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Topic: Social Security Questions and Answers

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Jun 21, 2011 05:52AM - edited Jun 21, 2011 05:56AM by NMM

NMM wrote:

Dear All,

My wife asked me to wrote this post as she thought I might be useful.

Background on my wife. 36, wife, mother of a 4 yo boy and turning 2 in August girl, and as of June 3 stage IV bc with mets to the liver.  Yeah I know, sucks.

As for me, bad news I am an attorney. Good news, I am an attorney who devotes 100% of his practice to representing individuals who have been denied disability by the SSA.

So I may be able to help address some concerns and quesitons about this topic.

First off, this is not an advertisement. Just trying to be helpful.

Second, I will try to answer any questions in a general manner. My answers are not meant to be legal advice and should not be taken that way. So when I read a post with a specific question or problem I will try and answer it in a broad general way.

Third, again this is not a troll for clients. While we are in California SS is a federal program so the laws and rules are the same across the country. So I think I can be helpful.

Fourth, again my answers should not be construed as legal advice.  While I have experience in this area of law any response I make may or may not be correct and you should not rely on it.  there is no substitute for your own due diligence.

Fifth, I would liek to keep this topic focused on dealing with what is, not what it should be.  Basically, SSA is the largest administrative system in the world.  Getting frustrated that it is not set up they way it should be does not help focus on the way it is and how to navigate to improve your chances of getting approved.

So here are some inital thoughts:

1. If you have/get an attorney, under federal law they cannot charge you any money up front for the attorney service. Period. It is actually a federal crime for an attorney to receive payment for attorney services from a SS client from anything except their back benefit.

The law says that any attorney fee cannot exceed 25% of the back benefit. If you have an attorney and they help when the case at or before a first hearing with an Administrative Law Judge (ALJ) the fee is 25% or $6,000 whichever is smaller.

So if an attorney tells you that it is 25% if you win or some less amount of money if you lose that is not correct. If you don't win your case or even if you win but get no back money, your attorney gets zero.

Now the one thing is that your attorney can charge you, win or lose, any costs that he pays to get medical records to help prove your case. So if your attorney gathers medical records from your doctors who charge him $25, $50, etc.. And you lose your case, an attorney can send you a for that cost. Because it is not an attorney fee but a cost.

2. Some of you may have what is called an overpayment issue. Where SSA pays you some money and then at some point says they paid you too much and they want their money back. If that happens to you, or if it happened to me, I would call/visit SSA and request forms/file a waiver of overpayment form. It is pretty simple and SSA should help you. It is not hard to do and it may reduce or eliminate what SSA says you owe.

Anyway, feel free post some general questions and I will try and address them.

Take care

Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 21, 2011 06:20AM EnglishMajor wrote:

Hi Steven

Thanks for doing this

This has come up previously, but here goes.

Can one potentially be disqualified despite having a Stage IV diagnosis (and attendant initial pathology and scan results)? (I have met the years of work requirement.)

What if your oncologist expresses doubt you would qualify for disability (because you are stable, have a low volume of disease, etc)?

I think my doctor may be thinking of disability in LTD terms (where the MD must specifically certify your disability).  

My understanding is that my doctor does not have to "approve" my application--merely to affirm I am being treated for Stage IV metastatic breast cancer (which I am).  

Surgery is not standard of care for Stage IV. But I had a mx last year. But they won't be removing my bone mets anytime soon. (Just wondering how this might apply to "nonresectable"?

I think my case straightforward--I have worked since HS. I don't have any dependents. I presented with mets as confirmed via a bone biopsy. If my job ends, I think I would apply for SSDI.

Would there be value to retaining a legal specialist to do the application? I don't want to screw things up. 

Dx 7/6/2009, IDC, 3cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 21, 2011 09:04AM Chickadee wrote:

I'm not Steven but I had no difficulty qualifying for SSDI by presenting my path reports that detailed my mets and were obviously from my cancer center.  They didn't ask for any other information.........I assume they contacted MD Anderson for the same documents but when I followed up with the disability determination office, he stated that I had provided all the documentation they needed.

The online application was very easy to fill out but did take time and require detailed responses from you.  Best of luck.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012 Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 21, 2011 02:18PM NMM wrote:

English,

In general one can be denied no matter how advanced any illness is. While there are lots of rules, at the end of the day the system requires human input which leads to error. If I recall correctly, for the last fiscal year stats are available, something like 2 million people applied. Even if we assume an error of 1%, that is 20,000 incorrect grants and denials.

