Personal Stories - Social Security Disability

Disabled Population Often Faced with Tough Choices

Catherine Burrows understands firsthand the frustration that dealting with the Social Security Administration can bring

Catherine Burrows understands firsthand the frustration that dealting with the Social Security Administration can bring.

For a single person living on a fixed income, meeting their own basic needs can prove challenging. However, families with dependent children living on fixed incomes are often faced with the decision of which basic needs they should even attempt to meet. Should they choose life saving medication or paying the rent? Should they choose buying groceries or keeping the electricity on? Of course, they need the medication, but they also need food and shelter – and basic utilities. Even though Social Security Disability Insurgence (SSDI) benefits are something of a safety net for people who have become disabled and can no longer earn an income, they aren’t always sufficient to keep disabled households afloat during times of financial crisis.

Catherine Burrows of Orange County, Florida was faced with making some of these hard choices recently. Her son is 14 years old and suffers from a seizure disorder. His anti-seizure medication prescription costs $400, which was being paid for by Medicare until Burrows lost those benefits recently. Burrows had been working full time and her income put her over the income limit for her son to receive SSDI or Medicaid. Just as she received a notice from the Social Security Administration (SSA) alerting her that her son’s benefits had been denied, Burrows was diagnosed with lung cancer and had to quit her job. The SSA told Burrows that she had to go through the appeals process to get the benefits reinstated, but Burrows contacted her local media station because she said she cannot wait that long for assistance. If she paid the rent, she would have no money left for the medication. If she bought the medication, they would be facing eviction due to falling behind on the rent.

“It’s very frustrating. This is my child’s life,” Catherine Burrows told WFTV.

WFTV journalists contacted the SSA on Burrows’ behalf, but were also told she would have to go through the appeals process to get her son’s benefits reinstated. The journalists contacted the makers of her son’s anti-seizure medication and the manufacturers donated a 30 day supply of the medication to  Burrows’ son. The Florida Department of Children and Families is trying to get Burrows’ son’s medical coverage reinstated while the SSDI appeal goes through the SSA system.

“I’m just hoping, praying with the Lord, it will get better,” Burrows said of her situation.

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SSI Recipients in Tennessee Losing Heath Care Benefits

Tennessee SSI Recipiects May Lose Health Care Coverage

Tennessee SSI Recipiects May Lose Health Care Coverage

Since January of 2009, Tennessee has withdrawn coverage for 100,000 residents who were insured through TennCare, Tennessee’s version of the Medicaid program. These cuts come on the heels of a resolution to a decade’s long court battle involving recipients of Supplemental Security Income (SSI).

TennCare’s eligibility guidelines have always stated that anyone who ever qualified for SSI would also qualify for medical coverage under their program. Due to rising costs and the state’s unstable financial situation, Tennessee wanted this provision overturned to withdraw health coverage from those who no longer qualified for SSI. In 1987, a class-action lawsuit involving SSI recipients was brought against the state. The lawsuit resulted in an injunction barring Tennessee from denying coverage under TennCare to all SSI recipients, both past and present.

"Here I am three-quarters of the way through getting well after two types of cancer and needing surgery and colon tests and CAT scans to see if the lymphoma's come back and here they cut me off. There's nothing I can do until I turn 65 now, except wait and hope I don't get sicker." - Thomas Moore, 64, Woodbury, Tennessee

The state argues that all SSI recipients should qualify for TennCare on their own, taking their current income and assets into consideration. This is the same process that applicants who have never received SSI have to go through to determine their eligibility. State officials say that assuring that everyone follows the same set of rules not only benefits those seeking assistance, but also reduces wasteful spending of state resources by ceasing to pay out benefits to people who clearly are not entitled to them.

TennCare’s spokesperson Kelly Gunderson maintains that SSI recipients are not being unfairly targeted. Gunderson said TennCare is only re-evaluating their eligibility based on income, which is the same process every other TennCare recipient must go through. If their household incomes qualify them for health coverage, they will receive it. However, Social Security is the very income that has put some TennCare recipients over the qualifying threshold in some cases.  Further, the vast majority of those losing TennCare benefits under the new ruling were receiving treatments for live-threatening conditions and are now being forced to discontinue those treatments due to lack of health coverage.

