January, 2016: Jeff’s Case: The Unfortunate Realities of SSI and SSDI and Applying Too Early

Jeff’s case is a good example of how the need to apply for both Supplemental Security Income (SSI) and Social Security disability insurance (SSDI) at an early stage is a double edged sword. Jeff’s story is about a hard working gentleman in his mid-fifties who had always worked very physically demanding positions who became disabled all of a sudden as a result of cervical disk herniation that was causing burning pain and numbness into both his hands and his legs. This required Jeff to undergo a surgical procedure, called a cervical fusion, within weeks after going out of work which was going to keep him out of work for potentially three (3) to six (6) months.

At that time, Jeff and his significant other were faced with the lack of his income and the need to pay the mortgage for the home they shared. Because they were unmarried, the income of Jeff’s significant other was not counted as income that would exclude his ability to collect an SSI check. Because SSI pays the month after one becomes disabled, assuming one remains totally disabled from all forms of gainful income for a year or longer and remains in poverty circumstances, failing to wait to apply for benefits could result in the loss of benefits. Unfortunately, however, the filing of a claim for benefits this early on after going out of work is likely to result in a denial of benefit. This is exactly what happened to Jeff.

Upon getting denied upon the filing of his disability claim with the Portland, Maine Social Security district office, we filed a request for reconsideration on Jeff’s behalf. During this period of time, it becomes clear that Jeff did not have a good result from his surgery and is referred for both physical and occupational therapy as a result of the continuing problems he’s experiencing. By the time he’s finishing these treatment modalities, he still remains only 8 months disabled from working: he had not quite made it disabled from working for a year or longer. Thus, not surprisingly (given the very high denial rate on reconsideration: our experience is that the reconsideration process is very much a rubber stamp denial of an initial denial), Jeff’s claim was denied on reconsideration.

Fortunately, Jeff has continued to treat with a very involved and sympathetic neurologist who has managed his care since the time of surgery and release from his neurosurgeon. He has required continued increases in his medication management which has made evident that the neuropathic pain he has continued to experience has remained extreme. Likewise, he is provided with TENS unit gloves given the severity of the burning pain he’s experiencing in his hands (making it very difficult for him to function in any meaningful way). Jeff’s neurologist was kind enough to address a Physical Residual Functional Capacity Questionnaire we provided with detailed he nature and severity of Jeff’s ongoing condition and how, despite his treatment, Jeff has remained severely functionally compromised. In addition, Jeff followed up aggressively with all treatment options available to him, which included psychiatric evaluation and treatment and referral for pain management that included the possibility of a spinal cord stimulator for potential control of his pain.

The lesson learned from Jeff’s story is that however disabled one may be early on, the Social Security rules are looking to see if one remains totally disabled from all forms of gainful employment for a year or longer, despite prescribed treatment. If there appears to be an avenue for getting better, then SSA is not about to provide benefits at such an early stage. However, given SSDI benefits are not payable until after a full five (5) month waiting period, it may be necessary to apply early on so one does not forego payment of the SSI welfare benefits that will be available beginning the month after one applies, assuming one is ultimately found disabled a year or longer.

While Jeff had to wait quite some time for a favorable decision to be rendered in his claim, he stood the course with both the appeals processes and his treatment. I’m happy to report that help arrived for Jeff and his significant other in the nick of time: prior to the foreclosure of their home. While there was not much we could do to help Jeff’s physical problems, he is certainly resting easier knowing that his significant other no longer has to carry the full freight.

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