"Work Disability / SSDI / Health Insurance" Chat Transcript for Ms. Sheri Abrams

Moderator
Good afternoon. The Lupus Foundation of America is pleased to welcome Ms. Sheri Abrams.

Ms. Abrams is a Fairfax, Virginia, Attorney dedicated to helping people with Social Security Disability Benefits issues, as well as working with people to prepare Special Needs Trusts, Wills, Living Wills, a Health Care Power of Attorney, or a Financial Power of Attorney.

Ms. Abrams is a solo practitioner in Virginia, whose niche-within-a-niche is in the Special Needs area of estate planning, which requires additional care and experience, to properly understand and meet the needs of the community involved.

Ms. Abrams has received an AV Superior Rating, the highest ranking possible in the Martindale-Hubbell Law Directory.

We welcome Ms. Abrams, and thank her for joining us this afternoon.

Before we begin, Ms. Abrams asked me to post the following note.

Ms. Abrams
Good afternoon … I appreciate the chance to participate in this Webchat and talk to everyone about the Social Security Disability programs and how people with lupus can qualify for benefits. What I would like to do first is give you some brief information on the law so that we are all on the same page.

Basically the Social Security Act requires that you prove that you suffer from medical problems that are so severe that they make it impossible for you to perform any type of work available in the national economy. Remember, what we are focusing on here is how these medical problems impact on your ability to "function" -- how they affect your ability to sustain work activities in a job setting. This law is the same for both Social Security Disability benefits (SSDI) and Supplemental Security Income (SSI) claims -- the difference in these programs is your work history - to qualify for SSDI, you must have worked and paid FICA taxes for a sufficient period of time -- to qualify for SSI you must meet stringent asset and income limitations.

Since this chat is only an hour, I know I will not be able to get to all of your questions. I will, however, be answering some of the questions that were submitted in advance and they will be posted.

If you would like more information, please go to my website at http://www.sheriabrams.com and my blog at http://sheriabrams.com/blog/. There is a contact form on my site that you can use to ask me questions that are not answered by my website and blog. You can also take a look at Social Security’s website at http://www.ssa.gov.

You may also want to contact one of the Disability/Insurance Case Managers at the Patient Advocate Foundation for any questions you may have about your particular circumstances.

Moderator
Thank you Ms. Abrams. Without further delay, let's begin. The first question comes to us from Kentucky.

Moderator
Can someone tell me why chances of winning a disability case goes up after the patient turns age 50? Does anyone know exactly how sick you have to be to get disability with lupus? I have been penalized because I am educated and can work in theory but in reality I do not have the energy to do anything. I am killing myself literally while working because I don't qualify for disability. All of my energy is used while working therefore I cannot get out of bed while I am home. I do not cook clean, or have any kind of life. -- Henderson, KY

Ms. Abrams
The Social Security Act does consider age. Anyone under 50 yrs old is considered to be a younger individual. Between ages 50 and 55 you are considered to be "closely approaching advanced age" and the law is slightly relaxed, especially if you do not have a high school degree. Between ages 55-60 you are considered to be of advanced age and the law is relaxed a little more, especially if you've only been doing physical work in the past. The standards are relaxed a little more between ages 60-64 when you are considered to be "closely approaching retirement age." As far as how sick you have to be, you need to be sick enough that you are unable to work in theory or not. Social Security does not care if you are not able to do other things except work, just that you are able to work.

Moderator
I work part-time at 24 hours/week. This works fine for now as my husband works full-time and I stay home with my daughter. However, I have come to the realization that I couldn't work full-time if I wanted to. I am simply too sore, fatigued and get sick when I push myself beyond any of my current responsibilities. In fact, I cannot even handle working 2 days in a row. At what point would I qualify to apply for SSD? Would it supplement my current income? Should I wait until my daughter (only 2 1/2 now) starts school 5 days a week. I don't want to depend on SSD but realize I may need to in the future. I sincerely thank you for your time! -- Rochester, NY

Ms. Abrams
If you are able to work 24 hours a week you probably will not qualify for Social Security Disability. It really depends on how much you are earning gross each month, not annual earnings. Social Security deems you to be working if you are able to make more than $980 gross each month, which is called SGA (Significant Gainful Activity). Remember the issue in a disability claim is whether you are totally disabled and are unable to perform any type of work. It does not matter whether the work you can do pays well or is a job that you like. If you can still work on a sustained basis, even at a lower level job, you are not totally disabled.

PAUL
I have been rejected twice by Social Security, and appealed to the Admin Law Judge. I have just been told that my case has been “outsourced” to the Texas Department of Health for review. I live in Florida. Can you explain why this has happened?

Ms. Abrams
Because of the backlog at Social Security, they are sending cases for review at other offices. In my area, it is a good thing to be sent for another review before a hearing since we tend to get more favorable decisions this way.

