This Web Site is committed to the memory of Janis Morrow.

Human liver    

   Insurance & Financial Aid

 


 
 
 Patient Assistance Programs Useful Internet Resources
 

Partnership for Prescription Assistance Web Site

https://www.pparx.org or call 1-888-477-2669 (toll free) for more information.
To speed up the process, have the following information available:

• Age

• State of residence and zip code

• Estimated gross annual household income

• Number of people living in the household

• Brand name of the prescription medicines that you are currently taking or have been prescribed (Pegasys/Copegus – Roche; PegIntron/Rebetol – Schering)

• Type of health insurance and/or prescription coverage (if any)

• Name and contact information of physician who prescribed or will prescribe the medication.

The pharmaceutical companies that provide patient assistance programs can also be contacted directly:

• Roche – Pegasys plus Copegus (ribavirin): Pegassist Patient Assistance Foundation – 1-877-734-2797

• Schering – PegIntron plus Rebetol (ribavirin): Commitment to Care – 1-800-521-7157
 

The Network is a national, non- profit group. We provide no-fee case management, advocacy and counseling, and treatment and access information and referrals (English or Spanish) to people with AIDS/HIV, chronic hepatitis, and other diseases. If you need assistance with ADAP, Medicaid, Medicare, State Insurance Programs, viral hepatitis (hepatitis C or B), or other state resources please first visit The Access Project page for your state. The state resource pages for the following States have been updated.

 

The Access Project of AIDS Treatment Data Network
www.atdn.org/access/pa.html
This organization, which helps people with HIV access treatment, has a Web page dedicated to up-to-date information on Patient Assistance Programs, particularly for drugs used to treat HIV, hepatitis C, hepatitis B, and opportunistic infections related to HIV. Scroll down the page and click on the name of the drug you need, and you will be linked to a page with the corresponding company name, contact information and general eligibility requirements for that company's Patient Assistance Program.

 

PhRMA (Pharmaceutical Research and Manufacturers of America)
www.helpingpatients.org/Intro.php
If a drug you need isn't listed on The Access Project, here's another source to try. Surprising as it may seem, this lobbying organization for the drug industry has easy-to-use, up-to-date contact information for all of the different Patient Assistance Programs offered by its members. The best way to use the site is to know the name of the drug you need and the name of the company that manufactures it.

 


ACRIA
www.acria.org
As an online addition to this issue of ACRIA Update, our Web site includes a list of the PAP contact information for the most commonly used medications for HIV, hepatitis C, hepatitis B, and AIDS-related opportunistic infections (click here).

Warning

There are a few sites on the Internet that offer to help you apply to any drug company Patient Assistance Program you need. Some of them charge a small fee that may or may not be refunded to you. Some of these sites are run by perfectly reputable folks, but others aren't. It's probably best to skip them all together. They usually create extra steps for you. They can only use the exact criteria that the drug companies provide. You will be far better off applying directly to the PAP yourself so that you can explain your individual situation as necessary.

 

 

Pharmaceutical Research and Manufacturers of America
2001-2002 Directory of Prescription Drug Patient Assistance Programs
http://www.phrma.org/

NeedyMeds.com
http://needymeds.com/

Northeastern Pennsylvania Transplant Support Group Inc. (NEPATSG) list of
Pharmaceutical Manufacturer Financial Assistance Programs
http://www.nepatsg.org/finance.htm

To receive a copy of Pharmaceutical Research and Manufacturers of America's
Directory of Prescription Drug Patient Assistance Programs, contact 1-800-835-3410

 

 

Missing Out on Benefits?

BenefitsCheckUp helps thousands every day to find programs for people ages 55 and over that may pay for some of their costs of prescription drugs, health care, utilities, and other essential items or services. Please fill out our simple questionnaire to find programs that can assist you or your loved ones
http://benefitscheckup04.governmentguide.com/  
 

 Disability Benefits - Important Steps to Apply

Some people with chronic hepatitis are unable to work and need to turn to Social Security Disability or the Supplemental Security Income (SSI) benefits as an alternative. Unfortunately, because so little is known about hepatitis and its symptoms and effects, the process is often long and complicated.

To apply for Social Security disability payments contact your local Social Security Office or call 1-800-772-1213. Ask for a copy of the booklet on Social Security disability (No. 05-10029) and/or SSI (No. 05-11000) and the forms for applying. Eligibility for disability is based on prior work under Social Security, while SSI payments are made on the basis of financial need. For both programs, the medical requirements and determination process are the same. You will be considered disabled if you are unable to do any kind of work for which you are suited and your disability is expected to last for at least a year or to result in death. A claim may be filed by phone, mail, or visiting your local office. HFI has a few suggestions to help you with the application process.

  • Read the full instructions completely and carefully before you begin filling out any part of the application form.
     
  • Ask for extra forms so you can make a draft before filling out the final version.
     
  • Fill the form out yourself if at all possible - you know and understand your case better than anyone else.
     
  • Have someone else, a third party, not a spouse or parent or anyone who might be too sympathetic to be objective, read the form to give you constructive criticism.
     
  • Print or type the form, making sure that it is legible.
     
  • Always keep a copy of any form you fill out or paper verifying your claim that you file at the SS office.
     
  • Be thorough and exact when answering the questions.
     
  • Give a complete medical history because a lot is unknown about hepatitis and how it might affect you. Don’t leave out symptoms or problems because you think they are not related. Many members of the medical community may not know what is related. Describe the symptoms and side effects that you experience because you will have a better chance of fighting a denial.
     
  • You will need to supply the names, addresses and phone numbers of doctors, hospitals and clinics that have treated you and dates of treatment. If possible, get complete medical records yourself from doctors, hospitals, test results, etc. This way you don’t leave it to the SS office to decide what is and isn’t important and relevant. You have a right to have access to your records, so don’t let people refuse to let you see them. Include receipts for medication, cost of treatment, and medical bills to show expenses incurred because of the disease. Keep copies of everything you send or bring.
     
  • Get written statements from friends, family members, co-workers, and doctors to document your case. People can simply write a "To whom it may concern" letter citing specific changes in relationships and everyday activities due to your condition (lack of energy, depression).
     
  • Include an official copy of your birth certificate and any other document they request. You will need the SS number and proof of age for each person applying for payments. This includes your spouse or children if they are applying for benefits. You also need dates of prior marriages if your spouse is applying.
     
  • You will have to supply a summary of places you worked in the past 15 years and the kind of work you did.
     
  • Bring/Send a copy of your W-2 Form (Wage and Tax Statement) or if self-employed your Federal Tax return for the past year. They base their determination on earnings in the last 3 quarters so let them know if any changes occur.
     
  • Be patient. It will take time for your claim to be processed. It is reviewed by a medical board, and they may ask you to see a doctor or have additional tests at their expense.
     
  • Be cooperative.
  • We would like to thank Hepatitis Foundation

HEPATITIS FOUNDATION INTERNATIONAL
30 Sunrise Terrace, Cedar Grove, NJ 07009-1423, U.S.A.
Phone: 800-891-0707 FAX: 973-857-5044
 

 
On The Way To The Social Security Office

Disability & Benefits: HCV Meets HMO
Jacques Chambers, CLU-

2008

Although they are not as popular as they once were, Health Maintenance Organizations (HMOs) and their close relatives, Exclusive Provider Organizations (EPOs) and Point of Service (POS) Plans, still provide coverage to the majority of people with health insurance.

While these plans have worked well for people who are generally healthy and have only temporary or minor medical problems, they can be a real challenge for persons dealing with chronic or catastrophic medical conditions, such as HCV.

The basic principle of HMOs is that, in return for a flat fee called capitation or premium, as well as nominal co-pays for services, they will provide all your medical needs. However, to make sure you get the “quality of care you need,” and, coincidentally avoid “unnecessary” and expensive “over-utilization,” a Primary Care Physician (PCP) must coordinate all your treatment. Regardless of what treatment you may need, you must first go to your PCP, who will usually be a general practitioner, possibly an Internist or Family Practice specialist.

This Primary Care Physician is also called the “Gatekeeper” – an extremely descriptive title. If you believe you should see a specialist, it is the Gatekeeper who decides whether or not you get to see the specialist, and, if so, which specialist you will see.

Remember the game of “Simon Says?” In the HMO world, it is “PCP Says.” Unless the PCP says you need a specialist, you will have to rely on the PCP to provide your care, whether it is something he/she is familiar with or not. Keep in mind that the fewer doctor visits, tests, and treatment you undergo, the bigger an HMO’s profits and the more the doctor/clinic will earn.

With a set-up like this, it makes you wonder if anyone ever gets good care from an HMO. Health care from an HMO does not have to be inferior. Thanks to the public outcry about HMOs skimping on care to increase their profits, Congress and many state legislatures have tightened regulation of this industry. Publicity by the media of problems with care from HMOs and the frequency of large jury awards have forced HMOs to make an effort to improve the quality of their care, or at least improve the image of their quality of care.

In fact, medical care can be excellent in an HMO. This is due in part to stricter oversight and regulation. It is also due to the doctors and other medical providers actually treating patients who still care about providing quality care to people who need it. However, the key to the quality of the care you receive is you and how actively you participate in the decisions about your healthcare.

There are a lot of excellent and caring medical providers working with HMOs, but you will have to seek them out. You will also have to make sure they continue to focus on your medical care, despite the bureaucratic barriers built into the HMO system.

In reality, the HMO is not that different from any other type of healthcare delivery system. You are the person who is ultimately responsible for seeing to it that you get the best care available. It is up to you to know the level of care you are actually receiving and to determine what quality of care you should be receiving.

It is up to you to take control of your medical care, and, to do that, you need to become more knowledgeable about all areas of your medical condition and its treatment.

Know your medical condition. Thanks to sites like the HCV Advocate and others on the web, there is a lot of information about hepatitis C and its treatment. Thanks to the Internet, you can stay current on new treatments, clinical trials, and new diagnostic methods.

HCV is a relatively recent discovery. There is a lot of information available about it, and there is a lot of research being done to learn more. It would be nice if everyone could find a physician whose practice consisted only of HCV patients, but that is not possible. You can become one of your physician’s sources of new information about HCV treatments and trials.

You should feel free to print out information, cut out articles and take them to your physician. Hopefully, he/she is already current, but you may be providing new information. If your doctor is not the type that welcomes such input from the patient, you may be seeing the wrong doctor.

Find a knowledgeable Primary Care Physician. The Centers for Disease Control states: “Any physician who manages a person with hepatitis C should be knowledgeable and current on all aspects of the care of a person with hepatitis C.”  Following this statement means that in an HMO, your Primary Care  Physician should be “knowledgeable and current” in HCV and its treatment.

Within virtually all HMO networks, you are able to select your own Primary Care Physician. Your selection of a PCP will determine not only who provides the majority of your care, but will also determine which specialists will be utilized when needed.

However, the HMO directory will give you only minimal information about your choices, and it won’t tell you which PCPs frequently treat patients with HCV or stay current about it. Clearly, you will need to do some research.

If you attempt to call the HMO itself, it will not provide much information, as they are prohibited from “steering” patients to particular clinics or doctors, even if it would mean better health care. You may have to call several doctors’ offices to learn more. Keep in mind the chances that you will actually get to speak to the doctor are very slim, but his nurse should be able to handle the questions as well. Some questions you may want to ask include:

   •  What is the doctor’s specialty? Is he/she board-certified? Many PCPs are internists, which may give them more experience with HCV.

   •  What chronic medical conditions does the doctor treat most frequently?

   •  Does the doctor treat other patients with HCV? How many? What percentage of their practice is HCV?

   •  What has been the doctor’s experience with HCV treatment? Do not hesitate to ask very specific questions, referring to treatments and using terms you have learned in your research on HCV. If they don’t know what you’re talking about, scratch them off your list and move on.

   •  Who are the gastroenterologists, hepatologists, infectious disease specialists, or other HCV knowledgeable specialists that the doctor works with and refers patients to? You may want to talk to their offices as well.

   •  How long does it take to get a referral once the PCP requests one?

Some PCPs even have the ability to permanently refer you to a specialist for treatment of chronic conditions such as HCV. In those cases, the specialist effectively becomes your PCP.  Ask your prospective PCPs if this is a possibility. This is particularly important if you can’t find a PCP knowledgeable in the treatment of HCV.

These are a lot of questions, I realize. However, neither the HMO nor your physician has as much at stake as you do in your medical care. This is your health and your life you are protecting, so spending some time and energy on this now can give you piece of mind and better healthcare later.

Medical office personnel are not always as helpful to prospective patients as you may think. One alternative is to learn as much as you can about your PCP choices, select one and schedule an appointment. Then you can ask the doctor directly and decide whether you want to stay with that PCP or switch to another. This will give you an excellent idea of how well they listen to you, how much time they are willing to spend with you, and their general “bedside” manner as well as their knowledge and experience of HCV.

Know your plan and your rights. You should spend some time with your Plan Document, the booklet that describes the provisions of your HMO coverage. While it is important to have a good idea of what is and isn’t covered, it is even more important to understand your rights under the plan. Not everything you need to know about your plan will be in the document. You may have to talk to a representative at the HMO itself or at the state regulatory agency, either your state’s Department of Insurance or Department of Managed Health Care, for information. Things you should know about your plan include:

   •  How do you change your PCP and how often can you do it? Be aware that if you are totally dissatisfied with your PCP, an HMO will often accommodate your request for a change regardless of their “rules.”

   •  What right do you have to appeal the denial of a referral or of a particular course of treatment? What are the time limits on such appeals? How does the appeal process work?

   •  What is the timeline for an expedited appeal if medical treatment is being withheld pending the appeal? Many states have enacted laws which require such appeals to be handled within 24 or 48 hours.

   •  Does the HMO offer Nurse Case Management for patients with chronic diseases such as HCV? Case Managers have an underlying purpose of saving the HMO money, but most of these case managers are trained nurses, and can be a valuable source of information about the HMO’s policies and rules and may even be an ally for you when “fighting the system.”

The days are long gone in any healthcare delivery system when patients could put themselves in the doctor’s hands and rest assured that they were getting the best and latest treatment. However, in the HMO system of healthcare, where the providers can increase profits by withholding care, it becomes even more important that you stay actively involved in your medical care. To do that, you must find knowledgeable medical providers who not only know about HCV, but who will listen to you and answer questions candidly about the input of the HMO in determining the direction of your care.

On The Way To The Social Security Office
By Larry Wagner


1. Whatever you do don't believe anything the folks at the Social Security Office tell you. They don't have the authority or the knowledge to give you advise about your claim. In most cases your claim will be forwarded for review by a Medical Board usually made of of a couple of Drs. They make the determination. The primary job of the folks that work the counter at Social Security Offices is to say "no" when applying for benefits. Don't let them fill out some computerized form for you either. They don't know you, they don't know your symptoms and they are just trying to speed up the process so they can say no quicker any way they can. Get the form from them. Fill it out yourself. Make copies and proof-read it for accuracy. You may be asked to see a Doctor at their expense, I was never asked because my documentation was complete.

2. Hand print or type (I typed mine on a regular typewriter) the application. Don't believe any stories you hear that claim if you type they will consider you not disabled because you can type. They will thank you for taking the time to making sure they can read it. If you print it by hand, print legibly . Use a dictionary if you have to.

3. Don't leave any blocks blank and don't put "don't know" or "NA" in any block. If you don't know the answer you can bet they don't know and you've given another person in the paper chain a chance to knock it down and return it disapprove your application. Be thorough in answering all
questions. Use a separate sheet of paper if necessary to elaborate your point. Make sure that if you use a separate sheet of paper that the item on the form that you are trying to explain corresponds with the same number on the original form. Be exact, be complete. Include your complete medical
history with the exception of minor illnesses such as the "flu" or cuts and scraps on the form. When your done completing the form get someone else to look it over. Preferably someone who is a third party to your illness. a spouse or parent might be too sympathetic to provide constructive criticism.  If the third party doesn't understand what is on the form then you can bet the folks down at the Social Security Office won't either.

4. Ask for extra forms in case you screw it up or make copies of the original and make a draft before preparing the final form for submission to the Social Security Office. In addition to the main form you'll be given medical release forms asking you to give the name of your doctor, his or her
address and the names and addresses of any hospital where you have ever been treated. Be complete and don't leave anything out even if you think it's not related to your claim. There is a lot about this disease that the medical community doesn't know and no one can say for sure that something
that happened to you previously before being diagnosed isn't a symptom or a warning sign of this disease. The more ammo you give them the better your chances are of getting approved.

