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Hackensack Disability Law Blog

You need to have disability evidence ready days before a hearing

One of the most difficult aspects of pursuing a successful disability claim with the Social Security Administration is the requirement that you submit adequate medical evidence to prove that your illness or injury prohibits you from gainful employment or fulfilling the basic duties of self-care on a daily basis.

Any given diagnosis will have a range of severity depending on unique factors such as the age of the individual, their overall health, other medical conditions they may have and the lifestyle they lead. In order to make a fair and reasonable determination about someone's eligibility for Social Security Disability benefits, it is necessary for the administrative law judge (ALJ) reviewing the case to understand the true medical impact of the diagnosis.

Understanding the definition of "disability"

The federal government administers a program that provides financial benefits to persons who are deemed to be permanently and totally disabled. A person is eligible for benefits if he or she has earned sufficient work credits and is totally and permanently disabled. "Disability" can seem to be a vague term, but the regulations that govern the administration of Social Security Disability benefits have added a sufficient degree of specificity. In order to understand the complete meaning of disability, a section by section review of the relevant regulations is necessary.

Disability is a medically determinable condition or injury that deprives a person of the ability to engage in substantial gainful activity. The injury or illness that causes the disabling condition must either be expected to result in death or to be continuous for a period of at least 12 months. Substantial gainful activity is defined by a maximum monthly income. For 2019 the monthly maximum is $1,220. This limit is usually adjusted upward by the Social Security Administration on an annual basis. In 2018, the limit was $1,180. In 2020, the limit will be $1,260.

Understanding the benefits of COBRA

One of the most beneficial federal statutes has an especially ominous nickname: COBRA. The name stands for Congressional Omnibus Budget Reconciliation Act. The statute was passed in 1985 to assist employees whose group health insurance was discontinued, either because the employee's job was terminated or because the employer decided to discontinue the coverage.

COBRA requires employers to continue the health insurance coverage for employees, their spouses and dependent children upon the happening of certain events. The law applies to all private-sector employers with 20 or more employees. Qualifying events for COBRA coverage include

  • Termination of the employee's employment for any reason other than gross mis-conduct;
  • Reduction in the employee's hours of employment
  • Covered employee becomes eligible for Medicare
  • Divorce or separation of the spouse from a covered employee
  • Death of the covered employee.

Supplemental Security Income eligibility

Supplemental Security Income is an important financial assistance program for persons who have limited income and who suffer from blindness or disability. Understanding the difference between SSI criteria and ordinary Social Security criteria can help people qualify for SSI benefits.

The SSI program is run by the Social Security Administration. As its name implies, it provides supplemental income for persons who are financially distressed and who meet the other eligibility criteria. To collect SSI benefits, a person must be over the age or 65, be blind or be disabled. The person must also demonstrate limited income, limited assets and United States citizenship. The person must also reside in one of the 50 states, the District of Columbia or the Northern Mariana Islands. The applicant must not have been absent from the United States for a full calendar month during the year before the application is filed.

Enforcing a health benefits plan under ERISA

The Employee Retirement Income Security Act is a federal statute intended to protect workers' rights under various benefit plans that may be provided by an employer. ERISA does not require New Jersey employers to provide specific kinds of plans, but once an employer offers a benefit plan, it must obey ERISA's requirements for processing and granting or denying claims.

Health benefit plans are among the most popular employee benefit plans, but they can also be troublesome because the medical judgments required to support a claim for benefits may be open to dispute. Many employees have filed claims for health care under a plan subject to ERISA only to have the benefit claim denied by the plan administrator. While ERISA provides an internal appeal procedure, most employees with disputed claims turn to the federal courts to secure their rights under the plan.

SSDI benefit for mental disorders

People who suffer from mental disorders or have a family member who suffers from one of these disorders are often unaware that the Social Security Disability Insurance program provides benefits if the illness meets SSDI eligibility requirements. Also, the process of applying for SSDI benefits for a mental or emotional disorder is complicated by the fact that these conditions rarely have any visible manifestation or any reliable medical diagnostic procedure that can be used to verify the existence of the condition. Nevertheless, the Social Security Administration recognizes several mental conditions as eligible for SSDI benefits.

As with all qualifying illnesses or injuries, a mental condition must be deemed to be permanent or to cause death within 12 months. The illness or condition must also render the patient totally and permanently disabled. These conditions are usually proved with written opinions from the medical provided and employment records. The list of mental impairments that may qualify a person for SSDI benefits is set out in full in the SSA's Blue Book, a compendium of all illnesses and injuries and medical conditions that may qualify a person for SSDI benefits.

Spinal cord injuries and returning to work

A person who suffers a spinal cord injury is often facing a challenging time trying to navigate everything that happens after the incident. Not only do they need to worry about their medical care, they also have to think about finances. This isn't an easy journey but there are options to help with this trying time.

Trying to return to work is another issue that you might encounter. This isn't a problem for some people because the injury might not be that severe, but people who have more limiting injuries can have a more difficult time.

Criteria for an award of Social Security Disability Benefits

Many residents of New Jersey have applied for Social Security Disability Insurance benefits and come away empty handed when their applications were denied. In many such cases, the applicant may have lacked the necessary understanding of SSDI benefits criteria and failed to provide the required information to satisfy those criteria.

SSDI benefits are a federal benefits program administered by the Social Security Administration. To be eligible for SSDI benefits, a person must be totally disabled by a medical condition, either an injury or a disease that is expected to be permanent or to result in death within 12 months. The SSDI benefits program differs from workers' compensation provided under New Jersey state law in two respects: under workers' compensation, the disability is not required to be permanent or total, but it must have resulted from a work-related injury or condition.

For SSD benefits, information about past work must be provided

When New Jersey residents are seeking Social Security disability benefits, they might have a vague understanding of the basic requirements to be approved. Of course, the person must be disabled with an injury, condition or illness that renders them unable to work. Still, there are subsets to the process that people might not be fully cognizant of and can be explained by a qualified legal professional experienced in the entire SSD benefits process.

The five-step process involves multiple factors that the Social Security Administration will consider when deciding on the case. The past work a person did is integral. The SSA must receive certain information about that past work so it can come to an informed determination. The applicant must let the SSA know about the work done in the previous 15 years. It must be described and its title should be given. Some jobs have similar names, but the duties can differ. The title is not enough to be considered an adequate description for the SSA's purposes.

Rule changes possible for those seeking SSI benefits

When disabled individuals over the age of 65 meet the financial requirements to get Supplemental Security Income in New Jersey, the benefits can help in myriad ways. SSI benefits are for those who are limited in their resources and income. It can be problematic for those who have more resources than the current rules state they can have if they want to get these benefits. This is true even if they meet the other criteria. Keeping track of potential changes to the law is important. When dealing with these concerns, an experienced Social Security disability attorney might be able to help.

Those who are seeking or already receiving SSI benefits should be aware that a recent proposal would let them retain more assets than they are currently allowed. In addition, there would be no penalties for getting married. Now, a person getting SSI is limited to $2,000. That could be raised if the U.S. House of Representatives moves forward with its proposed changes. The bill that would let an individual retain $10,000. A couple could keep $20,000.

  • New York City Bar
  • Bergen County Bar Association
  • New Jersy State Bar Association
  • Nosscr
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