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An Overview

Traumatic Brain Injury and the Social Security Disability Process. An Overview. Kelly Blad, MA, EDPNA. Social Security Disability Programs. Retirement, Survivors, and Disability Insurance (RSDI, Title II) Work based disability program Must prove disability prior to Date Last Insured

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An Overview

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  1. Traumatic Brain Injury and the Social Security Disability Process An Overview Kelly Blad, MA, EDPNA

  2. Social Security Disability Programs • Retirement, Survivors, and Disability Insurance (RSDI, Title II) • Work based disability program • Must prove disability prior to Date Last Insured • Supplemental Security Income (SSI, Title XVI) • Federal welfare program for the disabled, blind, and elderly • Must meet income and asset requirements

  3. Retirement, Survivors, and Disability Insurance • Monthly benefit amount based on earnings record • Must be disabled and insured • 5 month waiting period for eligibility • Auxiliary benefits available • Medicare coverage after 24 months of eligibility • Not reduced by income or assets

  4. Supplemental Security Income • $721 for an individual and $1,081 for a couple and may be reduced depending on • Living situation • Income • Medical assistance coverage

  5. Income/Asset limits for 2014

  6. Concurrent Claims • Both SSI and RSDI

  7. Disability • Inability to engage in substantial gainful activity by reason of a medically determinable impairment that has lasted or is expected to last at least 12 months or result in death.

  8. Sequential Evaluation Process • Step 1: Is the claimant engaged in SGA?

  9. Substantial Gainful Activity • Work done for pay or profit • $1,070 gross per month

  10. Substantial Gainful Activity

  11. Sequential Evaluation Process • Step 1: Is the claimant engaged in SGA? • Step 2: Does the claimant have a severe impairment?

  12. Severe Impairment More than a minimal limitation on one’s ability to work

  13. Sequential Evaluation Process • Step 1: Is the claimant engaged in SGA? • Step 2: Does the claimant have a severe impairment? work? • Step 3: Does the impairment meet or equal a medical listing?

  14. Medical Listings • Social Security Website, “Blue Book” • Organized by body system • Separate listings for children and adults • First step in which someone may be approved

  15. Blue Book Listings - Adult

  16. Blue Book Listings - Child

  17. Step 3.5 – Residual Functional Capacity Maximum ability to do work related activities on a sustained basis

  18. Sequential Evaluation Process • Step 1: Is the claimant engaged in SGA? • Step 2: Does the claimant have a severe impairment? work? • Step 3: Does the impairment meet or equal a medical listing? • Step 4: Can the claimant perform his or her past relevant work?

  19. Past Relevant work Work performed gainfully within the last 15 years and performed long enough to be learned

  20. Sequential Evaluation Process • Step 1: Is the claimant engaged in SGA? • Step 2: Does the claimant have a severe impairment? work? • Step 3: Does the impairment meet or equal a medical listing? • Step 4: Can the claimant perform his or her past relevant work? • Step 5: Can the claimant perform any other work?

  21. Other Work • Work in the national economy • Age affects this step • Last step in which someone may be approved

  22. Grid Rulings • Special rules for older workers • Take into account RFC, age, education, and transferable skills

  23. Sedentary RFC, Advanced Age

  24. Application Process • Initial Application • Online or in person application taken by district office • State agency collects medical records and makes determination • Clear medical records, no red flags

  25. First Appeal: Reconsideration • 60 deadline • State agency takes into account new evidence

  26. Second Appeal: Request for Hearing • 60 day deadline • Claimant/claimant’s representative is responsible for providing medical records • Testimony and medical records are used to make determination

  27. Third Appeal: Appeals Council • 60 day deadline • Not a new determination

  28. Fourth Appeal: Federal District Court • 60 day deadline • Civil suit against Social Security • Must be represented by an attorney

  29. Potential Claim Issues • Chemical Dependency • Lack of medical treatment • Noncompliance with treatment • Criminal background

  30. Provider’s Role in SSA’s Determination • SSA uses medical, education, and rehabilitation records in the determination • Providers record diagnoses and symptoms • Providers can provide medial opinions

  31. Screening • Is the individual unable to work full time? • Is it due to a medically determinable impairment? • Ultimate decision is with Social Security

  32. Social Security Disability: An Overview Kelly Blad, MA, EDPNA

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