5. Now here's where the big secret is: When I filled out the medical release forms I was told it might take anywhere from 30 days to 3 months to get all the medical info from the doctors and the hospitals and that would delay the processing time. No way I said. I made a personal trip to each Drs office and hospital and made complete copies of everything they had on file on me. In some cases you may have to pay for the copies and in some cases you won't but it depends on who you are dealing with. If you let the Social Security folks and the medical records clerks at Drs offices and hospital do the work you're letting them decide which info is relevant to your condition and what info isn't. I personally don't trust their judgment. I want all the info with nothing left out. So make complete copies front and back of everything they have on you. If you can get your hands on xrays get them. I went to the hospital and went to the radiology lab and told them I had an unscheduled appointment with my Doctor and he was asking me to
see if they would let me pick up the xrays to speed things up. The clerk just handed them to me and off I went. I had copies made from them and returned the originals in a couple of days. Not exactly honest way of doing things but it worked and they did get the original back. But if you just go in there and say give me my xrays they are going to laugh at you. In some cases the hospitals will be willing to make copies for you at a small charge.  This applies to ultra-sounds, endoscopies, e.t.c.... When they do an endoscopy they make a video and have prints of your esophagus and stomach.
These are important to include in your package. Make sure that results from any biopsies and all blood tests are included in the package. If you haven't had a recent liver panel done, get one done and include it. But I suspect most of you have had this done on a routine basis as it is. Another point to remember is never to let a hospital employee, or a clerk in a Drs office tell you "no" or that something can't be done or provided. Ask to speak to their supervisor if you run into a stone wall and if you don't get any satisfaction from the supervisor ask to speak to the supervisors supervisor. Keep going until you get results. Don't take no for an answer. Also I would include receipts for medication to document the cost of treatment as well as receipts from paying the medical bills even if you filed it with your insurance carrier. You should have these anyway because they are a tax deductible item and unless you guys are wealthier than I thought these expenses are legitimate deductions. Make your own personal copies of all pertinent medical documents, put the copies you are forwarding with your claim in chronological order, keeping it together by stapling or a binder. Here's a hint that might help. Make single sided copies instead of two sided. The reason is that it will make your packet much larger and less likely that they will want to read through the whole damn thing just to get to the bottom line. My records I submitted were in excess of 750 single sided pages and I put them in a box and taped my application to the outside of the box. I really don't think they ever looked at any of it because it was too damn big. Also tell them they can keep the copies you provided them. They will be thankful that they don't have to copy the entire package which could eat up a whole days work. If they have to make a copy so they can return copies to you it will go into the back of someone's desk to be
done on a slow day, delaying your processing.

6. Get statements from friends, families and co-workers, clergy and who ever to document your case. Ask them to provide you a simple handwritten letter to "Whom it may concern" what they have noticed about you since learning of your condition. Have them be explicit, your temperament, your lack of energy, your depression etc and what effect this has had on them in their relationship with you. Also personal letters from your physicians will be of great help. Most MD's are sympathetic toward your condition and are more than willing to go the extra mile to help you get SS.

7. You'll be asked to provide your original birth certificate and a few other things in original form. Get them and provide them they will return them after they cite them and make copies of them.

8. The hardest part for some of you will be meeting the "means test" on income. Be honest, they have access to IRS files and if they catch you lying about how much you make they will quickly turn you down. The only expectation to this is if you have changed jobs during the last fiscal quarter and the IRS files aren't updated. In that case ask your payroll office to provide you a letter stating your income before and after taxes and include any deductions or contributions you are making to retirement plans. They base their income qualification decision on a scale over the last 3 quarters so
make sure you provide them with current info especially if you've taken a pay cut or went on reduced hours due to your condition or a work slowdown.

9. You'll have to wait 6 obligatory months from the date you filed until you get your first check. Regardless of how fast your application is approved. That's the law and there is no way around it. It's there way of making sure that someone doesn't come up with a miracle cure or that you were visited
by the Virgin Mary and healed mysteriously. If at anytime during the waiting period you make additional trips to your Dr. or have anything done in a hospital, get copies and take it promptly to the SS office to be included in your application. You will get your final approval/disapproval notice from
the SS office in Baltimore, Md. If they send you a letter asking for more info, get it right away and make copies and forward it to them as not to delay your application.

Most of all pray and be patient. Don't yell and scream at any SS employee it will only make matters worse. Be cooperative. I spent 23 years in the Military doing admistrative work filling out government forms and processing claims of all sorts. My thoroughness in this application only expedited the processing. No one ever came back to me and said, "Hey you did such a good job you can't be possibly disabled." But I bet you if you play it the way I spelled it out here they won't look real hard to find a reason to disapprove your request. It will be easier for them to stamp it "approved" and get it off their desk.

Good luck and if you have any questions I can help you out with in specific in completing the forms email me privately and I will help you the best I can. Like I said I got my approved in a little under 3 months and I hope the same for you.

Take care, God bless. Be well!!!
Larry Wagner
lwagner@ix.netcom.com
Maple Valley, Wa
This piece came from Hepatitis Haven

http://www.hcvadvocate.org/news/newsLetter/2008/advocate0308.html#6  

Crucial Information From HCV ADVOCATE:

PDF A Guide to Hepatitis and Disability

Getting the Most from Your Health Insurance
PDF
PDF (download)

Understanding Your Health Insurance
PDF
PDF (download)

Taxing Disability Benefits
PDF
PDF (download)

Life Insurance: The Basics
PDF
PDF (download)

Doctors and Disability Forms
PDF
PDF (download)

Can a Person With Hepatitis C Purchase Insurance? (2005)
PDF
PDF (download)

A Final Word on Medicare Prescription Drug Benefits
PDF
PDF (download)

Guarantee Issue Health Insurance (2005)
PDF
PDF (download)

Medicare Drug Coverage Part 2
PDF
PDF (download)

Medicare Part D – The Prescription Drug Plan Additional Help for Low Income Beneficiaries
PDF
PDF (download)

Working When Collecting Disability Benefits
PDF
PDF (download)

Getting Health Insurance after Diagnosis
PDF
PDF (download)

Preparing to Leave Work on Disability
PDF
PDF (download)

Presumptive SSI (and Other Fantasies)
PDF
PDF (download)

Timetable for Leaving Work Due to Disability
PDF
PDF (download)

Medicare Part B and Other Health Insurance
PDF
PDF (download)

Completing Social Security and Insurance Questionnaires
PDF
PDF (download)

2005 Changes to Social Security & Medicare
PDF
PDF (download)

An Overview of Disability Insurance Coverage
PDFPDF (download)

Short Term Disability Benefits
PDF PDF (download)

Medicare Prescription Drug Discount Cards (and Other Changes to Medicare)
PDF PDF (download)

Tips When Filing For Disability Benefits
PDF PDF (download)

First Annual State of Health Insurance Address
PDF PDF (download)

Cleaning up Benefits Odds & Ends: Issues of Note for 2004
PDF PDF (download)

Social Security Continuing Disability Reviews (CDRs)
PDF
PDF (download)

Appealing a Denial
PDF
PDF (download)

Medicaid
PDF PDF (download)

Surviving HCV in an HMO
PDF PDF (download)

Helping Your Social Security Claim through the System
PDF PDF (download)

Can a Person With Hepatitis C Purchase Insurance?
PDF PDF (download)

COBRA - Extending Your Employer-Based Health Insurance
PDFPDF (download)

What's the Condition of Your Benefits Safety Net? Part 1 - Income
PDFPDF (download)

What's the Condition of Your Benefits Safety Net? Part 2 - Health Insurance and Cash Reserves
PDFPDF (download)

What Happens When Cobra Ends?
PDFPDF (download)

Guarantee Issue Health Insurance
PDFPDF (download)

Medicare Is Not Enough
PDF
PDF (download)

Life Settlements and HCV (Cash for Your Life Insurance Policy)
PDFPDF (download)

Open Enrollment
PDFPDF (download)

Monitoring Your Health Insurance Coverage
PDFPDF (download)

Health Insurance and Alternative/Complementary Medical Treatment
PDFPDF (download)

*Articles authored by Jacques Chambers, Benefits Counselor.

Back to top

Disability*

Social Security Consultative Examinations
PDF
PDF (download)

American with Disabilities Act: What It Does, and Doesn't Do
PDFPDF (download)

Family and Medical Leave Act (FMLA)
PDFPDF (download)

Determining Financial Eligibility for SSDI
PDFPDF (download)

Fibromyalgia, CFIDS, HCV and Social Security Disability
PDFPDF (download)
 

When Should You Leave Work on Disability?
PDFPDF (download)

Getting Disability Benefits Under Social Security with HCV
PDFPDF (download)

SSI and SSDI: How Much Difference Can A Letter Make?
PDFPDF (download)

Working While Collecting Social Security Disability
PDFPDF (download)

Keeping the Disability Checks Coming
PDF
PDF (download)

When Disability Insurance Says You're No Longer Disabled
PDFPDF (download)

*Articles authored by Jacques Chambers, Benefits Counselor.

 

SOCIAL SECURITY DISABILITY FAQs

  1. What is the definition of disability used by Social Security?
  2. How many different types of Social Security disability benefits are there?
  3. How do I apply for Social Security disability benefits?
  4. I am disabled, but I have plenty of money in the bank. Do I have to wait until this money is gone before I apply for Social Security disability benefits?
  5. I used to work but lately I have been staying home taking care of the kids. I have now become sick. Can I get Social Security disability benefits?
  6. How long do I have to wait after becoming disabled before I can file for Social Security disability benefits?
  7. I am still on sick leave from my employer. Can I file for Social Security disability now or do I have to wait until the sick leave is exhausted?
  8. I got hurt on the job. I am drawing worker's compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the worker's compensation ends?
  9. Can I get both worker's compensation and Social Security disability benefits?
  10. How can I tell if I will be found disabled by Social Security?
  11. Can you receive Social Security disability benefits for chronic hepatitis C?
  12. Do you have to be permanently disabled to get Social Security disability benefits?
  13. I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security disability benefits?
  14. I got hurt in an automobile accident. I am disabled now, but I expect that I will be able to return to work after I recover. Should I file for Social Security disability benefits?
  15. How does Social Security determine if I am disabled?
  16. Who decides if I am disabled?
  17. Why does Social Security consider my age in determining whether I am disabled?
  18. Is there a list of impairments that Social Security considers disabling?
  19. What can I do to improve my chances of winning my Social Security disability claim?
  20. How do I find an attorney to represent me before on my Social Security disability claim?
  21. If I am approved for Social Security disability benefits, how much will I get?
  22. How far back will they pay benefits if I am found disabled?
  23. What do I do if Social Security denies my claim for Social Security disability benefits?
  24. Why does Social Security turn down so many claims for disability benefits?
  25. I only want to get back the money I put in Social Security. Why do they make it so hard for me to get my own money back?
  26. What is "reconsideration"?
  27. Who makes the reconsideration determination?
  28. What are my chances of winning at reconsideration?
  29. Do I have to go through reconsideration?
  30. How long does it take to get a hearing on a Social Security disability claim?
  31. What is the Social Security hearing like?
  32. What are my chances of winning at a hearing?
  33. If the Administrative Law Judge denies my claim, can I appeal any more?
  34. What is the Appeals Council?
  35. Can I appeal a case beyond Social Security to the Federal Courts?
  36. If I get on Social Security disability benefits and get to feeling better and want to return to work, can I return to work?
  37. Where can I go to get help with my Social Security disability claim?
  38. Do I really have to hire a lawyer to represent me in my Social Security disability claim?
  39. How do lawyers who represent Social Security disability claimants get paid?
  40. Can alcoholics and drug addicts really get Social Security disability benefits?
  41. I know someone who is on Social Security disability and he does not look a bit disabled. Why do they put all of these freeloaders on benefits?
  42. I am disabled, but I have never worked at public work. Can I get Social Security disability benefits?
  43. I am a widow. I have not worked in public work in many years. I am disabled. Can I get Social Security disability benefits?
  44. I have a daughter who has been disabled by cerebral palsy since birth and has never been able to work. Can she get disability benefits from Social Security?
  45. I am already on Social Security disability benefits, but I am worried that my benefits will be stopped in the future. What are the chances of this happening?
  46. If Social Security tries to cut off my disability benefits, what can I do?
  47. My doctor says I am disabled so why is Social Security denying my Social Security disability claim?
  48. VA says I am disabled, so why is Social Security denying my Social Security disability claim?
  49. I am 60% disabled. Do I get 60% of my Social Security disability benefits?
  50. I am disabled by mental illness. Can mental illness serve as the basis for a Social Security disability claim?
  51. Will it help if I ask my Congressional Representative to help me get Social Security disability benefits?
  52. How long does it take before Social Security makes a decision once I file a claim for Social Security disability benefits?
  53. How long does it take for Social Security to make a reconsideration determination on my Social Security disability claim?
  54. How long does it take for Social Security to act upon a request for Appeals Council review?
  55. I am disabled. I need help with medical bills even more than I need a cash income. How do I get help with medical bills?
  56. What is the difference between Medicare and Medicaid?
  57. If I get Social Security disability benefits will I get Medicare?
  58. If I get Social Security disability benefits will I get Medicaid?

1. What is the definition of disability used by Social Security?

Under the Social Security Act, "disability" means "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months."

2. How many different types of Social Security disability benefits are there?

There are at least five major types of Social Security disability benefits. Disability Insurance Benefits is the most important type of Social Security disability benefits. It goes to individuals who have worked in recent years (five out of the last 10 years in most cases) who are now disabled. Disabled Widow's and Widower's Benefits are paid to individuals who are at least 50 and become disabled within a certain amount of time after the death of their husband or wife. The late husband or wife must have worked enough under Social Security to be insured. Disabled Adult Child Benefits go to the children of persons who are deceased or who are drawing Social Security disability or retirement benefits. The child must have become disabled before age 22. For Disability Insurance Benefits, Disabled Widow's or Widower's Benefits and Disabled Adult Child benefits, it does not matter whether the disabled individual is rich or poor. Benefits are paid based upon a Social Security earnings record. Supplemental Security Income benefits, however, are paid to individuals who are poor and who are disabled. It does not matter for SSI whether an individual has worked in the past or not. SSI child's disability benefits are a variety of SSI benefits paid to children under the age of 18 who are disabled. The way in which disability is determined is a bit different for children.

3. How do I apply for Social Security disability benefits?

The best, surest way to file a Social Security disability claim is to go to the nearest Social Security office in person and wait (often for a few hours) to see someone to file the claim in person. In the alternative, a person may contact Social Security by telephone and arrange for a telephone interview to file the claim.

4. I am disabled, but I have plenty of money in the bank. Do I have to wait until this money is gone before I apply for Social Security disability benefits?

No. If you have worked in recent years or if you are applying for Disabled Widow's or Widower's benefits or Disabled Adult Child benefits, it does not matter how much money you have in the bank. There is no reason to wait to file the claim.

5. I used to work but lately I have been staying home taking care of the kids. I have now become sick. Can I get Social Security disability benefits?

Possibly. If you have worked five out of the 10 years under Social Security before becoming disabled, you will have enough earnings in to potentially qualify for Social Security disability benefits. For individuals 31 or less, the requirements are a little different, since such individuals have not had such a long time to work. Unless a person has been staying home and taking care of their children for quite a long time, however, it is very possible that they will qualify for Social Security disability benefits based upon their own earnings. Also a homemaker, if poor enough, can qualify for Supplemental Security Income (SSI) whether he or she has worked in the past or not.

 

6. How long do I have to wait after becoming disabled before I can file for Social Security disability benefits?

Not even one day. You can file for Social Security disability benefits on the very same day that you become disabled. Many individuals make the mistake of waiting months and even years after becoming disabled before filing a Social Security disability claim. There is no reason to file a Social Security disability claim if one has only a minor illness or one which is unlikely to last a year or more. However, an individual who suffers serious illness or injury and expects to be out of work for a year or more should not delay in filing a claim for Social Security disability benefits.

7. I am still on sick leave from my employer. Can I file for Social Security disability now or do I have to wait until the sick leave is exhausted?

No, you do not have to wait until the sick leave is exhausted. You should file for Social Security disability benefits now, if you believe that you will be out of work for a year or more.

8. I got hurt on the job. I am drawing worker's compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the worker's compensation ends?

You do not have to wait until the worker's compensation ends and you should not wait that long. An individual can file a claim for Social Security disability benefits while receiving worker's compensation benefits. It is best to file the Social Security disability claim as soon as possible because otherwise there may be a gap between the time the worker's compensation ends and the Social Security disability benefits begin.

