The Social Security Disability system in the United States is very complicated. Whether you are a recently disabled father trying to provide for your family, a single mother who can no longer work because of an illness, or the parent of a child who needs extra help because of a challenging condition, obtaining benefits is not easy. The “system” involves a complex set of rules and requirements that make it very hard for the average person to successfully receive payments.

There is hope, however, and we appreciate you looking for help here. Our law firm provides unique benefits to clients just like you, which include:

  • A singular focus on representing the injured and disabled.
  • Having all important work performed by an experienced disability attorney.
  • A guarantee that you pay no fees unless you obtain social security disability benefits.
  • A proven track record of success in both routine and difficult cases.

Regardless of whether you are considering filing for benefits for the first time, or have been denied numerous times in the past, please call our office at (404) 255-9838. We will discuss your options free of charge, and help you make an informed decision about what to do next. We look forward to talking with you.

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First, right before the holidays, Congress approved another short-term funding bill, funding the government through January 19, 2018.  Congress did fund the Children’s Health Insurance Program through March 31, 2018.  I have previously blogged on the importance of funding that program.  More on that as we head to March.

The final version of the tax bill repealed the penalty for not having health insurance (“the individual mandate”) that was an important part of the Affordable Care Act.  The structure of providing low-cost, affordable and portable healthcare available to all Americans depended on everyone — young and healthy alike — purchasing healthcare.  Not only does this control costs for the consumer and risks to the insurance provider, but it reduces the number of uninsured Americans.  Sure, many healthy young adults balked at the mandate.  But since even these individuals cannot rule out getting hit by a bus or injured in an accident, it was hardly an onerous federal regulation.

But Congress eliminated it so there you have it.  According to the National Budget Office, the repeal of the individual mandate will cause 13 million fewer people to be insured by 2027.  Some people will elect not to purchase coverage and some will not be able to afford coverage.

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Many potential clients I speak with daily are shocked to learn that the average wait time for a disability decision with the Social Security Administration is two years.  Yes, you heard me correctly – two years.  Why is that?  First, most applications are denied.  Second, the time period for a decision on the initial application is five months.  An appeal to the next level of review (reconsideration) is three to five months.  The next level of review – and where your best chance of a favorable decision exists — is the hearing level.  The current approval rate in Georgia at the hearing level is 48%.

But wait times for a hearing are currently over a year.  Here are the official wait times for a hearing in Georgia:  Atlanta Downtown Hearing Office – 20 months; Atlanta North Hearing Office –         18 months; Covington  –  18 months; Macon  –  16 months; Savannah – 17 months.

From a  2017 CBS News report, there were 1.1 million applicants waiting on a hearing before an administrative law judge.  That is a 31 percent increase from 2012.  However, the agency’s annual budget is the same as it was in 2011.  Five years ago the hearing wait times were less than a year.   “No search for efficiencies, reprioritization of tasks or technological improvements can substitute for adequate resources,” said Lisa Ekman of the National Organization of Social Security Claimants’ Representatives.

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One of the most frustrating problems people with disabilities experience is that a loss of a job usually leads to loss of healthcare coverage.  Filing for Social Security disability takes several months if not two years on average for a decision on an application.  When people with chronic or traumatic health problems lose their health insurance, they usually go without needed care.   Sadly, many health-impaired individuals who are unable to return to work for health reasons, also lose much-needed access to health care.

Researchers at the Boston University School of Public Health found that poverty has “emerged as an increasingly important risk factor for mortality in American adults.”  “Income is more associated with length of life now than it was 15 years ago .. we may be seeing the emergence of a health poverty trap, where essentially people who are poor don’t have the same access to the important determinants that allow them to stay healthy,” explains Jacob Bor, Assistant Professor of Global Health at Boston University and the author of the study.