Jessica Pipkin is a Tennessee resident who lost the use of her limb in an accident five years ago. She requires 24 hour nursing care in her home, which was covered under TennCare until the recent ruling went into effect. Her husband makes $19,000 a year at his job. Her disability benefits are $14,400 per year. This combined income puts them well over the threshold to qualify for TennCare coverage, even though Pipkin’s care costs $37 per hour.

Thomas Moore, a 64 year old Tennessee resident and cancer survivor also had his health coverage dropped under the new ruling. In 2008, Moore began receiving SSI benefits because of a hip fracture, but was required by the state to move to the Social Security program when he reached the age of 62. The change in programs put his income at too high a level to qualify for TennCare coverage, which he subsequently lost. Moore was still undergoing follow up treatments for his cancer and had a hip surgery scheduled at the time he lost coverage.

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Disabled Without Health Insurance? You’re Not Alone

According to government sources, there are approximately 30 million uninsured citizens in this country. The majority of these are working in jobs where health care plans are not offered by their employers. Although many of the uninsured do not make enough money to purchase private health insurance on their own, their incomes still render them ineligible for government-funded health programs. We could assume that these 30 million Americans are in relatively good health and that their out-of-pocket medical expenses are little to non-existent. However, we would be sadly mistaken.

Many Disabled Americans Still Uninsured

Included in those 30 million uninsured is a demographic of people who not only do not qualify for government-funded health care programs, but are also disabled and/or terminally ill. While their medical conditions may warrant them being approved for programs such as Social Security Disability according to one doctor’s diagnosis, the guidelines set forth by the doctors employed by the Social Security Administration often tell a different story.

Disabled with no health insurance

Wanda Reddick and her husband, Carl. Wanda became disabled and lost her job, leaving them both without health insurance benefits.

Wanda Reddick, 61 of Tennessee, is one of millions of Americans caught in the red tape of the flawed  Social Security system. Reddick suffers from chronic obstructive pulmonary disease (COPD) and requires a number of medications plus a supply of oxygen in order to survive. Despite her disability, Reddick worked as long as she was able. She spent three days in the hospital and took twelve weeks of sick leave. As a result, Reddick lost her job and what insurance coverage she had. Reddick was eventually diagnosed as being disabled due to the COPD by a private doctor and unable to return to work. However, when she was examined by the Social Security Administration’s doctor, she was told she was not disabled and therefore did not qualify for Supplemental Social Security Income (SSI).

"The whole system is a mess. It’s just a shame….. like going to the end of a road and finding there’s nothing, but a drop off."

In the meantime, Reddick is without some of the medications that help her to breathe. One of her prescriptions costs $194. Reddick said she hasn’t gotten it filled because she cannot afford it. It’s one of five prescriptions that remain unfilled due to their cost. She still has to wait a year before she qualifies for Medicare. Meanwhile her husband Carl, who is 71 with a host of ailments of his own, receives his medications through Medicare. Instead of using the supply of oxygen that was prescribed to him for his own breathing problems, he gives it to Wanda.

In the interim, as they wait to appeal Wanda’s denial, they boil water on the stove to produce steam. Carl says it helps them breathe. Wanda’s letter of denial was dated March 15th – and it gave her sixty days to plead her case to the Social Security Administration Appeals Board. Carl’s frustration was obvious when he voiced his feelings on the situation.

“The whole system is a mess. It’s just a shame….. like going to the end of a road and finding there’s nothing, but a drop off.”

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Cancer-Stricken Social Security Claimant Makes YouTube Plea To Obama

Illness, Pain, Misdiagnosis & Denial

Gayle DeVilbiss, a 54 year-old woman in Arizona, was originally diagnosed with fibromyalgia back in 2007.  She applied for Social Security benefits and was denied. Then, after various treatments and further study, Ms. DeVilbiss learned that she was actually suffering from Non Hodgkin’s Lymphoma, a serious form of cancer requiring chemotherapy and other long-term treatments.

After starting her regimen of routine treatments, her immune system became depleted and she needed more medication to keep her healthy while the chemotherapy went to work destroying the cancer cells.  Soon the pain set in.  Nausea, fatigue and other physical ailments only added to the mental and emotional anxiety and constant worry.