PAUL
Does this mean they can reject me as well?

Ms. Abrams
It would not be a rejection; it would be that they could not grant so they are returning you to your place in line at the hearing office.

Bryan
I am an attorney whose primary area of practice is in Social Security Disability. My wife has CNS lupus and has a SS application pending. Do you have any suggestions as to forms that can be filled out by her doctors or CFR citations (or those to the POMS or SSR) that would be helpful?

Ms. Abrams
To be honest, I would not use any form provided by SSA (if there are any). I have designed many forms (interrogatories) for doctors to fill out. You can also contact me off line to get some professional resources I would recommend.

Moderator
Is there a set amount of time one should be off from work before applying for disability? -- Benton, KY

Ms. Abrams
If you believe that you will be off of work for a year or more and are not collecting unemployment insurance, you should apply for Social Security Disability benefits immediately.

Moderator
I have been out of work since last year. My doctor has put me out of work permanently due to some serious/complex issues with SLE. All is documented. Is this a disease that gets approved for social security disability? And how long does that take? Will it be a fight as usual I have nothing left I can do all of my joints are affected. That’s just the beginning. I have been turned down for life insurance because of the disease. Any hints on making the process go any faster? -- Media, PA

Ms. Abrams
SLE is a disease that does get approved for Social Security Disability benefits. However, normally it takes a year and a half to get through the process and get approved for benefits. Yes it is a fight to get benefits but it is a winnable fight. It does not matter if you were denied life insurance (Social Security does not take this into consideration). There is very little you can do to speed up the process. Having an Attorney represent you can help but sometimes it just takes a very long time.

Lupina
Good Afternoon Ms. Abrams. I'm sorry I didn't get my question in sooner, but hopefully you will have time to respond, My question is “What would be the recourse for a disabled person who is initially approved SSDI and receives benefits for several years and is later denied?”

Ms. Abrams
I believe what you are asking about is a review denial. After you are approved for SSDI you are still reviewed periodically. I suggest you appeal your denial immediately; if you do so within 10 days of the date of the letter, you can keep receiving benefits.

Lauralei
What is available during the SSDI determination waiting period ? Can I get UI (universal insurance)? What about SSI? Thanks

Ms. Abrams
SSDI and SSI decisions come together so you cannot get SSI while you are waiting for an SSDI decision. If you are approved for SSI there is no waiting period you will get paid from your application date. We do not have UI (universal insurance?) here, but if that is welfare, then yes you can get that while you are waiting if you qualify.

dcole15
Last year I was hospitalized and diagnosed with lupus, rheumatoid arthritis and congestive heart failure. I had no insurance and had to get on Medicaid. I am in the appeal process with disability. My question is, if I ever do get approved for disability will I be kicked off Medicaid?

Ms. Abrams
It depends on how much per month you will receive from SSDI and how much your back benefits will be. To be honest, most of my clients do lose their Medicaid because Medicaid is a welfare program. However you will qualify for Medicare when you have gotten 24 months of SSDI.

jake
I am on my husband’s health plan. Can I stay on it if I am on SSI or SSDI?

Ms. Abrams
Social Security will never make you drop your medical insurance. So yes, you can stay on it.

Moderator
My question (and I don't know if you can answer it) is … I haven't worked since 2002 due to my lupus. Now it seems to have manifested in many other areas of my body and in different diseases. I was thinking that I possibly might be able to file for SSDI but didn't know if there was a certain amount of years after one had worked to still submit for it. Thank you for your answer. -- Parker, CO

Ms. Abrams
You are only fully insured for Social Security Disability benefits for 5 years after you stopped working. The general rule is that to be eligible for SSDI you have to have worked and paid FICA taxes for 20 quarters of the 40 quarters prior to the date you became totally disabled. It is often easier to think of this as requiring that you worked and paid FICA taxes for 5 of the 10 years prior to the date you became totally disabled. That rule is slightly relaxed if you are under 28 years old. So you would need to be able to prove that you were unable to work by 2007. If you do not qualify for SSDI benefits you should consider if you quality for SSI benefits which is the welfare version of Social Security Disability. There is no work requirement or time frame but there is an income and asset limitation. If you are not sure you should apply for benefits at Social Security which will give you your actual work figures.

Moderator
How can you get disability when you have no insurance to go to a doctor for treatments? When you have lupus you don't always look sick, but no employer can put up with the on again / off again ability to work when you have flare ups. How do I communicate this to SSI/Disability? -- St. Petersburg, FL

Ms. Abrams
To address your first question, unfortunately Social Security does not care that you have no insurance to go to a doctor for treatment since they know that there are free clinics available for a person to go to. In regard to your second question, Social Security does not care if no employer will hire you or put up with your off and on again ability to work, Social Security just cares if you are able to work at all. However in response to your third question, an Attorney who specializes in Social Security Disability matters can help you communicate some of these issues and others that may help you receive your benefits.

