You have just been told by your Primary Care Physician that you have what society politely calls a disability. You are floored! ‘Why me,’ you ask. This is a critical time. It will take considerable effort and courage to come to terms with your new life and this new label.
The most important thing to understand about being disabled is that the sooner you accept your condition, the better off you will be. But just accepting the situation isn’t enough. It requires immediate action and diligence to actually take control of your new life. And taking action while you are still working means you will have more and better options over the long haul.
One of the foremost challenges you will face as a disabled person is that the definition of “disabled” varies between different forms of insurance. The fact that your doctor has stated in writing that you are disabled does not automatically guarantee benefits. This is a difficult and confusing reality, and it happens to be the primary reason 60% of first-time applications are denied.
With that in mind, you need to prepare for your future disability support documentation and qualification requirements. Planning is crucial and everyone will be involved in this process including your spouse, caregiver, immediate and extended family and your medical professionals. Basic knowledge and understanding about your medical condition, your current health insurance coverage and various supplemental disability insurance programs is often a maze of complexities but of critical importance.
Unlocking Your Benefits
This document has been designed to assist you in understanding the complicated world of disability benefits. It is based on the actual experiences of an active healthy, executive-level individual who was diagnosed with secondary progressive Multiple Sclerosis and has successfully made the transition from well-compensated executive to financially secure, fully disabled individual.
Disability Key is designed to assist you in understanding Disability Insurance Benefits, including your options in selecting help and how to begin compiling the documents that will be needed to apply for the benefits for which you are eligible. This process has been specifically designed for wage earners whose disability is not the result of a workplace accident or otherwise covered by Workers’ Compensation.
The goal of this particular document is to give you an overview of the various disability insurance plans that may be available and what steps you will have to take as you make your way into the benefits maze.
CHAPTER 1: Getting Started
So now you have realized that you cannot ignore your disability and that it will not go away. Congratulations on taking the first step toward regaining the control you once had over your life. Keep in mind that YOUR ULTIMATE GOAL is to regain control of your life and your financial stability. You’re no doubt wondering how to go forward; where to begin?
Asking Questions, Getting Answers
Can I still work? How much work can I really do?
What and when do I tell my Employer about my situation?
I want to continue working. How do I work within my disability restrictions and still make a living wage?
How do I keep my health insurance if I can’t work?
What if I need to go on to Short or Long Term Disability (STD or LTD)?
Does Social Security apply to me if I am disabled?
Can I get Social Security if I am under the age of 65?
What about Medicare? Can I get Medicare coverage? When does it begin?
If I loose my job, I think that I can get something called COBRA. What is it and how long can I get it? Will it last until I am eligible for Medicare?
These are certainly not all of the questions that you will have, but they are the most common and the most immediately addressable. As you review this document you’ll find answers to these and others, as well as some direction on getting information particular to your situation. As you think about the specifics of your case, you are encouraged to write down your questions in the forms and spaces provided in this document. Do so as often as necessary as you work through the process; no question is too small or insignificant to be asked! If it occurs to you, it must be answered for your ultimate success.
As you move forward into this new life, your primary concerns are likely to be financial. The first order of business is to create a financial safety net for you and your family. By doing so you will be better equipped to spend the time and energy it takes to manage your life around your disability.
Financial Safety Net: What Is It?
The financial safety net is nothing more than ensuring a steady, reliable income through any and all insurance benefits that you may have. Disability Key will assist you in analyzing what you currently have, what you will need going forward, and how to follow the convoluted processes necessary to maintain a “livable” income level given your changed employment situation.
You must determine what benefits could potentially be available to you. Do you have private insurance? Short term? Long term? What’s the Difference? What do I need to Know?
Types of Disability Insurance
Regaining income is most often accomplished by activating the benefits of a disability insurance policy. The insurance company pays out a predetermined sum of money to claimants who have earned the money because they are eligible as a result of premiums paid either by the claimant (you or your spouse) or the claimant’s employer.
In general, eligibility for disability insurance benefit income is dependent upon two (2) major conditions:
There is a non-Workers’ Compensation disability that impacts your normal daily living activities (NDL) so that you no longer can work. This symptom impact keeps you from performing your same occupation, and/or any occupation. And,
You and/or your employer have been paying premiums on these types of insurance policies and they are currently in force. The policies can be Short Term Disability (STD) or Long Term Disability (LTD)
You may also qualify for Social Security Disability Insurance (SSDI). You qualify for SSDI if you have worked for at least 40 calendar quarters, and have contributed into the Social Security System. (Note: there are other ways to qualify for Social Security. They are not addressed here. See www.socialsecurity.gov for additional information.)
In general, STD and LTD coverage’s are either individually purchased by you, or are plans offered by your Employer and are most likely ERISA qualified. ERISA refers to Employee Retirement Income Security Act of 1974. This is the law that governs LTD plans and sets standards for the administration of these plans. Your employer can verify if your company’s issued policy is ERISA qualified.
The process for qualifying for any disability benefit is paper intensive. It is critical to collect and organize all documents detailing your medical history and current condition application forms. You will also need to gather all of the documents relating to your medical, STD, and LTD insurance policies when applicable. Your employer is obligated to provide you with copies of any insurance policies that would apply to you.
In addition to the general medical and insurance information described above, you will need all documentation relating specifically to your disability. This will include records of doctor visits, results of laboratory tests and all physical exam reports. You can request this information through your doctor’s office, (you may be asked to sign a Medical Records Release Form to obtain them). Some hospitals, clinics and medical facilities may require a nominal fee ($25 - $35) for this service.
