Sunday, June 16, 2013

The unfair Social Security Disability benefit process

So here is Penny's Social Security issue in a nutshell (as we get asked this question a lot).... so I hope others can get an idea of how tricky filing for Social Security actually is.

Penny has been disabled (through no fault on her own) multiple times in the past almost 22 years we've been married.

She was a waitress when I met her and she loved waitressing. In 1991 (3 months after we married on 9/11/1991), she slipped on a wet floor in the Kitchen at the restaurant she worked at (JB Finnegan's) and she had ripped the medial meniscus in her right knee. The restaurant had been asked to put a rubber carpet in that area, and they never did. Penny slipped on water on the floor and went right down. Luckily, I was working for Metlife at the time, she had insurance via my employer and she went for surgery. Of course, the restaurant allowed their Workers Comp to elapse prior to her injury, so we had to fight for her medical care and for lost wages (ultimately for 7 years our lawsuit worked its way through the process). In the interim, she started to work for Walmart in 1994 - 1999 as a cashier (and she slowly developed Carpal Tunnel Syndrome). She then started to work as a Home Daycare provider until she was shot April of 2011 on Good Friday at JB's Pub in Elgin, IL. (the first two people that were shot were killed, she was the third one shot and she survived with a major left arm wound). She lost the ability to use her left arm and hand after that. Miraculously, we found a doctor who could repair the damage to her arm that would allow her to use her hand again (not like before she was shot, but good enough to manipulate objects, use a fork and knife, and to lift a glass). She had surgery on her left arm on our 10th wedding anniversary (9/11/2001) that morning to move her nerves and connect them to her thumb and other fingers so she'd be able to use her hand. She went through 2 years of rehabilitation. She was able to rehab enough to get a job at TCF Bank (as a teller) despite her fear of the bank being robbed and worked full time for over a year (and luckily, she had Disability Insurance coverage since she was a full time employee). When putting money into the bank's ATM, she had injured her knee as she fell. She went on short term disability through the employers Disability Carrier. She then went on to long term disability after that as her physical condition kept getting worse. She applied for Social Security and has had surgery and follow-up medical treatment. She did not have a legal representative when she went to the ALJ hearing in April of 2008 as she thought the medical evidence was overwhelming (and we were still dealing with the legal issues from 2001 separately plus I was at a new employer and had no vacation earned yet to take the day off). Her last Social Security decision was 10/2008 (at the administrative law judge level). When we received her denial, we contacted Allsup & Associates (who was contacted by the Standard) forwarding the denial to them by fax and asking for their assistance. We never got a response. I again forwarded the denial by Fax in February of 2009, and still received no response.Considering that the Administrative Law Judge had basically called her a malingerer in the denial (the decision makes for incredible reading), she felt only a representative could help her and Allsup didn't (for whatever reason). She was approved by Standard Insurance for functional limitations for any occupation based on Training, Education, and experience. And yet the government thinks otherwise.

So on November 2nd of 2012, we checked with her disability carrier and again asked for representation to re-file and start the process over to get Social Security for her (since I was now unemployed and she needed Medicare if Cobra wasn't approved or we couldn't afford the cobra premium). We were then told that due to a recent law change, that the ALJ decision in 2008 was the final decision because she hasn't worked since 2005 and her eligibility for SSD ended in 2006 due to her hours worked during the previous 10 years (if she had filed a request for a review within 60 days of the last decision, it would have went to the fourth and final review level). Essentially, if she hadn't worked in 2004/2005 and had pursued the SSD case then, she would most likely had a different outcome. Instead, she did what she was asked and rehabbed her arm so she could go back to work.

She was never told that she had no more options until November 02, 2012 (by anyone), and now because she worked so hard to do the right thing.... she is not eligible for Social Security Disability due to a change in the law (a technicality).... and being afflicted with Cancer, she now has no options until the age of 65. but it gets even better...... because of the fact she isn't receiving Social Security Disability and isn't working because she is actually disabled, her Social Security Retirement amount will be less than half what she would have gotten as they will be counting ALL years since she started working (and without SSD... which is counted as a continuation of earnings, she is will get a substantially less amount at the age of 65 as she will have over twenty years of no earnings).
And that is our Social Security story about Penny. Tomorrow, I'll post about Travis and his situation.

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