The Developmental Disabilities Institute at Wayne State University Webinar with Autism NOW May 5, 2011

8/6/2019 The Developmental Disabilities Institute at Wayne State University Webinar with Autism NOW May 5, 2011

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Ann CarrellasDevelopmental Disabilities Institute

Wayne State UniversityDetroit, Michigan

Social Security Disability Benefits:

Steps to a Positive Application

May 5, 2011

Acknowledgments

My colleagues from the WashtenawAssociation for Community Advocacy in AnnArbor Michigan

Marsha Katz of the Rural Institute at theUniversity of Montana Deb Hemgesberg of Northeast Community

Mental Health in Alpena, Michigan

All participated over the years in creating thisslideshow and have continued to add to myknowledge in this area and others.


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What I want to know

Please take a moment and think aboutone or two things you hope tounderstand about Social SecurityDisability programs.

If I dont answer your questions during

the presentation, please ask at the end.

2 Social Security Disability

Programs

Supplemental Security Income (SSI)

Retirement, Survivors, and DisabilityInsurance aka Social Security Disability(RSDI or SSDI)


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SupplementalSecurity Income

(SSI) Title XVI

1. Based on need (income and resource limits).

2. Check arrives on the 1st of the month.

3. Benefit amount varies with living arrangement.

4. SSI eligibility may confer Medicaid eligibility.

5. Asset and resource limitations are:

$2,000 for individual, $3,000 for a couple.

6. Payment is about 75% of poverty level.Individuals receive $674, couples get $1,011.These amounts have stayed the same since2009.

SocialSecurity Disabilityor

Benefits Retirement, Survivors,

Disability (SSDI, RSDI) TitleII

1. No resource limits, no limit on unearnedincome.

2. Check arrives on 3rd or another assignedday.

3. Benefit amount depends on work record,age when benefits begin, # of peoplereceiving.

4. Medicare after 24 months of eligibility.


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Concurrent Recipient

Receives both SSI and SSDI in twochecks.

Total of benefits is $20 more than SSIalone.

The Law

1. The Social Security Act and currentamendments (applies at Administrative LawJudge level)

2. Code of Federal Regulations--CFR 20, parts400-499 applies at Administrative Law Judgelevel)

3. Program Operations Manual (POMS)-day today policy used by SSA District office staff.

4. Social Security Rulings (SSRs)


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OtherProgram Resources

Social Security Handbook

Disability Evaluation Under Social Security(aka the Blue Book)

The Red Book aka A Guide to EmploymentSupports

All available on line at www.ssa.gov

How doesSSA define disability?

Go to the Blue Book aka DisabilityEvaluation under Social Security

There are: Childhood ListingsAdult Listings


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Adult Listings

Musculoskeletal System

Special Senses and Speech

Respiratory System

Cardiovascular System

Digestive System

Genitourinary Impairments

Hematological Disorders

Skin Disorders

Adult Listings (cont.)

Endocrine Disorders

Impairments that Affect Multiple Body

Systems Neurological

Mental Disorders

Malignant Neoplastic Disorders

Immune System Disorders


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Childhood Listings

Growth Impairment

Musculoskeletal System

Special Senses and Speech

Respiratory System

Cardiovascular System

Digestive System

Genitourinary Impairments

Hematological Disorders

Childhood Listings (cont.)

Skin Disorders

Endocrine System

Impairments that Affect Multiple BodySystems

Neurological

Mental Disorders

Malignant Neoplastic Diseases

Immune System Disorders


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12.10AutisticDisorderand Other

PervasiveDevelopmentalDisabilities-Adults

Warning: The Social Security Administration isnot up to speed on Person First language.

Characterized by qualitative deficits in thedevelopment of reciprocal social interaction, inthe development of verbal and nonverbalcommunication skills, and in imaginative

activity. Often, there is a markedly restrictedrepertoire of activities and interests, whichfrequently are stereotyped and repetitive.

AdultDefinition

The required level of severity for these disorders is metwhen the requirements in both A and B are satisfied.

A. Medically documented findings of the following:

1. For autistic disorder, all of the following:

a. Qualitative deficits in reciprocal socialinteraction; and

b. Qualitative deficits in verbal and nonverbalcommunication and in imaginative activity; and

c. Markedly restricted repertoire of activities andinterests;


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AdultDefinition (cont.)

OR

2. For other pervasive developmentaldisorders, both of the following:

a. Qualitative deficits in reciprocalsocial interaction; and

b. Qualitative deficits in verbal andnonverbal communication and inimaginative activity;

AdultDefinition (cont.)

AND

B. Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining socialfunctioning; or

3. Marked difficulties in maintaining concentration,persistence, or pace; or

4. Repeated episodes of decompensation, each ofextended duration.


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112.0AutisticDisorderand Other

PervasiveDevelopmentalDisorders-Children

Characterized by qualitative deficits inthe development of reciprocal socialinteraction, in the development of verbaland nonverbal communication skills, andin imaginative activity. Often, there is a

markedly restricted repertoire ofactivities and interests, which frequentlyare stereotyped and repetitive.

Child Definition (cont.)

The required level of severity for these disorders is metwhen the requirements in both A and B are satisfied.

