Disability and the Law Test 4 (ch13 & ch14)

How does the Social Security Disability Administration define disability?

"the inability to engage in any substantial gainful activity by reason of any medical determinable physical or mental impairment, which can be expected to result in death or can be expected to last for a continuous period of no less than 12 months"

What are some of the most common reasons for initial denial? (5)

1. Previous denial 2. Lack of medical evidence 3. Too much income possessed by the applicant 4. Failure to follow recommended medical treatment 5. Failure to cooperate with Social Security **not enough to claim disability tie disability to inability to work

Social Security Administration Office Methods for Application Process: 4 Methods

1. The first is traveling to your local Social Security Office in your community. There you may apply in person for benefits. You may speak to an official there to receive assistance in ensuring that everything is filled out correctly. 2. The second method is by scheduling a phone appointment by calling Social Security's main office. Once an appointment is scheduled, they will send you documents that you may fill out over the phone with their assistance. This also gives you time to gather the necessary documentation about your condition. 3. The third way to apply is through Social Security's website at www.ssa.gov (Links to an external site.). While this method allows you to work from home at your own pace, there is no way to get assistance from one of the officials from the government. 4. The final way is to hire an attorney. This individual will help you through the process as your advocate as opposed to being a neutral government official. This is usually the preferred method of applying but is expensive and in many cases cost-prohibitive.

Most individuals wait how long for an initial decision from social security?

6 months during this time period many individuals have no money coming in so the waiting period can be hard to endure

What percentage of applicants are denied on their first attempt to get benefits?

70%

Social Security Disability was meant to take care of who?

A citizen who had an inability to work for their life b/c of their DISABILITY - NOT for a temporarily unemployed citizen

Level 3 of the appeals process

Administrative Law Judge Hearing- the individual will take their second denial to an admin law judge hearing before a court, not a jury a disabled person can finally speak on their own behalf, the file has a face to it ONLY HAVE SIXTY DAYS FROM THE DATE OF YOUR LEVEL 2 DENIAL TO MAKE THIS REQUEST

When did Congress finally act in passing a bill?

After WW2 when disabled vets returned gome

The cash payment a disabled individual receives depends upon?

Amount of TIME person worked previously and the amount of MONEY they EARNED in their working lifetime Requires you to work and pay into the system, the benefit is based upon what you pay (trust fund) EX: doctor who becomes disabled will see higher cash benefits than a teacher because her time working is much greater

Level 5 of the appeals process

Appeal Council- final venue for an applicant at this point, applicant files a lawsuit against the Social Security Administration Office Very UNUSUAL to get to this level of appeal b/c of time and expense involved Not at high success rate at this point Many people will either abandon their claim or file a brand new claim starting the process all over again.

Level 4 of the appeals process

Appeal Council- sixty days to request a review before this group is you are denied by administrative law judge Not a hearing or personal meeting with any individual Someone from the group will review the judge's decision to determine if it was proper Takes a year, but if granted you will receive retroactive benefits back to your initial date of application (level 1)

How to qualify for SSDI

Applicant must prove that their disability will affect their ability to work for AT LEAST 12 MONTHS or their disability will result in DEATH

At the end of the waiting period what can the Social Security Administration do?

Approve you, deny you, or request more information

How long can the entire appeals process take?

Can be 5-6 YEARS

Due to 70% of the initial applications denied, many seeking benefits will go through the appeals process. How many different levels of appeals are there? Know the levels

FOUR different levels- beginning with level 2 that an individual may attempt to get benefits L1: Initial Application Process and Initial Denial L2: Reconsideration Process L3: Administrative Law Judge Hearing L4:Appeal Council L5: Federal District Court

How to qualify for SSI?

Fed gov. bases payments in part on the applicant's CURRENT resources Under this program, you are only allowed a certain amount of assistance you may receive and a certain amount of assets you may own

How can a widow widower of a deceased spouse receive initial or higher benefits?

If a widow or widower of a deceased spouse paid into the system and the applicant is between the ages of 50-60 yrs, they may receive initial or higher benefits

In regards to SSI, the federal gov bases payments in part of the applicant's current resources. How does this effect the federal benefit rate

If you make more than the FBR you do not qualify for SSI

HOR passing?

Included a cash assistance, ultimately agreed to by Senate and HOR

Social Security did not become a law until

July 1956

SSI is set out to help?

