Narcolepsy Forum Posting

Posted by Austin on August 19, 2003 at 15:00:23:

In Reply to: Experience applying or disability? posted by PillowGirl on August 18, 2003 at 10:06:29:

You're in a tough spot. You may have already discovered the following, but there seem to be a lot of misperceptions floating on this site about "disability," so let me digress. (FWIW, I have N; work in health education with disabilities, 18 yrs exp. My spouse is a senior Disabilities Examiner "DE" for Social Security; he decides whether people get SSDI. We talk about this stuff over dinner almost every night --- for years! :-) If you're really serious about legal details, you can also go to your local law library and research it.

1. Social Security Disability Income (SSDI) is an insurance program paid for thru SS taxes. People misperceive that just having a medical condition, even a condition which MAY be regarded as disabling, entitles the person to receive payment (SSDI). Wrong! It's insurance, not a savings account to draw on at will. The TOUGH question SS wants answered is: CAN YOU WORK AT ALL, even if meds are needed to control the problem? If you can, you likely will be denied as not severe enough to grant SSDI; you may not be able to perform the job function you'd like (which is why I'm not a surgeon), but they figure you can do something gainful (like health education).

SSDI, altho a federal program, is administered by state government, like Medicaid. Leniency or denial varies somewhat by state: conservative states like TX deny a lot; liberal states like CA are more lenient.

Most private disability plans are far more generous with allowances, because they have a lower threshold question: Do you have a covered condition that makes you unable to do the job you were hired to do? Big difference.

ERISA plans (employer self-funded), unfortunately, are the notoriously stingy wild cards of the insurance picture and are usually tough to crack. Hence, their requirement that you get tagged "disabled" by SS: if you can meet the stringent standard of SSDI, they'd be on shaky ground trying to deny you.

Having an attorney is not likely to make any difference in the SS process. It's just likely to cost you a bundle, unless s/he is willing to work on contingency (percentage of the proceeds), which is not the norm, since the proceeds would not amount to a hill of beans anyway.

Having a KNOWLEDGEABLE attorney typically helps in only one way: s/he will be sure all the i's are dotted and the t's crossed before the application is submitted. (Failure to provide adequate medical records is the most frequent cause of delay, altho if eventually provided, may not make a lot of difference in the outcome.) DEs love for you to have an experienced attorney, because it makes their job sooo much easier, but it seldom affects the outcome. The DE is sitting there with a checklist. If claimant meets the requirements of the "listing" in this enormous book, they collect; if not, they don't.

So (finally) the advice (per my senior DE):
-- Be sure to provide all the requested medical documentation. They're not interested in hearing from your roommate about how much time you spend sleeping -- just the medical data.
-- If YOU have provided what was asked, then almost all delays are because YOUR MD's office did not respond to SS's request in timely fashion. They're the thorn in the process's side. Don't hesitate to prod the doc's staff to follow up on sending the requested info.
-- Making a decision usually takes an hour or less, once the info is complete. DEs really, really HATE delays -- you're not the only one -- because it eats at their performance evaluation. They WANT to give you an answer quickly.
-- If they need added data, they may send you to a contract MD/consultant -- at SS's expense. Don't miss your appointment!
-- Be nice to the DE if you have to call on the phone (honey, not vinegar...).
-- There's nothing personal about SS's decision, so don't be hurt if you get denied -- the checklist just didn't weigh out. Your best chance is to wind up, round #1, with a sweet bleeding-heart DE who grants every benefit of the doubt.
-- If denied, you can appeal, and a more senior DE will review your case (re-consideration) to see if anything to your benefit was overlooked. IF they were provided what they asked, a lawyer is not going to help. IF!
-- If denied on re-con, you can appeal for an admin hearing; it's not likely to get you very far, because the checklist has already been gone over and over, but you can try.

I'm always curious about folks applying for SSDI. The benefit amount is so paltry (usually less than minimum wage would pay), why would anyone with N want it, IF they are capable of holding down any kind of half-way decent job? (Some really expensive diseases make sense, because MediCare is auto with SSDI.) Your situation, Pillowgirl, is a bit different, in that if you get "disabled" by SSDI, you've got an argument toward your LTD determination, which (one assumes) pays much more. If you get SSDI but not LTD, THEN is when that lawyer could come in real handy.

Hang in there!
Austin

Follow Ups:

• Re: Experience applying or disability? sleepyCat 23:33 8/19/03 (0)
• Re: Experience applying or disability? sleepykitty 16:30 8/19/03 (1)
  • Re: Experience applying or disability? Austin 15:27 8/20/03 (0)

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