So yes you can be denied even if you are at stage IV. The question is if it will stick on appeal.

With respect to your doctor's opinion that can carry weight. But at the third step of the analysis, SSA looks first to the diagnostic criteria and objective findings. If a person has the medical findings that satisfy what is required then they are disabled regardless of what their physician says. That opinion may matter at the fourth and fifth step.

When you file initially their is not much any can help you with. If you can fill out the application and describe your question adequately and list your medical sources, SSA will contact your doctors, gather the evidence and make a decision. As long as you can complete the application and other forms you will be okay.

Finally, one must always relate their disability to why they stop working. So if you are working now and stop, try to remember that you need to relate it to your diagnosis. Losing your job because your company relocated, and hey now you want your SSA money, may hinder the process.

Steve

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 21, 2011 09:41PM Fearless_One wrote:

Steve, how long must one have been out of work for in order to be approved (if other criteria is met)?   For example, getting diagnosed with stage IV while currently working full-time.... 

lump/chemo/rads/hyster-ooph/mastectomy/implants
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Jun 21, 2011 11:56PM EnglishMajor wrote:

Thanks Steve, very insightful!

Dx 7/6/2009, IDC, 3cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 01:43AM Medigal wrote:

Thanks Steve for offering to give us insight into what can be a very frustrating and agonizing process for some!  Maybe you can answer a question which has been plaguing me.  I have a relative who got fired from her job because her medical problems made it agonizing for her to work the 8 hour 5 day shifts without enough days off to recoverer.  WE went to hospitals she had been in and got her medical records, letters from her doctors, filled out the 12 page form we thought we had to have for her interview and went to her Social Security Disability appointment with her bringing all the documents we felt would help with the process.  The person who was interviewing her did not want our 12 page Disability Document or the Medical Reports from hospitals etc or letters from her doctors..  He instead had her sign so he could get it himself and anything else he needed.  Do you have any idea why an agent would do this?.  He preferred to type stuff on his computer instead of using what we already had for him.  I thought our doing a lot of the work would make the case go faster but it was useless, it seemed, to him.

Also, I called a Disability lawyer who was recommended to us and he told me he does not go to the initial interview.  He only comes in if she is denied and he has to appeal the case.  Is this the normal way the lawyers handle these cases?   Thank you for any information you can share to help me understand this disability process.  You are very kind to offer to share what you can.  

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Jun 22, 2011 02:58AM blondiex46 wrote:

so Steven is it $720.00 - $ 1000.00 a month or a year?

Original 8/96 - 1cm, chemo, rads. Recurr..9/09...Mets to lungs, chest wall, lymph nodes under arm & chest, cervical & lumbar spine, ribs, hip. Femera, Falsodex, Zometa, Xeloda, Gemzar,Taxotere, Adriamycin,Havalen.WENT OFF CHEMO 7/20/14 Dx 9/1/2009, 3cm, Stage IV, ER+/PR-, HER2-
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Jun 22, 2011 03:45AM Foxlairfrm wrote:

Steven, thank you so much for sharing your knowledge. I have owned a dog grooming salon for 25 years now, the salon is attached to my house. I am fortunate that I can set my own hours and schedule time off for treatments. My onc and ortho Dr's say I cannot and should not be working at the pace I have been. No more large dogs and dogs that require pulling on this arm that has broken. I have been approved for disability. My dilemma - I do not want to close the shop. I would like to keep some of my old customers with small dogs. I also have a groomer who is willing to come in 1or2 days a week on commission. Can I work some on disability? What would be the process for someone that does not have a set income? I can't say for sure that I will make xxx amount every week. (I never could do that). I don't know if the process would be worth the effort with calculating business expenses vs profit. I have an accountant take care of all that.
I know that I won't be able to continue this occupation forever, but I hate to close the door after 25 years. It keeps my mind occupied and gives me a reason and purpose every day. I love my customers!
Thank you
Deborah

Original dx 1996. Mets to a LOT of bones 2010. living every minute to it's fullest! Dx 10/18/2010, IDC, 1cm, Stage IV, 8/11 nodes, ER+/PR-
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Jun 22, 2011 05:37AM NMM wrote:

Fearless:

Here is the genral answer to your question on how to think of SS:

Social Secuirty is not a medical disability system in that people get benefits because they have a medical problem(s).  