Sandy
I have a family member who has had subacute LE with APS. Something is changing in her disease and she has exhausted all of her sick leave and vacation because of the disease progression. Her job is currently protected to FML, but if this keeps on, it could be exhausted as well. From this description can you tell me where she is on the disability continuum and what her next steps should be if the FML is exhausted?

Ms. Abrams
It is hard to say where she stands. It depends on whether her doctors will say she is unable to do any work (not just the work she was doing before). At this point I would ask her doctors what they think. I would also look into whether her company has short term and/or long term disability insurance. Going on short term disability is probably her next step.

vprez
My husband has just been diagnosed with lupus. It has caused damage to his kidney and his nervous system. He does not have sick leave on his job, only paid time off which was about 80 hours. The doctors don't know how long it will be before he can return to work. What are his options for financial assistance if disability is going to take 1 and 1/2 years?

Ms. Abrams
This is a question I get a lot. Unfortunately there is not much available. Many of my clients borrow from friends or family, some go into their savings or retirement funds. Some have to apply for welfare. You may want to check to make sure his job does not have short term or long term disability insurance.

mentos
I hear that disability just automatically denies you. Is it best to consult an attorney to start? Any recommendations and what kind of fee can I expect for such an appeal?

Ms. Abrams
Depending on the case, I take cases at the first stage or after the first denial. All Social Security disability lawyers charge the same fee that is set by the U.S. Government. That is we charge 25% or $6000 whichever is less of your back benefits, none of your future benefits. So if you get $4000 back benefits, we get $1000. If you get 100,000 we get $6,000. It does not matter at which stage you hire an attorney the fee is the same.

ventana
I am currently on Short Term Disability and I have insurance through my job. I was told that I wouldn't be eligible for SSI because I have no kids and because I am a permanent resident, not a citizen. Is that true?

Ms. Abrams
That is true, only U.S. citizens can get SSI. Since you are getting STD you probably are receiving too much to get SSI anyway. But since you are getting STD that means you have worked so maybe you can get the main Social Security program (SSDI). You do not need to be a U.S. citizen for SSDI.

Moderator
Hello. I have paid into the SSDI system for 25. I am soon to file for SSDI and would like to know if they consider my husband’s income into the equation. My SSA statement said I qualify for $1,074 a month, according to my credits and taxes paid into the insurance fund. I am married and my spouse makes decent money, but I can no longer work. Do they modify my benefits according to what he earns? Or does it matter? Also, can I own a car or a home? I have heard rumors that you need to be dead broke to file. I feel that because I can't work any longer and that I have paid into the system, none of that should matter. Can you shed any light on the subject? -- Salt Lake City, UT

Ms. Abrams
Because you are applying for Social Security Disability benefits and not SSI, it does not matter what your husband makes or what assets you own. You could be a millionaire and still collect your $1074 a month.

Moderator
My COBRA coverage has been cancelled and I can't get medical coverage anywhere else due to my lupus. What are my options with SSDI? I work for myself, as I can't work for a company because of my lupus. I need to make my own hours etc. Please help. I am fighting with COBRA to reinstate me, but no luck at this point. -- Stockton, CA

Ms. Abrams
If you are able to work even for yourself, you will not be able to collect SSDI. It really depends on how much you are making and how many hours you are working. Remember the issue in a disability claim is whether you are totally disabled and are unable to perform any type of work. It does not matter whether the work you can do pays well or is a job that you like. If you can still work on a sustained basis, even at a lower level job, you are not totally disabled.

Greek God
I have applied for disability and am awaiting a decision. How long does this process take?

Ms. Abrams
The whole process usually takes 1 and 1/2 years. However between stages it takes different amounts of time. In my area, it is usually 1 to 3 months to get a denial at the initial and the recon stages and then a year to get a hearing date. Then it usually takes 1 to 3 months to get a decision from a judge.

Lauralei
I am a nurse, and need to work a certain amount of hours per year to keep my license current. Is this harmful to do while awaiting my SSDI/SSI decision? Thanks.

Ms. Abrams
It really depends on how many hours and what you get paid for them. If possible I would do these hours as a volunteer. If it isn’t that hard to get your license back, it probably will look better to a judge that you had to let your nurse's license lapse.

Brooksy
I am on long term disability through my job. At what point, if any, should I apply for Social Security Disability?

Ms. Abrams
If you have been out of work for a year or will be out of work for a year or more, you should apply immediately, your LTD will make you apply at some point anyway because there is an offset between LTD and SSDI. I suggest that you hire your own attorney and do not let the LTD suggest or assign you an attorney – same attorney's fee but better representation with no conflict of interest.

Tammy
What is the difference between Medicaid and Medicare, and do physicians have to accept them?

