A Story About A Social Security Disability Claimant: An American Tragedy
In 2008, a 27-year-old man (let’s call him John) was enjoying his work as a Supervisor, making about $4,000 a month. Life was good and his opportunities were endless. He was working for a company with great benefits and was enjoying the American dream. He had a beautiful stay-at-home wife, two lovely kids, a nice car, and a lovely home. He’d been smart, saved his money and made some good investments. By all accounts, he was a success.
But, in the fall of 2008, his life took on a turn. He woke up one day and had difficulty talking. He was numb on one side of his body and he struggled to walk. He didn’t know what was wrong. His wife rushed him to the hospital. Doctors kept him overnight and determined he’d had a stroke.
John spent a month in the hospital before regaining his ability to speak. During that time, he used his sick time and Family Medical Leave . When he got out of the hospital, he still dragged his left foot, experienced memory loss, and loss of some muscle coordination. Two months went by and he was still having problems. He used up the rest of his vacation time and decided to quit his job because he wasn’t sure when he would be healthy enough to return. Unfortunately, he didn’t have short term or long term disability so he was out of insurance. In order to take care of the family, and support the house, his wife had to go to work. Eventually she found a job, but couldn’t afford to put John and the kids on her insurance so she insured the kids.
Unable to find a free clinic or any providers who would take him on a low cost basis, John had to take money out of the savings and investments to start paying for private insurance and treatment. After about 7 months, he tried to go back to work and found a job as a toll collector. But he continued to have memory problems so his cash register is always off. He was let go after working only three weeks. To make matters worse, he suffered a relapse and had to go back into the hospital for a couple of weeks. When he got out, he had an expensive hospital bill to pay but no ability to pay it. By this point, 10 months have gone by and John has no insurance, no savings, and no investments. So he decides to apply for Social Security benefits.
Unfortunately, it’s a long process. It takes five months from before he gets a denial. In that time, his wife has begun working two jobs because they can’t afford the mortgage and car note . They lose the house in foreclosure and have to move in with her parents. John appeals the denial, waits another six months and is denied again l. In that time, the family’s car is repossessed. He appeals to go before a judge and now is told that he has to wait another 12 months. Twelve months of no insurance, no health care provider, no car, and no home. John’s wife struggles to pay for the few visits that he can attend at a local doctor. It’s not much but it’s something. Twelve months later, he has a hearing. After the hearing, he has to wait three to four months for a decision. Finally, he gets the good word he’s been waiting for: a fully favorable decision. He’s been approved. Now, he’ll have insurance coverage. Now, he’ll have some money.
However, to his surprise, he only gets $1200 a month. He gets a lump sum going back two years in the amount of $24,000 but John has so many bills and debt that the money is gone in less than a month. Now, the question is: How do you start back over? The money is not enough to put them in the position as they were in before. So what do they do?
This story may sound like fiction but it is not. There are thousands of Johns-and Janes-who go through this every day while trying to put their lives back together after something devastating has happened. It’s a tragedy and unfortunately, it’s an American tragedy. So what do we do to fix it?
Never understand what is happening in the mind: Mental Health conditions and Social Security Disability
Mental Health conditions are some of the most devastating conditions that can afflict a human beings. Most of the time when we hear about them, they usually are in relations to two circumstances:
1) Somebody popular
Chynna Phillips of the pop group Wilson Phillips checked herself into rehab for anxiety over the weekend, her manager, Lizzie Grubman, tells PEOPLE exclusively.
2) Something traumatic
Thursday, Joseph Andrew Stack flew a small airplane intentionally into an IRS building. The IRS had 199 people who worked there. Joe Stack set his house on fire, left what is being considered a suicide note, and then flew his Piper Cherokee PA-28 into the Austin, Texas IRS building.
The brain is always going to be considered a mysterious organ. Of all parts of the body, this part is the one that continues to baffle the medical community. So it should come to know surprise that it can be difficult to ascertain the severity of a mental health conditions.
