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My disability claim was denied. What happens next?

My disability claim was denied. What happens next?


If you have filed a claim for disability benefits and it was denied then you may be wondering what options you have for moving forward. Applying for disability can be very confusing for those not dealing with it on a daily basis and it’s important that you be familiar with the appeals process.

Chances are you don’t agree with the Administration’s decision in which case you can file an appeal, asking the Administration to review your case again. As with everything when the federal government is involved, there’s a regimented process that must be followed. If you want an appeal, and you should, you need to make a written request within 60 days of receiving the Administration’s official letter denying your initial claim.

In most states (several states have eliminated the reconsideration step) there are four levels of the Social Security appellate process. The first is known as reconsideration and it involves a full review of your case by someone who was not involved in the first go-round. New evidence will be considered during this phase as well as the evidence that was part of your initial claim. Your presence is not required during this phase of the appellate process.

If after the reconsideration you are still not satisfied with the outcome, you can move on to a second level of review, a hearing before an administrative law judge (ALJ). The ALJ will serve as a completely neutral party and will not have been part of either the first review or the second round reconsideration. At this hearing before the ALJ you will be permitted to call witnesses on your behalf and the ALJ is empowered to ask questions of those who testify at the hearing. You can and should be represented at the hearing and, if you are, your representative will also be permitted to question witnesses at the hearing. After listening to all of the evidence and reviewing the previous decisions in your claim process, the ALJ will make a decision and the SSA will send you the judge’s final opinion in writing.

The third step of appeals process involves a review by the aptly named Appeals Council. If the Council believes that the ALJ made the right decision, the Appeals Council will not review the case and the decision of the ALJ will stand. The Appeals Council can also choose to disagree with the ALJ directly or remand the case back to the ALJ for further consideration. You will, as always, be notified in writing once the Council has made a decision.

The fourth and final level of review is to file a lawsuit in the nearest federal district court. It will be handled like any other lawsuit. At every stage of the process, it’s wise to have the help of counsel, but if you are going to appeal the decision of the Administration, you should absolutely contact an experienced attorney. If you think you may be entitled to Social Security Disability benefits and have questions, call The Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.

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Can I receive disability SSI / SSDI for my anemia?

Anemia CellsIt is estimated that more than three million Americans suffer from anemia. That already high number is expected to grow as the population of the country continues to age – currently 10% of those over the age of sixty-five have some form of the disease. Red blood cells are rich in a substance called hemoglobin, a protein that is responsible for carrying oxygen molecules to the body’s other cells. In adults, hemoglobin-rich red blood cells make up between 35% and 52% of a person’s blood; this number is called the hematocrit level. Normal variations in the hematocrit level occur and depend on factors such as gender and a person’s physical fitness. Anemia is said to exist when a person’s hematocrit levels drop too low, indicating that their red blood cells are not properly transporting oxygen to the rest of their body.

The American Society of Hematology believes anemia has two basic causes: a low amount of red blood cells and red blood cells that don’t function properly. Social Security has a section (Hematological Disorders, Section 7.00) that addresses both forms of the disorder.

For anemia caused by low hematocrit levels, the key factors considered are “chronicity” and impairment. Chronicity is demonstrated by proof that a person’s condition has existed for at least three months. This can be shown by at least two medically acceptable tests over a three-month period showing hematocrit levels below 30%. Impairment can be demonstrated by showing that this low red blood cell number has affected an individual’s body systems. Blood transfusions at least once every two months or an evaluation by a doctor will both suffice as proof of impairment.

Sickle cell anemia falls into the second anemia category – anemia caused by malfunctioning, or malformed, red blood cells. Normal red blood cells are shaped like discs, which allow them to travel through an individual’s blood vessels, including capillaries that are only wide enough to allow one cell to pass through. Sickle cell anemia occurs when red blood cells form more rigid, sickle shapes. These bizarrely shaped cells are more easily trapped in smaller blood vessels which can impede proper flow and cause severe pain. Sickle cell is an inherited trait that affects certain groups in particular, especially African Americans.