Ms. Abrams
Medicare comes with SSDI after 24 months and is the same as you get at 65. Medicaid is the welfare based insurance and it comes with SSI immediately … no waiting 24 months. No doctor has to take either of them. Medicaid is usually only taken at free clinics.

Ani
Ms. Abrams, when I was diagnosed I was under my husband’s insurance. Later we got divorced and I am no longer on insurance policy. Since then I have been denied private insurance several times. What are my options?

Ms. Abrams
I am afraid you do not have many options. There is no insurance that you are guaranteed of getting. You can apply for private insurance but because of pre -existing condition will probably get denied or will be very expensive. If you are low income maybe you can get Medicaid.

ventana
What's the difference between SSI and SSDI?

Ms. Abrams
The law is the same for both Social Security Disability benefits (SSDI) and Supplemental Security Income (SSI) claims -- the difference in these programs is your work history -- to qualify for SSDI, you must have worked and paid FICA taxes for a sufficient period of time -- to qualify for SSI you must meet stringent asset and income limitations.

Moderator
I am working part time, with lupus and I also receive my disability. I would like to know more about the program to work a full time job because my check is only covering my bills it is just not enough. What type of program is there for me to work or go back to school for training to live a better quality of life with this disease. -- Brinkley, AR

Ms. Abrams
There is really no program where you can work full time and still get disability benefits from Social Security. You do have a 9 month trial work period you can use that would allow you to work full time and still get your disability benefits, but it is only for 9 months.

Moderator
It took me getting a lawyer to get disability, but they gave it to me for 18 months and it ends in June. I was told by the judge to see a psychologist, get better, and get back to work. At that time, I was diagnosed with Auto-Immune Disease, Fibromyalgia, Colitis, back and neck problems etc. They threw out my lupus because a ND diagnosed me. Now a rheumatologist has diagnosed me with it. Can they force me back to work when I am not well even if they think I am? What are my rights? -- Grants Pass, OR

Ms. Abrams
I have never heard of a judge limiting how long a person can receive Social Security Disability benefits. What a judge can do is recommend that a person’s case be reviewed at a certain point. So in your case all is not lost at 18 months, if you are reviewed you just have to show that you are still unable to work.

Jimmy
My wife is currently working and wishes to apply for social security but her lupus doctor told her to wait until she has a 2nd child then he will help her. Do you understand why he would tell her this?

Ms. Abrams
He may have said this because it is very difficult to get disability if you were pregnant during any of time that you claim your wife was disabled and unable to work.

Moderator
I am 35 years old; I have three young children, 9, 10, 15. I have been diagnosis with lupus for almost 5 years. I was denied disability and SSI because I was too young, that I could not receive it. Am I entitled and how can I get SSI or disability? -- Washington, DC

Ms. Abrams
In general you cannot be too young to receive Social Security Disability and SSI benefits. However you don’t qualify for Social Security Disability and SSI benefits just because you carry a diagnosis of lupus, you must be unable to work. Also Social Security does not care how many children you have in determining if you are unable to work. I suggest that you contact me or another Attorney in our area to discuss your case.

cjb
After I was diagnosed with SLE, I later found out I have Overlapping (or Mixed) Connective Tissue Disease and Fibromyalgia. The MCTD symptoms are basically lupus and scleroderma/CREST symptoms. How does this affect my claim for SSDI? BTW, I applied in mid-2007 and just found out my hearing is in Feb. 2010 (2 and a half years!).

Ms. Abrams
It does not really matter what your diagnosis is, just that you are unable to do any work in the national economy.

Moderator
I am 64, afflicted with systemic lupus, unable to get a part time job to supplement my 830 monthly retirement benefits. Since this amount is far less than needed to live on a day to day basis, is it entirely impossible for me to go from SS to permanent disability which increases my income approximately 300 more a month? -- Riverside, CA

Ms. Abrams
It is not impossible. As you know if you take early retirement at age 62, you receive about 80% of your retirement benefit. If you also qualify for SSDI then your check will be increased to the full 100%. I suggest that you talk to an Attorney to get assistance on this matter as soon as possible.

Moderator
I am looking to apply for disability. I have been advised that I should go through an attorney than trying to do it myself. I have lupus, thyroid, fibromyalgia and rheumatoid arthritis. -- Houston, TX

Ms. Abrams
In my opinion it is always better to use an Attorney for Social Security Disability cases.

Moderator
How do you make the decision to go out after fighting against it so long? My pain has increased lately and every morning it is getting harder and harder to make it out of bed to go to work. I try when at work to get as current as possible with my work so that if I go out my employer won’t have a back log. But should I even care or attempt to put more pressure on myself during the time that I am there or just go out on faith? -- Philadelphia, PA

Ms. Abrams
Whether you should go out on disability is a very difficult decision. I suggest to my clients that they confer with their doctors for advice.

