Disability: The Great Paper Chase

1. Disability:The Great Paper Chase Hilary Suzawa Med/Peds 2006 Updated March ‘09

2. Topics • Disability • Social Security Title II: Disability Insurance Program • Social Security Title XVI: Supplemental Security Income • METROLift • Disability Parking Placard • Jury Duty Exemption

3. Disability Application • Application sent to Disability Determination Services (DDSs) – Federally funded agency, but operated by individual states • Applicant must provide the following information • Legal Name • Social Security Number, DOB • Current mailing address and phone • Basis of claim for disability • Date that you contend that you became disabled • Names and addresses of all doctors and hospitals who have tx you since your disability began

4. Disability Application • Takes ~3 months for decision • Agency requests copies of medical records from doctors and hospitals • May have “consultative” exam with medical or mental health professional on DDS panel

5. Disability Application • In the Initial stage ~30% approved • All applications reviewed by two individuals – only one is a licensed health professional • In the Reconsideration stage ~30% approved • Hearing stage—hearing in front of Administrative Law Judge – 70% approved • Case Denied • Must file appeal within 60 days from date of denial to proceed to next stage • If past 60 days, applicant must start over • Disability Lawyer- “No fee unless you win” • Pay 25% of past due benefits with max fee $5300

6. Disability Eligibility • “Disabled” • If he/she has a medical problem that prevents that person from working • In addition, the medical problem must be severe enough that it will last at least 12 months • Or severe enough where it might result in death

7. Disability Benefits • Benefits available depend on the work history of the applicant • For Title II Disability the applicant must have worked at least 5 out of the past 10 years • If the applicant has not worked enough, he/she may still be eligible for Title XVI Supplemental Security Income (SSI)

8. Social Security Title II Disability • Offers disabled workers monthly benefits and access to medical care through Medicare • Eligibility • Must be disabled per SS Administration regulations • Must be insured (or paid into system) for Title II • Have worked for 5 out of the past 10 years • Have worked for 20 of the past 40 quarters • Based on earnings (May earn 4 quarters worth of pay in one month—counts as 4 quarters)

9. Title XVI Supplemental Security Income (SSI) • Established in 1972 • Is a federal income supplement program funded by general tax revenues (not Social Security taxes) • Offers a modest disability benefit to individuals who did not have enough work credits to qualify for Title II Disability • Program is administered by the Social Security office.

10. Title XVI Supplemental Security Income • Who qualifies for SSI? • Disabled, blind, or at least 65yo with limited income. • Be a resident of the US, and a citizen/national/certain eligible non-citizen categories • Monthly benefit determined by law • If pt receives other food and housing assistances, SSI payment can be reduced based on “deeming rules” • Again, Title II (Social Security) based on ‘work history/work credits’ vs. SSI based on disability/level of need

11. Title XVI Supplemental Security Income • If you are eligible for SSI you will also automatically be eligible for Medicaid benefits • For SSI you can only collect benefits as of the date you apply vs. for Disability you can collect retroactive benefits up to one year prior to the date of application • Average Title XVI Disability payment is only $300-500/mo. (Getting disability is not like winning the lottery)

12. Federal Loan Discharge • Has the strictest disability requirements • Patient has to show permanent disability – i.e., cannot perform any type of work.

13. Tips on Determining Disability • Ignore the patient’s diagnosis • Focus on the patient’s exertional limitations • Can refer to Occupational Therapy to help assess • Have patient make a separate appt for completing disability forms from lawyers • www.ultimatedisabilityguide.com/medical_listings.html • Gives listings of criteria for disability evaluation based on the Disability Evaluation Under Social Security, aka the Blue Book

14. METROLift • Two categories for METROLift eligibility • Can’t get on the bus • Persons with disabilities who are unable, without the assistance of another person, to board, navigate, ride, or disembark from an accessible local bus • Can’t get to the bus stop • Persons with disabilities who are prevented from getting to and from the local bus due to their disability. Eligibility is based on a functional limitation preventing the patron from walking or rolling to a bus stop without assistance from others