SS is a medical-vocational program that provides benefits whose medical problems prevent them from working, i.e. cause vocational relevant limitaitons on the ability to function in the workplace.

 So no matter how serious or debilitating the injury or illness if someone is perform an activity that is earning them an income they are not disabled for SS purposes. 

 Best example I give my clinets (a bit dated now) was Christopher Reeves.  Quadraplegic yes.  Made money for public speaking and or consulting yes.  Disabled No.

So to answer your question: Most people who are working and stop because of medical reasons will apply and put down the next day as their disablity onset date.  So if you work to 6/20/11 and never go back, for SS purposes you would put down 6/21/11 as when your disability started.  Because from a SS point of view that is when it did cuz you were working.

 Now this simple example applies to someone who is working pretty full time.  If for a year you are working off and on, missing a lot of work, and making less than on average $1,000 a month, I would put down the date that all that began cuz I would make the arguyment that the past year was not SGA and merely an work attempt.

But in general, your disablity onset date is not when you were first diagnosed but when your medical problem first stopped you from being able to work.

Now the sticky thing is this, if you are diagnosed with an impairment that SS persumes to be automatically disabling and you continue to work, then you are rebuting the presumption that SS has made.

 So just make sure that if you are diagnosed Stage IV and continue to work for a time afterward to document that you stopped wortking because your problem grew worse.

Which leads me to another point.  Someties I have client's who have demanding jobs, either physically/mentally/or both.  They try to go back to work and thier employer gives them modified duty, lighter or not so mentally taxing.  this can hurt you because while you may be not able to do what you consider your prior demanding work, if you do the modifed work long enough SS may conider that w hole seprate job that you can still do.

 Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 05:47AM NMM wrote:

Medigal:

 Second Q:  That is correct and your experience on the first Q shows that.  A person really needs to be denied at least once before an attorney can make a difference. At the intial level SSA gathers the evidence and is only looking for the easy grants/denials.  SSA does not ask for a lot of input from either attorney or claimants. 

First Q:  Not much experience at the intial level.  Best guess is that they just want to make sure they get a complete file and not one culled out. Also, SSA has pretty much got rid of paper.  Everything medical is proceesed through a central facility in Colorado I think and then scanned and electronically sent to field offices.

So it may have not been a question of want but that they just can't because they have no way of physically processing it at the local office.  But that is a guess.

I would though just hang on to it to make sure SSA does get those records in case you get a denial.

Steven
Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 05:57AM NMM wrote:

Blondie:

 In regards to what?  If you mean amounts you can earn it is per month averaged.

$720 is the amount for a trial work period.  $1,000 is the current amount with respect to SGA and an unsuccessful work attempt.

Before making this separate topic I posted a few times here

http://community.breastcancer.org/forum/8/topic/424992?page=31#idx_911

This is what I posted with respect to earnings:

This is from SSA website:

***

Earnings trigger a trial work period
During a trial work period, a beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled. We do not consider services performed during the trial work period as showing that the disability has ended until services have been performed in at least 9 months (not necessarily consecutive) in a rolling 60-month period. In 2010, any month in which earnings exceed $720 is considered a month of services for an individual's trial work period. In 2011, this monthly amount increases to $720.

***

here is link:

http://www.ssa.gov/oact/cola/twp.html

So making $1000 in any month, regardless of the hours one works, more than 9 times in a rolling 60 month period may effect benefits. But also the regulation also makes clear that unpaid services like volunteering as long as it is a service that people do get paid for can count towards the trial work period.

Example: if a person volunteers to answer phones for some type of charity for 10 hours a week that this charity normally pays $20 to do that job, SSA may consider that as part of trial work period.

So the. answer to your question is yes, working can always cause you a headache. In my experience SSA is big and slow, but at some point the computer notices the data being inputted.

Best chance is to keep earnings below the amount SSA considers the trigger, this year that is $720.

And I posted this:

Correct. Once you exceed the trial work period limitations, SSA then looks at whether or not you are engaged in substantial gainful work activity (SGA). Which currently the bright line is $1,000.

