Social Security Disability Denials

Laws Make Understanding Social Security Qualifying Process Difficult.

Social Security laws are written in such a way that it is often confusing for disabled applicants to know whether they will qualify for benefits.

Social Security laws are written in such a way that it is often confusing for disabled applicants to know whether they will qualify for benefits.

The rules involving Social Security benefits are confusing at best. The Social Security Administration (SSA) denies sixty five percent of claims the first time they are filed. With so many different criteria to meet, regulations to follow and red tape to get tangled up in, it’s no surprise that most applicants resort to hiring an attorney to manage their application for them.

There are two types of benefits which a disabled person may apply for. One is for people who are recently disabled with a solid work history. The other is for people who do not have a recent work history or may not have accumulated enough qualifying “quarters”.

The first type of benefits are called Title II benefits (SSDI). These benefits are for people who have a recent work history and that have worked at least five of the past ten years. Each year is divided into four quarters so this means that in order to qualify for Title II benefits, a person must have worked for twenty of those forty quarters.

Disabled applicants who fall into this category are eligible to receive benefits for five years. During that time, their children are eligible to receive benefits on their behalf as well. The benefits for minor children will be one half of those awarded to the disabled parent. This amount increases to two thirds of the disabled parent’s benefits if the disabled parent dies while receiving benefits. Workers who qualify for benefits under the Title II guidelines will become eligible for Medicare two years from the onset of Social Security benefits.

The other kind of Social Security benefits is called Social Security Supplemental Income (SSI). In order to qualify for benefits under the SSI guidelines, the applicant must have very a limited income and very limited financial resources at their disposal. For a married couple, the value of their assets cannot exceed $3,000 – excluding necessities such as the home itself and vehicle. As of 2010, the maximum benefit amount for a person qualifying for SSI could receive is $674 per month. Under the umbrella of SSI benefits, there are no benefits granted to dependents or minor children.

If your original claim to the SSA for benefits has been denied, you are given sixty days in which to file for what is known as a “reconsideration”. This means you ask the SSA to reconsider your application for benefits, based on current information and any other new and supporting information you can provide. If turned down a second time, the SSA allows another sixty days for the filing of a second appeal.

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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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