Moderator
What are the criteria for getting disability? My doctor does not file disability papers, should I change doctors? -- Wyandotte, OK

Ms. Abrams
In general you have to be disabled enough to not be able to work at all in the national economy. It is very important that your doctor support your claim for benefits by being willing to file disability papers, so yes you should probably change doctors.

Moderator
I have SLE that led to kidney failure in 2005. Since then I had a transplant in 2006, I went back to work last year, but I usually suffer from tiredness, fatigue and joint pains. My question is since I had a transplant, my lupus is not active would I qualify for SSD, I did take SSD when I was on Dialysis because I was told I would have to pay it back, but now I am unemployed and paying for COBRA, which is taxing. -- New York, NY

Ms. Abrams
It depends on whether you are able to work now. You said that your lupus is not active but you still suffer from tiredness, fatigue and joint pains, what are these symptoms from? If you cannot work because of them and your doctor will say that you cannot work you probably have a case.

Tammy
I currently have private insurance but will soon be eligible for Medicare. Can my private insurance deny giving me supplemental insurance? I was told I will need to purchase supplemental insurance because Medicare won't cover everything.

Ms. Abrams
A private insurance company does not have to give you supplemental insurance. I would check with AARP for Medicare supplemental policies.

mentos
Can you recommend anyone or do you also handle the Illinois area as well?

Ms. Abrams
I do not have a name for you, but there is an organization that all Social Security lawyers belong to. It is called NOSSCR and can be reached at Nosscr.org. Please make sure that you use an attorney who does a lot of these cases; social security is not an area that you can dabble in.

Moderator
How is it possible to be approved for permanent disability through the state by my doctor, but denied through my private insurance Prudential? I have been fighting with them for years and am now seeking legal remedies for appeals in their denial of my claim. -- Ontario, CA

Ms. Abrams
Getting Disability benefits from one program or entity does not guarantee approval by any other program or entity.

Moderator
I have applied for disability and was denied because I work but I am the sole income in my family and can't afford to stop working to get disability so I am always in severe pain. Is there any way to get around this problem? I have SLE, Rheumatoid arthritis, fibromyalgia, anemia and DDD so far. -- Watertown, NY

Ms. Abrams
There is no way to get Social Security Disability if you are working. If your company provides Short Term or Long Term Disability benefits, then you can stop working and go on these while you apply for Social Security Disability benefits.

Mika
Can you take appeal claims from California?

Ms. Abrams
Sorry, I only practice in Virginia, DC and Maryland. I suggest that you contact Nosscr or your state bar for a referral.

Moderator
I have been diagnosed and living with lupus for the past 13 years. I don't qualify for health insurance due to "pre-existing" conditions. My flare-ups cause me to have costly medical expenses which take up most of my income. Is Lupus considered a disability and can I get any form of government help due to my lupus condition? -- Dallas, TX

Ms. Abrams
Lupus is considered a disability and if you get Social Security Disability benefits you can receive Medicare after receiving Social Security Disability benefits for 24 months.

Moderator
I have been on Short term disability 2 times with lupus. What criteria are needed to qualify for LTD/SS? -- Glendale, AZ

Ms. Abrams
LTD requirements vary by the policy that you have. However, in general you need to be able to prove that you are unable to do the work you were doing when you became unable to work.

Moderator
I have been denied for SSDI twice even though I have three doctors telling me I can't return to work. My doctors sent letters explaining my illness (lupus & crohn's). I explained with great detail why I can't work on the explanation forms. I now have to go before a Judge and explain everything. What can I say to the Judge to make them understand? I really need financial help. -- Indianapolis, IN

Ms. Abrams
In my opinion it would be a mistake to go before a Judge without an Attorney representing you. That Attorney should be one who does a lot of Social Security Disability cases and knows the Judge you will be going before. Do not wait until right before your hearing; hire an Attorney immediately.

Moderator
I have ulcers recurring on both ankles. I don't stand at work I sit down and I still get ulcers on my ankles. However, my job is very stressful. Do you think it would be possible to get on SSI or SSDI? -- Detroit, MI

Ms. Abrams
It depends on many factors, especially your age. I suggest that you contact an Attorney who specializes in Social Security Disability. However, how stressful your current job is does not help or hurt your case.

Moderator
I was told I did not work in the time period required, so therefore I am not eligible for benefits. The truth is that I did not apply because my husband was working and I did not feel we needed the money and I had health insurance. Now he was forced into retirement and my COBRA is running out in one month and cannot afford to get insurance or get turned down for pre-existing conditions. Can I go back to the time period I felt I was first disabled and apply for that date, during the time I was eligible by their terms but did not apply? Do I need an attorney? Thank you very much. -- Chula Vista, CA

Ms. Abrams
The general rule is that to be eligible for SSDI you have to have worked and paid FICA taxes for 20 quarters of the 40 quarters prior to the date you became totally disabled. It is often easier to think of this as requiring that you worked and paid FICA taxes for 5 of the 10 years prior to the date you became totally disabled. That rule is slightly relaxed if you are under 28 years old. Therefore in your case you would have to prove you were disabled in the past which is very difficult. I do suggest that you talk to an Attorney.