Low income families who have a disabled child in their home b/c this family's Federal Benefit Rate (FBR) would be minimal, SSI is tailored for this situation Parents FBR will only be used while the child is under 18, once they become "adult" FBR requirement will be vastly reduced

If one has a disability is that enough to qualify for benefits?

NO! You must have it to a level where it prevents you from working for AT LEAST a year or will cause DEATH

Do you have to wait 12 months to apply for SSDI benefit?

NO! Only need to prove that you will be disabled for at least that long

Does SSI require you to have previously worked and pay into the system?

NO! There is no requirement that recipients have previously worked and paid into the system.

Is having an attorney present a requirement?

NO.... having an attorney present at this stage may be invaluable It is expensive to sometimes involve the services of an attorney attorney fees are taken out of a percentage of back benefits a claimant may receive In many cases, it many not be worth the attorney's time to assist an applicant until this phase of the process

Initial Senate passing?

Passed a bill that ONLY provided rehab for the disabled NO cash assistance

Level 2 of the appeals process

Reconsideration Process- second look is taken at initial application Person receives a form letter from SS not explaining why their claim was denied You have sixty days from this date of letter to file your appeal, opportunity to include more medical documentation

SSDI differentiates from SSI in what way?r

SSDI you have to pay into system.. TRUST FUND

What does SSDI stand for?

Social Security Disability Insurance

SSDI is funded by

Social Security Trust Fund

SSI stands for what?

Supplemental Security Income

Emerging from the Great Depression, the drafters of the Social Security law wanted to create an assistance program that could survive the ups and downs regarding the country's economy. What definition did they include that was substantial in requiring proof?

They included a definition of "disabled" that was substantial in requiring proof

T/F: The medical evidence must show the connection between the CONDITION and INABILITY to work

True

Social Security Disability decisions are ultimately resolved at the what point in the process?

Ultimately resolved at the hearing before the administrative judge = LEVEL 3 either judge grants the application or L4/L5 appeal process is seen as rubber stamps of the judge's determination At the hearing, the judge is both the TRIER OF FACT AND LAW judge runs the hearing and also decides whether the applicant will receive benefits

To receive SSDI a person has had to do?

Work to pay into the system (one of the most difficult qualifiers for an individual to receive both benefits)

Is SSI kept separate from the Social Security Trust Fund?

YES

To QUALIFY for SSI, MUST your disability affect your ability to work for at least 12 months or result in your death

YES

Issues in the hearing: Does the court hear testimony from the applicant and other witnesses (including family, med professionals, and vocational experts?)

YES Administrative law judge may ask questions directly of the applicant There is no jury and courtrooms are housed in office buildings not in courthouses

For widows and widowers is there an exception to the effect of paying in the system?

Yes When the programs were initially created, idea was that women would stay at home and would not work. Therefore, there was a concern what would happen to females who became disabled after husband's death.

When an individual who receives social security returns to work and their disability subsides, is it possible for social security to be TEMPORARILY benefits?

Yes in some cases you need to continue to provide proof of your debilitating condition to social security to continue to receive gov could cease/reduce benefit payments if they believe the severity of your disability has changed

Can recipients of SSDI also receive SSI?

Yes and vice-a-versa

Should individuals apply for benefits as soon as possible?

Yes, many applicants mistakenly believe that they must be ill or unemployed for 12 months before applying

What is the Federal Benefit Rate (FBR)? Does it apply to SSI or SSDI?

You are only allowed a certain amount of assistance you may receive and a certain amount of assets you may own Applies to SSI

SSI program focuses on what type(s) of individuals?

disabled individuals, including children, who need extra assistance in living comfortably

How is SSI funded?

funded by tax dollars collected by the federal government

SSDI focused on what type of individuals

individuals who could no longer work at a "typical, full time job."

Medicare and Medicare are applied to which recipients?

medicare: SSDI medicaid: SSI

Are SSDI and SSI mutually exclusive?

no

is a diagnosis of disability sufficient enough in qualifying for benefits

no

What are workers compensation benefits?

payments made to workers injured on the job regardless of fault. workers can receive workers comp benefit and social security benefits workers comp benefits can offset the amount one may receive in social security

Purpose of Medicaid and Medicare?

provide the disabled health insurance to help ay for medical expenses.

Can adult children who become disabled before 22 receive SSDI benefits?

they may also receive benefits, even if they adult child never worked or payed into system Social Sec Admin will look at the parents' work history to determine benefit amount For this to occur parent must currently be receiving Social Security Retirement Benefits, Social Security Disability Benefits, or is deceased Parent also needed to pay into system