Qualifications to obtain SSD benefits from the SSA.

Calling the Social Security Administration (“SSA”) office is unlikely to help you understand whether or not you qualify for Social Security Disability. This is because when you call the SSA office you will be speaking with a service representative, who is not qualified to make a determination regarding a person’s disability. That is a decision that is assessed by disability examiners who work at DDS, Disability Determination Services, a state agency which is entirely separate from SSA.

DDS assesses many factors in determining a person’s ability to return to the workforce. First, the determination is made whether the claimant can return to their old job. If they can, their claim is denied. Next, DDS will consider whether the claimant has transferrable skills, and will consider factors such as the claimant’s level of education, past work experience, and age. After the age of 50, a person is generally not expected to learn a new trade or skill. Assessing these factors along with a claimant’s physical or mental disabilities or limitations is part of a complex process that service representatives at SSA cannot and should not attempt to inform potential claimants on. This is why you are better off seeking an attorney who is knowledgeable and experienced in navigating the process of proving one’s qualifications to obtain SSD benefits from the SSA.

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Credit for Work and Social Security Disability

The Social Security Administration requires that you have earned enough “work credits” in the past  in order to be eligible to apply  for Social Security Disability benefits.

What are work credits?

When you work and pay Social Security taxes, you earn up to a maximum of four “credits” for each such year.

The amount of earnings it takes to earn a credit has changed since 1978. In the year 2016, you must earn $1,260 in covered earnings to get one Social Security or Medicare work credit and $5,040 to get the maximum four credits for the year.

The number of work credits needed for disability benefits depends on your age when you become disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.

This is why, when you call a Social Security Disability attorney about filing for disability, they will probably ask you the following question:

“Have you worked on the books for at least five of the ten years before you became disabled?

If you worked LESS, you may not even be eligible to apply for Social Security Disability Benefits (SSDB.)

In addition, the more you worked and earned over your lifetime, the higher your monthly benefit amount will be!

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Perks of Winning Your SSD Claim

Did you know?
Applying for and receiving Social Security Disability Benefits, ( when one is UNDER retirement age and unable to work for at least 12 months,) bestows perks from the Government that many people don’t know about. These include (if you win):
*Wage Freeze: If there is a period of time you are not paying into your Social Security account due to being disabled, Social Security IGNORES this and computes your benefits as if you had been working! *Medicare: Two years after being approved for Disability Benefits, disabled workers may elect to receive Medicare coverage, regardless of age. *Children: When you qualify for Social Security disability benefits, your children may also qualify to receive benefits on your record. Your eligible child can be your biological child, adopted child or stepchild. A dependent grandchild may also qualify. To receive benefits, the child must be unmarried and be:

  • under age 18; or
  • 18-19 years old and a full-time student (no higher than grade 12); or
  • 18 or older and have a disability that started before age 22.

Within your family, each qualified child may receive a monthly payment up to one-half of your full disability amount.

Bet you didn’t know these things… Feel free to call my office with any questions about Social Security Disability or NY Workers’ Compensation.

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Workers’ Comp Fraud—The Other Side of the Coin

There’s an insurance industry radio ad campaign currently running, containing the following warning: Don’t commit Workers’ Comp insurance fraud or you’ll end up in jail and you will shame your family. It’s clearly aimed at injured workers. I get it.

