When i got married i lost my ssi benifits is there a way to get them back?
–Paula

Jonathan Ginsberg answers: Paula, SSI is a disability program based on need and work limitations. There are strict income and resource limitations. What you have discovered is that SSI looks at household income and resources.

So, when you got married, your husband’s income and assets are considered in evaluating your eligibility. It would appear that his earnings take you over the limit and thereby disqualify you from SSI.

By contrast, Title II disability does not look at a spouse’s income or resources because those benefits arise from the claimant’s own earnings record.
–Jonathan

[tags] SSi and income and resources, SSDI, Supplemental Security Income, marriage status and Social Security disability [/tags]

I have a frontal brain injury causing a severe visual memory loss. This brain damage or TBI makes me depressed, have low energy , not able to focus , low concentration and I need to know how to apply these difficulties to each question asked on ssi and ssd applications.
–Paul

Jonathan Ginsberg responds: I have studied the Social Security disability application process in great detail. I have even written a book about it called the Disability Answer Guide. Here are the main “big picture” points about filling out the forms for your condition:

1. At the initial and reconsideration levels, the State Agency adjudicators are primarily looking for listing level impairments. It appears to me that the appropriate listing category for brain injury is Listing 11. I would suggest that you print out this listing, take it to your neurologist or neurosurgeon and ask for his help. A letter from the doctor tracking the language of the listing would be most helpful.

2. When you answer the questions on the form, focus on how your brain injury would prevent you for performing work activities. For example, every job requires a certain level of attendance and concentration. No doubt there are other general work activities that you can no longer do. Keep these limitations in mind when you answer the questions on the forms.

3. The State Agency personnel frequently do not get all of the medical records they need to make a decision. If you have not already been doing so, you should obtain and organized copies of your own medical records. I advise people to send these records in themselves to make sure that the State Agency adjudicator has all relevant records.

I also find that cases involving brain injury, mental health problems and even chronic pain require testimony from witnesses. You, as the claimant, may not be able to objectively describe how your condition has changed you. Therefore, you may want to include a statement or statements from friends, family or former co-workers that discuss these changes.
–Jonathan

Attorney Charles Hall published an interesting post on his very informative Social Security News blog. The post, entitled “Inconsistency Between ALJs” discussed a report by a Houston television station that revealed a tremendous difference in the percentages of favorable and unfavorable decisions issued by judges in the downtown Houston Office of Hearings & Appeals. Favorable decision rates ranged between 68% down to 7%.

I have noticed this inconsistency in hearing offices where I practice. Most of the judges I have appeared before are patient, considerate and willing to consider the claimant’s testimony. I have also been before one or two who are rude, condescending and give the claimant’s testimony very little consideration.

The real inconsistency, in my view, arises from the way various judges analyze the evidence. Some judges have no interest whatsoever in listening to the claimant – they are looking for medical diagnostic test results, lab test results and vocational conclusions by treating doctors.

I distinctly remember a case where my client was involved in a serious auto accident in January, but did not get an MRI until October. MRI tests are expensive and her doctor wanted to try conservative treatment like physical therapy and medications. The MRI showed disc herniations at several levels as well as other degenerative changes that were clearly consistent with her allegations of pain. There had been no other accidents and there was no question in my mind that this lady’s pain and limitation of motion arose in January, when she had her accident.

The judge, however, would not concede that my client’s back problems started in January. The October MRI report was the first objective proof of injury and he refused to grant the case with a January onset date. Instead, we were given the choice of amending our onset date to the October date of the MRI or face the risk of a partially favorable or even unfavorable decision. He also let us know that a fully favorable decision with the amended onset would be issued within a week, but any other type of decision might take several months because of the backlog.

My client did not want to wait nor did she want to risk her claim for benefits. By amending the onset, she gave up over $7,000 in past due benefits.

Had we drawn another judge, this never would have happened. But that is what a claimant faces – the draw of the judge is a huge factor in what is likely to happen.

