IS EPILEPSY KEEPING YOU FROM

Transcription

1 IS EPILEPSY KEEPING YOU FROM WORKING? SOCIAL SECURITY DISABILITY AND EPILEPSY KNOW YOUR RIGHTS! By: Thomas J. Giordano, Jr., Esquire

2 INTRODUCTION AND TYPICAL LAWYER DISCLOSURES. Social Security Disability and SSI are two very complex and detailed areas of the law. There are many rules and regulations to follow and in many states, including Pennsylvania, the process of applying for benefits can last longer than one year. Today s presentation is designed only to give you a basic understanding of the requirements for receiving benefits as well as how those diagnosed with Epilepsy may be eligible for Social Security Disability benefits.

3 SOCIAL SECURITY DISABILITY THE BASICS 2 types of programs: Social Security Disability Insurance (SSDI): for workers who have paid into the Social Security system Supplemental Security Income (SSI): for disabled individuals (including children) with limited income and assets

4 SOCIAL SECURITY DISABILITY (SSDI) Who qualifies? Any disabled worker under the age of 65 who has worked both long enough and recently enough to qualify. General rule: If you worked 5 out of the past 10 years and paid SS taxes, you qualify Best way to know if you are eligible for SSDI: The Social Security Earning Statement which is mailed to your home approximately 3 months before your birthday every year

5 SUPPLEMENTAL SECURITY INCOME (SSI) A disabled individual qualifies for SSI if: Your monthly income does not exceed the Federal Benefit Rate (FBR) which is $ for an individual and $1, for couples. You do not have resources exceeding $2, for an individual and $3, for a married couple SSA does exclude some resources such as: Your home; one wedding or engagement ring; one automobile; grants/scholarships, Income and resources matter!

6 IF AWARDED SSDI, WHAT DO YOU RECEIVE? If you are awarded SSDI benefits, you may receive: retroactive (past) benefits, if Social Security finds you were disabled before your application date. Please note: Retroactive benefits generally go back only 12 months. Also, Social Security does not pay a person benefits for the first 5 months you are out of work. Monthly benefits (amount based upon how much you paid into the system) Benefits for your children under the age of 18 Medicare (2 years from the onset of disability)

7 IF AWARDED SSI BENEFITS, WHAT DO YOU RECEIVE? Monthly benefit payments as early as the first day of the month after an individual files an application, but no earlier. (Maximum monthly benefit amount if $674.00) Medicaid insurance as soon as you are found disabled (no wait time) FYI: No benefits payable to your children regardless of age

8 THE DEFINITION OF DISABLED The formal definition: disabled means that you are unable to engage in any substantial, gainful activity because of a medically determinable physical or mental impairment. The disability must have lasted or be expected to last for a continuous period of at least 12 months, or expected to result in death.

9 INABILITY TO ENGAGE IN SUBSTANTIAL, GAINFUL ACTIVITY Simply means that you are unable to work 8 hours per day, 5 days per week due to your medical conditions. Also, Social Security regulations state that if you are earning more than $ per month in gross wages from work, you are NOT disabled regardless of the severity of your medical conditions.

10 MEDICALLY DETERMINABLE IMPAIRMENT A medically determinable physical or mental impairment is established by medical evidence consisting of signs, symptoms and laboratory findings. In other words: YOU MUST TREAT WITH A PHYSICIAN!!!

11 SEVERITY OF IMPAIRMENTS Your impairments (mental or physical) must be severe. If they do not significantly limit the work you could perform, they will not be considered severe. Remember: The effect of your impairments on your ability to function mentally and physically is what counts.

12 DURATION OF DISABILITY Your medical impairment or impairments, musty be severe enough to disable you for at least 12 continuous months or result in your death. Purpose: To make sure that those who are applying for disability truly need it. For example, a broken bone will likely heal within 12 months and therefore is not likely to disable you for 1 year.

13 YOUR ABILITY TO WORK After Social Security determines that you have severe medical impairments which have lasted or will last 12 months, they must determine whether your impairments are severe enough to prevent you from performing your prior work and any other work in the national economy. Prior work: work you have performed within the last 15 years Most people who are denied are denied based upon their ability to do other work. The Social Security Administration does not care if you can find a job, or if a job pays you what you are used to making, or if the job has skills that you have performed in the past they only care if you have the ability to perform and sustain that other work.

14 Children and SSI For children applying for SSI, the process requires a review by Social Security of the child s current work activity (if any), severity of his or her impairment, and an assessment of whether the impairment results in marked and severe functional limitations. Marked: more that moderate and less than extreme. Severe: condition that is more than mild or slight

15 LISTING OF IMPAIRMENTS The Social Security Administration has created a list of the most frequently found impairments. If any of your impairments exactly match the criteria of a listing, you will be found disabled and granted benefits regardless of your age, education and work experience. If none of your impairments meet a listing, then a reviewed or Judge must determine if your impairments are equivalent to the severity required for your impairment.

