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Social Security Disability by Disapproval

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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