It would seem to me that SSA would want more consistency but there is little qualitative review of administrative law judges. To my knowledge SSA has never surveyed the claimant’s bar about the judges and that is a shame because I suspect that most ALJs want to do a good job and many would be open to improving their performance.

I recently came across two very comprehensive web sites dedicated to mental health issues. Both of these web sites offer useful information about mental health disorders. I generally encourage my clients with mental health disorders and any witness who may testify in their Social Security hearings to learn what they can about the client’s mental health issues. Often it is difficult for a mental health patient to have insight about his/her condition since altered thought processes are often a symptom of the condition itself. For the claimant, reading about his/her condition helps reinforce testimony and for the witnesses, a little research can make their testimony more relevant as well. The first site I can suggest is bipolarcentral.com, a web site dedicated to Bi-polar Disorder. The site’s publisher, David Oliver, and I have correponded a bit and he explained to me that the impetus for this site was the plight of his mother, who is and was a bi-polar patient. David offers a great deal of useful information and he has published a book about living with a bi-polar relative. The other mental health research site I recently came across is the Mental Health Sanctuary web site published by Tim and Andrea Phiel, who live in Washington State. This site is very well organized in that it is divided into nine "sanctuaries" covering such topics as bi-polar disorder, depression, PTSD, Schizophrenia, etc. Each of these sanctuaries offers in-depth information, links to relevant blogs and web sites, therapist links, and other information. The site also utilizes the services of volunteers who can answer questions by email. Both of these sites are worth a long look by SSDI claimants disabled by mental health problems and by their families and friends.

I have been receiving LTD from Northwestern Mutual for 2 years now while waiting on my SSD hearing. Now I am being told when and if my SSD is approved I will have to pay back all that I drew from LTD from the time SS determined I was disabled until rhe present, thus all back pay from SS would go to Northwestern Mutual. Is this true and if so how can this be? This was a group policy through my employer. Any suggestions or input would be most grateful.
–Janet

Jonathan Ginsberg responds: Janet, the situation you describe is fairly typical with group policies. Several years ago, I brought this issue up in a meeting of lawyers who represent claimants in LTD cases to see if there was any interest in possibly pursuing a class action. I also discussed this issue with my own insurance agent.

Basically the consensus opinion is that this repayment requirement is legal and that the cost of the insurance (the policy premium) reflects the SSDI recovery expectation. According to my agent, the price of the group policy would be higher if there was not a repayment provision. Arguably the employer would be less likely to offer this benefit if the price was higher, thereby the lower cost of the group policy indirectly benefits you.

I am sure that none of this is any consolation to you but I don’t know that you have any argument against the policy. I am also sure that no mention of this repayment provision was made during the time you were working.

What some LTD carriers are doing now is offering claimants the option of a lump sum repayment at the time the lump sum is received or they are proposing to pay the LTD benefits at a reduced rate to account for the expected lump sum. I advise my clients to keep their full LTD benefit and pay the lump sum upon reciept.

One final point – some carriers will not require their claimants to repay the attorney’s fee from the SSDI claim. As you may know if you have a lawyer for your SSDI claim, the fee agreement provides that you must pay 25% of past due benefits.

Given that the LTD carrier benefits if you receive SSDI (your monthly LTD payment will be reduced by your SSDI payment) I think it is only fair that the LTD carrier pick up the lawyer’s fees. If your carrier will not reduce the repayment to account for the lawyer’s fees, you will owe the LTD carrier more than what you have received in your lump sum, so be very careful.

I am sorry that I can’t offer you more favorable information but group LTD policies almost always have this repayment issue. Private LTD policies, by contrast, usually do not require a repayment.
–Jonathan

My wife has cancer known as multiple myeloma and has been treated by doctors been taking medicines that cost a lot.
–Karl

Jonathan Ginsberg responds: First of all, Karl, I am sorry to hear about your wife’s illness. As you know, multiple myeloma is a blood cancer that prevents plasma cells from correctly forming and becoming part of her immune system. There has been a great deal of research into the causes and treatment of multiple myeloma and I hope that your wife responds well to the medical treatment she is receiving.

