Appealing Disability Determination/SSI

[Captain Serious]

We applied for Katie Beckett for both our boys, which is a state disabled home care program. The people who decide eligibility are the same people who make the determinations for SSI, and use the same criteria.

J was denied, and M's case I'd still in progress. I know that something like 85% of people who apply for SSI are denied the first time the apply, and often are granted benefits if they appeal. So here's my question:

Have you appealed a disability determination, and if so, what was the process like?

Strictly by listed conditions, J should qualify, but do they consider the severity of the condition when it is not specifically spelled out that way in the regulations? What I mean is, if you look up congenital heart conditions, it's pretty clear that they consider severity and impact on life, but if you look up neurological conditions, they just list examples, and say that they consider if it is accompanied with a speech issue. J has NF1, which is a neurological disorder and apraxia of speech. We don't know why he was denied unless they judged that it isn't severe enough to qualify. If that is the case, what is the standard/level of severity we would have to prove for him to be approved?

We don't want to stretch this or try to get him the determination of its not appropriate, but from reading the list of conditions, it seems he should have been approved. What has your experience been?

[ginger]

When my mom applied for disability, she was not approved until they had a lawyer.

I don't know if KB is the same and will need a disability lawyer to push things along or not.

My BFF's daughter was denied because someone didn't submit all the paperwork after she turned it in, so make sure it wasn't something like that too.

Good luck. It shouldn't be this hard to advocate for special needs.

[Bernadine]

Paperwork and documentation can play a huge role in approving/denying disability applications. I would go ahead and appeal, but be prepared to wait a long time for a decision, unfortunately.

[Captain Serious]

Feb 12, 2016 11:52:01 GMT -5 Bernadine said:

Paperwork and documentation can play a huge role in approving/denying disability applications. I would go ahead and appeal, but be prepared to wait a long time for a decision, unfortunately.

We submitted a two-inch packet of information, and were denied in less than a month. I feel like they didn't even look through it all to make a decision that fast.

Unfortunately, we already had issues with M's application getting forwarded (more than once) to SSA and other offices for benefits we weren't applying, so I'm don't really have a lot of confidence in this office.

[BirdGirl]

I agree with the lawyer rec. I've done this type of work on a probono basis in the past and having someone who knows the process makes a huge difference. Finding someone good (or even decent) can be hard though because they often get paid so little. I'd call your state bar and ask if they have any sort of referral program. I assume your boys are already getting other services too. Those therapists may have recs as well.

[shoeaholic]

Do you have a local advocacy group that you can work with? I'm in the process of getting this done for my son and I have found a service that helps with the process. They are actually a service provider approved by the state so they are motivated to get my son approved. They are helping with all paperwork and advised me that it may get declined initially but they are used to that and know how to work on getting it approved.

I would start by looking for some organizations on your area specific to their needs and see what support they can offer.

[spankswife]

Lawyer.

You will generally get back pay from date of first filing, and atty gets a percentage of that. Usually no OOP expenses.

[sallywalker]

My biggest advice would be to make sure you hand deliver all of the documentation yourself. Don't rely on the physician offices or hospitals to send the documentation. Get it yourself and make sure your whoever is working your case receives it. Also call, call, call. Staying involved and knowing what is going on in the process helps so much.

[auntie]

It's pretty typical to be turned down the first time out.

In my state Katie Becket/non-means tested Medicaid are determined separately with different paperwork. We had a KBW when DS was first dxd; it brought nothing to the party for us, so we never re-applied.

In some states you have to go through the SSI process in order to access KBW and could qualify for that without getting SSI.

Your kids are still children, no? Do you meet the income and asset guidelines to qualify for SSI? We never did while DS was minor. Now that he's an adult, he could apply for SSI based on his own income and assets but TBH, it wouldn't be worth the hassle of spending down his savings.

www.socialsecurity.gov/ssi/spotlights/spot-deeming.htm

[tripleshot]

I don't have any direct experience, but I've heard many people say that claims are often denied the first time because SSI are assholes. Getting a lawyer increases your odds of being approved dramatically for whatever reason.

[weelass24]

You need an attorney who specializes in SSD/SSI cases

[starryfish]

My mom was denied the first time. She got a lawyer and is working on the appeal now. GL

[thebreakfastclub]

My brother was denied but his lawyer won him benefits on appeal.