A. Medically documented findings of the following:

1. For autistic disorder, all of the following:

a. Qualitative deficits in the developmentof reciprocal social interaction; and

b. Qualitative deficits in verbal andnonverbal communication and in imaginativeactivity; and

c. Markedly restricted repertoire of activities andinterests;


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OR

2. For other pervasive developmental disorders,both of the following:

a. Qualitative deficits in the development ofreciprocal social interaction;

and

b. Qualitative deficits in verbal and nonverbalcommunication and in imaginative activity;


AND

B. For older infants and toddlers (age 1 toattainment of age 3), resulting in at leastone of the appropriate age-group criteriain paragraph B1 of 112.02; or, forchildren (age 3 to attainment of age 18),resulting in at least two of theappropriate age-group criteria inparagraphs B2 of 112.02.


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What B1and B2 say

For a child ages 1 to 3:

At least one of these areas:

Communication or cognition or fine or gross motor development or

social functionis no more than half the childs chronological age(according to standardized tests and medicalfindings)

What B1and B2 say (cont.):

For older children ages 3 to 18 years old:

Must have 2 areas of marked impairment in:

a. Age appropriate/communicative function

b. Age appropriate social functioning

c. Age appropriate personal functioning

d. Maintaining concentration, persistence orpace


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Othersourcesofinformation

Letters from parents describing theimpact of the childs disability in theseareas and other daily living activities

Information from teachers, friends, andothers who interact regularly with thechild

These are good sources for adults too aswell as employers re: work activities,extra help needed on the job

5StepSequential Evaluation

forAdults

The process that the Disability

Determination Service (DDS) uses todetermine if a person has a disability thatprevents them from performingSubstantial Gainful Activity (earn $1,000a month or more).


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5 step sequentialevaluation

Step one: Are you earningSGA? (Substantial GainfulActivity) If yes, then you are not disabled.

If no, got to step 2.


Step 2: Do you have a severeimpairment? Is the impairment

expected to last at least 12months, or has lasted 12months or is expected to resultin death? If yes go to step 3.


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Step 3: Does your impairmentmeet or equal in severity asdefined in the listing ofimpairments. Ifyes, you are

disabled according to the medicallistings.


Step 4: Are you able to go backto your previous work i.e. can

you do any work which youhave performed in the past 15years?

If you cannot go to step 5.


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Step 5: Is there other workwithin your residual functionalcapacity considering your age,education and experience that

you could do that is available inthe national economy?

The 6 reasons you could be

found not disabled:

Earning SGA. Do not have a medically determinable

impairment. Have an impairment that does not significantly

limit the physical or mental ability to do basicwork activities.

Fail to meet the duration requirement (12months).

Be capable of past relevant work. Be capable of other work.


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Childrenareevaluated by:

Functional limitations compared tosimilarly aged children:Acquiring and using informationAttending and completing tasks Interacting and relating with others

Moving about and manipulating objects Caring for yourself Health and physical well-being

Theprocess toapply

Stepone--ContactSSA

Call or go into your local SSA office orcall the national number at 1-800-772-1213 to request an application

ORApply on line at www.ssa.gov. You may

apply for RSDI but not SSI on line.

This activity assures your protectedfiling date (the date

benefits will go back to when you are approved).


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Alittle known, butimportant

factabout theprocess

The claimant is responsible for making sure thattheir medical evidence reaches SSA andtherefore, the Disabili ty Determination Service.

DDS and SSA will request your medicalinformation but it is better to ensure they receiveeverything by taking an active role!

Your active participation in this, will make a HUGE difference in

whether or not you are awarded benefits on first application.

Step twothe Paperwork

Fill out all the paperwork in detail. Writeas if you are drawing a picture ofyourself and your disability for the

examiner (who will never meet you).

The forms can be intimidating - take abreak, ask for help.


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Step threeDocumentation

Call the DDS examiner every 10 days to checkon your case. Find out what they have formedical evidence.

If there are medical reports that will help theexaminer make a decision and recognize yourdisability, get copies of them to DDS.

Have your treating MDs fill out supportingmedical evidence paperwork.

StepfourMoreDocumentation

Go to consultative examinations. If youdo not have or have not had healthinsurance, make sure you let SSA knowthis in your forms and at yourappointments.

Ask your primary doctor who treats you tofill out forms, write a letter explaining theimpact of your disabilities- their opinionmeans a lot.

The process takes 3 to 4 months usuallybut can be longer or shorter


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Step5--ApprovalorDenial

If approved, you will get a letter stating this.You will need to go to SSA to begin receivingbenefits.

If denied, you need to decide within 60 dayswhether or not you want to appeal.

If you decide to appeal, go to SSA or go online

and file the appeal forms.

Appeals

Do I need a lawyer to appeal?

No, you can do it yourself or get a non-attorney

representative. You can also use a lawyer.However we encourage everyone to get arepresentative who is familiar with the socialsecurity system to represent them. Fees arepaid to the representative out of the backbenefits you are due if the case is one and theSocial Security Administration sets a limit onfees.


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Thank you

Are there any questions?

Documents

The Developmental Disabilities Institute at Wayne State University Webinar with Autism NOW May 5, 2011