Q&A with Sheri R. Abrams - Social Security and Disability

Ask the Experts is a series of educational talks and presentations on a variety of topics designed to provide you with important information about living with lupus. 

1. What is the first step towards applying for disability, do you always need a lawyer? Springfield Gardens, NY

I always suggest that before anyone applies for Social Security Disability or SSI benefits that they talk with their doctor (preferably their specialist) and find out if their doctor will support their claim and say in writing that they are unable to work.

If you are able to receive your Social Security Disability or SSI benefits when you first apply then you do not need a lawyer. If you are denied initially then in my opinion you need a lawyer.

2. Is there a time limit that I can be out of work and still apply for SSDI? I have been unable to work since last September 2012. Riverview, FL

You need to work 5 of the last 10 years to be fully insured for SSDI. In general if you have not worked for 5 years you will need to prove you were disabled before these 5 years have run out, making it much more difficult. I suggest that claimants apply as soon as they are unable to work and they believe that they will be unable to work for a year or more. Therefore you should apply right away.

3. My question concerns your mentioning receiving over $2,000 a month from SSD or SSI. That figure doesn't seem to match with what I or someone I know who receives SSI/Medicaid for many years. Is this amount reflective of a current change or is this amount a yearly quote which would also be unrealistic? I have lupus and I could use that amount if that was the case. New York, NY

The amount of your monthly SSD benefit is based on your earnings over your entire lifetime. The most it can be for 2013 is $2,533. This benefit is for those people whose earnings have exceeded the maximum taxable rate ($113,700 in 2013) for many years. The maximum SSI benefit is $710 per month in most States.

4. As a former SSI employee, I am familiar with the disability process. But I am still confused why lupus is not listed as one of the main diseases for quick response? Philadelphia, PA

Compassionate Allowances (CAL) are a way for Social Security to quickly identify diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate Allowances allow Social Security to target the most obviously disabled individuals for allowances based on objective medical information that they can obtain quickly.

There are currently 200 conditions on the CAL list.

Social Security is planning to add new conditions on an annual basis. Social Security works with both internal and external medical experts, National Institute of Health (NIH), and many others to identify and research potential CAL conditions. I am sure that Lupus Foundation of America is advocating for lupus to be added to the CAL list.

5. What is the minimum time from time of diagnosed with SLE can you file and what if you have multiple problems associated with SLE? Oklahoma City, OK

Social Security does not really care when you were diagnosed with SLE. They care when the SLE and the multiple problems you have associated with SLE have made you unable to work. You should file as soon as you become unable to work and feel that you will be unable to work for a year of more. When you apply you should list all the multiple problems that you have associated with your SLE.

6. After nearly a 2 year wait and with the help of an attorney my SSDI was approved in 2005 due to lupus. Annually for the last few years, I have received claim review letters. Can you shed some light on the review process? Yakima, WA

Unless the Judge in your case specified how frequently you were to be reviewed, it is mostly unknown when you will be reviewed by Social Security. I have had clients reviewed every year, every 3 years, every 7 years and some have never been reviewed. As long as you are not working (and are not able to work) and are still receiving medical treatment for your conditions, you should have no problem with a Review. Also note that the reviews will stop when you reach your full retirement age.

7. Next year my SSDI will be up in May 2014, when do I need to reapply for SSDI? What do I need to do in order to go before a judge so I don't have to apply every 3 years? Is going before a judge possible? Lancaster, TX

I am confused with your question since SSDI is never “up”. Perhaps you are thinking about getting reviewed. If you go through a review process you do not have to reapply. You also could be thinking that when your “date last insured” (which is generally 5 years after you last worked) runs out you will need to re-apply. After you are receiving Social Security Disability benefits this “date last insured” date does not matter. Also after you receive Social Security Disability benefits there is no reason to go before a Judge. If you are unsure, contact a lawyer in your area.