Moderator
I have had lupus since I was 16. Now that I am 32 it is not seeming to get any better. I am looking to get some type of disability, but I can do a little work, also I am in school to become a teacher and right now I don't have health insurance. What am I supposed to do about this issue? The health insurance and the disability. I have tried to explore every option and it seems like a dead end. I hope my question was clear. -- Alexandria, VA

Ms. Abrams
You have a complicated and specific situation; I suggest that you call me or another Attorney here in Northern Virginia to discuss it.

Moderator
My SSD hearing is this November, my lupus is extremely complex and I have disability support from my doctor, I'm organizing my personal notes but find it overwhelming to try and explain this to others, if I didn't live it I think I would have a hard time understanding it. What do you suggest for preparing/presentation for a SSD hearing? I'm also being represented by AllSup. -- Ballston Spa, NY

Ms. Abrams
Each Attorney or Representative suggests different things to their clients. Since you are represented by Allsup (which for those who do not know is a large company that represents claimants all over the country) I feel I need to refer you to them for their preparation strategies.

I must say, however, that I am not a fan of the big companies who represent claimants nationally.

Moderator
Hello, my question is, I haven’t be able to work for at least a year already, every job I had I have to quit after 2 or 3 months because I just cant take it. The lupus just won’t let me do what I am supposed to do. So I want to know is there anyway I can receive help? Disability? I have a bunch of bills to pay, right now am receiving Medicaid because I am pregnant and really sick, is that the only help I can receive? -- Stamford, CT

Ms. Abrams
You can apply for Social Security Disability benefits and SSI but you should know that Social Security always seems to think that pregnancy is what is really making you ill and therefore it is very difficult to prove disability if during the time in question you were pregnant. Also you have a lot of bills to pay now and it can take a year to 2 years to get approved, so you should not count on Social Security for quick help.

Moderator
It is hard to find life insurance where can I get insurance for my 39 year old daughter who has lupus. -- Pittsburg, CA

Ms. Abrams
I suggest that you check with an insurance agent. However, many times when there is a pre-existing condition, no life insurance company will issue a policy.

Moderator
I worked for the federal government for nearly 20 years before I had to retire on disability. I have an annuity from the Civil Service Retirement System. I have always assumed that this means I do not qualify for social security. But is SSDI something separate that I can apply for? I do not work because if I am exposed to anything, I get really sick; also the stress of a job exacerbates the lupus. Thanks for your help. -- Henderson, CO

Ms. Abrams
In general if you have a Civil Service Retirement from the Federal Government you do not qualify for Social Security Disability unless you also worked in the private sector for a good number of years. This would be different if you retired on the FERS system from the U.S. Government. I suggest that you check with both OPM and Social Security to find out.

Moderator
Why does Social Security give you such a hard time, even though your job has said you're unable to perform the duties of your job? -- Stone Mountain, GA

Ms. Abrams
In order to receive Social Security Disability benefits, most people (depending on age) have to prove that they cannot do any work in the national economy, not just what you used to do.

Moderator
Since applying for SSD 11/07, I was denied and now awaiting my hearing on 11/12/09, I have had multiple new diagnoses and testing done for heart related problems. Are my chances good for approval? -- Swansea, MA

Ms. Abrams
It is hard to say what your chances are without more details, such as your age, education, past work, and what your doctors are saying about your ability to work. However, in my opinion if you do not have an Attorney who will represent you at your upcoming hearing I think you will be making a big mistake.

Moderator
I have a 22 year old son, diagnosed with down syndrome and a year ago was also diagnosed with lupus. Where can I go for help besides what I get from the state of NJ? -- Ridgefield Park, NJ

Ms. Abrams
Since your son is over 18, your income and assets are not taken into consideration, so as long as your son is not working (or working very little) and does not have assets of more than $2,000, he should be able to qualify for SSI (Supplemental Security Income). I suggest that you make an appointment with Social Security to determine his eligibility for SSI. However I do suggest that you contact an Attorney who works in this area to discuss the pros and cons of SSI, his living arrangement (is he paying rent?) and if your son does have more than $2000 or may inherit some money the benefits of a Special Needs Trust.