9. Can I get both worker's compensation and Social Security disability benefits?

Yes. There is an offset, which reduces Social Security disability benefits because of worker's compensation benefits paid, but in virtually all cases, there is still some Social Security disability benefits to be paid. In a few states the offset works the other way - - worker's compensation benefits are reduced because of Social Security disability benefits.

10. How can I tell if I will be found disabled by Social Security?

Unless your disability is catastrophic (such as terminal cancer, a heart condition so bad that you are on a heart transplant waiting list, total paralysis of both legs, etc.), there is no easy way for you to tell whether you will be found disabled by Social Security. In the end, the decision of whether or not to apply for Social Security disability benefits should not be based upon whether or not the person feels that Social Security will find them disabled. Attorneys familiar with Social Security disability can make predictions about who will win and who will lose, but even they can seldom be sure. An individual should make the decision about whether or not to file for Social Security disability based upon their own belief about their condition. If the individual feels that he or she is disabled and is not going to be able to return to work in the near future, the individual should file for Social Security disability benefits. If denied, the individual should consult with an attorney familiar with Social Security disability to get an opinion as to the chances of success on appeal.

11. Can you receive Social Security disability benefits for chronic hepatitis C?

 

In almost every case, no matter what the disease is, the answer is the same - "Maybe, it just depends upon how badly you are affected by the disease." One example might be cancer. The word "cancer" is scary to anyone, but there are many cancers which can be treated and cured very quickly, with little or no lasting effect. On the other hand, of course, there are cancers which cause great suffering and ultimately death. The question in each individual case is "How sick is this particular individual with cancer and how long is this person going to remain sick?" Skin diseases are another example. The vast majority of skin diseases, while annoying, would not be considered to be disabling. On the other hand, there are some uncommon, very severe skin problems which are clearly disabling. In extreme cases, psoriasis, which is not rare, may be disabling. Thus, almost without exception, the mere fact that an individual has a disease with a certain name does not guarantee that the individual either will or will not be found disabled. It all depends upon how sick the person is.

12. Do you have to be permanently disabled to get Social Security disability benefits?

No. You have to have been disabled for at least a year or be expected to be disabled for at least a year or have a condition that can be expected to result in death within a year.

13. I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security disability benefits?

Social Security is supposed to consider the combination of impairments that an individual suffers in determining disability. Many, perhaps most claimants for Social Security disability benefits have more than one health problem and the combined effects of all of the health problems must be considered.

14. I got hurt in an automobile accident. I am disabled now, but I expect that I will be able to return to work after I recover. Should I file for Social Security disability benefits?

If you expect to be out of work for a year or more on account of illness or injury, you should file for Social Security disability benefits.

15. How does Social Security determine if I am disabled?

Social Security is supposed to gather your medical records and carefully consider all of your health problems, as well as your age, education, and work experience. In general, Social Security is supposed to decide whether you are able to do your past work. If Social Security decides that you are unable to do your past work, they are supposed to consider whether there is any other work which you can do considering your health problems and your age, education, and work experience.

 

16. Who decides if I am disabled?

After an individual files a Social Security disability claim, the case is sent to a disability examiner at the Disability Determination agency in your state. This individual, working with a doctor, makes the initial decision on the claim. If the claim is denied and the individual requests reconsideration, the case is then sent to another disability examiner at the Disability Determination agency, where it goes through much the same process. If a claim is denied at reconsideration, the claimant may then request a hearing. At this point, the case is sent to an Administrative Law Judge who works for Social Security. The Administrative Law Judge makes an independent decision upon the claim. This is the only level at which the claimant and the decision maker get to see each other.

17. Why does Social Security consider my age in determining whether I am disabled?

Social Security has to consider age, because that is what the Social Security Act requires. As people get older, they become less adaptable, less able to switch to different jobs to cope with health problems. A severe foot injury which might cause a 30- year- old to switch to a job in which he or she can sit down most of the time, might disable a 60- year- old person who could not make the adjustment to a different type of work.

18. Is there a list of illnesses that Social Security considers disabling?

Not really. Because most types of illness can vary from minor to severe, there is no one simple list of illnesses which Social Security considers to be disabling. However, if an illness has reached a very severe level with certain medical hallmarks, Social Security will award benefits on the basis of medical considerations alone.

19. What can I do to improve my chances of winning my Social Security disability claim?

Be honest and complete in giving information to Social Security about what is disabling you. Many claimants, for instance, fail to mention their psychiatric problems to Social Security because they are embarrassed about them. In almost all cases, individuals who were slow learners in school fail to mention this fact to Social Security, even though it can have a good deal to do with whether or not the Social Security disability claim is approved. Beyond being honest and complete with Social Security, the most important thing that you can do is just keep appealing and hire an experienced person to represent you. It is important to appeal because most claims are denied at the initial level, but are approved at higher levels of review. It is important to hire an experienced person to represent you because you do not understand the way Social Security works. Statistically, claimants who employ an attorney to represent them are much more likely to win than those who go unrepresented.

20. How do I find an attorney to represent me before on my Social Security disability claim?

The National Organization of Social Security Claimants' Representatives (NOSSCR) offers a referral service. You may call NOSSCR at 1-800-431-2804 during regular Eastern Time business hours.

21. If I am approved for Social Security disability benefits, how much will I get?

For disability insurance benefits, it all depends upon how much you have worked and earned in the past. For disabled widow's or widower's benefits, it depends upon how much the late husband or wife worked and earned. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of SSI which an individual can receive.

22. How far back will they pay benefits if I am found disabled?

 

For Disability Insurance Benefits and for Disabled Widow's and Widower's Benefits, the benefits cannot begin until five months have passed after the person becomes disabled. In addition, benefits cannot be paid more than one year prior to the date of the claim. For a Disabled Adult Child, there is no five-month waiting period before benefits begin, but benefits cannot be paid more than six months prior to the date of the claim. SSI benefits cannot be paid prior to the start of the month following the date of the claim.

23. What do I do if Social Security denies my claim for Social Security disability benefits?

First, do not be surprised. Only about 40% of Social Security disability claims are approved at the initial level. If you are denied at the initial level, unless you have already returned to work or expect to return to work in the near future, you should appeal, that is, file a request for reconsideration. You should also consider employing an attorney to represent you.

24. Why does Social Security turn down so many claims for disability benefits?

There is no simple answer to this question. One reason is that there is no simple way to determine whether an individual is disabled. Most people who are disabled suffer from pain. There is no way of determining whether or not another individual is in pain, much less how much pain they are in. A second reason is that Social Security over the years has been more concerned with making sure that everyone who is receiving Social Security disability benefits is "truly" disabled than with making sure that everyone who is disabled receives Social Security disability benefits. An underlying reason is that Congress has always believed that, given a chance, many people will "fake" disability in order to get benefits.

25. I only want to get back the money I put in Social Security. Why do they make it so hard for me to get my own money back?

Actually, when you file a Social Security disability claim, you are not trying to just get "your own money" back. The money that an individual may have paid into Social Security over the years would not last very long if that was all that an individual could draw from Social Security.

26. What is "reconsideration"?

When a claim for Social Security disability benefits is denied at the initial level, the claimant may then request "reconsideration" of that decision. The case is then sent to a different disability examiner for a new decision. Unfortunately, about 80% of the time the reconsideration decision is the same as the initial decision - a denial.

27. Who makes the reconsideration determination?

A disability examiner at the Disability Determination Section makes the reconsideration determination. Most of the time, the claimant does not see the disability examiner or even know his or her name.

28. What are my chances of winning at reconsideration?

Statistically, about 20% of the time a claimant wins at reconsideration.

29. Do I have to go through reconsideration?

If you want to appeal a denial of Social Security disability benefits, you have to go through reconsideration. There is no way to avoid it.

30. How long does it take to get a hearing on a Social Security disability claim?

There is much variation around the country. In a few areas of the country the wait is only three months. In a few areas of the country the wait is more than a year.

31. What is the Social Security hearing like?

The hearings are fairly informal. The only people likely to be there are the judge, a secretary operating a tape recorder, the claimant, the claimant's attorney, and anyone else the claimant has brought with him or her. In some cases, the Administrative Law Judge has a medical doctor or vocational expert present to testify at the hearing. There is no jury nor are there any spectators at the hearing. There is no attorney at the hearing representing Social Security trying to get the judge to deny the disability claim.

32. What are my chances of winning at a hearing?

Statistically, over half of the claimants who have a Social Security disability hearing win.

33. If the Administrative Law Judge denies my claim, can I appeal any more?

Yes. You can appeal to the Appeals Council which is still within Social Security.

34. What is the Appeals Council?

The Appeals Council exists to review Administrative Law Judge decisions. The Appeals Council is located in Falls Church, Virginia, and neither the claimant nor the attorney sees the people at the Appeals Council who are working on the case.

35. Can I appeal a case beyond Social Security to the Federal Courts?

Yes. After being denied by the Appeals Council, it is possible for a claimant to file a civil action in the United States District Court, requesting review of Social Security's decision. A Social Security disability claim can go all the way to the Supreme Court. Perhaps once every year or two years, the United States Supreme Court actually hears an appeal about a Social Security disability case.

36. If I get on Social Security disability benefits and get to feeling better and want to return to work, can I return to work?

Certainly you can return to work. Social Security wants individuals drawing disability benefits to return to work and gives them every encouragement to do so. For persons receiving Disability Insurance Benefits, Disabled Widow's and Widower's Benefits, and Disabled Adult Child Benefits, full benefits may continue for a year after an individual returns to work. Even thereafter, an individual who has to stop work in the following three years can get back on Social Security disability benefits immediately without having to file a new claim. In SSI cases, things work a differently, but there is still a strong encouragement to return to work.

37. Where can I go to get help with my Social Security disability claim?

For help, go to a lawyer or other person who represents Social Security disability claimants on a regular basis. If you need a referral to a lawyer who represents Social Security claimants, call the referral service of the National Organization of Social Security Claimants' Representatives (NOSSCR) at 1-800-431-2804.

38. Do I really have to hire a lawyer to represent me in my Social Security disability claim?

No. You can go through all of the levels of review on your own, if you wish, but statistically claimants who are represented by an attorney win a good deal more often than those who are not represented.

39 How do lawyers who represent Social Security disability claimants get paid?

In almost all cases, the attorney receives one- quarter of the back benefits if the claimant wins and no fee if the claimant loses.

40. Can alcoholics and drug addicts really get Social Security disability benefits?

Not anymore. There never were all that many people getting Social Security disability benefits on account of alcoholism or drug addiction, but Congress has now prohibited Social Security from paying disability benefits on the basis of alcoholism or drug addiction. However, alcoholics and drug addicts have heart attacks, get cancer or get sick in other ways just like everyone else. Alcoholics and drug addicts who become disabled apart from their alcoholism or drug addiction can become eligible for Social Security disability benefits.

41. I know someone who is on Social Security disability and he does not look a bit disabled. Why do they put all of these freeloaders on benefits?

When it comes to disability, looks can be very deceiving. There are many people who look quite healthy but who are quite disabled by anyone's standard. For instance, many individuals who suffer from very severe psychiatric illness are physically healthy and able to do things such as mow their yards.

42. I am disabled, but I have never worked at public work. Can I get Social Security disability benefits?

If you are poor enough, you can qualify for Supplemental Security Income (SSI) if you are disabled, even if you have never worked in the past. It is also possible to qualify for Disabled Adult Child Benefits on the account of a parent if you became disabled before age 22 or for disabled widow's or widower's benefits on the account of a late husband or wife.

43. I am a widow. I have not worked in public work in many years. I am disabled. Can I get Social Security disability benefits?

If you are over 50 and became disabled within seven years after your husband or wife died or within seven years after you last drew mother's or father's benefits from Social Security, you can get Disabled Widow's or Widower's Benefits. Perhaps more important, if you are poor, you can draw Supplemental Security Income benefits no matter what age you are or when you became disabled.

44. I have a daughter who has been disabled by cerebral palsy since birth and has never been able to work. Can she get disability benefits from Social Security?

Very possibly. If the child is under 18 and you are poor enough, the child may be able to qualify for SSI child's disability benefits. If the child is over 18, she may be able to qualify for SSI disability benefits without regard to the income of her parents. If her father or mother is drawing Social Security benefits of some type or is deceased, the child may be eligible for disabled adult child benefits.

45. I am already on Social Security disability benefits, but I am worried that my benefits will be stopped in the future. What are the chances of this happening?

Social Security is not supposed to cut off disability benefits for an individual unless his or her medical condition has improved. When Social Security reviews a case of someone already on Social Security disability benefits, they continue benefits in the vast majority of cases. In recent years, Social Security has been doing few reviews to determine whether or not individuals already on Social Security disability benefits are still disabled. This is changing and Social Security should be doing far more reviews in the next few years. However, the vast majority of individuals who are reviewed will see their Social Security disability benefits continued.

46. If Social Security tries to cut off my disability benefits, what can I do?

You should appeal immediately. If you appeal within 10 days after being notified that your disability benefits are being ceased, you can ask that your disability benefits continue while you appeal the decision cutting off your benefits. You may also want to talk with an attorney about representation on your case, but you should file the appeal immediately.

47. My doctor says I am disabled so why is Social Security denying my Social Security disability claim?

Social Security's position is that it is not up to your doctor to determine whether or not you are disabled. It is up to them and they will make their own decision regardless of what your doctor thinks.

48. VA says I am disabled, so why is Social Security denying my Social Security disability claim?

It is Social Security's position that VA decisions are not binding upon them. Social Security and VA have very different standards for approving disability claims.

49. I am 60% disabled. Do I get 60% of my Social Security disability benefits?

No. There are no percentages of disability in Social Security disability determination. For purposes of Social Security disability benefits, you are either disabled or not disabled. There are no percentages of disability, nor any percentages of disability benefits.

50. I am disabled by mental illness. Can mental illness serve as the basis for a Social Security disability claim?

Yes. Mental illness is a frequent basis for awarding Social Security disability benefits.

51. Will it help if I ask my Congressional Representative to help me get Social Security disability benefits?

Many Social Security disability claimants become frustrated with claim delays and eventually ask their U.S. Representative or Senator to help. The local Congressional office typically will have staffers who are experienced with Social Security procedures and personnel. A “Congressional Inquiry,” as it is called at Social Security, may help to get a stalled process moving again. Note that the inquiry will have no impact on how Social Security decides the outcome of the case.

52. How long does it take before Social Security makes a decision once I file a claim for Social Security disability benefits?

In most cases Social Security makes the first decision within four months.

53. How long does it take for Social Security to make a reconsideration determination on my Social Security disability claim?

In most case Social Security makes the reconsideration determination within four months.

54. How long does it take for Social Security to act upon a request for Appeals Council review?

About a year, maybe longer.

55. I am disabled. I need help with medical bills even more than I need a cash income. How do I get help with medical bills?

Getting help with medical bills is usually tied up with getting cash benefits, that is, you don't start getting help with medical bills until after you start getting the cash benefits, so you have to keep going with the Social Security disability claim in order to get the help with medical bills.

56. What is the difference between Medicare and Medicaid?

The short answer is that Medicaid is a poverty program and Medicare isn't. Most disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). To get SSI and thereby get Medicaid you have to be poor and disabled. Medicaid pays doctors at very low rates. People who have only Medicaid can have a hard time finding doctors willing to take them on as patients. Medicaid does pay for prescription medications. Medicaid can go back up to three months prior to the date of a Medicaid claim. For Medicare it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefits or Disabled Adult Child Benefits for 24 months you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid. Almost all doctors are happy to take Medicare patients. The bad things about Medicare are that it does not begin until after a person has been on cash disability benefits for two years and that it generally does not pay for prescription medications.

57. If I get Social Security disability benefits will I get Medicare?

If you are approved for any kind of Social Security disability benefit other than SSI you will get Medicare after you have been entitled to Social Security disability benefits for two years.

58. If I get Social Security disability benefits will I get Medicaid?

If you are approved for SSI you will get Medicaid. It is possible to get both Medicare and Medicaid if you are entitled to SSI and some other type of Social Security disability benefit.

Mike gives us some help on applying for Financial Aid

CAUTIONARY NOTE: This article is intended to be a general explanation of the law and regulations. Claimants are encouraged to consult experienced representatives to determine how these issues relate to their particular claims. While a representative in this area of the law need not be a licensed attorney, experience with this program and its unique structure is important. Readers should not rely upon this article as legal advice.


FIRST, ME:

I'm Mike, "heppie" or "heppie2000".
I'm not a lawyer...I'm a "hepper".
I have Hepatitis C...known to us heppers as "The Dragon".

I lost my job because of The Dragon.