But remember, this is a very large agency. So making $990 a month does not me a person safe because the regulations and rules state that SSA will "generally" not consider amounts below a certain amount ($1,000 this year) as SGA. But that does not mean they won't

So I guess to put it in list form in order from safest to risky:

A. Do not work.

B. If you do work keep it under the TWP max. which this year is $720.

C. If you do work above $720 and are out of TWP keep it below SGA levels (this year $1,000) and document how you were able to work. Here are some examples to show why what a person does is not SGA no matter what they make:

***

Performance of Work Under Special Conditions: One situation under which your SGA-level work may have ended, or may have been reduced to the non-SGA level, as set out above, is "the removal of special conditions related to your impairment that are essential to your further performance of work." That is, you may have worked under conditions especially arranged to accommodate your impairment or you may have worked through an unusual job opportunity, such as in a sheltered workshop. Special or unusual conditions may be evidenced in many ways. For example, you:

May have required and received special assistance from other employees in performing the job; or

Were allowed to work irregular hours or take frequent rest periods; or

Were provided special equipment or were assigned work especially suited to your impairment; or

Were able to work only within a framework of especially arranged circumstances, such as where other persons helped you prepare for or get to and from work; or

Were permitted to perform at a lower standard of productivity or efficiency than other employees; or

Were granted the opportunity to work, despite your medical condition, because of family relationship, past association with the firm, or other altruistic reason.

***

Basically, if the only way yo work is because you are accommodated or treated specially then SSA may not count that as SGA. Why? Because unlike the ADA, SSA does not consider employer accommodation in the analysis. A person must be able to perform work without accommodation for their disability.

D. If you do make consistently over $1,000 be upfront with SSA to avoid any overpayment issue and to establish a history of credibility if you need to re-apply or re-start your benefits.

Again this is not meant to be legal advice but just a more detailed discussion of the issues you have raised.

Fianlly and unrelated to your quesiton I did put this up there:

 Here is something that may be of interest from SSA website.

***

Compassionate allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate allowances allow Social Security to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly.

http://www.ssa.gov/compassionateallowances/

***

What qualifies for a passionate allowance?

Here is the link to list:

http://www.ssa.gov/compassionateallowances/conditions.htm

Of note number 14 is:

Breast Cancer - with distant metastases or inoperable or unresectable

Finally, here is a link to a section of the POMS Manuel.

Essentially POMS is a non-binding Manuel that takes the law of SSA and writes it in a manner thatnthe field staff in local offices can follow to process claims correctly. This document is how they should handle a claim involving someone who is Stage IV diagnosed.

Before you click though, it ain't pretty. Bottom line SSA does notmlike to make mistakes. Therefore, the fact that an impairment is fast tracked to being approved as disabling may be a good thing as far as getting paid SSA benefits, but like I tell my clients, often whatnisngoodmto help in SSA claim is bad for health overall.

secure.ssa.gov/apps10/poms.nsf...

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 05:58AM Medigal wrote:

Steven:  Finally, someone who makes sense in all this!  We could have saved ourselves a LOT of work if the Disability webpages would have revealed this info to us instead of encourageing us to do just the opposite.  And now we just wait and hope against hope!  Thanks so much for the reply.

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Jun 22, 2011 06:02AM NMM wrote:

All:

Here is a link to SSA website that gives a good overview of working and getting SSA.

http://www.socialsecurity.gov/pubs/10095.html 

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 06:07AM NMM wrote:

All:

This is a good primer to understand how SSA looks at a disability claim and the 5 steps it goes through.

How Do We Decide if You Are Disabled? SSDI or SSI

The process we use to decide if you are disabled involves five steps. They are:

1. Are you working? If you are working and your average monthly earnings, after considering the effect of work incentives, are at the SGA level, we generally cannot consider you disabled. If your monthly earnings average less than the SGA level, we look at your medical condition using steps 2 through 5.

2. Is your medical condition "severe"? For us to consider you disabled, your impairment(s) must significantly limit your ability to do basic work activities, for example walking, sitting, seeing, and remembering. If it does not, we cannot consider you disabled. If it does, we go to the next step.

3. Is your medical condition in the list of disabling impairments? For each of the major body systems we maintain a Listing of Impairments that are so severe we automatically consider you disabled. If your medical condition(s) is/are not on the list, we have to decide if it is of equal severity to an impairment on the list. If it is, we approve your claim. If it is not, we go to the next step.