Moderator
My husband is self-employed and I carry health insurance on the family. What happens if I can't do this anymore and I have to file for disability? I'm not eligible for any private insurance and state insurance wouldn't cover me for lupus. All my medications and doctor visits...I'm stuck! Is there a partial disability? I seem to do okay for about 3 days a week and then become really fatigued, increased pain, memory problems...cycle repeats. -- Bristol, VA

Ms. Abrams
I am afraid that there is no partial disability from Social Security; however your job may have short term and long term disability insurance through an insurance company. Unfortunately medical insurance is going to be a big problem, since you will not be eligible for Medicare until you get 24 months worth of Social Security Disability benefits and Medicare will only cover you and not your husband or children.

Moderator
My mother has discoid lupus. She's battling the hair loss, flares, aches, etc. It is difficult more times than not to engage in daily routines such as work. Her boss decided that due to her health and appointments that he would decrease her hours. From five days a week she is now working two days a week and it has been extremely difficult for her to make ends meet. She has children still in her care and she is the sole bread winner. I want to know what assistance is available for her, if any. -- Teaneck, NJ

Ms. Abrams
If your mother is still able to make more than $980 gross per month, which is SGA (Significant Gainful Activity), then she will not be able to qualify for Social Security Disability benefits even if she has children and is having difficulty making ends meet. Remember the issue in a disability claim is whether you are totally disabled and are unable to perform any type of work. It does not matter whether the work you can do pays well or is a job that you like. If you can still work on a sustained basis, even at a lower level job, you are not totally disabled.

Moderator
I left the workforce in 1997 to be a Stay-At-Home Mother. But I became ill in 2006 just as my youngest child was about to enter Kindergarten and I would be able to start working again. I became increasingly ill and have only recently been diagnosed with Lupus. I did work full time from 1987 until 1997, but I have not been employed since that time. Can I still receive SSDI? -- Orlando, FL

Ms. Abrams
Probably not, since in general you are only fully insured for Social Security Disability benefits for 5 years after you stop working. The general rule is that to be eligible for SSDI you have to have worked and paid FICA taxes for 20 quarters of the 40 quarters prior to the date you became totally disabled. It is often easier to think of this as requiring that you worked and paid FICA taxes for 5 of the 10 years prior to the date you became totally disabled. That rule is slightly relaxed if you are under 28 years old. This means that you would have to be able to prove that you were not able to work during the 5 years after you stopped working. In your case you would have had to have become ill before 2002.

Moderator
I work outdoors for our county parks. I found out in June that I was allergic to the sun. I was diagnosed with Systemic Lupus. What do I do to get on disability? I still work outdoors and I have to be very careful or I'll end up in the emergency room again. -- Dayton, OH

Ms. Abrams
I am afraid that you probably would be unable to get Social Security Disability since you can work ... just not in the sun. So you could do other work. I think you would also have a lot of problems collecting short term or long term disability benefits or an ADA accommodation.

Moderator
Can I collect Disability for my Lupus now that I'm unable to work even though I have not worked in the past 11 years but I am now in a financial hardship and returning back to work would be difficult? -- Phoenix, AZ

Ms. Abrams
Sorry, but it would be very difficult given that your benefits ran out 5 years after you last worked. The general rule is that to be eligible for SSDI you have to have worked and paid FICA taxes for 20 quarters of the 40 quarters prior to the date you became totally disabled. It is often easier to think of this as requiring that you worked and paid FICA taxes for 5 of the 10 years prior to the date you became totally disabled. That rule is slightly relaxed if you are under 28 years old. I suggest that you go over your case with an attorney and consider applying for SSI.

Moderator
I have not been in the work force for over 3 yrs. unfortunately after my SLE diagnosis in 1995 I have lived with chronic anxiety and panic attacks along with all the other symptoms of Lupus. I have been out of the work force for over 3 yrs. Will it be hard for me to be approved for SSD Benefits? My husband is on SSD with MS and can't work anymore. Our health ins. is $1500 a month which eats up his SSD check. When our retirement money is all eaten up for health insurance I fear we will be left uninsured. Do I have any options? -- Brunswick, ME

Ms. Abrams
Given you situation I suggest that you immediately apply for Social Security Disability benefits. You can probably get benefits based on your Lupus or your anxiety or a combination of both.

Moderator
How can I get State Disability? I am on Chemo/prednisone and unable to work. I do not have enough "work credits" within consecutive years. -- Phelan, CA

Ms. Abrams
You can only get state disability if you worked as an employee of the state.

Moderator
Good day. I have seen many advertisements regarding representation in filing for SSDI benefits. Statistically, is it truly an advantage to work with and pay someone to help collect SSDI? I am a smart person and know how to read guidelines and fill out forms. It seems like I would be giving needed money to someone else for something I could have done myself. My condition is deteriorating and I am considering filing a claim. Any thoughts or suggestions? -- Salt Lake City, UT

Ms. Abrams
You have a much better chance of getting your Social Security benefits if you hire an attorney. It also will look bad if on one hand you say that you are unable to work but then you are able to represent yourself in your claim and do all the work that is necessary for that. In addition, you probably will make yourself weaker if you attempt to do this yourself.