On February 2nd, 1999, I was given 30 days off with pay before my forced retirement was effective. Before that time was up I had realized my working days were over. I made my application for Social Security Disability effective the same day my termination was effective...March 2nd. I had filled out all their forms, even wrote a letter explaining all about Hep C, it's effect on my health, my mental state and my ability to work. I had all my bases covered.

I got turned down flat.

The very day I was turned down I called a law firm that specializes in Social Security Disability cases. I talked with their main man two days later, and hired him. He got the name & address of my gastro-doc and he set the ball rolling for my appeal. Now we were getting somewhere!

I got turned down again.

The next step was to have a hearing before an Administrative Law Judge (ALJ) and my attorney said that's what really counted.

The hearing was held December 3, 1999. It seemed to go well. I had already sent the ALJ 2 letters from my gastroenterologist and 1 from two Primary Care Physicians, all saying that I was a very sick puppy. He also had copies of all my test results, as well as my biopsy (which was very important, I believe). At the hearing, we gave him a letter from my former employer saying that I had become too sick to work. A former co-worker testified that he had actually picked me up off the ground and carried me after I had fallen and couldn't get up. That was a real tear-jerker.

On February 3, 2000, one year exactly from the first full day I missed from work, I received notification that my ALJ's decision was "FULLY FAVORABLE"!!!

Actually, the judge found that my impairments "do not meet or equal in medical severity the criteria of any impairment listed."...Scared the pee out of me.....

BUT.....He also determined that a "preponderance of the evidence in this case establishes that the claimant's combined impairments ARE SEVERE and PRECLUDE him from engaging in his past relevant work" and that the "next step to consider under the sequential evaluation process for disability purposes is WHETHER HIS IMPAIRMENTS PREVENT HIM FROM DOING ANY OTHER WORK. In this regard, the claimant is 59 years of age, which, according to section 404.1563 (d) constitutes 'advanced age'" (humph) In the next paragraph, he mentions that "the claimant's testimony regarding the pain and profound fatigue that he experiences WAS CREDIBLE and not inconsistant with the entire medical record". He then considered my "residual functional capacity, age, education and work experience" and found me "DISABLED". The severe impairments that he said the evidence established were "chronic Hepatitis C, cirrhosis of the liver, chronic fatigue, depression, and anxiety."

So.......

It seems to me that ALL FACTORS ARE IMPORTANT. The judge took into account my credibility during the hearing, all the medical evidence, my doctors' letters, my education, my co-worker's testimony, my age, my fatigue, depression, and anxiety. Then he determined that this ol' dawg cain't do his tricks any more, and is too old and dumb to learn any new ones.....so he is officially disabled.

I understand that SSA does a review every 5 years or so. In my own case, I could care less. I'll be 65 by then. But for the rest of you....That was one of the factors considered in my evaluation. I don't know how BIG a factor it was...Just want you to know it was one of them.


SO IT ALL WORKED OUT OKAY. BUT WHY DID I GET TURNED DOWN EVEN ONCE?

I thought I had done everything right, and yet I still got turned down twice. I talked with my lawyer, and he said this is normal. He said most people don't see a penny until at least a year and a half after they file.

WHAT HAPPENED
was that even though I thought I was prepared, I was nowhere near it.

In the meantime my wife, Bertie, was working two jobs, trying to keep us from losing everything. On one particularly bad day, she said,
"Not only am I going to lose my husband, but now I'm going to lose my home and everything else we worked so hard for."

THIS DOESN'T HAVE TO HAPPEN TO YOU !!!

WHY?

I'll tell you why:
Because while I was waiting for the bureaucratic wheels to grind, I did some research on the Internet, talked with a great many other heppers, and learned a lot. If I had known then what I know now, I would have been getting disability payments a long time ago. In fact if you use the information I give you here it may make the difference between waiting years for your Social Security Disability, not getting it at all, or getting it WITHIN 5 MONTHS!


NOW, YOU:

It's time for a really hard-core
REALITY CHECK:

You have Hepatitis C. So?
Just the fact that you have Hepatitis C doesn't mean you're disabled. MILLIONS of other people in the United States have Hep C and aren't disabled yet. In fact they DON'T EVEN KNOW THEY HAVE IT! SO WHAT GIVES YOU THE RIGHT TO APPLY FOR DISABILITY?

Well, you may have been noticing that your health is failing. Maybe it has been for quite some time. You may not be able to do many of the things you used to. You may be afraid you're going to lose your job because you can't cut it any more. Or maybe you already have lost your job.

So...HERE'S what you have to ask yourself:

CAN you work any more? No really....
CAN YOU?

If you'd rather not work but still can, then maybe you'd better start preparing for the day, but continue working until then.

If you can't work your same job, but could work that office job (as much as you hate office work) then the same thing applies. Go for the office work, but prepare for the day.

But if you just are all used up...If you have pushed yourself PAST your limits...and you STILL can't function, that's another matter. If you just can't stay healthy enough for long enough to hold down a job...If you never know whether tomorrow you'll be able to function or not, then you can't even work a part-time job, because employers have to make out a schedule.

If that sounds like you, then you have a very hard truth to face.Your working days are over. Your life is going to change very dramatically. So is your mate's, if you have one. This whole thing can be very difficult to face. But know this. Some things in life are within your control, and some aren't. If you're too sick to work any more, that's a fact that's out of your control. Don't let this drive you into a useless funk. If it already has, tell your doctor. I highly recommend Effexor XR as an anti-depressant. I have heard that after taking it for many months, it may begin to drive some people's blood pressure up. If it eventually affects you that way, there's medicine for that. In the meantime, it has no discernable side effects and doesn't harm the liver. So take the stuff and go on with your life.


GASTROENTEROLOGISTS/HEPATOLOGISTS:

If you don't already have one of the above, RUN, DON'T WALK to your nearest phone book, Hepatitis Central on delphi, people you know who have Hep C... any way you can...and find the BEST BOARD-APPROVED SPECIALIST YOU CAN FIND. It will take a while to see him/her. Good Gastro-docs are awfully busy these days for some reason!

When you finally do get to see your new doc, take prepared notes/questions with you. Be prepared to give the doctor as complete and accurate a medical history of yourself as possible. It is CRITICAL that your relationship with him/her is good. You MUST have confidence in him/her. And you're paying them, so don't feel bad about the questions. If you think your new doc doesn't really care about you and you can't clear up any misunderstanding, get a NEW new gastro-doc. For one thing, you need the medically specialized help that only they can give you. For the other, you will NEVER GET YOUR DISABILITY NO MATTER HOW SICK YOU ARE, if your gastroenterologist recommends that they think you are still capabile of working.

Oh......A VERY IMPORTANT TIP!!!!!!!!!!!
If you are suffering from extreme fatigue, depression, pain, etc. TELL YOUR DOCTOR EVERY SINGLE TIME YOU SEE HIM/HER! That may be the ONLY record the Social Security officials have to look at as an indication of your condition, other than just your telling them you're tired. And you can guess about how much water THAT'S going to carry!

Now...They will sooner or later run tests on you that will include lots of blood tests, probably an ultrasound, maybe a catscan, and eventually a biopsy, which is really the only way you can tell for sure exactly what condition your liver is in.

Once the "jury is in", if there is medical proof to back up the fact that you are disabled,(See Section 5.05 of the Listings of Disabilities, farther into this atricle)BEGIN PREPARATIONS for your Social Security Disability Insurance.

DON'T WAIT! If you do everything I have outlined here, there is an awful lot for you to do, and it's going to take time!


LAWYERS:

Should you use a lawyer or not?
If so, WHEN should you get one?

There are at least two lines of thought on this decision. One says get one from the very first to keep from saying something early on that will make things more difficult for you later...In other words, hire a lawyer right away to avoid legal pitfalls. The other line of thought is to prepare very carefully and thoroughly and file your application yourself. THEN if you get turned down, hire a lawyer.

A couple of tips about the above:
(1) If you Do go ahead and hire an attorney from the very first, MAKE SURE they specialize in Social Security Disability cases and MAKE VERY SURE they have worked Hepatitis C cases...and ACTUALLY WON some!

(2) If you decide to go ahead and do it yourself, be THOROUGH and ACCURATE.

(3)A word about "advocates". A word is about all I know, but I intend to find out more, because it has been suggested to me. I think there are people called "advocates" who aren't necessarily licensed attorneys, but have expertise in this particular field. If I had that choice I would DEFINITELY look into it. You just might get better, more personalized, more sympathetic service, if you could find one. I have no idea about their fees. Actually, I guess that's what I'm sort of doing right here for FREE...But I think an advocate will go to court with you if it comes to that.

HOW MUCH DOES A LAWYER COST?

If/when you are approved for Social Security, the effective date becomes retroactive to the date of your disability as determined by the SSA. They will send your attorney UP TO 25% of that back-pay. If your attorney asked for 15%, for instance, they will send him/her 15% and you 85%. If the attorney asked for 35%, they will only send him/her 25%, and you 75%. The other 10% is up to you and your lawyer.
And there's a $4,000 cap on the fee your lawyer can charge.

IF YOU DECIDE TO DO-IT-YOURSELF, HOW DO YOU START?

First, ask your gastroenterologist or hepatologist if there's any remote possiblity of his/her staff knowing all about Social Security Disability, having all the papers, and doing all the work themselves. Lotsa luck! But I HAVE heard of that happening...twice. Both times, the patient was approved in less that 90 days and began receiving payments in the minimum time available. But in the REAL world, I don't see how a doctor's ofice has the time to do all that, along with HMO, insurance, etc, etc ,etc. to do. So it falls under the realm of anything being possible...but I wouldn't count on it.

.......SO YOU'RE PROBABLY GOING TO HAVE TO INITIATE THINGS YOURSELF............

Now......I'm NOT going to tell YOU what to do......

I'm going to tell you what I would have done if I had known then what I know now. And by the way, I'm still learning. Whenever I learn anything new, I'll pass it on to you. Okay. Here we go:


First I would print this whole report if at all possible so I could read it over & over. I would try to figure out if I really did qualify for Disability according to THEIR rules. Because don't make any mistake...It's THEIR rules you're going to have to play by!

Then if I thought I qualified, I would call any and every doctor I had ever been to who might have something in his/her records that would show past symptoms of Hep C. I would concentrate on the most recent, showing my most severe symptoms. And most importantly, I would get EVERYTHING my gastroenterologist/hepatologist has, especially any and all biopsies, the pathologist's report, and my gastro-doc's own comments.

If I were still working, I would try to set things up so that my application became effective the day I lost my job, if at all possible.

I would call or email the Social Security Administration at:

1-800-772-1213 or
www.ssa.gov

and get them to help me find and set up an appointment with my nearest local SSA office. It's even possible for them to set up a phone interview to get things started, but I wouldn't recommend it. Too much room for error. I would go on to their office if at all possible. I would answer their questions, give them all the information I had, THEN READ what they had written to make sure they got it right. Then I would take home the huge pile of papers I still had to finish on my own, and start in on them.

I would fill out all these forms I had brought home and send off for any information needed that I didn't have on hand. Then I would put all my medical records on one side of a desk/table and the Section 5.05 requirements I mentioned above on the other. And any place I found in my medical records that met the SSA criteria, I would HIGHLIGHT BOTH and write down MATCHING REFERENCE NUMBERS on both so the SSA Board could easily match them up. THEN I would write a letter to the SSA Disability Determination Services office in my state pointing out exactly where my conditions meet their requirements.

I would get LETTERS FROM EVERY DOCTOR I could that points toward my symptoms being SO SERIOUS that I COULDN'T WORK ANYMORE!

An old family doctor might be able to point out that I seemed to have "the flu" more than normal for years, or that I had suffered from joint aches for no apparent reason...whatever.
A more current general practitioner could contribute by describing my declining condition through recent years...and speaking of SYMPTOMS...
ESPECIALLY FATIGUE AND DEPRESSION!!!!!

I would submit all records from my gastroenterologist, including hand-written notes, all test results, including ultra-sound, catscan, biopsy...everything...making sure to HIGHLIGHT and NUMBER everything that matched in my records and the 5.05 regs. AND...A LETTER FROM MY SPECIALIST would be the CRITICAL! His/her expertise will be looked at more closely than any other doctor's, by far. I would want to find out if my specialist was willing to write a letter to the effect that I was suffering from disabling symptoms as SOON AS POSSIBLE. Because if my own gastroenterologist were to testify that it is his/her opinion that I am able to continue working, I WOULD HAVE VIRTUALLY NO CHANCE of qualifying for disability.

Another thing I would do if possible would be to contact people I have been working with and find out if any of them would write a notarized letter (or even personal testimony, if it comes to that) to the effect that they have had daily contact with me on the job for however long, and personally seen me deteriorate until I have become so fatigued and/or depressed that I am no longer able to function.

Of course if I had a lawyer, I would have him/her take a look at all of this and give his/her opinion. BUT...I WOULD NOT allow them to do my thinking for me! If they say they don't think these things are necessary and that I should wait to see what the board says first, then send in more if I needed to...That would be like a red flag to me. It is my firm opinion that AS MUCH SOLID MEDICAL INFORMATION AS POSSIBLE should be given to the Social Security officials RIGHT FROM THE FIRST!

I have another idea, but I can see a problem with it right away:

The most successful results I've heard of have been by way of the patient's specialist sending in the application. Therefore, I would talk with my gastroenterologist's office. I would tell them that I wouldn't expect them to do all the legwork, with all they have to do. So I have done it, gathered it all together, and have it ready to send. And then I would take the whole package to their office and HAVE THEM MAIL IT WITH THEIR ENVELOPE, PUTTING THE DOCTOR'S RECOMMENDATION RIGHT ON TOP, using their stationary, of course, stating that in his/her opinion I am unable to work and recommending that I be placed on disability. That way, I should get the same result as those who were lucky eough to have the doctor's office do everything for them...even though I did it all myself!

All of the things I have mentioned here can weigh in the SSA's evaluation of your case. If you have ENOUGH of the medical information the SSA is looking for, you just very well might GET IMMEDIATE APPROVAL!

I said I could see a problem with this right away, and here it is:

If I had hired an attorney right from the very first, he/she would NOT want me to submit the papers myself, or send them through my doctor's office. This is just too much like taking them out of the loop, and I can't see them putting their blessing on it. So I guess if I were going to take this route, I might just go ahead and do everything myself before hiring an attorney.

But if you try this and get a letter back from Social Security stating that they realize you can't perform the duties you have in the past, but surely with your background and education you could find SOMETHING, even if it's part-time...................................

THEN IT'S TIME FOR AN ATTORNEY!!!!!!!!!!

HOW LONG DOES IT TAKE.....
for your disability payments to begin?

AT BEST, they could approve your application in 90 days or less. Then there is a mandatory FIVE MONTH WAITING PERIOD, beginning from the date of your disability, as determined by the Social Security Administration..
So the short answer is...AT LEAST FIVE MONTHS.

AT WORST, you could not qualify. Remember, this program is for people who are really disabled.

AVERAGE TIME is 1 to 2 YEARS. BUT it is my belief that this may be largely due to the fact that we are all told that the Social Security Administration ALWAYS TURNS YOU DOWN THE FIRST TWO TIMES. This may be true. They may not even read the applications. They may just automatically...But wait a minute. I have already said that I have talked with people who actually got approved THE FIRST TIME. So I'm not so sure. I still think that if they get an obviously well-prepared, easy-to-read application, medically proving that the applicant is disabled, there is a CHANCE of immediate approval.

BUT remember, the money you are awarded begins five months after the date of your last day of employement...So if it takes 18 months from the day you last worked to the day you get your first check...You get 13 months' RETROACTIVE PAY...OVER A YEAR'S PAY...minus the amount your lawyer gets!!!

HOW MUCH DOES DISABILITY PAY?

LUMP SUM
Your retroactive pay DOES NOT GO BACK TO THE DATE OF YOUR DISABILITY.

It goes back to FIVE MONTHS AFTER YOUR DATE OF DISABILITY. I know that was a real "shocker" to me. I understood that I had to wait at least five months before I could start receiving payments. But I DIDN'T understand that those five months just DIDN'T COUNT. They sure counted when my wife and I were fighting to survive!

PAYMENTS
If you have already gotten an estimate on what your payments will be at maturity, (65-plus) you know what you will get on disability. It's about the same amount. If you have not yet gotten an estimate, then get one through Social Security. It's based on how long you've worked and how much you've paid into the system. I've heard the ceiling is $1400/mo. but I don't really know.

TAXES

YES, you MAY have to pay taxes on your Social Security Disability!