What the public generally does NOT see is the other side of the coin…when insurance companies overstep their bounds and infringe on injured workers’ rights (happens all the time—sometimes with bad results, especially when injured workers are unrepresented .)
This happened to my client and me YESTERDAY:
My client, a nurse’s aide, was receiving weekly Workers’ Comp checks for a severe back injury (she now needs surgery for it) that she incurred at work. At the last hearing, the insurance company attorney for the employer accused my client of fraud and told the Judge they were stopping her benefits because they have a private eye who followed her and videotaped her doing something bad (presumably, working while collecting comp checks.) They were ordered to produce the investigator and his evidence. My client flatly denied committing fraud. A mild-mannered woman, she has been beside herself with stress because of this fraud allegation. She could not understand it. Luckily, in this country, you get to face your accuser in court, face-to-face. At the next hearing (yesterday) , I made a simple request: call in both my client and the investigator into the courtroom and let the investigator look at my client, face-to-face. When they were called in, the Judge asked the private eye: “Is this the woman you have been following?” The investigator turned red. ” No, Your Honor, it isn’t, “we must have been following the wrong person.”
You simply can’t make this stuff up. I got my client’s benefits reinstated (she was crying with relief, she could not understand what she had done wrong) but unfortunately there is no penalty against an insurance company for such shoddy work and behavior……………
Call us if you have questions about Workers’ Comp or Social Security Disability benefits!

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Workers’ Comp in New York, Social Security, and Medical Marijuana

Section 10 of the Workers’ Compensation law in New York State says, among other things,  that there shall be no liability for compensation “when the injury has been solely occasioned by intoxication from alcohol or a controlled substance………”

It has long been the law that if someone gets injured on the job SOLELY because they are drunk or stoned, the employer is NOT responsible.

But what about the recent legislation regarding medical marijuana? Does this affect the Workers’ Comp system in New York?

In my opinion, New York State and Governor Cuomo’s recent passage of a limited medical marijuana bill should NOT affect Workers’ Comp. Why? Because the bill says:

To be prescribed medical marijuana, a patient must receive a certification from a licensed practitioner who must register with the Department of Health and be qualified to treat the serious condition for which the patient is seeking treatment. The serious conditions for which medical marijuana can be prescribed are cancer, HIV/AIDS, ALS (Lou Gehrig’s Disease), Parkinson’s Disease, multiple sclerosis, damage to the nervous tissue of the spinal cord with objective neurological indication on intractable spasticity, epilepsy, inflammatory bowel disease, neuropathies, Huntington’s Disease, or as added by the commissioner by DOH.

Looking at this list, there are few if any such conditions that could possibly be work-related. The only ones that are possible are the nerve damage situations but those seem to cover only the most severe. So this law likely won’t affect Workers’ Comp.

But what about Social Security Disability and Medical Marijuana? I googled these together and found some interesting articles. Remember, marijuana is still illegal on the federal level and Social Security is a federal program. If someone is alleging a mental disability and is taking marijuana on a daily basis it might be hard for the Judge to decide their case. Anyone who is found to be disabled because of drug use can be denied benefits on that basis.

So the use of medical marijuana will make disability claims more complicated.

Bottom line—this is still new territory for the disability field, so stay tuned………

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SSD and SSI: Two Different Programs

I’m a bit fussy when it comes to use of the English language. Misplaced apostrophes and bad grammar tend to drive me nutty. One mistake that is commonly made that is not linguistic in nature, however, is the common tendency to say “SSI” when one means “SSD” and vice versa.This is more a product of a lack of understanding than anything else.
Perhaps this quick primer will help:
SSD: Social Security Disability – for anyone under retirement age who has worked long enough to qualify.
SSI: Supplemental Security Income – available even if person did not work.
SSD: Payments based upon a worker’s earnings record and lifetime FICA contributions.
(The more someone paid in, the more money they get to take out.)
SSI: Flat payments set by the government (usually much lower than SSD.)
SSD: No asset limitation (you could have a million dollars and still collect SSD.)
SSI: You may have no more than $2000 per individual in order to qualify.
(SSI is a welfare program.)
SSD: Qualifies you for Medicare after two years.
SSI: Qualifies you for Medicaid immediately.
SSD: Available to non-citizens
SSI: Not available to most non-citizens.
However, note that:
SSD and SSI use the same rules to determine if someone is disabled!!

I handle SSD cases, but not SSI cases.

Now, don’t get me started- please don’t ever call Workers’ Comp
“Workman’s Comp” !!!!!!!
But that’s for another day……………..