For Social Security purposes, there are two approaches I would take. First, you should be aware that there is a “listing” specifically for multiple myeloma (listing 13.07). If her doctor feels that she meets or equals this listing, and he is willing to put that opinion in writing, then she will be approved for SSDI or SSI quickly.

If she does not meet the listing because her treatment has been effective or for any other reason, then she still might qualify under a “residual functional capacity” argument. In other words, if her treatment regimen plus the symptoms of the disease and medications – fatigue, nausea, confusion, etc. – leave her unable to perform her job duties, then a Social Security judge would likely conclude that she would not be a reliable employee and therefore eligible for disability.

If your wife is approved for Social Security, she would become eligible for Medicare 25 months after Social Security eligibliity. If she qualifies for SSI (Supplemental Security Income), either because of low income or as a medically needy adult, then she could get Medicaid and its prescription benefits.

Finally, there is an interesting article entitled “Multiple Myeloma and Social Security and SSI Benefits” on R.M Bottger’s Disability Expert web site.  According to the site, Ms. Bottger previously worked as a State Agency adjudicator in Oklahoma and her article discusses a multiple myeloma case from the adjudicator’s perspective.

Best of luck to you and to your wife.

–Jonathan

Once again, SSA has released extensive paperwork describing substantial changes to the disability process.  One of the biggest changes is a new procedure for appeals from unfavorable hearing decisions.  Currently, a claimant who receives an unfavorable hearing decision must appeal to the Appeals Council.  Under the new rules, the Appeals Council is eliminated and appeals would be filed directly to federal court.

The new process also revives an old idea – the use of an Adjudication Officer (now called a Reviewing Officer).  Under the new system, if a claim is denied by the State Agency, it is reviewed by the Reviewing Officer.  The Reviewing Officer therefore becomes the decision maker in what we now call “Reconsideration.”  If the RO denies the claim, it goes to hearing (like it does now).

The most ambitious part of the new process are the proposed time frames.  The RO is supposed to make its decision within 90 days of receipt of appeal and the hearing office is supposed to schedule a hearing within 90 days of receipt of a hearing request.  This expedited procedure will certainly be a neat trick as we are now seeing delays of two years or longer from the time a hearing is requested until hearings are actually scheduled.   You can read more about the new disability adjudication process here.
I recently appeared with a client at a video hearing in a case that had been sent from one of the Atlanta hearing offices to an out-of-State judge.  At the beginning of the hearing, the judge told me that he had not had a chance to look at the file and he expressed frustration that he had been given all these Atlanta files along with pressure to hold hearings and issue decisions quickly.

Although this new “streamlined” SSDI decision making process will be rolled out slowly over the next few years, I expect that we will see more and more cases where judges are being pressured to preside over cases they have not reviewed prior to the hearings.

As a claimant’s attorney, I see this pressure on the judges as an opportunity to serve my clients by making sure that the record is updated and by organizing and presenting evidence prior to the hearing.  It would appear to me that this new process will make life even more difficult for unrepresented claimants who will have no idea about how to present their cases to time pressed and frustrated judges.

Can I receieve some grants for diability for me having self harming disabilities and bed wetting I also suffer from anxiety problems.
–Janette

Jonathan responds: Janette, your question illustrates the difference between what appears to be a signficant mental health problem and a vocationally significant mental health problem.

The two questions I would have for you – (1) does your self-harming activity and anxiety impact your capacity for work and (2) do you have a treating psychologist or psychiatrist who would support you in saying that these mental health issues prevent you from being a reliable worker in a job?

My guess is that your mental health problems may very well interfere with your ability to maintain attention and concentration but to win a SSDI or SSI case you need support from a treating doctor or psychologist.