If you file a joint return , and your "combined income" (consisting of the adjusted gross income of BOTH of you, any nontaxable interest you may have, and HALF your Social Security Benefits) is at least $32,000, you will have to pay tax on at least HALF your benefits.

If you file as an individual and make $25,000...same thing.

If you "are a member of a couple" (note, it doesn't say 'married') and file a separate return, you PROBABLY WILL PAY TAXES on your benefits. So that's yet another reason that filing married but separately may not be a good thing for you.


RULES & REGULATIONS

Your disability comes from the Social Security Administration. There are very strict rules they adhere to in determining what you get,if anything at all. And they don't volunteer many of the rules of the game to you.

Here's what they DO tell you:
If you try to help out through your roughest times by working part-time and make $700/mo or more (just recently up from $500), you DISQUALIFY YOURSELF FOR DISABILITY.

Here's what they DON'T tell you, but I've read: If you work part-time and make LESS than $700.mo (say, $400) and you DO eventually qualify, they very well may REDUCE your payments by that amount, telling you to make up the difference yourself, since you're obviously able to. So if you're trying to "do the right thing" and forcing yourself to help out for awhile, even though you can't last long this way...You may be doing yourself more harm than good, both physically AND financially.

HAVE YOU HEARD ABOUT SSI?

Perhaps even used the term to mean Disability? It's not. It's Supplemental Security Income. It's the $500/mo or so they send you while you're waiting for SSDI (the REAL disability pay) to kick in.

And it is meant for people who REALLY need it. If you're by yourself and own $2,000 worth of property, bank account, cash, stocks or bonds, you're disqualified. If you're with someone, the limit is $3,000 for the both of you. This doesn't include the home you live in, your personal household goods, and your car usually doesn't count. There is an income limit, but it varies state-by-state, so you'll have to look into this in the state where you live, if you're really interested.

WHAT IS DISABLED?

The Social Security Disability Program is designed to pay monthly benefits to claimants suffering from medical problems causing symptoms SO SEVERE that it becomes IMPOSSIBLE to function at ANY type of work, given the claimant's remaining functional capacity, age, education and work experience. Issues of employability, job existance, insurability, and location or desirability of alternative work are NOT RELEVANT and will not be considered. This is a medical program which focuses upon medically proven symptoms and their impact on the ability to perform work activities.

The LOWEST LEVEL of work is called "sedentary" and requires only the ability to sit six hours out of an eight hour day, walk and stand two hours out of an eight hour day and lift up to ten pounds on an occasional basis. The determination of disability considers both the medical problem and the severity of the symptoms. THE DIFFICULTY IN CLAIMS BASED UPON HEPATITIS C AND LIVER DISEASE IS TO PROVE THE SEVERITY OF THE SYMPTOMS...PARTICULARLY FATIGUE, WHICH IS OFTEN THE MOST DISABLING FEATURE.

Therefore, the focus is on FUNCTION, NOT on a DIAGNOSIS.

SSA oftens admits that claimants have medical problems and are "impaired", but DENIES that they are "TOTALLY DISABLED".


So you must have PROOF that you are disabled, or you may as not bother applying. How do you GET that proof?

You MUST go to a specialist...a gastroenterologist or a hepatologist. And this specialist MUST be involved with your application! He/she MUST agree that you are unable to work, and his/her opinion MUST be backed up with medical proof, in the form of test results, etc.


WHAT KIND OF PROOF?

Well, there TWO WAYS to prove disability in the eyes of the Social Security Administration:

(1) They have something called the "LISTINGS OF IMPAIRMENTS" for each of the major body systems which are so severe they AUTOMATICALLY mean you are disabled.

And guess what...There is NO LISTING FOR HEPATITIS C. What there IS a listing for, however, is LIVER DISEASE.
There are very specific medical standards (Test results, etc.) which must be met. If your medical proof meets or exceeds the appropriate criteria, you may be presumed disabled, and benefits will be rewarded, as long as the other disablilty requirements of the law are met.

(2) The OTHER method of proof is to provide MEDICAL PROOF of SYMPTOMS that are SO SEVERE that you can't function at ANY type of work...ANY type. The focus for this is upon medical proof AS IT RELATES TO YOUR ABILITY TO PERFORM WORK ACTIVITIES. As you might imagine, this gets really touchy. The ALJ or the original committee has to be CONVICED BY MEDICAL PROOF that you can't work in any way.


THE SPECIFICS:

Okay, here we go...Remember that I said the first way to prove your disability is to meet the standards on the LISTINGS OF IMPAIRMENTS? Well the section that covers liver disease is...

SECTION 5.05 (Chronic liver disease (e.g., portal, postnecrotic, or biliary cirrhosis, chronic active hepatitis; Wilson's disease). With:

(A)Esophageal varices (demonstarted by x-ray or endoscopy) with a documented history of massive hemorrage attributable to these varices. Consider under a disability for 3 years following the last massive hemorrage; thereafter, evaluate the residual impairment; or

(B)Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter, evaluate the residual impairment; or

(C)Serum bilirubin of 2.5 mg. per deciliter (100ml) or greater persisting on repeated examinations for at least 5 months; or

(D)Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 30gml per deciliter (100ml) or less; or

(E)Hepatic encephalopathy. Evaluated under the criteria in listing 12.02; or

(F)CONFIRMATION OF LIVER DISEASE BY LIVER BIOPSY (OBTAINED INDEPENDENT OF SOCIAL SECURITY DISABILITY EVALUATION) AND ONE OF THE FOLLOWING:
(1)Ascites not attributable to other causes, recurrent or persisting for at least three months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0gm per deciliter (100ml) or less; or
(2)Serum bilirubin of 2.5 mg per deciliter (100ml) or greater on repeated examinations for at least 3 months; or
(3)HEPATIC CELL NECROSIS OR INFLAMMATION PERSISTING FOR AT LEAST THREE MONTHS, documented by repeated abnormalities of prothrombin time and ENZYMES INDICATIVE OF HEPATIC DYSFUNCTION.


And the OTHER method of proof is to provide medical proof of SYMPTOMS SO SEVERE that you can't work.

There two lines of thought on this.

The first is that FATIGUE is what most often persuades the SSA to award assistance.

The other is that DEPRESSION does the trick.

FATIGUE:

Remember that you must have medical proof of symptoms SO SEVERE that you can not function at any type of work. The focus is upon the medical proof AS IT RELATES TO YOUR ABILITY TO PERFORM WORK ACTIVITIES. The most important thing you can do to help this along is to FULLY DESCRIBE YOUR PROBLEM WITH FATIGUE EVERY TIME YOU VISIT YOUR DOCTOR'S OFFICE. That way, it goes into his notes, his notes are read by the board or the judge, and it BECOMES OFFICIAL, rather than you just trying to tell them you're tired! So don't be like I was and try to keep a stiff upper lip, saying you're okay. If you're having problems with fatigue, BITCH ABOUT IT! EVERY TIME YOU SEE YOUR DOCTOR, COMPLAIN ABOUT YOUR FATIGUE! Please excuse me for talking to you like a child, and for the "profanity" (?). It's just that I want you to understand how IMPORTANT this is. Now...

DEPRESSION:

Many heppers swear that THIS is the most important symptom to emphasize to the Social Security people. Following is a list of symptoms taken from DSM-IV published by the American Psychiatric Association. They say you should have 5 or more of these symptoms to demonstrate clinical depression:

(1)Depressive mood most of the time.
(2)Markedly diminished interest of pleasure in alsmost all activities.
(3)Significant weight loss or gain.
(4)Insomnia or hypersomnia.
(5)Fatigue or loss of energy
(6)Feeling of worthlessness
(7)Diminished ability to think or concentrate.
(8)Recurrent thoughts of death or suicide.

Of course, it really helps if you are PRESENTLY taking medication prescribed by your doctor for depression. And again, this fact stated in a letter by your doctor, is a good thing.


A TIP OR TWO:

* At the beginning of this article I mentioned that you may feel like working at least a partial day, but just not know WHAT day. Well, this might well be true, but I WOULDN'T SAY IT, nor any other information that you don't have to. It may leave a door open for them to use to deny you your benefits.

* Many states have an assistance program, in addition to the federal one. It would be a very good idea to look into this in YOUR state.

*I was told by a very knowledgable person that there is a "3-month Trial Work Period" while you're still trying to get your Disability. He told to me that he worked ALMOST three months, then got canned for not doing his job. He said this was a factor noted in his Judge's summary, and looked upon favorably, because he tried to work and failed. Okay. This worked out great for him. But I can't help but think, "What if someone were to really push themself beyond reason and work that length of time, and DIDN't get canned? If they just quit, it seems as though it would really backfire, indimating that they just didn't WANT to work. And if they last LONGER than three months, their disability date is RESET...And they just might have to start all over again! So...I'm pretty ignorant about this, but it sounds very scary to me...Too easy for it too come back and bite you...



The specific information presented about Section 5.05 of the Listings of Impairments came from a lawyer in Chicago whose law practice focuses exclusively on this area of the law.

His name is JEFFRY A. RABIN. His telephone number is 1-888-LAW-0600.


I have presented this web site because we're all in this same leaky old tub together.

I wish you good luck, love and light.
 


UPDATES:

(1)If you've heard that you have to be off work for a year before you can even apply for disability, please know that this is TOTALLY INCORRECT! I had heard rumors to this effect, and then a few days ago I called Social Security's main office (the 800 number) and some "kidiot" (my name for a kid who thinks he knows everything, but is an idiot) told me just that...He said if I hadn't already missed a year's work because of my illness, I might as well not bother. I looked this up in the booklet they sent me, and it said if you ANTICIPATE that you are going to be off a year OR that your illness may end in death, you should apply! I called back to the 800 number to try & find him, and a very nice, knowledgable, helpful lady told me that he was totally incorrect, but they have answering centers all over the country, and you're routed according to work loads, availability, etc. So this guy is still out there telling people the wrong information, destroying lives with his ignorance.

(2)Social Security Disability payments DO get a cost of living increase each year.

(3)The booklets read that you must be able to do ANY kind of work. In fact, my first turn-down was based on this. They said, "We realize that you can't do what you have BEEN doing, but surely you could do SOMETHING, given your experience and education. Well, THAT'S NOT TRUE if you're OLD ENOUGH. I don't know at what point you become old enough right now, except that I AM. I'm 59 years old...will be 60 January 15th.
 


I would like to say before I leave here that I am sorry you have reason to be reading this article, whether for a loved one or for yourself. As you can see, this entire experience is more than a little humiliating...humbling. But not applying for disability does not make it go away. If you are disabled, you are disabled. You MUST BE PREPARED FOR THAT, GET PAST IT, AND MOVE ON.

GOOD LUCK !
 

 
 

Handling Disability Examinations www.cfsdoc.org/disabil.htm

Social Security Admin. Online  www.ssa.gov/SSA_Home.html

SSA Disability Information  www.ssa.gov/odhome/odhome.htm

SSA How To Apply  www.ssa.gov/howto.htm

SSD Reviews  www.ssa.gov/pubs/10068.html

SSD's CFS Fact Sheet  www.ssa.gov/odhome/cfsfacts.htm

Toll Free Numbers To Agencies  http://macdds.org/m_toll.htm

When we emailed Mike to ask him if we could use his information. He was more then happy to share it will all. This is only a example of all the great people out there helping those with Hepatitis. Thank you so much Mike, you are one in a million. Please visit Mikes site  http://heppie2000.tripod.com/index-3.html

 

  AMERICANS WITH DISABILITIES ACT

U.S. Equal Employment Opportunity Commission

U.S. Department of Justice Civil Rights Division

Questions and Answers

Barriers to employment, transportation, public accommodations, public services, and telecommunications have imposed staggering economic and social costs on American society and have undermined our well-intentioned efforts to educate, rehabilitate, and employ individuals with disabilities. By breaking down these barriers, the Americans with Disabilities Act (ADA) will enable society to benefit from the skills and talents of individuals with disabilities, will allow us all to gain from their increased purchasing power and ability to use it, and will lead to fuller, more productive lives for all Americans.

The Americans with Disabilities Act gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services, and telecommunications.

Fair, swift, and effective enforcement of this landmark civil rights legislation is a high priority of the Federal Government. This booklet is designed to provide answers to some of the most often asked questions about the ADA.

For answers to additional questions, call the ADA Information Line

800-514-0301 (voice)

800-514-0383 (TDD)

Additional ADA resources are listed in the Resources section of this document, page 30.

July 1996

Employment

Q. What employers are covered by title I of the ADA, and when is the coverage effective?

A. The title I employment provisions apply to private employers, State and local governments, employment agencies, and labor unions. Employers with 25 or more employees were covered as of July 26, 1992. Employers with 15 or more employees were covered two years later, beginning July 26, 1994.

Q. What practices and activities are covered by the employment nondiscrimination requirements?

A. The ADA prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment-related activities.

Q. Who is protected from employment discrimination?

A. Employment discrimination is prohibited against "qualified individuals with disabilities." This includes applicants for employment and employees. An individual is considered to have a "disability" if s/he has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment. Persons discriminated against because they have a known association or relationship with an individual with a disability also are protected.

The first part of the definition makes clear that the ADA applies to persons who have impairments and that these must substantially limit major life activities such as seeing, hearing, speaking, walking, breathing, performing manual tasks, learning, caring for oneself, and working. An individual with epilepsy, paralysis, HIV infection, AIDS, a substantial hearing or visual impairment, mental retardation, or a specific learning disability is covered, but an individual with a minor, nonchronic condition of short duration, such as a sprain, broken limb, or the flu, generally would not be covered.

The second part of the definition protecting individuals with a record of a disability would cover, for example, a person who has recovered from cancer or mental illness.

The third part of the definition protects individuals who are regarded as having a substantially limiting impairment, even though they may not have such an impairment. For example, this provision would protect a qualified individual with a severe facial disfigurement from being denied employment because an employer feared the "negative reactions" of customers or co-workers.

Q. Who is a "qualified individual with a disability?"

A. A qualified individual with a disability is a person who meets legitimate skill, experience, education, or other requirements of an employment position that s/he holds or seeks, and who can perform the oeessential functionsî of the position with or without reasonable accommodation. Requiring the ability to perform "essential" functions assures that an individual with a disability will not be considered unqualified simply because of inability to perform marginal or incidental job functions. If the individual is qualified to perform essential job functions except for limitations caused by a disability, the employer must consider whether the individual could perform these functions with a reasonable accommodation. If a written job description has been prepared in advance of advertising or interviewing applicants for a job, this will be considered as evidence, although not conclusive evidence, of the essential functions of the job.

Q. Does an employer have to give preference to a qualified applicant with a disability over other applicants?

A. No. An employer is free to select the most qualified applicant available and to make decisions based on reasons unrelated to a disability. For example, suppose two persons apply for a job as a typist and an essential function of the job is to type 75 words per minute accurately. One applicant, an individual with a disability, who is provided with a reasonable accommodation for a typing test, types 50 words per minute; the other applicant who has no disability accurately types 75 words per minute. The employer can hire the applicant with the higher typing speed, if typing speed is needed for successful performance of the job.

Q. What limitations does the ADA impose on medical examinations and inquiries about disability?

A. An employer may not ask or require a job applicant to take a medical examination before making a job offer. It cannot make any pre-employment inquiry about a disability or the nature or severity of a disability. An employer may, however, ask questions about the ability to perform specific job functions and may, with certain limitations, ask an individual with a disability to describe or demonstrate how s/he would perform these functions.

An employer may condition a job offer on the satisfactory result of a post-offer medical examination or medical inquiry if this is required of all entering employees in the same job category. A post-offer examination or inquiry does not have to be job-related and consistent with business necessity.

However, if an individual is not hired because a post-offer medical examination or inquiry reveals a disability, the reason(s) for not hiring must be job-related and consistent with business necessity. The employer also must show that no reasonable accommodation was available that would enable the individual to perform the essential job functions, or that accommodation would impose an undue hardship. A post-offer medical examination may disqualify an individual if the employer can demonstrate that the individual would pose a "direct threat" in the workplace (i.e., a significant risk of substantial harm to the health or safety of the individual or others) that cannot be eliminated or reduced below the oedirect threatî level through reasonable accommodation. Such a disqualification is job-related and consistent with business necessity. A post-offer medical examination may not disqualify an individual with a disability who is currently able to perform essential job functions because of speculation that the disability may cause a risk of future injury.

After a person starts work, a medical examination or inquiry of an employee must be job-related and consistent with business necessity. Employers may conduct employee medical examinations where there is evidence of a job performance or safety problem, examinations required by other Federal laws, examinations to determine current oefitnessî to perform a particular job, and voluntary examinations that are part of employee health programs.