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Facts: Dangerous things in the right hands

My new hero (heroine?) is a scholar named Kathy A. Ruffing. She works for a group called “The Center on Budget and Policy Priorities” which is – according to its website- “(O)ne of the nation’s premier policy organizations working at the federal and state levels on fiscal policy and public programs that affect low- and moderate-income families and individuals.”

Simply put, Ms. Ruffin researches how this country’s economic policies affect our poor. Her latest paper – 24 pages in length, replete with charts and graphs- is entitled “Social Security Disability Insurance is Vital to Workers with Severe Impairments.” Why would she write such a paper? Simply put again, Social Security Disability as a Federal program is under attack. Some critics have charged that spending on the program is “out of control.” Note that the present Republican candidate for President has constantly railed against the U.S. becoming the “Entitlement Society.” However, Kathy addresses these allegations with an interesting approach: using facts. Like these well-researched nuggets:

– Disability recipients receive modest benefits. The average monthly benefit in 2011 was $1,111- or $13,326 per year.

-Most recipients depend upon their disability benefits for their subsistence. Disability benefits make up more than 90 percent of income for nearly half of non-institutionalized recipients, and more than 75% of income for the vast majority.

-If recipients could actually perform work- which they are allowed to do under SSA’s work incentive programs- they would. There is no disincentive in the program for recipients to try to work for up to 9 months (there is no loss of payments in such cases) but few do.

-Fewer than half of applications are ultimately allowed, often after prolonged appeal. Eligibility criteria are quite stringent.

-Even rejected applicants fare poorly in the job market.

Basically, Ms. Ruffing uses statistics melded with logical arguments to show that Social Security Disability is a bedrock program for our country’s disabled and poor and it should not be messed with. The politicians need to find ways to keep it vibrant and healthy, in the long-term. And those are the facts.

A link to her article: http://www.cbpp.org/files/8-9-12ss.pdf

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If I file for Benefits can I still go back to work?

I get this question a lot. Whether it’s Workers’ Comp or Social Security Disability, clients are sometimes confused about whether going back to work is “bad” or can somehow “hurt” their case. So let me be clear: in my opinion it’s almost always better to go back to work, if you can, rather than depend on Workers’ Comp or Social Security payments. But here’s some common questions and my answer to those questions:

Q: Since I filed for comp against my employer, doesn’t this mean I can never work there again?

A: This is not true. I have plenty of clients who may even have several accidents at different times all at the same employer, filed for comp each time and continue to work there.

Q: Will I lose my Social Security Disability (SSD) case if I return to work?

A: Possibly. To be found disabled in a SSD case, an individual must be unable to engage in any substantial gainful activity (SGA) by reason of a 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 at least 12 months.But, and this is a big but, once you meet the 12-month requirement, if you return to work afterwards, you may still receive benefits, after a 5-month waiting period, for the time you were out of work! This is called a “closed period” type of case. In other words, once you are out at least 12 months, if you are awarded benefits you can get them until you return to work, and even sometimes later on if you go back out of work.

Q. My treating Workers’ comp doctor told me that I shouldn’t work but the company doctor cleared me. What should I do?

A. The best advice is to always follow your own doctor’s advice about returning to work. If there is a conflict between doctors, that is why there are Judges at the Workers’ Compensation Board—to decide these kinds of disputes.

Q. What’s a Trial Work Period in Social Security?

A: To quote from the SSA website:

We have special rules that allow people who get Social Security disability benefits to work without losing their monthly benefits.

A trial work period allows you to test your ability to work for at least nine months and receive full Social Security benefits regardless of how much you are earning as long as you disabled.

After your trial work period, you are allowed a period of 36 months during which you can work and still receive benefits for any month your earnings are not substantial.

So, to sum up, it’s never “bad” to return to work after you have applied for comp or SSD. What IS bad? Returning to work but NOT TELLING THE INSURANCE COMPANY IN A COMP CASE OR THE GOVERNMENT IN A SSD CASE. Bottom line: As long as you INFORM THEM that you have returned to work, there’s nothing to be afraid of!

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