Questions about disability and insurance

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Jul 29, 2012
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My husband is at the point that he can no longer function at work. Honestly, I don't know how he's been doing it this far...He has been the sole provider and insurance carrier for our family. Im working part time with no benefits. Its hard to work a full time job and help care for him, plus two minor children and everything else in-between.
My question is, is anyone on permanent disability due to crohns? Is anyone on medi-cal as well due to their disease?
If anyone can please help with some info, I'd greatly appreciate it.
Thanks
 
Hi and welcome, there are members in the States that are on disability, someone will weigh in with some help I'm sure. It's a little different in Canada but some things are similar. Expect delays, get ALL your info together, write about his WORST day in minute detail be graphic, include colour pictures of colonoscopies (glossy is good lol), be friends with your Dr. he/she will have to do a lot of writing on your behalf. If you can find an advocacy group? very helpful to steer you through the process. It will all work out, trust in the process of life.
 
Your husband should apply TODAY for SSI via the social security website (www.ssa.gov). SSI is Supplemental Security Income. It is a needs based program and he may not qualify for this program since he is still working and you are working. You may have too many assets (limits of $3,000 for a couple last I checked.)

However. There is a reason to do this. Should he qualify, SSI starts from the day you apply. So delaying means another day that you do not receive benefits should you qualify.

SSI automatically qualifies you for Medicaid or in California, MediCal. Even if you only get $1 of SSI, you qualify for MediCal.

He should also apply for SSDI. This is Social Security Disability Income. It is based on his work history. SSDI is funded from taxes on wages so you must meet wage tests - you must have worked a set number of quarters, over a set period of time and earned a set amount in those quarters to qualify. If he is currently working and has worked for more than a couple years he will almost certainly qualify.

The amount of SSDI you get depends on your income.

To qualify for SSDI you must be determined disabled based on limits in your activities of daily living. It is not based on your diagnosis.

There is a lot of information on the SSA website about this stuff. I suggest your husband spend some time reading and reviewing that information.

No matter what he should file his initial applications online today if he can.

Best wishes
 
patricia do u know if the qualifications are the same for ssa and ssdi? Hmm that was a loaded question. I think what Im asking is are ssa's requirements more relaxed then ssdi?
 
Yes I receive SSI (not full disability but you can apply for both, there is someone on the site who I think has both if not then its disability) and am on Medi-Cal. :)

Apply at your local Social Security office NOW (it takes time to be accepted plus your payments will begin on the date that they received your application so if you apply today and aren't approved until next year, you'll get a check that has a large sum from the months you didn't get a check from when you first applied till the month you were accepted, then you'll get a check each month after that) or apply online: http://www.ssa.gov/applyfordisability/

Apply for SSI: http://www.ssa.gov/pgm/ssi.htm

If you are denied appeal. Just about everyone is denied their first time. A lawyer can help (I had to use one). They take a small percentage of the first check you get which I described above. SS hates dealing with lawyers so you're more likely to get benefits sooner with one (you can start with one if you like to help fill out the paperwork properly).

When you fill out the paperwork only talk about worst days possible. Never ever say that you sometimes feel fine. Exampe: If you run into a question that asks, "do you need help dressing yourself?" If there were some days where you actually needed help but don't always, say "yes" anyway.

Have a doctor back you up. Tell your GI or GP what you're trying to accomplish and they will fill out the paperwork accordingly. My lawyer worked with a doctor so that's the doctor who helped me (he wasn't even my doctor). He knew a lot about Crohn's and the legal system so knew exactly what to say.

If he has any other medical conditions he may be able to use those to help his case as well (even depression and anxiety).

Check out the ADA (Americans with Disabilities Act): http://www.crohnsforum.com/wiki/Disability-and-Crohns-USA
Know your rights: "a physical or mental impairment that substantially limits one or more major life activities of such individual"
"major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working."
"Major bodily functions:
For purposes of paragraph (1), a major life activity also includes the operation of a major bodily function, including but not limited to, functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions."