4. Can you do the work you did previously? If your medical condition is severe, but not at the same or equal severity as an impairment on the list, then we must decide if you can do your past relevant work. If you can, we will deny your claim. If you cannot, we go to the next step.

5. Can you do any other type of work? If you cannot do your past relevant work, we then see if you are able to do any other type of work. We consider your age, education, past work experience, and transferable skills. If you cannot do any other kind of work, we will approve your claim. If you can, we will deny your claim.

The only thing missing is that after step 3 and before 4 and 5 SSA will look at your medical imopiamtns and detemrine what funcitonal limitaiotns you have (mental and physical) and then detemrine if those limitaiotns prevent past work or other work at step 4 and 5.

And that in a nutshell is what SSA does when it evaluates your claim.

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 06:09AM NMM wrote:

Another good link that takes the complex law and puts it into easy to read format:

http://www.socialsecurity.gov/redbook/eng/introduction.htm 

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 06:10AM SpecialK wrote:

Question - I am currently receiving LTD payments from my employer's insurance company for an ADA accomodated leave of absence.  My last day of work was 10/29/10, have not worked since that day due to 5 surgeries and just finished chemo.  I work in a hospital, in the Blood Bank, very fast-paced, bio-hazardous, and stressful.  I physically could not have worked during this period and my oncologist has supported this in my documentation.  I received a call yesterday from a subcontracted advocate for the insurance company that wants me to apply for SSDI based on a BC diagnosis (stage II) and my age, 54.  They told me that since I am over the age of 53, I am considered unable to be retrained (I found that hysterical!) and that even though I do not have distant metastasis I would most likely qualify for SSDI.  Is that correct?  Of course the insurance company/advocate want me to apply and/or receive SSDI because it reduces their obligation by the offset of SSDI funds.

BMX w/ TE 11/1/10, ALND 12/6/10. 13 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+
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Jun 22, 2011 06:36AM NMM wrote:

Fox:

Self employed are different.  They still have $720 limit for TWP or a 80 hour per month max work in your business no matter what net is.  And yes SSA looks at net not gross.  Also unlike employees who have to get 12 months of ssa before TWP applies you need to get 24 months.

I recently has a client who was a hairdresser.  He was making $200-300 a month for several years just keeping long term clients (10-20 years) he had.  It took a while and a couple of appeals andf hearings but we got him benefits.

So if you can keep your income below the threshold that would be best. So keeping a few of your long term clients and staying below the $$ and time limit would be best. Or an easy way to avoid the hour limit is to do what you mentioned which is act as a referring person to a groomer who pays you a commission.  Just watch the income and time spent. 

If you have family you can trust you can also turn it over to them and perhaps turn it into a passive income stream. Get it off Sch. C and I think a K.  That is just an idea and not something I ever researched.

Steven

 

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 06:51AM NMM wrote:

SpecialK

Most LTD insurance policies actually have a provision in the contract that you have to apply for SS (or any other program) to offset what the ins. co. has to pay you.  The are lookign to "offset" what they owe.  Offset is what they call it.

 Example:  Person make $2,000 a month.  LTD plan has to pay them 50% or $1,000.  Person applies for SS and gets a $500 SS benefit.  LTD ins. co. now only pays $500.  That is because a perosn under LTD contract is only entitled to $1000 total from all sources.  So LTD ins. co. gets to "offset" the amount a person gets from SS.

Yeah I know, sucks.  LTD law is tough.  We used to do it but just to darned hard the way law is writtien.

And it is true that both SSA and LTD plans generally make it easier to get beneifts the older one gets. Not slam dunk but a 54-55 yo person is a better profile then a 30 yo assuming all other factors are same.

As far as whether you would qualify for SS, I have no idea.  Based on what  you told me it appears you have a postive profile.  You have a serious illness that you can document.  You are over 50 (closely approaching advanced age in SSA parlance) and almost 55 (advanced age) which is favorable factors.  It sounded like your job was both physically demanding and somethingthat a sick person who could not risk infeciton could do.

But no one can say for sure until you apply.  But if you walked through my door with a denial letter based on what I have read I would def sign you up as a client because you have a case.  Which is to say not that I think it is a slam dunk but that it is worth my time.  Which is important because remember I don't get paid unless my client wins.