[nikki25]

Re-apply. It is nearly identical to the original process, if it is denied then that is a different story. However,  an attorney could help bypass the legal BS.

It is 100% true most are denied, which is bullshit, but it is what it is. Keep all documentationset since the time you applied until current and thus after. 

Seek out legal aid in either your state or county depending on the set-up. Legal aid can usually help with denials and will do it for free or reduced fee. Don't give up. I don't know what state you are in but if PA please PM me. 


I am sorry : (

[mich1]

Feb 12, 2016 11:52:01 GMT -5 Bernadine said:

Paperwork and documentation can play a huge role in approving/denying disability applications. I would go ahead and appeal, but be prepared to wait a long time for a decision, unfortunately.

This. When I applied for SSDI I had my medical records in front of me and used them to work from. I threw every piece of information they asked for at them. That meant that I kept adding lines to the form.

I didn't use a lawyer, and received it about 5 weeks after I applied.

[Captain Serious]

Thank you all. We are applying with the help of the state office for Children with Special Health Needs. They have been helping us prepare all the paperwork and are in touch with the determiners, but I think we'd be largely on our own to figure out how to appeal. I asked our social worker about it, and she didn't have to much information to share.

There is a local family advocacy group that does a lot for families with disabilities, and they might be able to help us out hook us up with an attorney. It sounds like a lawyer is the way to go.

[Captain Serious]

Feb 12, 2016 12:21:51 GMT -5 auntie said:

It's pretty typical to be turned down the first time out.

In my state Katie Becket/non-means tested Medicaid are determined separately with different paperwork. We had a KBW when DS was first dxd; it brought nothing to the party for us, so we never re-applied.

In some states you have to go through the SSI process in order to access KBW and could qualify for that without getting SSI.

Your kids are still children, no? Do you meet the income and asset guidelines to qualify for SSI? We never did while DS was minor. Now that he's an adult, he could apply for SSI based on his own income and assets but TBH, it wouldn't be worth the hassle of spending down his savings.

www.socialsecurity.gov/ssi/spotlights/spot-deeming.htm
[/q]We aren't trying to get SSI, just Katie Beckett. My understanding is that it will cover whatever insurance doesn't, and for us, that's quite a lot. Also, for M, I think he will need SSI as an adult, and I hear it's a lot easier to qualify as a child than as an adult, so we'd like to do that now as well, of we can. Once we have the determination, we will be able to apply for SSI if he meets the income qualifications later in life.

[livinitup]

Keep copies of everything. And keep copies of your copies.

Keep track of deadlines. Don't miss any deadlines.

[auntie]

Captain Serious,, said:

We aren't trying to get SSI, just Katie Beckett. My understanding is that it will cover whatever insurance doesn't, and for us, that's quite a lot. Also, for M, I think he will need SSI as an adult, and I hear it's a lot easier to qualify as a child than as an adult, so we'd like to do that now as well, of we can. Once we have the determination, we will be able to apply for SSI if he meets the income qualifications later in life.

I see.

Can you qualify for Katie Becket or non-means tested Medicaid without qualifying for SSI?

I hope your experience is better than mine. No one I would have trusted with DS accepted the HMO Medicaid assigned us to. Hell. DS's dev pedi and psychologist don't take commercial PPO insurance. We still pay OOP. 

From what I see among my friends whose kids have HFA, it's easier to qualify for SSI as an adult. YMMV. My one friend has a son with Aspegers and OCD. His IQ is about 140. He qualified on the first shot because he's struggling to be independent. 

[pegasuskat]

I just got denied a few weeks ago and will be filing an appeal too. I have not talked to a single person who got it on the first try, I think they just deny everybody as a rule. Good luck, hope you appeal and it goes through quickly.

[nikki25]

Feb 12, 2016 18:03:45 GMT -5 Captain Serious said:

Thank you all. We are applying with the help of the state office for Children with Special Health Needs. They have been helping us prepare all the paperwork and are in touch with the determiners, but I think we'd be largely on our own to figure out how to appeal. I asked our social worker about it, and she didn't have to much information to share.

There is a local family advocacy group that does a lot for families with disabilities, and they might be able to help us out hook us up with an attorney. It sounds li ke a lawyer is the way to go.

Contact legal aid or the public defenders. Our office doesn't handle SSI appeals but not every PDs office is the same however we will forward it to legal aid and there is one specific attorney who only handles these types of cases.

Good luck!