Information from all medical examinations and inquiries must be kept apart from general personnel files as a separate, confidential medical record, available only under limited conditions.

Tests for illegal use of drugs are not medical examinations under the ADA and are not subject to the restrictions of such examinations.

Q. When can an employer ask an applicant to "self-identify" as having a disability?

A. Federal contractors and subcontractors who are covered by the affirmative action requirements of section 503 of the Rehabilitation Act of 1973 may invite individuals with disabilities to identify themselves on a job application form or by other pre-employment inquiry, to satisfy the section 503 affirmative action requirements. Employers who request such information must observe section 503 requirements regarding the manner in which such information is requested and used, and the procedures for maintaining such information as a separate, confidential record, apart from regular personnel records.

A pre-employment inquiry about a disability is allowed if required by another Federal law or regulation such as those applicable to disabled veterans and veterans of the Vietnam era. Pre-employment inquiries about disabilities may be necessary under such laws to identify applicants or clients with disabilities in order to provide them with required special services.

Q. Does the ADA require employers to develop written job descriptions?

A. No. The ADA does not require employers to develop or maintain job descriptions. However, a written job description that is prepared before advertising or interviewing applicants for a job will be considered as evidence along with other relevant factors. If an employer uses job descriptions, they should be reviewed to make sure they accurately reflect the actual functions of a job. A job description will be most helpful if it focuses on the results or outcome of a job function, not solely on the way it customarily is performed. A reasonable accommodation may enable a person with a disability to accomplish a job function in a manner that is different from the way an employee who is not disabled may accomplish the same function.

Q. What is "reasonable accommodation?"

A. Reasonable accommodation is any modification or adjustment to a job or the work environment that will enable a qualified applicant or employee with a disability to participate in the application process or to perform essential job functions. Reasonable accommodation also includes adjustments to assure that a qualified individual with a disability has rights and privileges in employment equal to those of employees without disabilities.

Q. What are some of the accommodations applicants and employees may need?

A. Examples of reasonable accommodation include making existing facilities used by employees readily accessible to and usable by an individual with a disability; restructuring a job; modifying work schedules; acquiring or modifying equipment; providing qualified readers or interpreters; or appropriately modifying examinations, training, or other programs. Reasonable accommodation also may include reassigning a current employee to a vacant position for which the individual is qualified, if the person is unable to do the original job because of a disability even with an accommodation. However, there is no obligation to find a position for an applicant who is not qualified for the position sought. Employers are not required to lower quality or quantity standards as an accommodation; nor are they obligated to provide personal use items such as glasses or hearing aids.

The decision as to the appropriate accommodation must be based on the particular facts of each case. In selecting the particular type of reasonable accommodation to provide, the principal test is that o effectiveness, i.e., whether the accommodation will provide an opportunity for a person with a disability to achieve the same level of performance and to enjoy benefits equal to those of an average, similarly situated person without a disability. However, the accommodation does not have to ensure equal results or provide exactly the same benefits.

Q. When is an employer required to make a reasonable accommodation?

A. An employer is only required to accommodate a "known" disability of a qualified applicant or employee. The requirement generally will be triggered by a request from an individual with a disability, who frequently will be able to suggest an appropriate accommodation. Accommodations must be made on an individual basis, because the nature and extent of a disabling condition and the requirements of a job will vary in each case. If the individual does not request an accommodation, the employer is not obligated to provide one except where an individual's known disability impairs his/her ability to know of, or effectively communicate a need for, an accommodation that is obvious to the employer. If a person with a disability requests, but cannot suggest, an appropriate accommodation, the employer and the individual should work together to identify one. There are also many public and private resources that can provide assistance without cost.

Q. What are the limitations on the obligation to make a reasonable accommodation?

A. The individual with a disability requiring the accommodation must be otherwise qualified, and the disability must be known to the employer. In addition, an employer is not required to make an accommodation if it would impose an "undue hardship" on the operation of the employer's business. "Undue hardship" is defined as an "action requiring significant difficulty or expense" when considered in light of a number of factors. These factors include the nature and cost of the accommodation in relation to the size, resources, nature, and structure of the employer's operation. Undue hardship is determined on a case-by-case basis. Where the facility making the accommodation is part of a larger entity, the structure and overall resources of the larger organization would be considered, as well as the financial and administrative relationship of the facility to the larger organization. In general, a larger employer with greater resources would be expected to make accommodations requiring greater effort or expense than would be required of a smaller employer with fewer resources.

If a particular accommodation would be an undue hardship, the employer must try to identify another accommodation that will not pose such a hardship. Also, if the cost of an accommodation would impose an undue hardship on the employer, the individual with a disability should be given the option of paying that portion of the cost which would constitute an undue hardship or providing the accommodation.

Q. Must an employer modify existing facilities to make them accessible?

A. The employer's obligation under title I is to provide access for an individual applicant to participate in the job application process, and for an individual employee with a disability to perform the essential functions of his/her job, including access to a building, to the work site, to needed equipment, and to all facilities used by employees. For example, if an employee lounge is located in a place inaccessible to an employee using a wheelchair, the lounge might be modified or relocated, or comparable facilities might be provided in a location that would enable the individual to take a break with co-workers. The employer must provide such access unless it would cause an undue hardship.

Under title I, an employer s not required to make its existing facilities accessible until a particular applicant or employee with a particular disability needs an accommodation, and then the modifications should meet that individual's work needs. However, employers should consider initiating changes that will provide general accessibility, particularly for job applicants, since it is likely that people with disabilities will be applying for jobs. The employer does not have to make changes to provide access in places or facilities that will not be used by that individual for employment-related activities or benefits.

Q. Can an employer be required to reallocate an essential function of a job to another employee as a reasonable accommodation?

A. No. An employer is not required to reallocate essential functions of a job as a reasonable accommodation.

Q. Can an employer be required to modify, adjust, or make other reasonable accommodations in the way a test is given to a qualified applicant or employee with a disability?

A. Yes. Accommodations may be needed to assure that tests or examinations measure the actual ability of an individual to perform job functions rather than reflect limitations caused by the disability. Tests should be given to people who have sensory, speaking, or manual impairments in a format that does not require the use of the impaired skill, unless it is a job-related skill that the test is designed to measure.

Q. Can an employer maintain existing production/performance standards for an employee with a disability?

A. An employer can hold employees with disabilities to the same standards of production/performance as other similarly situated employees without disabilities for performing essential job functions, with or without reasonable accommodation. An employer also can hold employees with disabilities to the same standards of production/performance as other employees regarding marginal functions unless the disability affects the person's ability to perform those marginal functions. If the ability to perform marginal functions is affected by the disability, the employer must provide some type of reasonable accommodation such as job restructuring but may not exclude an individual with a disability who is satisfactorily performing a jobs essential functions.

Q. Can an employer establish specific attendance and leave policies?

A. An employer can establish attendance and leave policies that are uniformly applied to all employees, regardless of disability, but may not refuse leave needed by an employee with a disability if other employees get such leave. An employer also may be required to make adjustments in leave policy as a reasonable accommodation. The employer is not obligated to provide additional paid leave, but accommodations may include leave flexibility and unpaid leave.

A uniformly applied leave policy does not violate the ADA because it has a more severe effect on an individual because of his/her disability. However, if an individual with a disability requests a modification of such a policy as a reasonable accommodation, an employer may be required to provide it, unless it would impose an undue hardship.

Q. Can an employer consider health and safety when deciding whether to hire an applicant or retain an employee with a disability?

A. Yes. The ADA permits employers to establish qualification standards that will exclude individuals who pose a direct threat -- i.e., a significant risk of substantial harm -- to the health or safety of the individual or of others, if that risk cannot be eliminated or reduced below the level of a oedirect threatî by reasonable accommodation. However, an employer may not simply assume that a threat exists; the employer must establish through objective, medically supportable methods that there is significant risk that substantial harm could occur in the workplace. By requiring employers to make individualized judgments based on reliable medical or other objective evidence rather than on generalizations, ignorance, fear, patronizing attitudes, or stereotypes, the ADA recognizes the need to balance the interests of people with disabilities against the legitimate interests of employers in maintaining a safe workplace.

Q. Are applicants or employees who are currently illegally using drugs covered by the ADA?

A. No. Individuals who currently engage in the illegal use of drugs are specifically excluded from the definition of a "qualified individual with a disability" protected by the ADA when the employer takes action on the basis of their drug use.

Q. Is testing for the illegal use of drugs permissible under the ADA?

A. Yes. A test for the illegal use of drugs is not considered a medical examination under the ADA; therefore, employers may conduct such testing of applicants or employees and make employment decisions based on the results. The ADA does not encourage, prohibit, or authorize drug tests.

If the results of a drug test reveal the presence of a lawfully prescribed drug or other medical information, such information must be treated as a confidential medical record.

Q. Are alcoholics covered by the ADA?

A. Yes. While a current illegal user of drugs is not protected by the ADA if an employer acts on the basis of such use, a person who currently uses alcohol is not automatically denied protection. An alcoholic is a person with a disability and is protected by the ADA if s/he is qualified to perform the essential functions of the job. An employer may be required to provide an accommodation to an alcoholic. However, an employer can discipline, discharge or deny employment to an alcoholic whose use of alcohol adversely affects job performance or conduct. An employer also may prohibit the use of alcohol in the workplace and can require that employees not be under the influence of alcohol.

Q. Does the ADA override Federal and State health and safety laws?

A. The ADA does not override health and safety requirements established under other Federal laws even if a standard adversely affects the employment of an individual with a disability. If a standard is required by another Federal law, an employer must comply with it and does not have to show that the standard is job related and consistent with business necessity. For example, employers must conform to health and safety requirements of the U.S. Occupational Safety and Health Administration. However, an employer still has the obligation under the ADA to consider whether there is a reasonable accommodation, consistent with the standards of other Federal laws, that will prevent exclusion of qualified individuals with disabilities who can perform jobs without violating the standards of those laws. If an employer can comply with both the ADA and another Federal law, then the employer must do so.

The ADA does not override State or local laws designed to protect public health and safety, except where such laws conflict with the ADA requirements. If there is a State or local law that would exclude an individual with a disability from a particular job or profession because of a health or safety risk, the employer still must assess whether a particular individual would pose a "direct threat" to health or safety under the ADA standard. If such a "direct threat" exists, the employer must consider whether it could be eliminated or reduced below the level of a "direct threat" by reasonable accommodation. An employer cannot rely on a State or local law that conflicts with ADA requirements as a defense to a charge of discrimination.

Q. How does the ADA affect workers' compensation programs?

A. Only injured workers who meet the ADA's definition of an "individual with a disability" will be considered disabled under the ADA, regardless of whether they satisfy criteria for receiving benefits under workers' compensation or other disability laws. A worker also must be "qualified" (with or without reasonable accommodation) to be protected by the ADA. Work-related injuries do not always cause physical or mental impairments severe enough to "substantially limit" a major life activity. Also, many on-the-job injuries cause temporary impairments which heal within a short period of time with little or no long-term or permanent impact. Therefore, many injured workers who qualify for benefits under workers' compensation or other disability benefits laws may not be protected by the ADA. An employer must consider work-related injuries on a case-by-case basis to know if a worker is protected by the ADA.

An employer may not inquire into an applicant's workers' compensation history before making a conditional offer of employment. After making a conditional job offer, an employer may inquire about a person's workers compensation history in a medical inquiry or examination that is required of all applicants in the same job category. However, even after a conditional offer has been made, an employer cannot require a potential employee to have a medical examination because a response to a medical inquiry (as opposed to results from a medical examination) shows a previous on-the-job injury unless all applicants in the same job category are required to have an examination. Also, an employer may not base an employment decision on the speculation that an applicant may cause increased workers' compensation costs in the future. However, an employer may refuse to hire, or may discharge an individual who is not currently able to perform a job without posing a significant risk of substantial harm to the health or safety of the individual or others, if the risk cannot be eliminated or reduced by reasonable accommodation.

An employer may refuse to hire or may fire a person who knowingly provides a false answer to a lawful post-offer inquiry about his/her condition or worker's compensation history.

An employer also may submit medical information and records concerning employees and applicants (obtained after a conditional job offer) to state workers' compensation offices and "second injury" funds without violating ADA confidentiality requirements.

Q. What is discrimination based on "relationship or association" under the ADA?

A. The ADA prohibits discrimination based on relationship or association in order to protect individuals from actions based on unfounded assumptions that their relationship to a person with a disability would affect their job performance, and from actions caused by bias or misinformation concerning certain disabilities. For example, this provision would protect a person whose spouse has a disability from being denied employment because of an employer's unfounded assumption that the applicant would use excessive leave to care for the spouse. It also would protect an individual who does volunteer work for people with AIDS from a discriminatory employment action motivated by that relationship or association.

Q. How are the employment provisions enforced?

A. The employment provisions of the ADA are enforced under the same procedures now applicable to race, color, sex, national origin, and religious discrimination under title VII of the Civil Rights Act of 1964, as amended, and the Civil Rights Act of 1991. Complaints regarding actions that occurred on or after July 26, 1992, may be filed with the Equal Employment Opportunity Commission or designated State human rights agencies. Available remedies will include hiring, reinstatement, promotion, back pay, front pay, restored benefits, reasonable accommodation, attorneys' fees, expert witness fees, and court costs. Compensatory and punitive damages also may be available in cases of intentional discrimination or where an employer fails to make a good faith effort to provide a reasonable accommodation.

Q. What financial assistance is available to employers to help them make reasonable accommodations and comply with the ADA?

A. A special tax credit is available to help smaller employers make accommodations required by the ADA. An eligible small business may take a tax credit of up to $5,000 per year for accommodations made to comply with the ADA. The credit is available for one-half the cost of "eligible access expenditures" that are more than $250 but less than $10,250.

A full tax deduction, up to $15,000 per year, also is available to any business for expenses of removing qualified architectural or transportation barriers. Expenses covered include costs of removing barriers created by steps, narrow doors, inaccessible parking spaces, restroom facilities, and transportation vehicles. Information about the tax credit and the tax deduction can be obtained from a local IRS office, or by contacting the Office of Chief Counsel, Internal Revenue Service.

Tax credits are available under the Targeted Jobs Tax Credit Program (TJTCP) for employers who hire individuals with disabilities referred by State or local vocational rehabilitation agencies, State Commissions on the Blind, or the U.S. Department of Veterans Affairs, and certified by a State Employment Service. Under the TJTCP, a tax credit may be taken for up to 40 percent of the first $6,000 of first-year wages of a new employee with a disability. This program must be reauthorized each year by Congress. Further information about the TJTCP can be obtained from the State Employment Services or from State Governors' Committees on the Employment of People with Disabilities.

Q. What are an employer's recordkeeping requirements under the employment provisions of the ADA?

A. An employer must maintain records such as application forms submitted by applicants and other records related to hiring, requests for reasonable accommodation, promotion, demotion, transfer, lay-off or termination, rates of pay or other terms of compensation, and selection for training or apprenticeship for one year after making the record or taking the action described (whichever occurs later). If a charge of discrimination is filed or an action is brought by EEOC, an employer must save all personnel records related to the charge until final disposition of the charge.

Q. Does the ADA require that an employer post a notice explaining its requirements?

A. The ADA requires that employers post a notice describing the provisions of the ADA. It must be made accessible, as needed, to individuals with disabilities. A poster is available from EEOC summarizing the requirements of the ADA and other Federal legal requirements for nondiscrimination for which EEOC has enforcement responsibility. EEOC also provides guidance on making this information available in accessible formats for people with disabilities.

Q. What resources does the Equal Employment Opportunity Commission have available to help employers and people with disabilities understand and comply with the employment requirements of the ADA?

A. The Equal Employment Opportunity Commission has developed several resources to help employers and people with disabilities understand and comply with the employment provisions of the ADA.

Resources include:

A Technical Assistance Manual that provides "how-to" guidance on the employment provisions of the ADA as well as a resource directory to help individuals find specific information.

A variety of brochures, booklets, and fact sheets.

For information on how to contact the Equal Employment Opportunity Commission, see page 30.

State and Local Governments

Q. Does the ADA apply to State and local governments?

A. Title II of the ADA prohibits discrimination against qualified individuals with disabilities in all programs, activities, and services of public entities. It applies to all State and local governments, their departments and agencies, and any other instrumentalities or special purpose districts of State or local governments. It clarifies the requirements of section 504 of the Rehabilitation Act of 1973 for public transportation systems that receive Federal financial assistance, and extends coverage to all public entities that provide public transportation, whether or not they receive Federal financial assistance. It establishes detailed standards for the operation of public transit systems, including commuter and intercity rail (AMTRAK).