The government periodically sends you information about your Social Security earnings, so you should already have these on file. If you do not have copies, you can request a current statement from the Social Security Administration office (find that contact information in the Resources section at back of this booklet).
Know The Disease. Another key to success in this process is to learn as much as you can about the condition causing your disability. Collect brochures or booklets from your doctor’s office or from drug companies. Visit your local library or bookstore, or search on-line book retailers. The Internet is an excellent resource, but must be used cautiously to make sure you are getting the most valid information from the best sources. The most serious and chronic diseases have specific organizations dedicated to serving those affected. They often provide a great deal of information and support via the Internet, and can be invaluable.
Employment Regulations and Insurance. As you plan what you need to do in order to prepare for you disability insurance claim, consider the following general pieces of information concerning disability timeframes and document requirements:
If you loose your job, you can usually continue your company-provided health insurance through COBRA (Consolidated Omnibus Budget Reconciliation Act) for up to18 months. This is a step you need to examine closely up front. COBRA insurance coverage tends to be far more expensive than what you may have contributed to previously while fully employed. Should you elect to use COBRA, you are personally responsible for all of the premiums necessary to keep the current policy in effect. Avoid unwanted surprises by getting a complete understanding of the costs involved, in writing, before going forward.
You need to be covered by SSDI (Social Security Disability Insurance) for 24 months before you qualify for Medicare. Note: this 24 month time frame is really 29 months, as you must wait 5 months after having qualified for SSDI to begin receiving payments. The Medicare qualification is triggered by the date of the first SSDI payment, NOT the date of application or acceptance. Keep this in mind when creating budgets
Within the first 30 days after receiving your SSDI qualification, you can ask your COBRA Administrator to extend COBRA for an additional (11) eleven months based on disability. This extension is called OBRA, and is granted only for disability purposes.
And getting educated isn’t just about the outside world of medical records, employment issues and insurance carriers. Listen carefully to your body and monitor its reaction to each of the symptoms. Learn to describe those symptoms in graphic detail. This information will be critical when completing the matrices within in this workbook. It is strongly recommended that you keep a daily diary or journal of what is happening with your body. With every new symptom, try to identify and document the trigger. Also document how you managed out of, or around the symptom.
CHAPTER 2: Obtaining Disability Insurance
Do not be surprised if your claim for benefits are denied at the initial stage of the SSDI and/or LTD insurance benefit claim process. The numbers are sobering: Roughly 60% of all claims are rejected on the first attempt, and 80% of those are rejected at the Reconsideration stage.
The odds start to improve somewhat in the next stage, which is the Hearing. The case is heard in an informal setting by an Administrative Law Judge and his/her secretary. Often times the judge will have a vocational expert present to testify as to what jobs the individual can perform.
The challenge in attaining and retaining LTD status depends entirely upon your ability to document and to prove that your disease symptoms impair you from both your own occupation and any occupation. AND you’ll be expected to prove your status not just once, but several times periodically throughout the duration of your LTD benefit.
As a result of the complexity of attaining and retaining these disability insurance benefits, increasing numbers of applicants are deciding to get help with the process. There are two major options available to you.
Option I - Hire An Attorney To Represent You
As a rule, attorneys do not collected fees if your Social Security Disability Insurance claim is not granted. While some attorneys require retainers, they are usually willing to collect their fees on the back end of the successful disability claim. Most Attorneys receive 25% of the back benefits, with a not-to-exceed limit of $4,000.00.
· Statistically, claimants being represented by an attorney are more likely to win their claim in the earlier stages
· An experienced attorney knows what proof the Social Security Administration and the SSDI system requires
· Using legal help eliminates the necessity of having to wait in long government lines
· All aspects of your case including complicated paperwork will be handled professionally
In order to understand the potential costs associated with the use of an attorney, you should understand the real numbers involved. Some attorneys might charge up to $150.00 per hour just to hear your case before considering whether or not to help you. Let us say that you have accrued SSDI back eligibility of $1,000 per month; you are due 12 months back pay, for a total of $12,000.00. If your attorney is eligible for 25% of this amount, it would cost you $3,000.00 in legal fees – or three full month’s worth of your benefits.
Option II – Use Experiential Support
There are a growing number of Disability Advocates ranging from independent consultants, web sites, non-profit organizations to quasi government agencies all specializing in helping individuals qualify for disability benefits. The costs and success rates for these services vary as widely as the groups themselves. We recommend that you thoroughly understand what someone is promising to do and exactly how that fits with what you are trying to accomplish.
Option III – DIY (with a little help)
You will always be your own best advocate. It’s your condition, your body, and your future on the line. No one can know those issues better than you and, with some help, you’ll have everything needed to make a good case.
Our proven processes:
· Will walk you through the decision-making processes using thorough timelines and checklists to help you remember critical steps;
· Allow you to take each step in your own time, at your own pace;
· Contain proprietary forms, guidelines and actual examples to help you describe what’s happening to you and how it’s impacting your life; and most importantly,
· Have been written by a Nationally-recognized Human Resources expert who is disabled and used these same processes and documents to regain control of her life.
Visit our web site at www.disabilitykey.com to learn more about applying for disability benefits. As an example of what you will find in our various packages, here is a document for you to use as you begin your documentation process.
 Note: There is a separate Worker’s Compensation Workbook designed to assist someone advocate for Worker’s Compensation benefits.