Understandably, Ms. DeVilbiss was completely unable to work.  Once again, she applied for Social Security Disability benefits, but within weeks she received a notice indicating that her disability benefits were denied based on the fact that her regimen of treatment is not expected to last more than 12 months.

The law as currently written states that a person is eligible for Social Security disability benefits if that person suffers from a severe impairment, is unable to work because of the severe impairment, and the impairment is expected to last for at least 12 months or result in death.

In her video to the president, Ms. DeVilbiss states, “I just don’t understand what [diagnosis] you have to have to get Social Security disability. I can’t work right now. I may be able to work in a year, I don’t know. I may be able to work six months from now.  But right now I can’t work. “

“I don’t feel 100 percent. I don’t feel seventy five percent, and I don’t feel even fifty percent of what I used to feel. I just need some help now”, she contined.

The sad truth is that there is no employer that would knowingly employ a person with the current diagnosis and set of symptoms displayed by this woman.  In an interview with a local news station, Ms. DeVilbiss pointed out that she’s constantly fatigued and most days has to be on oxygen; a result of her treatment program for the cancer.

There are no easy answers, it’s true.  However, we can’t ignore situations such as these. Confronting flaws and shortcomings in the Social Security programs is the only way to really incite change and improvement in the government services that we all sacrifice to support.

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Social Security Overpayments - What Can You Do?

video management, video solution, video streaming Claimant Received Social Security Benefits After Going Back To Work

From Action 9 News in Charlotte, North Carolina comes a story of Tommy Thompson, a disabled man who was billed by the Social Security Administration for overpayments that he received after taking a teaching job while on Social Security disability benefits.  At face value, it may sound like a legitimate case of the government simply trying to recoup money that was fraudulently obtained by someone claiming to be disabled but was secretly working on the side.  Not so.

The benefits recipient, it appears, had taken steps to notify the SSA that he had started working.  Later, when the payments continued, he again notified the feds, requesting that the checks be canceled.  So, by all appearances, it certainly seemed as though this claimant was acting in good faith, doing all that he reasonably could to obey the rules.

It is indeed confusing then, to learn than not only did the SSA not stop sending the payments, but instead sent a bill for the overpayments, as though it was all his fault.  Ultimately, the problem was sorted out and he didn’t have to pay the money.  The Social Security Administration admitted that since the overpayments were not his fault, then he didn’t have to pay back the money.

Lessons Learned And Other Questions

Looking into the facts of this story bring several things to mind. First, there is a long-held standard in insurance cases that, whenever a claimant receives money “in good faith” (meaning that the claimant did not take illegal, unethical, or improper steps to acquire the money) that the claimant is not responsible for repayment in the event that he or she receives more than the claimant would ordinarily be entitled to receive.  Since the Social Security Disability Insurance (SSDI) program is indeed a government sponsored insurance program, this legal theory should hold in all jurisdictions.

Next, it certainly makes one wonder at what level the administration’s process broke down, and who should be held responsible for this mistake.  While this particular case of overpayment was relatively small compared to other fiscal snafus that occur daily in government programs, this case still represents a clear mishandling of government funds at the cost of the taxpayers.  Additionally, after calculating the additional time, energy and money that the government used to fix the problem  it’s certain that the total amount of the taxpayers’ loss surely must have been significantly higher.

How often does this occur? How many Social Security Disability claimants are innocently overpaid, and then, after receiving notice of the overpayment, simply refund the money, believing that the government would never ask them to pay money that they don’t actually owe?  There is an old addage that states for every person who righteously complain, there are 10 others who go quietly by.  Businesses understand this concept, and I’m certain that our governmental administrators understand it as well.

Now there may be some who would argue that the right thing to do would have been to return the money, in spite of his legal right to keep it.  However, I disagree.  This claimant is clearly a model for others who depend on the government programs which we gladly support.  All his actions were in good faith, and he proved himself a good steward of public funds by doing his reasonable best at ensuring that the taxpayers’ money wasn’t wasted.  Perhaps he knew that as long as he continued to receive the funds, he would eventually be allowed to keep it, yet to his credit, he kept up the pressure until the error was fixed.  Surely, the $700 that he received is a paltry comparison to the potential thousands of dollars that would have been charged for an external auditor to discover the error at a later date.   We should all be as civic minded, dilligent, and responsible as he.

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