So you shoudl apply even if it doe snot add one dime into your pocket.  Why?  Because it is always better to have multiple streams of income even if the amount is the same.  That way if ins/ co. cuts you off you at least have something coming in form SS.  Or vice a versa.

Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 07:00AM SpecialK wrote:

Thanks for the info.  I love the advanced age thing - I will be 55 in October.  Here is part 2 (and I so appreciate your time!)  My current ADA leave of absence expires on July 1.  I have been sent paperwork from HR to extend the leave.  I am sure they are required to send it as the deadline approaches per ADA.  I actually am still receiving treatment, have low blood counts (important because of the bio-hazard environment) and will require another surgery during July.  At this point I am unsure if I should quit or try to extend the ADA leave.  I don't know if they will extend it, and if they don't they may fire me for abandonment.  At that point the LTD would cease and I could apply for SSDI straight away without involving the former employer/LTD.  The letter I received from them (insurance co. advocate) puts the SSDI potential start date at 5/1/11, I am assuming that is the 6-month of not working threshold.  Not sure what is my best option.

BMX w/ TE 11/1/10, ALND 12/6/10. 13 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+
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Jun 22, 2011 07:17AM NMM wrote:

SpecialK

Ok.  Background on SS.  This is for eveyone.  When you file a DIB applicaiton for SSDI it can be retroactive for up to one year.

Example:  illness starts June 2008.  Apply June 2010.  Found disabled as of June 2008.  Benefits will be paid starting June 2009.

That is the rule.

So SpecialK you went out  in 10/10.  As long as you aply by 10/11, actually 3 or 4/12 you should be ok to get max benefit retractive to April 11 (remember if you are found disabled in 10/10 there is 5 month wait period till benefits start).

So if you are doing ok now $$ wise on whatever your leave is with your employer and you don't have to apply for SS under LTD plan then you can delay a bit longer on SS and continue leave.

I am not sure why LTd would cease though if you were off leave.  Most LTD plans pay until a person is 65.  Most insurances have STD component (first 2 years) and LTD (2 years and over).

But what you describe sounds like more along the lines of an income replacement plan while out on leave, meaningg you get it as long as your employer as you out on approved leave. 

You might want to check with HR to see if there is also a typical STD/LTD beneift you might apply for.

Also if you get fired make sure you apply for any other programs available.  State, local, or federal.

As I said at the begining it is hard to be specific because I need to see documents and copies of plans to be able to know what is going on.  So remeber this is not legal advice.

Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 07:28AM NMM wrote:

To all:

Ok here is an overview of the extent of the disability system in America right now.  I will describe what is here in California.  Where you are may be a bit different.

There are typically 5 different disability programs one may apply for, both private and government based.I will cover them all although you may not eligible for all of them.

1. State disability.  This one most people are familiar with.  If you have some type of illness or injury that will keep you out of work anywhere form a couple of week up to a year you can file for state disability.

2. Workers Compensation.  If your illness or injury occurs at work or as a result of work you can file a workers compensation claim and receive medical treatment, wage replacement, and permanent disability benefit.

3. SS benefits.

4. Private STD/LTD.  Many people as part of their employment package have a disability benefit with a ins. co.  Conceptually it is similar to SS in that you are paid a certain % of money base don your earnings if you demonstrate you are disabled.

5.  Disability Retirement Pension.  Not as common any more but for those who have a traditional defined benefit retirement plan (not a 401k type defined contribution plan, but a plan that pays you a set amount for a period, usually unions, government workers and large employers) you can ask for your retirment benefit early because of disability and not be penalized as if you took early retirement.

Finally, not a disability type benefit but there is also Unemployment one could file for.

Steven

 

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 08:15AM SpecialK wrote:

What I had/have is a private STD/LTD.  I paid the premium for the STD which is I believe was a 12 week plan.  It ran concurrent with FMLA, after I had exhausted all available vacation time.  My FMLA had to be extended, due to unforseen additonal surgeries, and I used all FMLA leave available to me.  It ran from 11/2010 into 2/2011.  At the conclusion of the STD the company paid benefit of LTD came into play.  I believe the LTD is a 2 year plan, with continued monitoring/verification to make sure you are still disabled, but it only applies if you work for the company.  If I quit, am fired for abandonment, or an extension of my ADA accomodated leave of absence is not approved, that LTD goes away.  The leave of absence will only be approved if I cost the company no money, i.e. no temp hire, no hardship on co-workers, and no overtime by co-workers to cover my hours.