We see this every day in this practice area.  One of the most frequent questions I hear is: what should I do about healthcare?  First, stay on a spouse or relative’s healthcare policy even if it means an extra expense.  Second, use any other income to purchase coverage on the healthcare exchange.  A problematic loophole to this advice is that without income, many individuals are not eligible for subsidized plans provided through the healthcare exchange.   Third, COBRA coverage allows you to stay on employer-provided healthcare coverage for 18 months after leaving a job.  However, the employee is responsible for paying the entire monthly premium amount.  Most people who are losing income due to a medical-related job loss often find this is cost-prohibitive.  Fourth, after exhausting assets and income, apply for financial assistance at Grady Healthcare, Emory University or Wellstar Kennestone.  I will not profess to be an expert in their financial departments, but many of my clients have found assistance at these three hospitals.

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The Food and Drug Administration (FDA) has just approved a personalized cancer treatment that has the potential to have dramatic benefits for some types of cancer patients.

The therapy called Yescarta is a gene therapy, and involves the removal and genetic engineering of the immune cells of patients, so that they are better equipped to fight off the cancer cells.  This is the second gene therapy treatment for cancer approved by the Agency, and the first such therapy to be approved for the use of certain types of cancers like non-Hodgkin’s lymphoma. Experts believe that over the next few years, thousands of lives will be saved because of the treatment. There are, however, risks involved with the treatment and severe side effects attached. The therapy is also expensive, and it is likely to be used only in those cases where other treatment options have failed.

Persons who suffer from cancer may be eligible for disability benefits under the Social Security Disability Insurance program. To qualify for benefits, you must have paid into the Social Security system. Persons who suffer from certain types of cancer may qualify for expedited processing of their application. Several types of cancers are included in the SSA’s Compassionate Allowances program which allows claims to be approved quicker. If your cancer is inoperable, is recurrent in spite of treatment, or is spreading across the body, you may qualify for expedited processing of your claim.

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Young athletes who suffer frequent concussions have a higher risk of suffering multiple sclerosis later in life.

These findings were part of a study recently published in the journal Annals of Neurology.  Researchers in Sweden analyzed medical histories of Swedes who had been diagnosed with multiple sclerosis since 1964. When the same data was compared with another control group, the researchers found that the risk of development of multiple sclerosis later in life was higher in people who had suffered multiple head injuries during their youth.  Persons who had suffered at least one concussion were 22% more likely to suffer symptoms of multiple sclerosis later in life, compared to those who had not suffered such injuries. In the case of multiple concussions, the likelihood increased by a staggering 150%.

The study also revealed that concussions do not seem to be so damaging when they occur during childhood. Adolescent brains seem to be much less resilient, making them more vulnerable to the long-term effects of consistent concussions.

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Lupus patients from lower socio-economic populations have a higher risk of suffering organ damage as a result of the condition.

According to new research published in the journal Arthritis and Rheumatology, persistent poverty is linked to an increase in the amount of damage caused by lupus over time. On the other hand, persons who are able to improve their economic conditions may alleviate those signs of damage.

Chronic stress, which is often linked to poverty, could be to blame for the higher risk of organ damage that people from lower socio-economic backgrounds suffer. The study which focused on 783 patients found that stresses related to availability of food, affordable housing, and medical care were linked to a higher risk of suffering organ damage.

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A common question I get each while talking to prospective clients is whether a person can keep working while applying for disability.  Frequently, callers are baffled when I advise that “no, you cannot work and simultaneously apply for disability.”  Also, I do not accept prospective clients that are still working.  First, let’s define “work.”  Social Security defines work as “substantial gainful activity”  or “SGA”  SGA means that you are earning $1170 a month in gross income (in 2018 this amount will be $1180).  If you are legally blind, this amount is $1950.  SSA does not care how much your bills are each month; it only evaluates monthly gross income.  If you are earning SGA, then you cannot be disabled.  That will be the end of your disability application and no medical evaluation of your disability will need to take place.

