Disability Benefits What to Expect When You Can No Longer Work

Our mission O What are the differences between ADA, FMLA, Group Disability, Private Disability and SSDI? O How is disability defined? O When should you stop working? O Overview of the Application Process O Additional Considerations for SSDI O Your Questions

Life of a Disability Claim – Acute Conditions O Well defined beginning – onset of diagnosis concurrent with start of disability O Normal Progression O Concurrent Short Term Disability and FMLA Protected Leave O More severe conditions progress into LTD/SSDI

Life of a Disability Claim – Chronic Conditions O Challenging to determine a start point O Diagnosis is often months or years prior to disability O Gradual loss of function O Prior to full disability O ADA – Reasonable Accommodations O Federal and State Leave Programs O Potentially multiple Short Term Disability periods/claims

Disability Defined O Based on CAPACITY not DIAGNOSIS O Language normally references physical capacity and earning capacity O Examples O “…the inability to perform the material duties of your own occupation due solely to illness or injury…” O “…You must be unable to perform the regular duties of your occupation due to an illness or injury…” O “Unable to engage in Substantial Gainful Activity by reason of a medically determinable physical or mental impairment which has lasted or is expected to last at least 12 consecutive months or result in death”

Types of Coverage O Group/Employer Sponsored STD O Designed to protect income for a limited period O Closed-ended - generally 3 – 6 months O Group/Employer Sponsored LTD O Ongoing income protection O Extended waiting period O Open-ended – benefits generally end after recovery or normal retirement O Private Plans O Social Security Disability Insurance

When to Apply O Know your plan! O Partial versus total disability O Filing Deadlines O Impact of medical leave O Consult with your provider! O Generally do not file prior to stopping work O Exception – planned surgeries!

Social Security Basics O Federal/State Program O State DDS Reviews Claims O Paid under Federal Social Security program O Dates to 1956 O Advantages O Retirement Earnings Freeze O Medicare Eligibility after 24 months O Trial Return to Work program O Family SSDI Benefits O Access to Vocational Rehab Services

SSDI Eligibility O Eligibility based on credits O For 2015, 1 Credit = $1220 in wages O Maximum of 4 per year O General guideline is 40 credits are needed O Special Rules apply to younger workers

Source:

Types of Social Security Benefits O Primary Social Security Disability O Dependent/Family Social Security Disability O Supplemental Security Income (SSI) O Widow/Widower Disability Benefits

Dealing with SSDI O Filing Options O In Person – Your Local SS Field Office O By Phone O Online O pdf

5 Step Review Process O Step 1 – Are you working? O SS Definition of ‘working’ (SGA) = $1090/month O Determined by the Field Office No?Yes? Continue to Step 1Denial

5 Step Review Process O Step 2 – Is your condition ‘severe’ O Impairment must interfere with basic work- related activities No?Yes? Likely DenialContinue to Step 3

5 Step Review Process O Step 3 – Is your condition found on the List of Disability Conditions O PSC is not! O Some complications may be O List is available on the SSA Web Site ( No?Yes? Continue to Step 4Likely Approval

5 Step Review Process O Step 4 – Can you do the work you did previously? O If you CAN’T you are not necessarily approved O Most commercial plans WOULD approve at this point No?Yes? Continue to Step 5Denial

Process O Step 5 - Can you do any other type of work? O Much stricter definition than most commercial plans O DOES consider age, education, past work experience, but not as clearly defined as in most commercial plans No?Yes? Likely ApprovalDenial

Do I need an Advocate or Attorney? O Are you covered under a commercial plan? O Most carriers pay for advocacy! O SSDI is generally an offset to the commercial plan O Is you’re the condition that caused you to stop working on the SS List of Impairments? O Were you eligible/Technical Denial? O Attorney’s/Advocates generally work on contingency O 25% of past due benefits O Cap of $6000 O They can appeal to SSA for additional pay

Some Facts O Approximately 2.33 MILLION claims filed per year O 31% - Technical Denials O 62% of the remaining claims are initial denied O 48% of denials are appealed (Request for Reconsideration) O 90.3% of appeals are denied O Only 18% continue to the hearing phase! O 81.4% of those who continue are eventually approved

Mistakes to avoid O Failing to provide information O Missing deadlines O Discontinuing treatment O Not following through on the appeal process

Time for your Questions!