BMX w/ TE 11/1/10, ALND 12/6/10. 13 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+
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Jun 22, 2011 10:39AM blondiex46 wrote:

again thanks Steven you are a treasure!!

Original 8/96 - 1cm, chemo, rads. Recurr..9/09...Mets to lungs, chest wall, lymph nodes under arm & chest, cervical & lumbar spine, ribs, hip. Femera, Falsodex, Zometa, Xeloda, Gemzar,Taxotere, Adriamycin,Havalen.WENT OFF CHEMO 7/20/14 Dx 9/1/2009, 3cm, Stage IV, ER+/PR-, HER2-
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Jun 22, 2011 11:24AM cycle-path wrote:

Steven, I don't have SS issues but I want to thank you for providing all this info to those who do! It is a real gift to the community. 

Best wishes to you and your wife. I hope whatever treatment she's receiving is successful. 

I am an Uppity Woman. Don't like my posts? Put me on IGNORE. Dx 12/10/2010, DCIS, 1cm, Stage 0, Grade 2, 0/2 nodes, ER+/PR+
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Jun 22, 2011 11:34AM Chickadee wrote:

"Also unlike employees who have to get 12 months of ssa before TWP applies you need to get 24 months."

Steven, just caught that statement.  Does that mean that for 12 months from the receipt of first check you can not engage in any work?  Or is it 12 months from date of disability?  I looked on the SSA website but didn't see a timeline for when TWP started

Thanks so much.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012 Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 02:20PM NMM wrote:

Special

That is a different sort of plan then I am used to seeing. Again sounds like a wage replacement plan, sorta of like what Aflac sells. A true STD/LTD plan is more similar to SS where you prove you cannot do your own job first two years and then an job after 2 years.

Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 03:44PM NMM wrote:

Chick

It is not easily found on website. I actually am taking it from the regulations an rulings. Basically you should never work during the 5 month waiting period. Also if you work in the first 12 months of your onset of disability date and before you get your award letter then that is no good. Of course does not mean you lose benefits just that work is looked at under SGA standard not TWP.

Example: found disabled June 15 based on onset date of may 15. 5 month waiting period June to October Back to work august. Not eligible for trial work period.

Example: allege disability June 15...8 months pass no decision...you need money and go to work february ...get approved in march..not TWP.

Anyway best policy is not to work before you receive approval letter and not within the 5 month waiting period after approval.

Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 03:46PM NMM wrote:

Cycle

Thanks. First day of chemo today. Gemzar and taxol.

Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jun 22, 2011 11:51PM - edited Jun 22, 2011 11:55PM by SpecialK

Steven - Also wanted to thank you for all you for all your wisdom and assistance.  Good luck today,   I will be thinking of you and your wife and wishing you the best.

The STD (premium paid by me) is a 90 day plan, the LTD is a 2 year plan, but my company will not permit me to be absent for 2 years, that is what was driving my decision point in the next couple of weeks.  I think they would agree to a 30 day extension of my ADA leave (new date of return to be 8/1/11) but nothing beyond that.  I would either have to resign or be fired.

BMX w/ TE 11/1/10, ALND 12/6/10. 13 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+
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Jun 23, 2011 12:10AM NMM wrote:

Special

Then I would say you should apply for SS now. Hopefully you get it, if denied let me know and I will look to see if there are any local Tampa attorneys who might be able to help.

When filling out the forms, the ones that ask about your daily activities, make sure you detail both what you can and cannot do. SSA is not looking for that one thing that ,makes you completely helples. Rather just focus on being accurate and detailed about why you cannot work a full workweek anymore.

Also, when describing the past work you have done in the last 15 years think about the most demanding as pet of the job(s). If your case goes past step 3 SSA will look to what was required of you in your last job bothe physically and mentally but cannot just focus on the least demanding aspects.

It requires more time than I have to explain but at your age, if your case goes past step 3 and you can knock out your past work at step 4, then there is a good chance to win at step 5.

Steven

Dx 6/3/2011, IDC, 2cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-

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