16 ADULT LISTINGS 1.00 Musculoskeletal System 2.00 Special Senses and Speech 3.00 Respiratory System 4.00 Cardiovascular System 5.00 Digestive System 6.00 Genitourinary Impairments 7.00 Hematological Disorders 8.00 Skin Disorders 9.00 Endocrine System Impairments that Affect Multiple Body Systems Neurological Mental Disorders Malignant Neoplastic Diseases Immune System Disorders

17 11.02 EPILEPSY CONVULSIVE Epilepsy - convulsive epilepsy, (grand mal or psychomotor), documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month, in spite of at least 3 months of prescribed treatment. With: A. Daytime episodes (loss of consciousness and convulsive seizures) or B. Nocturnal episodes manifesting residuals which interfere significantly with activity during the day.

18 11.03 EPILEPSY - NONCONVULSIVE Epilepsy - nonconvulsive epilepsy (petit mal, psychomotor, or focal), documented by detailed description of a typical seizure pattern including all associated phenomena, occurring more frequently than once weekly in spite of at least 3 months of prescribed treatment. With alteration of awareness or loss of consciousness and transient postictal manifestations of unconventional behavior or significant interference with activity during the day.

19 EVALUATING EPILEPSY THROUGH SOCIAL SECURITY S PERSPECTIVE Epilepsy, regardless of etiology, degree of impairment will be determined according to type, frequency, duration, and sequelae of seizures. At least one detailed description of a typical seizure is required. Such description includes the presence or absence of aura, tongue bites, sphincter control, injuries associated with the attack, and postictal phenomena. According to Social Security - the reporting physician should indicate the extent to which description of seizures reflects his own observations and the source of ancillary information. Testimony of persons other than the claimant is essential for description of type and frequency of seizures if professional observation is not available.

20 WHAT IS PRESCRIBED TREATMENT Under and 11.03, the criteria can be applied only if the impairment persists despite the fact that the individual is following prescribed antiepileptic treatment. Adherence to prescribed antiepileptic therapy can ordinarily be determined from objective clinical findings in the report of the physician currently providing treatment for epilepsy. Determination of blood levels of antiepileptic drugs may serve to indicate whether the prescribed medication is being taken. When seizures are occurring at the frequency stated in or 11.03, evaluation of the severity of the impairment must include consideration of the serum drug levels.

21 WHY SERUM DRUG LEVELS ARE IMPORTANT? Social Security evaluates blood drug levels in conjunction with all other evidence to determine the extent of compliance. When the reported blood drug levels are low, the information obtained from the treating source should include the physician's statement as to why the levels are low and the results of any relevant diagnostic studies concerning the blood levels. Where adequate seizure control is obtained only with unusually large doses, the possibility of impairment resulting from the side effects of this medication must also be assessed. Where documentation shows that use of alcohol or drugs affects adherence to prescribed therapy or may play a part in the precipitation of seizures, this must also be considered in the overall assessment of impairment level.

22 MAJOR MOTOR SEIZURE DISORDER CHILD LISTING A. Convulsive epilepsy. In a child with an established diagnosis of epilepsy, the occurrence of more than one major motor seizure per month despite at least three months of prescribed treatment. With: 1. Daytime episodes (loss of consciousness and convulsive seizures); or 2. Nocturnal episodes manifesting residuals which interfere with activity during the day. B. Convulsive epilepsy syndrome. In a child with an established diagnosis of epilepsy, the occurrence of at least one major motor seizure in the year prior to application despite at least three months of prescribed treatment. And one of the following: 1. IQ of 70 or less; or 2. Significant interference with communication due to speech, hearing, or visual defect; or 3. Significant mental disorder; or 4. Where significant adverse effects of medication interfere with major daily activities.

23 MORE ON CONVULSIVE EPILEPSY FOR CHILDREN Convulsive epilepsy must be substantiated by at least one detailed description of a typical seizure. Report of recent documentation should include a neurological examination with frequency of episodes and any associated phenomena substantiated. There is an expected delay in control of epilepsy when treatment is started, particularly when changes in the treatment regimen are necessary. Therefore, an epileptic disorder should not be considered to meet the requirements of or unless it is shown that convulsive episodes have persisted more than three months after prescribed therapy began.

24 NONCONVULSIVE EPILEPSY CHILD LISTING In a child with an established seizure disorder, the occurrence of more than one minor motor seizure per week, with alteration of awareness or loss of consciousness, despite at least 3 months of prescribed treatment.

25 WHAT YOU CAN TAKE AWAY FROM THE EPILEPSY LISTINGS Treatment and documentation is key! Without medical reports documenting treatment it is impossible to meet or equal a listing Your physicians play an important role in the disability process and their records/reports can be the key to a successful Social Security Disability case. A Seizure log can be very beneficial to a judge or fact finder in a Social Security disability case.

26 CONCLUSION If your Epilepsy is keeping you from sustaining, full time employment due to the unpredictability of your seizures, side effects from medications, etc., you may want to consider applying for SSDI or SSI. Disability is not a life sentence! There are rules which state you can work while receiving disability benefits. Get educated and know your rights!