Disability Benefits

What to Expect When You Can No Longer Work

Our missionO What are the differences between

ADA, FMLA, Group Disability, Private Disability and SSDI?

O How is disability defined?O When should you stop working?O Overview of the Application ProcessO Additional Considerations for SSDIO Your Questions

Life of a Disability Claim – Acute Conditions

O Well defined beginning – onset of diagnosis concurrent with start of disability

O Normal ProgressionO Concurrent Short Term Disability and

FMLA Protected LeaveO More severe conditions progress into

LTD/SSDI

Life of a Disability Claim – Chronic Conditions

O Challenging to determine a start pointO Diagnosis is often months or years prior

to disabilityO Gradual loss of function

O Prior to full disabilityO ADA – Reasonable AccommodationsO Federal and State Leave ProgramsO Potentially multiple Short Term

Disability periods/claims

Disability DefinedO Based on CAPACITY not DIAGNOSISO Language normally references physical capacity

and earning capacityO Examples

O “…the inability to perform the material duties of your own occupation due solely to illness or injury…”

O “…You must be unable to perform the regular duties of your occupation due to an illness or injury…”

O “Unable to engage in Substantial Gainful Activity by reason of a medically determinable physical or mental impairment which has lasted or is expected to last at least 12 consecutive months or result in death”

Types of CoverageO Group/Employer Sponsored STD

O Designed to protect income for a limited period

O Closed-ended - generally 3 – 6 monthsO Group/Employer Sponsored LTD

O Ongoing income protectionO Extended waiting periodO Open-ended – benefits generally end after

recovery or normal retirementO Private PlansO Social Security Disability Insurance

When to ApplyO Know your plan!

O Partial versus total disabilityO Filing DeadlinesO Impact of medical leave

O Consult with your provider!O Generally do not file prior to stopping

workO Exception – planned surgeries!

Social Security BasicsO Federal/State ProgramO State DDS Reviews ClaimsO Paid under Federal Social Security programO Dates to 1956O Advantages

O Retirement Earnings FreezeO Medicare Eligibility after 24 monthsO Trial Return to Work programO Family SSDI BenefitsO Access to Vocational Rehab Services

SSDI EligibilityO Eligibility based on creditsO For 2015, 1 Credit = $1220 in wagesO Maximum of 4 per yearO General guideline is 40 credits are

neededO Special Rules apply to younger

workers

Source: http://www.ssa.gov/planners/retire/credits3.html

Types of Social Security Benefits

O Primary Social Security DisabilityO Dependent/Family Social Security

DisabilityO Supplemental Security Income (SSI)O Widow/Widower Disability Benefits

Dealing with SSDIO Filing OptionsO In Person – Your Local SS Field OfficeO By PhoneO Online

O http://www.socialsecurity.gov/pubs/EN-05-10550.pdf

5 Step Review ProcessO Step 1 – Are you working?

O SS Definition of ‘working’ (SGA) = $1090/month

O Determined by the Field Office

No? Yes?

Continue to Step 1 Denial

5 Step Review ProcessO Step 2 – Is your condition ‘severe’

O Impairment must interfere with basic work-related activities

No? Yes?

Likely Denial Continue to Step 3

5 Step Review ProcessO Step 3 – Is your condition found on

the List of Disability ConditionsO PSC is not!O Some complications may beO List is available on the SSA Web Site

(www.ssa.gov)

No? Yes?

Continue to Step 4 Likely Approval

5 Step Review ProcessO Step 4 – Can you do the work you did

previously?O If you CAN’T you are not necessarily

approvedO Most commercial plans WOULD

approve at this point

No? Yes?

Continue to Step 5 Denial

ProcessO Step 5 - Can you do any other type

of work?O Much stricter definition than most

commercial plansO DOES consider age, education, past

work experience, but not as clearly defined as in most commercial plans

No? Yes?

Likely Approval Denial

Do I need an Advocate or Attorney?

O Are you covered under a commercial plan?O Most carriers pay for advocacy!O SSDI is generally an offset to the commercial planO Is you’re the condition that caused you to stop

working on the SS List of Impairments?O Were you eligible/Technical Denial?O Attorney’s/Advocates generally work on

contingencyO 25% of past due benefitsO Cap of $6000O They can appeal to SSA for additional pay

Some FactsO Approximately 2.33 MILLION claims filed per

yearO 31% - Technical DenialsO 62% of the remaining claims are initial

deniedO 48% of denials are appealed (Request for

Reconsideration)O 90.3% of appeals are deniedO Only 18% continue to the hearing phase!O 81.4% of those who continue are eventually

approved

Mistakes to avoidO Failing to provide informationO Missing deadlinesO Discontinuing treatmentO Not following through on the appeal

process

Time for your Questions!