To qualify for disability due to sickle cell anemia, a claimant must show either:
A. Documented painful (thrombotic) crises occurring at least three times during the 5 months prior to adjudication; or


B. Requiring extended hospitalization (beyond emergency care) at least three times during the 12 months prior to adjudication; or

C. Chronic, severe anemia with persistence of hematocrit of 26 percent or less; or


D. Evaluate the resulting impairment under the criteria for the affected body system.

If you believe that you may be entitled to Social Security Disability benefits and have questions, call The Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.

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How do I show the SSA that I qualify for disability benefits?

disability_trophyIf you have an illness that you think should qualify you for Social Security benefits there’s one thing you and every other claimant must do regardless of your disability – provide sufficient proof that you actually are disabled.  The Social Security Administration defines disability as “the inability to engage in any ‘substantial gainful activity’ (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” In other words, the claimant must both prove both that he has a disability and that it is severe enough to qualify for federal benefits.

First and most important, the claimant must provide documentation from “acceptable medical sources” of his condition. Licensed physicians are prime examples of acceptable medical sources and are capable of establishing all disabilities. Other medical professionals are permitted to act as acceptable sources but only in limited situations specific to their areas of expertise. For instance, a psychologist is competent to provide evidence for mental disabilities and a podiatrist is competent to provide evidence for foot issues, but not the other way around. Medical professionals who are “treating sources” i.e. professionals who’ve tended to the claimant over a long period of time, are deemed the most important sources of information.

Once the claimant has chosen an appropriate medical source to assist in making a disability claim, that medical professional must then hand over reports to the SSA. Such reports include medical histories, lab tests, and reports describing the claimant’s ability to perform “work-related” tasks.

Sometimes, the claimant is not able to get all the information he needs from his own doctors or medical sources that are available to him. The claimant is then permitted to schedule a Consultative Examination with either his usual treating source or another medical professional to obtain the specific medical information needed by the SSA. A complete Consultative Examination Report would include the following information:

• the claimant’s major complaint;
• a detailed description, within the area of specialty of the examination, of the history of the major complaint;
• a description, and disposition, of pertinent “positive” and “negative” detailed findings based on the history, examination, and laboratory tests related to the major complaint, and any other abnormalities or lack thereof reported or found during examination or laboratory testing;
• results of lab and other tests (for example, X-rays);
• the diagnosis and prognosis for the claimant’s impairment;
• a statement about what the claimant can still do despite his or her impairment; and
• the consultant’s consideration, and some explanation or comment on, the claimant’s major complaint and any other abnormalities found during the history and examination or reported from the laboratory tests.

If you think you may be entitled to Social Security Disability benefits and have questions, call The Law Offices of John T. Nicholson at 1-800-596-1533 for a free consultation today.

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How much does SSI pay per month?

How much will your Supplemental Security Income (SSI)  checks pay each month? Well, it varies as some states award additional income to the base amounts listed below. That being said, here are the amounts for 2012. Keep in mind that these amounts change each year in conjunction with the cost of living adjustment (COLA).

Social Security Administration SSI payout amounts for 2012:

 

Calculation details
Recipient Unrounded annual amounts for— Monthly amounts for 2012
2011 2012 a
Eligible individual $8,095.32 $8,386.75 $698
Eligible couple 12,141.61 12,578.71 1,048
Essential person 4,056.93 4,202.98 350
The unrounded amounts for 2012 equal the unrounded amounts for 2011 increased by 3.6 percent.

 

Payment reduction
Remember, these payouts are lowered depending on your countable income each year. If you are thinking of applying for disability benefits click for a free consultation or call 1-800-596-1533.

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Can I receive Medicare or Medicaid benefits at the same time as I receive Social Security disability benefits?

Attorneys such as John T. Nicholson who practice Social Security law often hear questions about whether someone could receive Social Security disability benefits at the same time as Medicare or Medicaid benefits. In general, someone who satisfies all of the relevant eligibility requirements can receive Social Security disability benefits and Medicare or Medicaid at the same time. Whether anyone in particular could receive these benefits, however, would depend upon the specific circumstances.

The Centers for Medicare & Medicaid Services (“CMS”) has administrative responsibility for Medicare and Medicaid. Medicare is
a national health insurance program serving U.S. citizens (and permanent residents) who have reached at least age 65, as well those younger than 65 who have certain disabilities, permanent kidney failure or amyotrophic lateral sclerosis (“ALS,” commonly known as Lou Gehrig’s disease). Medicare comes in four types.

