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Tom Galli

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Perhaps you’ve heard?  The federal government is a large insurance business with a standing army.  Social Security is insurance — a specific kind of insurance called an annuity.  The insured and employer pay premiums every month to fund a defined benefit at a specified year (normally your federally mandated retirement year).  Everything is peachy-keen till a disability affects work because one has late stage lung cancer.  And, when a lung cancer survivor files for disability, allowed by law and regulation, the federal government almost always disapproves.  So, here are some suggestions for obtaining disability benefits by disapproval.

1. Expect to be Disapproved. I know a lot of folks with lung cancer.  Among this population, only one was approved on initial application.  He passed before he received his first benefit check.  My company provided disability insurance carrier filed my first application.  I had an unresolved bronchopleural fistula after a pneumonectomy that required a second and third surgery and indications of tumors metastasized to my remaining lung.  My claim, filed by a former Social Security claims adjuster, was disapproved.

2. Involve Your Doctors.  The disability application requires you to disclose all your physicians and medical providers.  Then, the administration asks for medical records, reports and observations. Doctors are busy folks; oncologists are bombarded by SSA requests for information, and for good reason.  Late-stage lung cancer (including treatment and side-effects) is often disabling.  Inform your medical providers of your application and ask them to help by responding to the request for information.

3. Complete the Application. The Social Security Administration is a bureaucracy.  Bureaucracies love to find “nits” in applications and return with some very vague description of the problem. This delays a decision and delays payment, and these are typical insurance company behaviors. Read every word of the disability application process (it is all online at www.ssa.gov) and check your application closely to ensure it is complete and error free.  Have several family members check it also after reading the application instructions. Ensure you completely describe your symptoms including those caused by side-effects.  Also, completely describe how these symptoms affect your ability to stand, sit, walk, bend over, think, concentrate, and etc. (Hint - read the criteria that will be used to determine your disability finding and use those words as descriptors).

4. Understand the Fine Print. There is payment delay: six full months after the date of disability (date shown on claim approval letter). Depending on other income sources, payments may be taxable. You are not found to be permanently disabled.  Regulations allow a review of your status after start of disability payments. It is not a good idea to join an adult softball team while receiving disability payments! You are not eligible for Medicare until 24 months after receipt of first disability payment. Your disability payment will be less than your full retirement benefit, and when you reach retirement age, your retirement benefit will not be increased. 

5. Lawyering Up. Filing the initial disability application online is a good idea, as long as it is properly completed and supported by doctor reports and observations.  But when denied, it is time to level the playing field and retain a lawyer. Not any lawyer, but a law practice that specializes in Social Security Disability appeals.  By law, they cannot charge you for their services.  They collect fees directly from the Administration if an administrative law judge approves your appeal.  And, most important, they know what they are doing and it is in their financial interest to do a good job on your appeal!

The disability process is deliberate, lengthy and frustrating. Like lung cancer, success involves persistence. Insurance companies don’t relish paying claims and every approved disability claim turns a premium into a disbursement.  But, Social Security is insurance with disability payment provisions that you pay for!  If you can’t work, apply, appeal and persist!  

Stay the course.

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My dad fought this battle when he became ill.  His neurologist certified him as totally and permanently disabled due to three strokes and ongoing seizures.  He was denied on his first application, hired an attorney and was approved but had to fight every year to remain disabled until he reached retirement age. 

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I have in the past helped a number of people with SS disability applications, or SSI disability .(Social Security is based on what you paid in to the system; SSI is available if you haven't paid enough into the system but have very limited income and resources--the disability standard for both programs is essentially the same) Tom's advice is excellent. Two things I'd like to add. First, submit the most complete documentation and information  you can at the initial application. If you have a case manager through any agency, ask for their help with this, or whether they can refer you to any other local agency that can help at the initial application stage. Second, the Socail Security Administration will probably send a questionnaire about your abilities/disabilitie to a person you name in your application. You need to be sure that this person knows that this is coming and is also aware of the disability standards (as Tom says in #3 that you should be). It can be difficult for some people to fill these out for others because they either want to maximize the extent of the disabilty to be helpful  (as in "she can't do anything for herself and requires total care") or minimize it because they are in denial or trying to be optiimistic. (as in  " she is a wonderful person who tries to do everything for herself and only needs a little help"). It's important for the person filling out the form to be detailed and realistic and as Tom says- be sure to include treatment side effects, especially when treatment is long-term.