Q. When do the requirements for State and local governments become effective?

A. In general, they became effective on January 26, 1992.

Q. How does title II affect participation in a State or local government's programs, activities, and services?

A. A state or local government must eliminate any eligibility criteria for participation in programs, activities, and services that screen out or tend to screen out persons with disabilities, unless it can establish that the requirements are necessary for the provision of the service, program, or activity. The State or local government may, however, adopt legitimate safety requirements necessary for safe operation if they are based on real risks, not on stereotypes or generalizations about individuals with disabilities. Finally, a public entity must reasonably modify its policies, practices, or procedures to avoid discrimination. If the public entity can demonstrate that a particular modification would fundamentally alter the nature of its service, program, or activity, it is not required to make that modification.

Q. Does title II cover a public entity's employment policies and practices?

A. Yes. Title II prohibits all public entities, regardless of the size of their work force, from discriminating in employment against qualified individuals with disabilities. In addition to title II's employment coverage, title I of the ADA and section 504 of the Rehabilitation Act of 1973 prohibit employment discrimination against qualified individuals with disabilities by certain public entities

Q. What changes must a public entity make to its existing facilities to make them accessible?

A. A public entity must ensure that individuals with disabilities are not excluded from services, programs, and activities because existing buildings are inaccessible. A State or local government's programs, when viewed in their entirety, must be readily accessible to and usable by individuals with disabilities. This standard, known as "program accessibility," applies to facilities of a public entity that existed on January 26, 1992. Public entities do not necessarily have to make each of their existing facilities accessible. They may provide program accessibility by a number of methods including alteration of existing facilities, acquisition or construction of additional facilities, relocation of a service or program to an accessible facility, or provision of services at alternate accessible sites.

Q. When must structural changes be made to attain program accessibility?

A. Structural changes needed for program accessibility must be made as expeditiously as possible, but no later than January 26, 1995. This three-year time period is not a grace period; all alterations must be accomplished as expeditiously as possible. A public entity that employs 50 or more persons must have developed a transition plan by July 26, 1992, setting forth the steps necessary to complete such changes.

Q. What is a self-evaluation?

A. A self-evaluation is a public entity's assessment of its current policies and practices. The self-evaluation identifies and corrects those policies and practices that are inconsistent with title II's requirements. All public entities must complete a self-evaluation by January 26, 1993. A public entity that employs 50 or more employees must retain its self-evaluation for three years. Other public entities are not required to retain their self-evaluations, but are encouraged to do so because these documents evidence a public entity's good faith efforts to comply with title II's requirements.

Q. What does title II require for new construction and alterations?

A. The ADA requires that all new buildings constructed by a State or local government be accessible. In addition, when a State or local government undertakes alterations to a building, it must make the altered portions accessible.

Q. How will a State or local government know that a new building is accessible?

A. A State or local government will be in compliance with the ADA for new construction and alterations if it follows either of two accessibility standards. It can choose either the Uniform Federal Accessibility Standards or the Americans with Disabilities Act Accessibility Guidelines for Buildings and Facilities, which is the standard that must be used for public accommodations and commercial facilities under title III of the ADA. If the State or local government chooses the ADA Accessibility Guidelines, it is not entitled to the elevator exemption (which permits certain private buildings under three stories or under 3,000 square feet per floor to be constructed without an elevator).

Q. What requirements apply to a public entity's emergency telephone services, such as 911?

A. State and local agencies that provide emergency telephone services must provide "direct access" to individuals who rely on a TDD or computer modem for telephone communication. Telephone access through a third party or through a relay service does not satisfy the requirement for direct access. Where a public entity provides 911 telephone service, it may not substitute a separate seven-digit telephone line as the sole means for access to 911 services by nonvoice users. A public entity may, however, provide a separate seven-digit line for the exclusive use of nonvoice callers in addition to providing direct access for such calls to its 911 line.

Q. Does title II require that telephone emergency service systems be compatible with all formats used for nonvoice communications?

A. No. At present, telephone emergency services must only be compatible with the Baudot format. Until it can be technically proven that communications in another format can operate in a reliable and compatible manner in a given telephone emergency environment, a public entity would not be required to provide direct access to computer modems using formats other than Baudot.

Q. How will the ADA's requirements for State and local governments be enforced?

A. Private individuals may bring lawsuits to enforce their rights under title II and may receive the same remedies as those provided under section 504 of the Rehabilitation Act of 1973, including reasonable attorney's fees. Individuals may also file complaints with eight designated Federal agencies, including the Department of Justice and the Department of Transportation.

Public Accommodations

Q. What are public accommodations?

A. A public accommodation is a private entity that owns, operates, leases, or leases to, a place of public accommodation. Places of public accommodation include a wide range of entities, such as restaurants, hotels, theaters, doctors' offices, pharmacies, retail stores, museums, libraries, parks, private schools, and day care centers. Private clubs and religious organizations are exempt from the ADA's title III requirements for public accommodations.

Q. Will the ADA have any effect on the eligibility criteria used by public accommodations to determine who may receive services?

A. Yes. If a criterion screens out or tends to screen out individuals with disabilities, it may only be used if necessary for the provision of the services. For instance, it would be a violation for a retail store to have a rule excluding all deaf persons from entering the premises, or for a movie theater to exclude all individuals with cerebral palsy. More subtle forms of discrimination are also prohibited. For example, requiring presentation of a driver's license as the sole acceptable means of identification for purposes of paying by check could constitute discrimination against individuals with vision impairments. This would be true if such individuals are ineligible to receive licenses and the use of an alternative means of identification is feasible.

Q. Does the ADA allow public accommodations to take safety factors into consideration in providing services to individuals with disabilities?

A. The ADA expressly provides that a public accommodation may exclude an individual, if that individual poses a direct threat to the health or safety of others that cannot be mitigated by appropriate modifications in the public accommodation's policies or procedures, or by the provision of auxiliary aids. A public accommodation will be permitted to establish objective safety criteria for the operation of its business; however, any safety standard must be based on objective requirements rather than stereotypes or generalizations about the ability of persons with disabilities to participate in an activity.

Q. Are there any limits on the kinds of modifications in policies, practices, and procedures required by the ADA?

 

A. Yes. The ADA does not require modifications that would fundamentally alter the nature of the services provided by the public accommodation. For example, it would not be discriminatory for a physician specialist who treats only burn patients to refer a deaf individual to another physician for treatment of a broken limb or respiratory ailment. To require a physician to accept patients outside of his or her specialty would fundamentally alter the nature of the medical practice.

Q. What kinds of auxiliary aids and services are required by the ADA to ensure effective communication with individuals with hearing or vision impairments?

A. Appropriate auxiliary aids and services may include services and devices such as qualified interpreters, assistive listening devices, notetakers, and written materials for individuals with hearing impairments; and qualified readers, taped texts, and Brailled or large print materials for individuals with vision impairments.

Q. Are there any limitations on the ADA's auxiliary aids requirements?

A. Yes. The ADA does not require the provision of any auxiliary aid that would result in an undue burden or in a fundamental alteration in the nature of the goods or services provided by a public accommodation. However, the public accommodation is not relieved from the duty to furnish an alternative auxiliary aid, if available, that would not result in a fundamental alteration or undue burden. Both of these limitations are derived from existing regulations and caselaw under section 504 of the Rehabilitation Act and are to be determined on a case-by-case basis.

Q. Will restaurants be required to have brailled menus?

A. No, not if waiters or other employees are made available to read the menu to a blind customer.

Q. Will a clothing store be required to have brailled price tags?

A. No, not if sales personnel could provide price information orally upon request.

Q. Will a bookstore be required to maintain a sign language interpreter on its staff in order to communicate with deaf customers?

A. No, not if employees communicate by pen and notepad when necessary.

Q. Are there any limitations on the ADA's barrier removal requirements for existing facilities?

A. Yes. Barrier removal need be accomplished only when it is "readily achievable" to do so.

Q. What does the term "readily achievable" mean?

A. It means "easily accomplishable and able to be carried out without much difficulty or expense."

Q. What are examples of the types of modifications that would be readily achievable in most cases?

A. Examples include the simple ramping of a few steps, the installation of grab bars where only routine reinforcement of the wall is required, the lowering of telephones, and similar modest adjustments.

Q. Will businesses need to rearrange furniture and display racks?

A. Possibly. For example, restaurants may need to rearrange tables and department stores may need to adjust their layout of racks and shelves in order to permit access to wheelchair users.

Q. Will businesses need to install elevators?

A. Businesses are not required to retrofit their facilities to install elevators unless such installation is readily achievable, which is unlikely in most cases.

Q. When barrier removal is not readily achievable, what kinds of alternative steps are required by the ADA?

A. Alternatives may include such measures as in-store assistance for removing articles from inaccessible shelves, home delivery of groceries, or coming to the door to receive or return dry cleaning.

Q. Must alternative steps be taken without regard to cost?

A. No, only readily achievable alternative steps must be undertaken.

Q. How is "readily achievable" determined in a multisite business?

A. In determining whether an action to make a public accommodation accessible would be "readily achievable," the overall size of the parent corporation or entity is only one factor to be considered. The ADA also permits consideration of the financial resources of the particular facility or facilities involved and the administrative or fiscal relationship of the facility or facilities to the parent entity.

Q. Who has responsibility for ADA compliance in leased places of public accommodation, the landlord or the tenant?

A. The ADA places the legal obligation to remove barriers or provide auxiliary aids and services on both the landlord and the tenant. The landlord and the tenant may decide by lease who will actually make the changes and provide the aids and services, but both remain legally responsible.

Q. What does the ADA require in new construction?

A. The ADA requires that all new construction of places of public accommodation, as well as of "commercial facilities" such as office buildings, be accessible. Elevators are generally not required in facilities under three stories or with fewer than 3,000 square feet per floor, unless the building is a shopping center or mall; the professional office of a health care provider; a terminal, depot, or other public transit station; or an airport passenger terminal.

Q. Is it expensive to make all newly constructed places of public accommodation and commercial facilities accessible?

A. The cost of incorporating accessibility features in new construction is less than one percent of construction costs. This is a small price in relation to the economic benefits to be derived from full accessibility in the future, such as increased employment and consumer spending and decreased welfare dependency.

Q. Must every feature of a new facility be accessible?

A. No, only a specified number of elements such as parking spaces and drinking fountains must be made accessible in order for a facility to be "readily accessible." Certain nonoccupiable spaces such as elevator pits, elevator penthouses, and piping or equipment catwalks need not be accessible.

Q. What are the ADA requirements for altering facilities?

A. All alterations that could affect the usability of a facility must be made in an accessible manner to the maximum extent feasible. For example, if during renovations a doorway is being relocated, the new doorway must be wide enough to meet the new construction standard for accessibility. When alterations are made to a primary function area, such as the lobby of a bank or the dining area of a cafeteria, an accessible path of travel to the altered area must also be provided. The bathrooms, telephones, and drinking fountains serving that area must also be made accessible. These additional accessibility alterations are only required to the extent that the added accessibility costs do not exceed 20% of the cost of the original alteration. Elevators are generally not required in facilities under three stories or with fewer than 3,000 square feet per floor, unless the building is a shopping center or mall; the professional office of a health care provider; a terminal, depot, or other public transit station; or an airport passenger terminal.

Q. Does the ADA permit an individual with a disability to sue a business when that individual believes that discrimination is about to occur, or must the individual wait for the discrimination to occur?

 

A. The ADA public accommodations provisions permit an individual to allege discrimination based on a reasonable belief that discrimination is about to occur. This provision, for example, allows a person who uses a wheelchair to challenge the planned construction of a new place of public accommodation, such as a shopping mall, that would not be accessible to individuals who use wheelchairs. The resolution of such challenges prior to the construction of an inaccessible facility would enable any necessary remedial measures to be incorporated in the building at the planning stage, when such changes would be relatively inexpensive.

Q. How does the ADA affect existing State and local building codes?

A. Existing codes remain in effect. The ADA allows the Attorney General to certify that a State law, local building code, or similar ordinance that establishes accessibility requirements meets or exceeds the minimum accessibility requirements for public accommodations and commercial facilities. Any State or local government may apply for certification of its code or ordinance. The Attorney General can certify a code or ordinance only after prior notice and a public hearing at which interested people, including individuals with disabilities, are provided an opportunity to testify against the certification.

Q. What is the effect of certification of a State or local code or ordinance?

A. Certification can be advantageous if an entity has constructed or altered a facility according to a certified code or ordinance. If someone later brings an enforcement proceeding against the entity, the certification is considered "rebuttable evidence" that the State law or local ordinance meets or exceeds the minimum requirements of the ADA. In other words, the entity can argue that the construction or alteration met the requirements of the ADA because it was done in compliance with the State or local code that had been certified.

Q. When are the public accommodations provisions effective?

A. In general, they became effective on January 26, 1992.

Q. How will the public accommodations provisions be enforced?

A. Private individuals may bring lawsuits in which they can obtain court orders to stop discrimination. Individuals may also file complaints with the Attorney General, who is authorized to bring lawsuits in cases of general public importance or where a oepattern o practiceî of discrimination is alleged. In these cases, the Attorney General may seek monetary damages and civil penalties. Civil penalties may not exceed $50,000 for a first violation or $100,000 for any subsequent violation.

Miscellaneous

Q. Is the Federal government covered by the ADA?

A. The ADA does not cover the executive branch of the Federal government. The executive branch continues to be covered by title V of the Rehabilitation Act of 1973, which prohibits discrimination in services and employment on the basis of handicap and which is a model for the requirements of the ADA. The ADA, however, does cover Congress and other entities in the legislative branch of the Federal government.

Q. Does the ADA cover private apartments and private homes?

A. The ADA does not cover strictly residential private apartments and homes. If, however, a place of public accommodation, such as a doctor's office or day care center, is located in a private residence, those portions of the residence used for that purpose are subject to the ADA's requirements.

Q. Does the ADA cover air transportation?

A. Discrimination by air carriers in areas other than employment is not covered by the ADA but rather by the Air Carrier Access Act (49 U.S.C. 1374 (c)).

Q. What are the ADA's requirements for public transit buses?

A. The Department of Transportation has issued regulations mandating accessible public transit vehicles and facilities. The regulations include requirements that all new fixed-route, public transit buses be accessible and that supplementary paratransit services be provided for those individuals with disabilities who cannot use fixed-route bus service. For information on how to contact the Department of Transportation, see page 30.

Q. How will the ADA make telecommunications accessible?

A. The ADA requires the establishment of telephone relay services for individuals who use telecommunications devices for deaf persons (TDD's) or similar devices. The Federal Communications Commission has issued regulations specifying standards for the operation of these services.

Q. Are businesses entitled to any tax benefit to help pay for the cost of compliance?

A. As amended in 1990, the Internal Revenue Code allows a deduction of up to $15,000 per year for expenses associated with the removal of qualified architectural and transportation barriers. The 1990 amendment also permits eligible small businesses to receive a tax credit for certain costs of compliance with the ADA. An eligible small business is one whose gross receipts do not exceed $1,000,000 or whose workforce does not consist of more than 30 full-time workers. Qualifying businesses may claim a credit of up to 50 percent of eligible access expenditures that exceed $250 but do not exceed $10,250. Examples of eligible access expenditures include the necessary and reasonable costs of removing architectural, physical, communications, and transportation barriers; providing readers, interpreters, and other auxiliary aids; and acquiring or modifying equipment or devices.

Telephone Numbers for ADA Information

This list contains the telephone numbers of Federal agencies that are responsible for providing information to the public about the Americans with Disabilities Act and organizations that have been funded by the Federal government to provide information through staffed information centers. The agencies and organizations listed are sources for obtaining information about the law's requirements and informal guidance in understanding and complying with the ADA.

ADA Information Line

U.S. Department of Justice

For ADA documents and questions

800-514-0301 (voice)
800-514-0383 (TDD)

Equal Employment Opportunity Commission

For ADA documents

800-669-3362 (voice)
800-800-3302 (TDD)

For ADA questions

800-669-4000 (voice)
800-669-6820 (TDD)

U.S. Department of Transportation

ADA documents and information

202-366-1656 (voice)
202-366-4567 (TDD)

ADA legal questions

202-366-1936 (voice)
TDD: use relay service

Federal Communications Commission

202-418-0190 (voice)
202-418-2555 (TDD)

Architectural and Transportation Barriers Compliance Board

800-872-2253 (voice)
800-993-2822 (TDD)

Job Accommodation Network

800-526-7234 (voice)
800-526-7234 (TDD)

President's Committee on Employment of People with Disabilities

202-376-6200 (voice)
202-376-6205 (TDD)

U.S. Department of Education
Regional Disability and Business Technical Assistance Centers

Call automatically connects to your regional center

800-949-4232 (voice)
800-949-4232 (TDD)

Addresses for ADA Information

U.S. Department of Justice
Civil Rights Division
Disability Rights Section
P.O. Box 66738
Washington, DC 20035-6738

U.S. Equal Employment Opportunity Commission
1801 L Street, NW
Washington, DC 20507

U.S. Department of Transportation
Federal Transit Administration
400 Seventh Street, SW
Washington, DC 20590

Architectural and Transportation Barriers Compliance Board
1331 F Street, NW Suite 1000
Washington, DC 20004-1111

Federal Communications Commission
1919 M Street, NW
Washington, DC 20554

Note: Reproduction of this document is encouraged.