Now does that mean that you can earn just under SGA and be successful on a disability application?  Practically speaking, the answer is no.  Usually, claimants (people applying for disability) that work in the upper end of this number or just at SGA are not successful either.  Probably because while the claimant is not technically barred from receiving disability, the ability to work and earn income close to SGA suggests that they could earn SGA.  Thus, these claims also usually fail.

When I explain this to callers, many are aghast that they might have to wait two years on a decision on a disability application while also not being able to earn an income of any sort.  I agree – that is a dilemma.  What do people do?  First, if you have a chronic condition, you might want to plan ahead.  If your employer offers disability insurance, then buy it.  Buy it even if you are healthy.  Many of clients with long-term disability insurance weathered the long wait time for Social Security Disability because they had private insurance payments coming in each month.  Without private insurance, my clients have downsized, exhausted savings, and borrowed from family.  These are not ideal plans, but it is a gap filler while awaiting Social Security disability benefits.  Delay times at this administration are not improving.  So preparing financially to be without an income for two years is a good idea.

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Last night Congress agreed to fund the government through December 22, 2017 and just hours ago the President signed that bill.  One of Congress’ constitutional obligations is to approve government funding.  The federal government’s fiscal year runs through October 1st to September 30th.   Because Congress cannot agree on spending priorities, particular the defense department, immigration and healthcare, annual funding has been delayed.  With the approaching holidays and more work to be done, another possible shutdown, days before Christmas, is a possibility.  According to Reuters, “the White House and lawmakers say the bill will give them more time to negotiate several end-of-year agenda items, including the budget, a children’s health program and hurricane aid.”   

For those of you who rely on SSDI or SSI monthly disability benefits, these will not be affected by a government shutdown.  However, for those of you who have pending claims before the Social Security Administration, there may be a slowdown in services.  It is hard to imagine that it could be any slower, but apparently that is possible.  If the shutdown lasts between 1-5 days, essential SSA employees will continue to work.  Ninety-seven percent of hearing office employees will report for work.  However, if the shutdown lasts for more than five days, SSA will “re-evaluate its contingency plan.”  We do expect that scheduled hearings will continue.  However, a shutdown that lasts beyond five days will furlough more employees and create more backlog in workloads.

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The Children’s Health Insurance Program (“CHIP”) is at risk of going belly up thanks to Congressional inaction on funding the widely popular children’s health insurance program.  Created in 1997, the program provides federal dollars to states to fund an insurance program for children whose families are low income, but earn too much to qualify for Medicaid.  CHIP benefits 9 million children nationwide.  In Georgia, that program is known as Peachcare.  Peachcare provides low cost (about $35 a month) health insurance coverage for children whose families earn below 200 % of the poverty level (roughly about $40,000 a year for a family of three).

While members of Congress from both parties agreed that the CHIP program should continue, neither the House nor the Senate can agree on how to fund CHIP.  CHIP provides about $13 billion in federal funds annually.  In November, House Republicans voted to fund CHIP by taking money from other public health programs (such as vaccinations).  House Democrats disagreed on that approach.

In Georgia, Medicaid and Peachcare cover over one-half of all the children in Georgia, approximately 1.3 million Georgia children.  Prior to 2018, CHIP had never had a lapse in funding.  State officials predict that Peachcare’s funds will last through Spring of 2018 if Congress does not fund this program over the next two weeks.  Meanwhile, both houses of Congress have passed a massive tax cut for this country.

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Exercise is an absolute must for good health, but overdoing exercise, especially for some members of the population, could cause an increase in the risk of cardiac disease.

According to researchers at the University of Illinois at Chicago, white men who over-exercise have a risk of heart disease that is almost twice as high as those who exercise in moderation. Researchers studied more than 3,000 participants over a five-year period, and found that white men who exercised for approximately 7 ½ hours per week were more likely to report symptoms of cardiac disease, including clogging of the arteries. White men were 86% more likely to suffer from symptoms of coronary artery calcification over time as compared to black males.

This should not, however, be taken to mean that you should stop exercising. Exercise in moderation is key to a healthy lifestyle.