Disability steps

Discuss here about Medical Disability claims and Insurance possibilities for PN treatment options

Disability steps

Postby jaxi123 » Tue Nov 11, 2014 2:20 am

Here is the info I was given by a Disability Attorney. Simply insane that as sick and in pain as we are that all of this is required. How does anyone survive financially who is single during the appeals battle?
Chime in if you had to go thru all if this.

If you are earning above what SSA calls "substantial gainful activity" level (currently $1,070 per month before tax) you would be automatically denied at Step 1 because you are working. You cannot work above SGA level and be disabled at the same time under the regulations.

If you are earning above SGA level ($1,070 per month in earned wages, salary) you would be automatically denied at Step 1.

By the way, here are the "steps" that are taken to decide if you meet SSA's rules for disability:

Step 1: Are you now working at SGA level? If Yes, you are denied. If No, go to step 2.

Step 2: Do you have a medically determinable impairment that has lasted or is expected to last at least 12 months OR end in death? Obviously, yes to lasting at least 12 months, so go to step 3.

Step 3: (A): Do you meet a Listing? I cannot answer this now based on limited information - but most claimants do not meet a listing because the severity of symptoms required to meet a listing are so extreme that few claimants can meet them. YOU CAN BE DISABLED WITHOUT MEETING A LISTING, AT STEP 5. (B) What is your residual functional capacity? In short, what is the most you are able to do in terms of work related activity? This will be determined by your medical records and your statements (testimony).

Step 4: Are you able to perform ANY of your past relevant work? Past relevant work is work you have performed at SGA level during the past 15 years; generally, this applies to full-time or almost full-time work that you performed long enough to become proficient in the work. So past work history is important. If Yes, you are denied. If No, continue to step 5.

Step 5. If you cannot perform any past relevant work (PRW), can you perform any other work that exists in significant numbers in the national, regional or local economy, based on your residual functional capacity, age, education, and work skills? If Yes, you are not disabled. If No, you should be approved.

Finally, there are guidelines called "Medical-Vocational Rules" or commonly called "Grid Rules" that direct a disability determination at Step 5. To determine whether you "grid" DISABLED under these guidelines, I need answers to the questions above about your education, current and past jobs.

I can tell you that age 57 is favorable because a person can "grid" as disabled much easier at "advanced age" (55 and over). A person with less education, advanced age, and no transferable work skills, who is also limited (RFC) to either light or sedentary work is likely to grid as disabled. However, you cannot be working or, as I said, you will be denied at Step 1.

As to time frames: In Alabama (I assume that's where you are) - it takes 90 to 120 days to get an initial decision. 72 percent of all initial decisions are denials. (Of course, that doesn't matter if you are approved; and at age 57 you would have a higher than average chance of approval, I think). If you are denied and have to appeal, it normally takes 11 to 12 months to get a hearing before an administrative law judge (after you are denied). After the hearing, it takes an additional 1 to 3 months to get a decision. After you get a favorable decision, payment of any back pay awarded takes up to 60 more days. So, I tell clients that you are potentially looking at a good 18 months start to finish if you have to go through the entire process.

Finally, it is possible to get "back pay" for the months you waited to be approved (after filing the application). From the "established onset date" of disability (the date Social Security finds you to have first become disabled), there is a 5-month "waiting period" in which no benefits are payable. For instance, if you are found to have become disabled on October 10, 2014, your waiting period would be November - March 2015 and your first actual payment would be for April 2015. (They eliminate the first 5 months of payments).

As for Medicare insurance, you have to wait 24 months from the date you first became eligible for payment of disability benefits.
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Re: Disability steps

Postby jaxi123 » Thu Nov 13, 2014 12:33 am

Since nobody has posted those of you who are on disability, did you go thru all these steps?
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Re: Disability steps

Postby Violet M » Sat Nov 15, 2014 4:37 am

I haven't gone through this but as I was reading I was wondering, if you have to quit your job to even apply, how do you survive while you are waiting the 18 months for approval? Does the attorney know how people manage this?

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: Disability steps

Postby jaxi123 » Sat Nov 15, 2014 9:50 pm

That is the point of me posting this. I would like to know how you are supposed to survive when you are single and totally on your own. How do you pay a house and car payment? How do you pay dr bills and for medication? How do you buy food? The attorney said he had no clue.
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Re: Disability steps

Postby jaxi123 » Mon Apr 11, 2016 1:11 am

Those of you who did get disability are the steps I listed what you went thru?
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Re: Disability steps

Postby nonsequitur » Thu Apr 14, 2016 6:48 am

jaxi123, not at all. I just applied online and got a call to come for an interview to the SS office. I did the interview and went through the usual "but you don't look sick..." routine and had to explain that I was experiencing severe pain. 2 months later I got another call that I had been approved.

The online application was simple. I uploaded some of my medical records as PDFs'. It took me 3 or 4 hours to collect and upload. It is not difficult. You don't need to do it all at once. If you have missing information that you need to go fetch, you can save and resume later.

https://www.ssa.gov/disabilityssi/apply.html

Your local SS office has direct access to all your federal tax records so they know exactly whether you qualify or not (that also means that you cannot finesse your way through and what you tell them should better match what they see on their screen).

Honestly, it was a longer process to stop receiving disability benefits...

If your question is uniquely about not getting wages, then you have to get short term disability first before you apply for long term disability.

Why don't you visit the SS office? They are there to help you and it is free. They have always been helpful and professional in my experience. I never used an attorney for any of my dealings with them --in fact it did not even cross my mind to contact one.
“Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”
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Re: Disability steps

Postby jaxi123 » Sun Apr 24, 2016 1:13 am

You are a one in a million to get disability immediately. I have been told No and have been to 6 attorneys who all said what are in the steps I posted and that I am screwed
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Re: Disability steps

Postby nonsequitur » Sun Apr 24, 2016 1:20 am

I am not 1 in a million. The approval rate for 1st time submission is something like 31%.
Have you applied in the past? Have you talked to the SS people at your local office (as opposed to attorneys)?

I do not really see steps in your list but only a set of requirements to qualify.
“Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”
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Re: Disability steps

Postby egley » Fri May 13, 2016 9:54 pm

May I ask your age nonsequitur?
I just had my last interview with SS, and have been assuming I would be denied first time.
I am 63 and have been hoping my age might tilt things in my favor, but was still assuming I would be denied first time.
I will try to remember to post my experience here once I find out. I am left wondering how many of those 31% approved first time were above 55? I too have seen other places (not just on pudendalhope) about the age factor, but never found much about the details.

If I forget, please feel free to PM me with a reminder in a few months (or so) from today...

skip
Right testicle pain started ~2005
Stanford Pain clinic (~2007).
Dr Weiss diagnosed PNE; said I needed to go to Hibner for surgery (2010'ish). Sorry, no surgery for me.
Neuro-stim (~2012); pain pump 13 or early 14.
Pump removes leg spasms (from neuro-stim surgery) but only maybe 25% of PNE pains.
Still hunting for the holy grail of 0 pain from PNE.
Prialt and fentanyly in pain pump (10 bolus/day allowed); Oxycodone (4x/day)
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Re: Disability steps

Postby nonsequitur » Fri May 13, 2016 11:29 pm

Egley, I was 51 when I got approved. I applied myself and did not use an attorney.

The only thing in my favor and I hate to say it as it shouldn't matter was the fact that I walked away from an executive position with a very comfortable salary. I first tried to find part time consulting work but had to even abandon that after a year due to the intolerable pain.

They clearly concluded (which I felt during my interview) that something seriously wrong must have happened to me.
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