The more you know your own rights, the better chance you'll have at being accepted. The quotes above are the things they are looking for.

Once you're approved for SSI, SSDI or both, then you should qualify for Medi-Cal. Here's a link that explains the difference: http://ssa-custhelp.ssa.gov/app/ans...social-security-disability-and-ssi-disability Anywhere it says Medicaid, its Medi-Cal here in Ca.

If you need more information feel free to ask but you can also get lots of information from your local Social Security office and from a lawyer (many do free consultations).

Edit: Benefits aren't forever. He will go up for review from time to time. He may be denied in the future and THAT'S when you get a lawyer for sure! I had to do that one time.
 
With SSI it doesn't matter if you're currently working. You're working to pay bills but once you qualify, it would be best if you stopped working. SS will take a percentage out of your benefits for every dollar you make. You can work while on SSI but the amount you make has to be pretty minimal. I worked a few times while I was on it. My benefits took a hit but I didn't lose them.
 
The disability determination is made by the same people whether you are applying for SSI or for SSDI. The same standard must be met.

The main differences between SSI and SSDI are:

1. SSI is needs-based, better known as welfare; therefore you can't have much money, no retirement savings, no assets other than a house and a car and personal property like clothes and furniture

SSDI is NOT needs-based; there are no limits on the amount of money you have or retirement savings or other assets. You can be rich and still get SSDI.

2. SSI automatically qualifies you for federal medical coverage for the poor - Medicaid. This program is generally free but it can be hard to get expensive things covered and it can be very hard to find a doctor because they get almost nothing for seeing a Medicaid patient. In California the Medicaid program is called MediCal.

SSDI does not come with health coverage for the first 2 years. Following a 2 year waiting period, you will receive Medicare part A benefits for free. Depending on a variety of other factors you will also receive Part B benefits and Part D benefits either for free, reduced cost of full cost.

3. SSI payments begin the day you apply and are paid retroactively once you are determined disabled. So you are likely to receive a lump sum benefit when you are approved because the approval process typically takes six months to a year. That's without appeals. There are a few illness/diseases/conditions like end stage renal failure that automatically qualify you but generally speaking you must be determined disabled based on your ability to work in any job - even if it's sitting in a toll booth or answering phones from your home - at a level sufficient to meet a certain level of income.

SSDI payments do not begin for six months from the date you are determined disabled. This is a waiting period that is built in and you cannot avoid. The process to be determined disabled is the same as for SSI and, if you apply for both, the determination for each program is basically done at the same time.

However, with SSDI, if you can support your claim with medical and employment records, you can say that you became disabled up to a year prior to submitting your application for disability. Your waiting period and benefits begin as of your onset date so you may receive benefits immediately once you are approved in this scenario.

4. SSI only pays benefits to the disabled person.

SSDI pays benefits to the minor children and potentially to other dependents of the disabled person.

Some people do qualify for both programs because their SSDI payment is lower than the SSI payment. In that case they receive SSDI and an additional payment from SSI. They also receive Medicaid if they receive any SSI - even as little as $1.

If you get SSDI you may still qualify for Medicaid but you will have to apply separately and may have a share of cost (basically a copayment).
 
Great information, thank you for taking the time to type all that out. I am currently trying to get ssi and have so many questions and concerns.
 
Im at the point now where I have to fill out questionaires, along with the 3rd party one. That is a bit stressful because its so hard for me to share my "downs" but yet I have to rely on someone being truthful with thier truth when maybe no one really truly understands all im going through. This is the most stressful part so far.
 
Have you tried buying him disability insurance? It may be a little late for that if his condition has worsened, but it won't hurt to try. SSI and SSDI are also good options if disability insurance premiums are too expensive to afford; Crabby and Patricia's posts are good information on Medi-Cal and related topics.

Pat Cassidy
Disclaimer: I work for AccuQuote and this is my personal opinion.
 
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