The mental health community relies heavily on a variety of different diagnostic testing, personal history, and mental status examinations to try to get a picture of how severe the mental health condition may be. It’s tough but the information these providers obtain is valuable and necessary if you are attempting to obtain medical benefits.
Regularly, I get asked by my clients what types of things does Social Security look for when trying to determine the severity of the medical condition. Here’s a few things you should consider:
1) The type of doctor tells alot.
I hate to tell you but SSA tends to give a bit more deference to a Psychiatrist or a Psychologist who is treating your mental health condition. There is nothing wrong with your family doctor but a specialist (Psychiatrist or a psychologist) tends to get greater favor. Now, before you ask, there is nothing wrong with going to a Mental Health counselor. However, it is helpful if the counselor is working with you in conjunction with a psychiatrist as part of a mental health plan.
2) The type of medicine you take says alot
Some medications give a clear indication of the significance of your mental health condition. There’s nothing wrong with Paxil or Zoloft. However, Risperdal and Geodon gives an indication of a much more serious mental health condition.
3) The BIG 4 things you need to know (Concentration, Memory, Crowds, Stress)
These are normal questions that are asked that you should give some thought to HOW you are going to respond. How is your concentration? Do you forget things? If you do, what do you do if you need to remember things? How are you around crowds? How many people is TOO many people?
4) Other THINGS MATTER
You have to remember that how you function in your day to day life matters. If you say that you can’t be around more than one person att a time but you go to church every other day (where you would expect to be MORE than one person), your response may be viewed as suspect.
5) Involuntary Admission
In Florida, the term “BAKER ACT” refers to an Act that permits for the involuntary admission of an individual into immediate psychiatric care for a short period of time. Every state calls it by a different name but this usually refers to a situation where a person expresses an intent to harm him or herself or someone else. These admissions may indicate the presence of something more severe.
6) STAY AWAY from the DRUGS (ILLEGAL DRUGS)
Let me blunt. Mental Health and Illegal drugs don’t mix. And when you’re applying for disability, you force SSA to try and figure out WHAT came first (the drugs or your mental health condition) and more important, do you get better if you’re NOT using drugs.
Like I said in the beginning, mental health disorders are tough and millions of people affected by these disorders are able to live productive and functioning lives. However, it’s important to realize that if you’re alleging that you are disabled due to your condition, you must understand that the few things I mentioned above may have a lasting impact on your ability to obtain disability benefits.
The hardest part about proving you’re disabled is relying on the medical treatment you are STUCK with
Today, a report was issued regarding the healthiest counties out 3000 counties nationwide.
Overall, the report found least healthy counties have childhood poverty rates more than three times higher than the healthiest counties. Residents of the least healthy counties are 60 percent more likely to be hospitalized for preventable conditions, a sign of poor primary care. A third of zip codes in the least healthy counties have at least one grocery store, compared to almost half of zip codes in the healthiest counties.
http://www.countyhealthrankings.org/
Of course, this information is probably not going to be broadcast on twitter, facebook or myspace. And with the winter olympics and the BACHELOR going on, few will truly appreciate the impact of this report.
What does this report tell you? Quite simply, as stated in one article, “Looking at each state’s best and worst further illuminates a well-known trend: The least healthy counties tend to be poor and rural, and the healthiest ones tend to be urban or suburban and upper-income. ” http://www.chicagotribune.com/health/chi-ap-us-med-countyhealth,0,2482605.story
Unfortunately, this doesn’t help the millions of people who are applying for Social Security Disability benefits. Why am I stressing this point? Quite simply this. The person bears the burden of proving they are disabled. The government doesn’t have to prove a thing. However, this presents a unique situation when you are sick, you aren’t working and you ‘DON’T HAVE INSURANCE’. So what do you do when you have those things striking against you? Well, you can either go to the free clinic, go to the Emergency Room, or get on the county health insurance.