8. When I have a significant flare, I end up having to take leave without pay. I've applied for disability at least five times and was denied because I was working. I was told by a friend if I quit my job I would still be denied. The truth is I would prefer to work but I need help when the flare-ups happen. Any advice on how to handle this? Roswell, NM

I am afraid that your situation is a difficult one. In order to receive Social Security Disability benefits you need to be disabled and unable to work for a year of more. If you quit your job you would still have to prove that you are unable to work. You may want to meet with a local attorney who can go over your specific situation before you quit your job so you can have a professional opinion as to whether or not you would have a strong case for Social Security disability benefits if you were not working. You may also want to ask your place of employment if they offer a short-term disability policy from an insurance company. If it is a company offered policy you should not be denied because of your pre-existing condition.

9. I have submitted the application to Social Security for SSDI benefits. Are there any ways you know of to shorten the typical lengthy process? Azusa, CA

Applying and appealing a case for Social Security Disability benefits takes a very long time (on average 1 and ½ years to go through the entire process). The only way that I know to speed up the process is if you can prove that your house is in foreclosure or if you are living in a homeless shelter.

10. If you are already receiving Social Security benefits can you still receive SS Disability? I am 70 years old with skin lupus. Jacksonville, NC

No, since Social Security Disability benefits are your Social Security Retirement benefits that you receive early. There may be other programs that you can qualify for if your retirement benefit is very low. For example if it is less than $710 you may be able to get SSI benefits that bring your monthly benefit amount up to $710/month). You should check with an attorney or the social services agency in your area.

11. I was diagnosed a year ago with lupus, and my symptoms are controlled with medication and lifestyle changes. I am working full-time and my office only offers limited FMLA insurance coverage for short term disability. Could you recommend other avenues for full short term disability insurance coverage? Los Angeles, CA

I am afraid that because of your pre-existing condition it would generally be impossible to get private short term disability insurance coverage. Even if you were accepted the cost would probably be prohibitive. You should, however, check with an insurance agent for their opinion.

12. I have SLE and along with the joint pain and fatigue, the most limiting factor is my photosensitivity. Both sunlight and fluorescent lights cause me to flare. Is it possible to obtain disability with photosensitivity as the biggest issue? Sonora, CA

I have never seen anyone receive Social Security Disability benefits only on photosensitivity unless they were unable to leave their house because of it. But do not sell your joint pain and fatigue short, combining those 2 symptoms with the photosensitivity may make your claim viable. You should consult an attorney in your area.

13. I have lupus and my husband is the sole income provider with an annual income of $75,000. If something happens to him, I will have no insurance or income. Is it possible to get on Social Security while still being supported by my husband? I do not have enough points on my own. Wikieup, AZ

No, I am afraid that because you do not have credits on your own you would only be able to apply for SSI benefits which is a welfare program. For SSI benefits, Social Security will count your husband’s income as belonging to you and will deny you based on this income. You should, however, consult with a local Estate Planning attorney so you can plan for what would happen if your husband passes away. You can also attempt to get your own medical insurance coverage that is not tied to your husband when the Patient Protection and Affordable Care Act (PPACA or Obamacare) goes into effect since pre-existing conditions will not be taken into consideration.

14. I am on SSI Medicaid due to my lupus and my doctor who I have had for the past 3 years has dropped me as a patient. Can a doctor do this? Should I contact my Medicaid insurance office to let them know? Atlanta, GA

I am afraid that doctors can take or drop patients at will, even if they are on Medicaid. Doctors can also decide to take, not to take, or decide not to continue to take Medicaid patients. The Medicaid insurance office will not care if your doctor dropped you. Hopefully you can find a new doctor to treat you.

15. While appreciated, disability income is often not enough to live off of. How much additional money can you make per month while receiving disability benefit income? Coconut Creek, FL

When you receive Social Security Disability benefits you are entitled to a 9 month trial work period. A trial work month is triggered when you earn more than $750 in any month (this is the 2013 amount). There are also various work incentives that Social Security offers.

I worry, however, when my clients try to work after they receive Social Security Disability benefits. There is a risk that this will cause Social Security to review you more frequently or that you will accidently do something so as to lose your benefits and be charged with an overpayment. I suggest that you contact an attorney to go over your specific situation before you start working.