Claim?

All Claimants are required to provide medical documentation to support their disability. You cannot obtain benefits, based in disability without a diagnosis and medical documentation of your symptoms.

In Virginia, the Social Security Administration  designates the Disability Determination Services (DDS), a Division of The Commonwealth of Virginia, Department of Vocational Rehabilitation, to evaluate your medical records to determine if you meet the criteria for disability. DDS will request all medical records from medical care providers that you list on your application or that you add to your record; they will analyze those records received and make a written Determination of Disability status based on the information in those records and your responses to forms DDS sends to you.

If medical care providers do not send the records or you do not return forms, you may be denied for lack of information or cooperation.

You do not pay for the medical records obtained by DDS. You should not need to get records from your medical care providers unless they fail to send them to DDS.

If you want copies of your medical records from your medical care providers to compare to what they sent to DDS then you MAY have to pay your medical care providers for copies of medical records to the limits set by the Code of Virginia, Section 8.01-413; check the statutes in your state for the same information. Hospitals are allowed to charge more than medical offices. The medical care provider MUST respond to your request within 21 days of the written request. “Respond” does not mean they have to provide the records in 21 days, only respond and tell you how much you owe for the copies. They cannot withhold your records because you owe treatment care money. Arrange to pay for your records on the day you PICK THEM UP.

If you are told that your records will not be released because you owe treatment costs, explain, nicely, that under Section 8.01-413 Code of Virginia, these are your records and that if they do not provide them to you, you may hire an attorney obtain them by subpoena and their practice may end up paying for the attorney. Usually, the medical care provider either is acting out of ignorance or their employee is uninformed as to the Statutes and placing the practice at jeopardy for the expense for violating this Statute.

If you have a Medicaid Application pending, you might explain to the medical care provider that when you win your Disability case, your Medicaid will be re-evaluted and those medical bills just might get paid by Medicaid,  Medicare, or both.

When should a SSA Disability Claimant Apply for Medicaid?

           You should apply immedicately either before you Apply for SSI/DIB or immediately after. That was a quick and easy answer; getting the benefits may not be!

It is not easy and it does require that you follow-up, do everything on time, and file Medicaid Appeals when deadline dates are not met by the Department of Social Services.

To begin, if you attempted to apply for Medicaid at the Department of Social Services (DSS) and the following happened:

•  DSS (Department of Social Services) told you that you could not be eligible for Medicaid unless you had already won your Disability status with the Social Security Administration;
• DSS denied your Medicaid based on a Denial by Social Security while you were in the SSA Appeal process;
• DSS denied your Medicaid Application without making an independent determination of disability by MDU;
• Someone at the DSS discouraged you from applying, such as telling you that you would not be eligible if you Apply;

YOU NEED TO FILE A MEDICAID APPEAL IMMEDIATELY! 

HOW TO FILE A MEDICIAD APPEAL:

Call your local DSS and tell them to mail you an Appeal form or go online to your DSS and get a form there. You do not have to explain why you need an Appeal form. If they do not send it in 5 business days … GO THERE AND GET ONE!

On the Medicaid Appeal form you are asked when did the violation of your Rights occur (they ask you when did you get Notice from DSS of the Appeal Issue); they will say you should have Appealed within 30 days, however IF YOU RELIED UPON THE REQUIRED SUPERIOR KNOWLEDGE OF THE DEPARTMENT OF SOCIAL SERVICES PERSONNEL, you have the Right to Appeal, based on not knowing your true Rights until you found out this information from us. On the Hearing day, there may be a “pre-Hearing” discussion on the issue of “good cause” for filing the Medicaid Appeal after 30days. We have never lost a case when the Applicant was able to clearly state that they had relied upon the statements made by DSS employees and the DSS employees were wrong.

Once you have an effective date of Application established, either by filing the Application or by the Hearing Officer determining what you Application date was, your Medicaid eligibility must be determined for a period of 90 days prior to that Application date unless you have been declared Disabled by Social Security, then they only have 45 days.

You may get a letter telling you that they are not going to meet the 90 day limit because (whatever they say); IMMEDIATELY file a Medicaid Appeal stating that they have failed to determine your eligibility within the time limit set by the Federal Regulations. There are no exceptions to the 90 day determination of disability by MDU allowed under the Regulations…. NONE!

When you do win your SSA BENEFITS, DSS will reopen this Application and reevulate your eligibility for Medicaid, or a Spend Down Medicaid. Any months you get at least $1.00 of SSI you will have Medicaid eligibility IF YOU FILED THE MEDICAID APPLICATION.

How do you get your retroactive Medicaid Benefits?

You have won your SSI benefits. Now, how do you get your retroactive Medicaid benefits?