15. METROLift form • “The doctor must describe in detail (using lay terminology) why your disability prevents you from boarding, navigating, riding, or disembarking from the local bus, even if the local bus provides accessible features such as a wheelchair lift, ramp, and stop announcements.” • Must also have letter on professional letterhead or prescription form

16. METROLift Interview • After fully completed application received, will have an in-person interview • Interviews must be scheduled within 14 days • Must have an appointment. No walk-ins • Decisions made in 21 days • If refused, may appeal within 60 days to the METROLift Appeals Committee

17. Disabled Parking Placard • Designed to provide those with visual or movement impairments with equal opportunities to access public or private facilities • Placard does not equal License Plate • TX allows person to have either • One set of plates with international symbol of access + one placard OR • Two placards • Display on rearview mirror or dashboard • Fee for placard is $5.00 • Blue vs. Red placard, Temporary vs. Permanent

18. Blue vs. Red Placard • Blue placard (Mobility related) • Cannot walk without the use of an assistance device • Red placard (Non-mobility related) • Is legally blind • Cannot walk 200 feet without stopping to rest • Is restricted by lung disease • Uses portable oxygen • Has a cardiac condition • Is severely limited in the ability to walk because of an arthritic, neurological or orthopedic condition • Color of placard specifies which parking places you can use

19. Temporary vs. Permanent • Temporary • Valid for up to six months • Permanent • Valid for up to four years • License plates • Valid as long as the vehicle belongs to the individual • Must be removed when vehicle sold • New license plates required after 7 years

20. Handicap Parking Application • In state of Texas, form is available to the public online – can download from anywhere. • Form needs to either be notarized or be accompanied by a physician’s prescription • Prescription needs to state: Temporary vs. Permanent; and mobility vs. non-mobility

21. Violations • It is illegal to continue using an invalid disabled placard or to improperly renew a disabled placard. • A violation is punishable by fines ranging from $250 to $1,000 and between 10 and 50 hours of community service.

22. Placard by Proxy • Placard may be displayed in any vehicle used for transportation of the disabled person • Someone other than the disabled applicant can renew a placard • Signed application, expired placards, written authorization from disabled patient • Legal guardian may make an application on behalf of a disabled child • Guardian’s signature, guardian’s driver’s license #

23. Harris County Jury Duty Exemptions • Age 70 years or older • You have legal custody of a child or children younger than 10 years of age and service on the jury would require leaving the child or children without adequate supervision • You are a student at a public or private high school • You are enrolled and attend college

24. Harris County Jury Duty Exemptions • You are an officer or an employee of the senate, the house of representatives, or any department, commission, board, office, or other agency in the legislative branch of the state government • You are the primary caretaker of a person who is an invalid unable to care for himself or herself. (This exemption does not apply to health care workers.)

25. Harris County Jury Duty Exemptions • You have been summoned for jury service and have served as a petit juror in Harris County during the current jury wheel reconstitution period. • You are a member of the United States military forces serving on active duty and deployed outside of Harris County

26. Jury Exemptions • No specific guidelines for exemptions secondary to medical conditions • Letter from MD may not guarantee exemption • Consider exemption for medical conditions that impair patient’s ability to sit for long periods of time

27. Main Points • For disability, pt must have a condition that prevents that person from working and must be severe enough that it will last at least a year or might result in death. • If pt has not worked enough to qualify for Title II Disability, may still qualify for Title XVI Supplemental Security Insurance (SSI)

28. Main Points • METROLift is for patients who can’t get on the bus or who can’t get to the bus stop • Red or Blue, Temporary or Permanent Placards are for patients with conditions that impair mobility and are not the same as Disabled License Plates

29. Main Points • There are no formal guidelines for jury duty exemption based on medical conditions. • Know the qualifications for benefits so you can be judicious about filling out papers for your patients.

30. Insert your own name here

31. Bibliography • http://www.4socialsecuritydisability.net/tx.html • http://www.social-security.net/state/texas • http://www.ridemetro.org/TransportationServices/MetroLift.asp • http://driversed.com/dmv/Texas-disabled-plates.aspx • http://www.tax.co.harris.tx.us/vehicles/placards/placardfaq.asp