1. Part A (hospital insurance). Medicare Part A helps to pay for the cost of inpatient care in hospitals and skilled nursing facilities—including care in critical access hospitals, but excluding custodial and long-term care in nursing facilities. Although the other types of Medicare usually require payment of a monthly premium, payroll taxes and self-employment taxes cover premiums for Medicare Part A in most cases.

2. Part B (medical insurance). Medicare Part B helps to pay for the cost of doctors’ services and outpatient care; in addition, it helps to pay for the cost of some of the services provided by physical and occupational therapists, as well as some of the cost of home health care. Those whose Medicare Part A premiums are covered by payroll or self-employment taxes may enroll in Part B. Coverage under Part B generally requires payment of a monthly premium.

3. Part C (Medicare Advantage plans). Those insured under Medicare Parts A and B can choose to enroll in a Medicare Part C, or “Medicare Advantage,” plan. Medicare Advantage plans, which must be approved by Medicare, are offered by private insurers. The coverage provided under these plans must be at least as good as what Medicare provides, but coverage otherwise varies from insurer to insurer. Medicare pays private insurers a specified amount each month for every Medicare Advantage member. Coverage under Medicare Advantage requires payment of a monthly premium for Medicare Part B, as well as a monthly premium for the private insurer.

4. Medicare Part D (prescription drug coverage). Medicare Part D helps to pay for the cost of prescription drugs. Those insured under Medicare Part A, Medicare Part B or Medicare Part C (Medicare Advantage) may choose to enroll in Part D. Medicare Part D generally requires payment of a monthly premium.

Medicaid is two programs that provide disability benefits: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). SSDI provides benefits to insured workers with disabilities, or in other words, those who: (1) have been employed for at least five of the last ten years; (2) have paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) have a “disability” as the Social Security Administration defines the term. A disability, for purposes of Social Security, is a serious medical condition that lasts (or has lasted) for more than a year and prevents someone from being gainfully employed. In addition, SSDI will provide benefits to the disabled children of insured workers, so long as the children became disabled before they reached the age of 22, as well as to the disabled surviving spouses of insured workers who have died.

SSI, on the other hand, pays benefits to disabled adults and children who have little or no income, or other financial resources. The program also provides benefits to adults without disabilities who are age 65 or older and whose financial means fall within the applicable limits.

Someone who receives SSDI benefits, or who is eligible to receive SSDI benefits, is also eligible to receive Medicare at the same time. Eligibility for Medicare begins after a waiting period of 24 months from the first date of eligibility for SSDI. For those with kidney disease who are on dialysis, however, the waiting period is reduced to three months from the date on which they began receiving dialysis. Medicare eligibility begins immediately for those with a terminal illness expected to cause death within six months, as well as for those with ALS. Those over age 65 are generally not eligible to receive SSDI benefits.

Likewise, eligibility for SSI and Medicare is also possible. Those under age 65 can receive SSI and Medicare benefits at the same time as long as they satisfy the eligibility requirements of both programs. For those age 65 and over, eligibility for Medicare is essentially automatic, and they can receive SSI benefits if their financial means are within the limits established under the Social Security Administration’s rules.

Eligibility for Medicaid often varies according to state law. In Ohio, children up to age 19; families with children under age 19; pregnant women; those with disabilities; and those over age 65 are eligible to receive Medicaid benefits if they meet certain financial requirements. Ohio residents under 65 who qualify for Medicaid can receive SSDI benefits, as well, if they qualify for SSDI under the rules of the Social Security Administration. Those over age 65 are usually not eligible to receive SSDI benefits.

Medicaid and SSI are similar programs inasmuch as they serve those with limited financial means. Ohio residents who have qualified to receive SSI benefits under the Social Security Administration’s rules can also qualify to receive Medicaid benefits if they qualify based on the rules established by the Ohio Department of Job and Family Services.

Although the receipt of benefits through all four of these programs is technically possible, the eligibility rules can be complicated—especially for receiving benefits from multiple programs at once. Furthermore, applications for disability benefits are often denied at first. If you think that you might be eligible to receive Social Security disability benefits, or if your application for benefits has been denied, then you should speak with a lawyer, like John T. Nicholson, who focuses on Social Security law.

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