Moderator
I am a Lupus patient for about 10 years now. I am currently on dialysis. I receive SSI benefit and medical. My question is how my SSI benefit and medical (California state health insurance) will be affected if I start working? -- Anaheim, CA

Ms. Abrams
I am not sure about California State health insurance, but if you work while on SSI, Social Security will reduce your check dollar for dollar.

Moderator
I am currently living in Australia since April 2009. What type of disability and insurance am I entitled to living abroad. I am an American Citizen. -- Seguin, TX

Ms. Abrams
Whenever you live in a foreign country and need info on Social Security, you need to consult with the U.S. Embassy.

Moderator
My computer is not working at the moment, but I can retrieve messages from my job computer. I am currently on Public Assistance through the state of New York, and I went to a hearing for SSI benefits. My case was denied; the judge stated in the results that my condition was not serious enough. I am out of work and I have been on chemotherapy for my lupus and on strong medication. Is there anything that I can do? -- New York, NY

Ms. Abrams
If you were denied by the Judge within the last 60 days you can appeal the denial to the Social Security Administration’s Appeals Council in Falls Church, VA (contact your hearing office or your local district office for the forms to do so).

Ms. Abrams
In my opinion it is always better to use an Attorney for Social Security Disability cases.

Moderator
I would like to know exactly to what extent of disability so you have to be? I have heard filing disability is a huge process & can take up to year or more. Is this correct? I have autoimmune disease. Lupus SLE, chronic kidney disease. -- Wichita, KS

Ms. Abrams
In general you have to be disabled enough to not be able to work at all in the national economy. It usually takes a year and a half to go through the process; it does not matter what disease you have.

Moderator
I applied for benefits in 1996 when I lived in Michigan. I went through the "system" and went before an administrative law judge. The judge said that I was disabled but I couldn't get disability because I was short 1 working quarter. I stopped working in 1992 to start a family and was diagnosed in 1996 with SLE, and by that time, I only had 25% kidney function. I ended up on dialysis for 1 year and in 1999 I had a kidney transplant. I still am really tired all of the time, and can;t go back to the same type of work that I was doing. I have muscle, back, neck, foot , knee and hip problems that prevent me from sitting or standing for long periods of time. I go to the chiropractor at least once a month. I also avoid large crowds because of my immune system from my lupus and my kidney transplant. I also have anemia and can't get E-poe shots because my insurance won't pay for them. I think that the SS system is not fair to people with Lupus, because Lupus does NOT happen overnight. I have 1 girl in college and another one going next year. I will be forced to find some kind of work, but I don't think that I could hold a job long enough because of my problems. I would like to know if there is anyone I could contact who might help me with my SS problem. -- Delmont, PA

Ms. Abrams
If you are short one quarter there is really nothing that can be done, as this is the law. The general rule is that to be eligible for SSDI you have to have worked and paid FICA taxes for 20 quarters of the 40 quarters prior to the date you became totally disabled. It is often easier to think of this as requiring that you worked and paid FICA taxes for 5 of the 10 years prior to the date you became totally disabled. That rule is slightly relaxed if you are under 28 years old. When people are as close to qualifying to SSDI - as you are, I often suggest that they try to get a part time job to earn enough money to get the additional credits they need. Sometimes they are lucky enough to be able to find a family member with a business to allow them to work. Before you do this go to your local Social Security office and make sure exactly how many credits you'll need and how much you have to earn to get those credits. You can also apply for SSI which does not involve quarters of coverage.

Moderator
What are the specific criteria needed to be considered disabled? What medical conditions qualify an individual for disability? Is it true you cannot have an income for 6 weeks prior to filing for disability? Is it true that if you have an education and have had a solid career history that your chances for obtaining a disability are slim to none? -- Clearwater, FL

Ms. Abrams
In general you have to be disabled enough to not be able to work at all in the national economy. Many medical conditions both physical and mental will qualify you for benefits. Even if you have no diagnosis but have symptoms you can qualify. You do not need to wait 6 weeks to apply for disability. No it is not true that an education and a solid career history will make your chances slim to none. I feel that having a solid career history helps a case. It shows the judge that you are not a person who wants to be on disability.

Moderator
Ms. Abrams ... do you have any final thoughts you'd like to share with today's audience?

Ms. Abrams
Thank you so much for joining me today. Please go to my website at www.sheriabrams.com if you have any further questions.

Moderator
That is all the time we have for today’s chat. Thank you to Ms. Sheri Abrams for joining us.

Please join us Wednesday, November 11 at 3 p.m. Eastern Time. Our guest expert will be Cindy Coney, who will discuss “Social Wellness, Making Connections and Helping Others Understand What you go through with Lupus.”

Help spread the word about our lupus chats. See you next month.