 

 
 
Social Security will pay disability benefits for Cirrhosis, if you meet the following criteria:
Chronic Liver Disease (e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's disease, etc.)

With:

A. Esophageal Varices (demonstrated by X-ray or endoscopy) with a documented history of massive hemorrhage attributable to these varices.
(Consider under disability for 3 years following the last massive hemorrhage; thereafter, evaluate the residual impairment);

or

B. Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter, evaluate the residual impairment;

or

C. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater persisting on repeated examinations for at least 5 months;

or

D. Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less;

or

E. Hepatic encephalopathy. Evaluate under the criteria in Listing 12.02;

or

F. Confirmation of chronic liver disease by liver biopsy (obtained independent of Social Security disability evaluation) and one of the following:

1. Ascites not attributable to other causes, recurrent or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

2. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on repeated examinations for at least 3 months; or

3. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction.

This information was obtained from:  

SSDI Cirrhosis Benefits 5.05

Please visit the following Web site for more information

http://homepages.about.com/imkindly/cirrhosis/id10.html

I Was Fired Because of My Hepatitis C: Was this Legal?

When is a disability a disability?


http://www.nolo.com/lawcenter/auntie/questions.cfm/objectID/A91C20F1-DD4F-4406-

I Was Fired Because of My Hepatitis C: Was this Legal?

QUESTION:
 

I was hired last year by a company in Maryland. I told my employer then that I suffer from Hepatitis C. Everything was fine until I started a new treatment that made me quite ill and forced me to miss work. They fired me. Do I have any rights here?


ANSWER:
 

Your Hepatitis C may bring you under the protections of the federal Americans with Disabilities Act (ADA) (42 U.S.C. §§ 12101-12213). I say "may" because having a medical condition or physical impairment -- even one that is quite serious -- does not necessarily mean that you have a "disability" under the ADA. And if you don't have a disability, you don't get the protections offered by the law, no matter how sick you are.

So what, then, is a disability? It is anything that "substantially impairs a major life activity." Now, there's a mouthful. If you're wondering, "What is substantial impairment?" or "What is a major (as opposed to a minor) life activity?" you are not alone. Even the courts have trouble with this, writing 50-page opinions on why talking and breathing are major life activities but other things aren't.

In the end, the facts of your own case will determine whether you are found to be disabled. In scanning federal cases, I found some cases where Hepatitis was deemed to be a disability, and some where it wasn't. It all depends on how it affects you. If your Hepatitis (or the treatment for your hepatitis) merely makes you feel bad, then it probably doesn't rise to the level of a disability. If it affects your ability to do things, however, such as walk or sleep or eat or remain awake, then it might.

I haven't even touched on your rights if you are disabled. Under the ADA, employers with more than 15 employees must make a "reasonable accommodation" for an employee's disability. Of course, this too is a definition that courts and lawyers spend lifetimes pondering. In some cases, courts have found that giving a disabled employee medical leave or a modified work schedule is a reasonable accommodation; others have found that granting employees long leave times is too much to ask of an employer.

As you can see, this is a very knotty area of the law. Add to this that your state, Maryland, has its own disability rights law with its own rules and intricacies, and it's enough to make one's head spin right off one's shoulders (which, I believe, does qualify as a disability).

The best thing for you to do is contact your local office of the federal Equal Employment Opportunity Commission, the federal agency that enforces the ADA. Its local offices are listed at the agency's website at http://www.eeoc.gov . You can also learn more about the ADA at the federal website http://www.disability.gov . For more on Maryland's disability rights law, contact the state Commission on Human Relations, which you should find in the state government listings of your phone book.

P.S. Depending on how large your employer is and how long you worked there, you might have qualified for unpaid leave under the federal Family and Medical Leave Act (FMLA) (29 U.S.C. § 2601 and following). For information about the FMLA, consult the website of the Wage and Hour Division of the U.S. Department of Labor at http://www.dol.gov/dol/esa/public/whd_org.htm.

 


Sign a petition make Hep C victims eligible for Social Security Benefits

http://www.i-charity.net/bin/ptn/sign/43

Hepatitis C
& Disability Benefits

Download PDF

 

 

  What follows is from the SSDI regulations. These are the some of the parts which can be relevant to filing for hepatitis.

 105.00

Digestive System

A. Disorders of the digestive system which result in disability usually do so because of interference with nutrition and growth, multiple recurrent inflammatory lesions, or other complications of the disease. Such lesions or complications usually respond to treatment.

To constitute a listed impairment, these must be shown to have persisted or be expected to persist despite prescribed therapy for a continuous period of at least 12 months.

B. Documentation of gastrointestinal impairments should include pertinent operative findings, radiographic studies, endoscopies, and biopsy reports. Where a liver biopsy has been performed in chronic liver disease, documentation should include the report of the biopsy.

C. Growth retardation and malnutrition. When the primary disorder of the digestive tract has been documented, evaluate resultant malnutrition under the criteria described in 105.08. Evaluate resultant growth impairment under the criteria described in 100.03. Intestinal disorders, including surgical diversions and potentially correctable congenital lesions, do not represent a severe impairment if the individual is able to maintain adequate nutrition growth and development.

D. Multiple congenital anomalies. See related criteria, and consider as a combination of impairments. 105.01 Category of Impairments, Digestive. 105.03 Esophageal obstruction, caused by atresia, stricture, or stenosis with malnutrition as described under the criteria in 105.08. 105.05 Chronic liver disease.

With one of the following:

A. Inoperable billiary atresia demonstrated by X-ray or surgery; or

B. Intractable ascites not attributable to other causes, with serum albumin of 3.0 gm./100 ml. or less; or C. Esophageal varices (demonstrated by angiography, barium swallow, or endoscopy or by prior performance of a specific shunt or plication procedure); or

D. Hepatic coma, documented by findings from hospital records; or E. Hepatic encephalopathy. Evaluate under the criteria in 112.02; or

F. Chronic active inflammation or necrosis documented by SGOT persistently more than 100 units or serum bilirubin of 2.5 mg. percent or greater. ***from an additional section listing various systems.*** ... 5.05 Chronic liver disease (e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's disease). With: A. Esophageal varices (demonstrated by X-ray or endoscopy) with a documented history of massive hemorrhage attributable to these varices. Consider under a disability for 3 years following the last massive hemorrhage; thereafter, evaluate the residual impairment; or

 B. Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter, evaluate the residual impairment; or

C. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater persisting on repeated examinations for at least 5 months; or

D. Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

E. Hepatic encephalopathy. Evaluate under the criteria in listing 12.02; or F. Confirmation of chronic liver disease by liver biopsy (obtained independent of Social Security disability evaluation) and one of the following:

1. Ascites not attributable to other causes, recurrent or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

2. Serum bilirubin of 2.5 mg. per deciliter (100 ml) or greater on repeated examinations for at least 3 months; or

3. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction. ***From life style changes for HIV because part of the need is to make a comparison between a listed and approved condition and Hepatitis*** N. Repeated (as defined in 14.00D8) manifestations of HIV infection (including those listed in 14.08A - M, but without the requisite findings,..... resulting in significant, documented symptoms or signs (e.g., fatigue, fever, malaise, weight loss, pain, night sweats) and one of the following at the marked level (as defined in 14.00D8): 1. Restriction of activities of daily living; or

2. Difficulties in maintaining social functioning; or

3. Difficulties in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

Posted by Peppermint Patti on the Hep C Alert

http://www.hep-c-alert.org/links/info/1909.txt

Working While Collecting Disability Benefits

Jacques Chambers, CLU, Benefits Consultant

Many people who are collecting disability benefits would like to consider doing some work if it won’t interfere with their benefit payments. Whether they are covered under Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), from a private disability insurance policy or a combination of programs, most will offer some incentives for work attempts. While work can provide a supplement to the disability income, more importantly, it can also improve the spirit and can help alleviate the depression that often accompanies total disability.

For persons with HCV symptoms, there are days when some work is possible even though it may not be eight hours, five days a week. However, people are often hesitant to try any type of employment out of fear that it may jeopardize their disability benefits.

The first rule of working while collecting disability is to thoroughly understand the rules so your benefits don’t get unexpectedly stopped. These rules vary depending on who is paying the disability benefits.

Private disability insurance contracts even vary from policy to policy; some provide for partial benefits while working; others provide assistance in reentering the work force; others stop completely if any work for pay is done. It is important that you review your own contract and understand what your policy provides, if anything. You may want to consult with a benefits counselor if the contract wording is complicated, which is often.

If your disability policy was purchased individually by you, even if there is no partial disability benefit, you can always return to work and start paying premiums again so the coverage will be ready for you if you cannot continue working at a later date.

If, however, your private disability insurance coverage comes from a prior employer, returning to work can be the end of access to that coverage. It’s all the more important to understand how your plan functions before trying to return to work. The most common provision in disability insurance policies will continue benefits in proportion to how much you are earning by working. For example, if you are earning 40% of your old income, adjusted for inflation, the carrier will pay you 60% of your regular benefit.

Note that many of the suggestions for working given below with SSDI or SSI can also apply to private disability insurance.

Both Social Security disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) offer incentives to encourage you to attempt some work without necessarily losing benefits. However, it is important before starting to earn any wages that you thoroughly understand Social Security’s rules about work. Mistakes and misunderstandings can result in overpayments that must be paid back to Social Security as well as the possible loss of future benefits.

The rules for working are totally different between SSDI and SSI. If you are receiving both SSDI and SSI, both sets of rules apply which can really complicate the process.

Before going into the rules of the two plans, there are some important points to be aware of that apply to both plans:

  • Consider a “Dry Run.” Before attempting to do any type of regular work for wages, make sure you can physically and emotionally handle a regular schedule. A person who has not had to maintain a regular schedule in some time may find that the stress and physical demands can quickly overwhelm a fragile health status. Start with a volunteer project, doing anything as long as it involves some regular hours and no wages. It may be at a child care center, stuffing envelopes for a candidate, or whatever you may feel capable of doing for one to four hours a day. The important issue is the schedule, not the work. See how you react to having to get up every morning and go somewhere for a few hours, five days a week. Two or three weeks of this will give you a good idea of how well you might handle some employment.
  • Keep careful records of income and hours worked. Once you start working for wages, keep all paycheck stubs. Also, maintain records of your work hours. Make sure that the records show not only gross pay, but also net pay, hours worked, and time period when the wages were earned.

While you may think that Social Security will have all it needs with the records of payroll taxes being paid, keep in mind that the records that Social Security receives only show gross pay and what tax year they were paid in. Plus, Social Security is approximately two years behind in posting them to your Social Security account. You should keep your paycheck stubs, especially if your earnings vary from month to month

  • Keep receipts and records of any additional expenses you incur due to working and your disability. Social Security allows you to subtract from your earnings any expenses you incur that are necessary for you to work. This can include the cost of special transportation to and from work, prostheses and assistive devices, even medical expenses such as acupuncture, massage therapy or chiropractic treatments. Keep receipts and records for all medical expenses you pay out of your own pocket.

Tell Social Security of your plans to work. Unless you are going to be earning very small amounts, you should notify Social Security of your plans to attempt to do some work. To preserve a record of your notification, either mail them a certified letter, keeping a copy, or personally deliver a letter outlining your plans to your local office and get a signed receipt for it.

  • Some people are afraid to tell Social Security about working because they fear that it will trigger a review of their disabled status. While that may seem like a rational concern, it does not turn out to be the case. The time for the next Continuing Disability Review is set at the time one is completed. Social Security is much too overloaded with work to track and compare people trying to work with their Disability Review date.
  • Don’t follow the wage maximums too closely. If your wages are just below the maximum limits on a consistent basis month after month, then sooner or later, Social Security will become “curious” to determine if your limited work is really due to your medical condition or if you are intentionally keeping your income low to qualify for benefits.
  • Do some more research on Social Security and Work before actually starting to earn wages. The rules regarding working while collecting disability benefits are too complicated to give in one short article. The Social Security website at www.ssa.gov has a wealth of information about working while collecting benefits:

How your wages affect your disability benefits depends on whether you are collecting SSDI or SSI benefits. Both look at what is called “Countable Income or “Countable Earnings.” Countable Income is the gross amount of your earnings less any expenses necessary to keep you working and less any subsidized earnings provided by your employer. See www.ssa.gov or the periodicals listed above for more on Countable Income.

Social Security Disability Insurance (SSDI) – Working with SSDI is an all or nothing type of program. You can collect your full SSDI benefits and earn all you are able to earn for nine months. These nine months are called the Trial Work Period.

Any month that you have Countable Income of $670 (amount for 2008) or more will count as one month in the Trial Work Period. That means that you can earn $5,000 per month or more for nine months and still receive your full SSDI benefits for each month. The Trial Work Months do not have to be consecutive, but are cumulative over a five year period. 

It also means that if your Countable Income is less that $670 (amount for 2008) in a month, then it does not count as a Trial Work Month. If you earn $500 per month every month, you will continue to receive your full SSDI benefits without any particular time limit.

Once you have used all nine months of the Trial Work Period, you will still receive your full SSDI benefits as long as your income does not exceed what Social Security calls Substantial Gainful Activity. In 2008, Substantial Gainful Activity is Countable Income that exceeds $940 per month.

Note to Self-Employed persons: For a self-employed person, Social Security considers any month that you work over 80 hours in the month as exceeding Substantial Gainful Activity, regardless of your Countable Income. Also, regular business expenses are subtracted from earnings to arrive at Countable Income.

Supplemental Security Income (SSI) – SSI treats wages from work more as an ongoing possibility where SSDI considers it to be part of a progression back to full-time employment. It is not unusual for someone to work regularly at a low paying job and still qualify for some SSI benefits.

SSI looks at your wages each month and computes your SSI benefit for the month based on how much you earned (your Countable Income) in that month. This is one reason for the importance of keeping your own records.

SSI ignores the first $20 each month you receive whether from earnings or SSDI or anywhere else. SSI will let you keep the next $65 of your Countable Income.

Any earnings above $65 will be used to reduce your SSI payment for that month, reducing the SSI benefit $1 for every $2 that you earn above $65. To compute this, ˝ of the remainder is subtracted from your SSI payment.

For example, assume SSI is paying you $579 (the federal amount for a single person in 2005). If you have no income other than SSI and work earnings, use $85 instead of $65 in the calculation below. Assume you had Countable Earnings of $365.

  • $365 less $65 leaves $300.
  • $300 X .5 = $150.
  • $579 (normal SSI) – $150 = $429 which will be the SSI payment for that month.
  • $429 (SSI) + $365 (wages) = $794 will be your total income for that month.

Obviously, Social Security does not have the ability to do this calculation before they send out each month’s payment. These calculations are all done some time later, so it is very important that you maintain your own records and set aside any money that was an overpayment, because eventually Social Security will be asking for it back. At least it can earn interest while you have it.

As you can see, the rules for working while collecting disability are fairly complicated and the repercussions for not following them can be expensive. If you feel well enough to attempt some type of employment, it can help you financially and, more importantly, emotionally. However, it is important that you understand the process well before attempting it.

Confused about applying for disability? Click here

[Jacques Chambers, CLU, and his company, Chambers Benefits Consulting, have over 35 years of experience in health, life and disability insurance and Social Security disability benefits. For the past twelve years, he has been assisting people with their rights, problems, and other issues concerning benefits and disability. He can be reached at jacques@helpwithbenefits.com or through his website at: http://www.helpwithbenefits.com.]

Copyright September 2008– Hepatitis C Support Project - All Rights Reserved. Permission to reprint is granted and encouraged with credit to the Hepatitis C Support Project.

Back to Living with Hepatitis C

 



 

   
   

Reviewed Mar 16  2009


copyright © 2003-2008 Janis and Friends Hepatitis C Web Site|  design )by carter

Design downloaded from Zeroweb.org: Free website templates, layouts, and tools.