Social Security is a really convoluted system, so if you can find someone to help who has experience with it, so much the better. And in any case, be sure to meet any appea deadlines and don't give up!

 

 

 

Edited by BridgetO
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Thanks for sharing important information on social security disability. I would recommend these points to my uncle as he is going to apply for social security disability benefits soon. As, he is unable to go to work for more than a year and suffering from chronic illness. His friend suggested him to apply for SSDI benefits. As this SSDI enrollment process is quite a lengthy and frustrating one. My uncle's friend also suggested him to take the help from an insurance agent in the enrollment process. I have also read online that for a permanent disability, social security benefit as well as affordable medicare insurance benefit works so well.

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There can be a lot of confusion regarding the two programs offered by Social Security for those who become disabled.

SSDI (Social Security Disability Insurance) is for those who worked and paid into the system and then become disabled and meet the SS's criteria to be considered disabled.  Generally, you need to be considered unable to work for a least one year.   IN my case my Disability date was the last day I worked.  I was approved in about 2 months, but needed to wait for the sixth month to start receiving my monthly benefit.   My understanding is that Stage IV Lung Cancer is approved quickly, but again, you'll still have to meet your waiting period before benefits start.    

 SSI  (Social Security Income) is also a program for the disabled and provides additional funds for those who have very limited assets and income.  In most cases if you are married and have a working spouse, you would be denied, because they look at "family income".   The asset level is very low, under $3,000 and that is also based on family assets.    It's basically for those at poverty level.   If however you are eligible there is not waiting period, so you'll start benefits much sooner.   In many States this also makes the recipients eligible for Medicaid (low income insurance programs that each State offers).     Check the rules for your State to see what you may be eligible for.  

I always share this link https://www.ssa.gov/benefits/disability/ to the SS website, which has many more details.  You can apply online and/or call your local SS office for more specifics, especially now with Covid, as I would assume many of the offices may not be staffed.   

Good Luck!

 

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I have Stage IV LC and was approved about 10 days after I applied. It helps, I think, if you have all your info ready about all your tests and treatments. I, too, have the 5-month waiting period before I get my check (it's actually 6 months because checks are for the previous month's benefits). The good news is that the time runs from when I was diagnosed, rather than when I started treatment and stopped working.

For non-Stage IV--patients who may actually feel worse symptoms than someone like me--you do have to go through the drill of showing you are too disabled to work. From what I understand, it is highly beneficial to get a disability attorney involved early on--you don't pay anything till you win your case and the lawyer is paid a percentage of any "back pay" benefits going back to when you became disabled.

I agree with Lisa--the SS website is great, and there are also several other good sources of info that promote attorney services (but you don't need to register to hook up with a lawyer to read the info on the site). Here's one that I found helpful: https://www.disabilitybenefitscenter.org. It's not affiliated with SS, and it does promote attorney services, but the info looked legit.

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Hey Lexie,

Did you follow up with submitting any medical documents to them when you applied?  I filed  2 days ago and it said I should send medical documents but they weren’t specific on what?  I did give my Doc a heads up that I applied and they would probably be hearing from them.  Thanks for any help,

Babs

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Hi, sorry, just seeing this. What I did was to very carefully answer EVERY question about the tests and treatments I've had since I was diagnosed in July (and included my surgery from 2017). I got a call from a caseworker a few days later who wanted copies of my paystubs. I asked if I should actually mail the records I had (I'd printed them all out, of course) and he said no need--they would get everything they needed. I think the specific answers I provided helped speed the process--they knew what they were looking for. Like I said, it wound up being 10-14 days from first application to approval, for me.

 

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