Here’s how it gets tricky but you gotta try:
1) Ask about free clinics
You gotta ask your health care provider, the ER, social worker, county services, or non profits about free medical clinics. I always tell people that free medical treatment is better than NO medical treatment.
2) Find out if you qualify for county health insurance
Every county is different so you want to check to see if you qualify for any type of medical insurance that the county may offer. You don’t know unless you try. AND, if it’s available in your county but you haven’t tried to get it, it may count against you.
3) if you have a “SHARE OF COST”, make sure you understand what it means
A ‘SHARE OF COST’ basically means that you are responsible for a certain amount and anything above that, the government will pay. However, it gets funky because some people don’t understand how that works so you want to make sure you get a complete explanation so you can get treatment.
4) Go to the ER if your condition gets worse.
The Emergency Rooms are flooded every day. Unfortunately for some people, the only primary treatment they can get IS the ER. Don’t be afraid to go to the ER. At least you can get something if you HAVE to get treated.
5) Make SURE you tell SSA that you’ve done ALL of these things
I can’t tell you how many times I’ve had people who literally didn’t do anything. They didn’t go to the county. They didn’t go to the ER. They didn’t go to the free health clinic. AND YET THEY STILL say they can’t get any medical treatment. You gotta try in order to show SSA you made the effort.
I know that is difficult but you have to make the best of what you have available because in the long run, only YOU can prove that you are disabled.
Cancer and Social Security Disability benefits: Not as easy as you think
Today, I was going through my normal surfing like most people do and realized that Bo Griffin, former TV Host of HGTV’s “The Big Reveal” passed away due to Cancer. She was experiencing pain in her back and was unaware that she had cancer. Unfortunately, her bought with cancer was fairly short as she died with a few weeks of its discovery. She was diagnosed with intestinal cancer. The news of her death spread fairly quickly (thanks to the advent of social media, twitter, and you tube).
However, upon hearing of her death, I instantly thought about Roger Ebert, noted movie critic, and his widely publicized bought with Thyroid Cancer. He was successful in his fight but it left him with the inability to speak.
The thing that really resonated to me was the distinctive difference between the two types of cancer. In Ms. Griffin’s case, she had no knowledge of the cancer and it overwhelmed her quickly. In Mr. Ebert’s case, a radical procedure saved his life yet the possibility of it returning still remains.
I’ve represented a number of people who have had different types of cancers over the years and I have found that each one presents a unique set of circumstances as they relate to Social Security Disability benefits:
1) Suspected Cancer versus Cancer
The word “Cancer” is a terrifying word. Like HIV and AIDS, there is no known cure for cancer. As such, you can use chemo, surgery and radiation but you may not totally keep it from reoccurring. For purposes of Social Security, it’s important to know the difference between being diagnosed with Cancer and being ’suspected’ of having cancer. Usually ’suspected’ comes into play when the doctor has a reason to believe that some type of nodule or growth or something that has alerted them to the possibility of cancer. However, for Social Security purposes, this doesn’t not guarantee the receipt of disability benefits.
2) No two cancers are the same
Under the Social Security regulations, individuals may be found disabled if they meet the criteria for certain medical impairments that are listed in the regulations (The listings). Most people don’t realize that Social Security maintains several listings of different types of cancers. As such, just merely being diagnosed with cancer by itself doesn’t guarantee an immediate favorable result.
3) Remission sometimes means Recovered
Cancer is a devastating condition. The treatment that people have to go through in order to combat cancer can be painful and traumatic. However, most people don’t realize that it is not uncommon for people who have gone through the treatment to go back to their normal lives. As such, Social Security can be tough on some cases where the person has completed the treatment and their doctor has given them a clean bill of health.
4) Remission and BEYOND: How are you doing now?
Most people have to follow an aggressive follow up routine to make sure that the cancer doesn’t come back. Some people come out of the treatment with no problems or any residual problems. The key is ‘how are you doing now’? Most people don’t understand that Social Security wants to know if you are still having problems and MORE IMPORTANTLY, does your doctor know that you are still having problems?