It is not easy and it does require that you mark your calendar and file Medicaid Appeals when deadline dates are not met by Social Services and your medical care providers, as well as your pharmacy. You are asking DSS to do their job and give you the benefits you should have gotten when you Applied for Medicaid… not an easy task in many locations!

  

If you attempted to apply for Medicaid at the Department of Social Services and the following happened:

• DSS (Department of Social Services) told you that you could not be eligible for Medicaid unless you had already won your Disability status with the SocialSecurity Administration;
• DSS denied your Medicaid based on a Denial by Social Security while you were in the SSA Appeal process;             
• DSS denied your Medicaid Application without making an independent determination of disability by MDU
• Someone at the DSS discouraged you from applying, such as telling you that it is a waste of time because you would not be eligible

YOU NEED TO FILE A MEDICAID APPEAL if you did not when you first Filed for SSI! You will be asked why you did not File a Medicaid Appeal within 30 days of the denying event, tell them you did not understand their system and relied upon their "greater knowledge".

On the Medicaid Appeal form you are asked when did the violation of your Rights occur (they ask you when did you get Notice from DSS of the Appeal Issue); they will say you should have Appealed within 30 days, however IF YOU RELIED UPON THE REQUIRED SUPERIOR KNOWLEDGE OF THE DEPARTMENT OF SOCIAL SERVICES PERSONNEL, you have the Right to Appeal based on not knowing your true Rights until you found out this information from this site. On the Hearing day, there may be a “pre-Hearing” discussion on the issue of “good cause” for filing the Medicaid Appeal after 30days. We have never lost a case when the Applicant was able to clearly state that they had relied upon the statements made by DSS employees and the DSS employees were wrong.

Once you have an effective date of Application established, either by Filing the Application or by the Hearing Officer determining what you Application date was, your Medicaid eligibility must be determined for a period of 90 days prior to that Application date.

ELIGIBILITY

You must meet income, resource, and disability restrictions. Any earnings in your household may count toward the monthly maximum allowed amounts. IF YOU APPLIED FOR SSI AND WERE FOUND ELIGIBLE FOR SSI, all of those dates of coverage must be accepted  by DSS as Medicaid eligible dates from the 90 days prior to the date of your Medicaid Application to the last date of SSI eligibility. Periods after SSI eligibility must have a new Medicaid Application and a new determination of resource and income eligibility. You may only be eligible for Medicaid under a Spend Down plan (similar to a “deductible amount” in regular insurances) after your DIB benefits begin. If you continue to receive as little as $1.00 per month of SSI, you will keep your Medicaid.

For example, if SSI approved you for benefits from Jan 1, 2007 through July 31, 2007, and you applied for Medicaid on April 1, 2007 (and got a denial), the full period from 1/1/07 through 7/31/07 will have Medicaid coverage. If you applied for Medicaid November 10, 2006, and got a Denial from DSS, now DSS must determine your eligibility for Medicaid by income and resources and disability from November 10, 2006 through December 31, 2006.

Remember that your MEDICAID APPLICATION DATE limits when your Medicaid coverage can begin. That is why we urge you to APPLY FOR MEDICAID, DO NOT DELAY.

RECOVERY OF MEDICAL FEES AND PRESCRIPTIONS PURCHASED

If you paid for medical or psychological care or prescriptions, you are eligible for receiving that amount, minus your Medicaid co-pay, back form the provider. You MUST have told the provider that you had “Medicaid pending” when you obtained services, except at the pharmacy.  I asked you to obtain a “master printout” from your pharmacy and told you to keep track of the amounts paid to the providers. This information will assist you when you are seeking your funds back.

If you have not kept track or obtained a master printout of prescriptions, do so before you present a Medicaid card to them.

When your Medicaid benefits will be for a period over 12 months prior to the card issue date, the Department of Social Services must provide you with a ”greater than 12 month” letter that your providers can use to file for the Medicaid Coverage prior to the exact date one year ago. You will give each provider a copy if that letter and a copy of the Medicaid card (or allow them to copy these two items) when you provide notice to the provider to refund your money paid. Also tell them that this Claim must be “hand processed”. You should do this in writing, keep a copy and mark the date on your calendar. Your letter should tell them that they have 30 day deadline for refunding your payments, minus your Medicaid co-pays. They will know how much your co-pay was to be for the service they provided. Mark your calendar for 30 days; also mark your calendar for 15 days and on the 15^th day call the person you directed your letter to and confirm that they have everything they need. If the provider tells you that the Claim was denied, tell them to file an Appeal but you have complied with your Regulatory requirements: provided your Medicaid card that covered the period of service, and a letter allowing the billing of services more than 12 months prior to the filing date.

The provider will then file a PAPER CLAIM to Medicaid, placing a qualifier 22 on the claim and attaching a copy of the greater than 12 month letter from DSS. 

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