5) Cancer and the TERI case
TERI stands for Terminally Ill. These cases are usually expedited because the person has a high likelihood of dying in a short period of time. I had the opportunity to represent my client’s mother when her cancer returned. Due to the aggressive nature of the cancer, she received disability benefits in less than a month. Unfortunately (god rest her soul), she passed a few months later.
I’ve had a few cases where I’ve literally watched someone deteriorate before my very eyes and so I take Cancer very seriously when clients complain that they believe they are disabled due to cancer. The word, by itself, doesn’t guarantee a result. Keep in mind that even though cancer is devastating, you must realize that you may need to provide SSA more in order to demonstrate that cancer is disabling to you.
Children and benefits: Kids are NOT a meal ticket
Alright, alright, BACK IT UP! I know that someone is reading this title now and getting FIRED UP! But before you tell me to “Go to HE…!!” or “GET OUT MY BUSINESS” or “DON’T TELL ME HOW TO RAISE MY KIDS”, slow your roll, pause and put it in reverse.
You need to understand that this country has hundreds of children who are great need of monetary benefits in order to receive the care and attention they deserve. In addition, families who have children with various needs are tasked with a huge responsibility that many average persons can not relate. So, I don’t want anyone to think that I am slamming people who attempt to obtain Social Security benefits on behalf of their children.
However,……(and you know there is HOWEVER), several years ago, I started hearing parents refer to disability checks obtained for kids as “CRAZY CHECKS”. Now, this really throw me because I didn’t know what that meant. After some discussions, I realized that there was a perception that the best way to obtain disabilty benefits for kids was through an allegation that they had a mental problem, it was possible to obtain Supplemental Security Income (a program under the Social Security Administration which provides needs based financial assistance and Medicaid insurance coverage for individuals including children).
As devastated as I was when I heard this, after a period of time, I observed that it wasn’t uncommon for some parents to utilize their children as a mechanism to receive additional financial assistance. Interestingly enough, not alot of people like to talk about this because who is going to admit that they are trying to get money by using their kids.
Yes, it’s sad but it is a reality. Some people are trying to get their “hustle on” and this way is just one way to do it. However, when I speak to parents who have kids, I try my best to keep a few things in mind when they are attempting to get disability benefits for their children:
1) A DEDICATED ACCOUNT MAY KEEP YOU FROM RUNNING DIRTY! Some times, parents don’t realize that they are being analyzed when a determination of benefits has been made. In some instances, Social Security may authorize the creation of a ‘dedicated account’. A ‘dedicated account’ is an account that has very specific things that can be purchased and social security must be provided an accounting of those things. These accounts are usually set up in situations where there is concern about the parents’ handling of the money.
2) YOUR MONEY makes a DIFFERENCE! Sometimes, parents forget that SSI benefits are NEED based so they think that if they get a big bonus or settlement from some other source, they will be riding high! Unfortunately, this is NOT the case. If you get money from SSI and you get a windfall of money, your SSI may be temporarily suspended until you spend the money down.
3) IF YOUR CHILD is REALLY SICK, treat them that way! Every now and then, I get a few parents who get the high pro glow because they think that once their child gets SSI benefits, they don’t need to do anything else. Most of my parents who have kids, genuinely want to make sure that they keep getting the treatment and attention they need. Remember, your child may get evaluated in the future by SSA.
4) ONE for ALL and ALL FOR ONE! NOT! Please don’t think that just because ONE of your kids got disability, that all of them can get it for the same thing.
5) 18 and OUT THE DOOR! Remember, in most cases, when the child reaches the age of 18, the child can now apply for SSI benefits as an adult (which means the parents no longer can control the money).
Like I said, I’m not trying to say that ALL parents run dirty. I’ve represented hundreds of parents who’s kids genuinely need help and the parents are struggling to do the right thing. However, it’s important that parents understand that their child is not a ‘pot of gold’ at the end of rainbow.
