Why Life Insurance Is Important For Families With Special Needs

Although financial planning is important for every family, families with special needs family members may require more attention than the average family to maintain a stable lifestyle.  Planning for a family with a disabled child or other member with special needs requires traditional planning plus additional strategies to ensure your family member is financially secure and their needs are met.

Planning is critical to ensure your child is financially secure for their lifetime, especially after a parent is gone.  Life insurance is commonly used to provide the necessary funds to ensure these goals are met.  Care must be taken to make sure the appropriate type of policy is used.  Second-to-die policies are often used during this planning.  Care must also be taken to ensure beneficiary designations are appropriate and special needs trusts are established especially if eligibility for government benefits must be maintained.

Can I Qualify For Disability With Meniere’s Disease?

Eligibility for disability due to Meniere’s disease is possible if the symptoms are severe enough to impact your ability to do work related activities. According to the American Academy of Otolaryngology-Head and Neck Surgery, Ménière’s disease describes a set of episodic symptoms including vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours.  As the symptoms can affect all types of work, even sedentary work, Social Security Administration (SSA) lists Meniere’s Disease as a listing to qualify for benefits.  Listing 2.07 applies to Meniere’s Disease:

2.07      Disturbance of labyrinthine-vestibular function (Including Ménière’s disease), characterized by a history of frequent attacks of balance disturbance, tinnitus, and progressive loss of hearing.  With both A and B:

A.  Disturbed function of vestibular labyrinth demonstrated by caloric or other vestibular tests; and

B.  Hearing loss established by audiometry.

If you do not meet or equal the above listing, you can still qualify for disability benefits if you are not performing substantial gainful activity and if the impairment prevents you from doing your past relevant work or other work that exists in significant numbers in the national economy.

 

 

Social Security Benefits For A Surviving Spouse

If you are receiving disability under the Social Security Disability Insurance (SSDI) program, your surviving spouse may be entitled to receive benefits on your record if you pass away.  The monthly benefit would be a percentage of the decedents Social Security benefit.  According to the Social Security Administration (SSA), the percentages allowed for the decedent’s dependents are as follow:

  • Widow or widower, full retirement age or older — 100 percent of the deceased worker’s benefit amount;
  • Widow or widower, age 60 to full retirement age — 71½ to 99 percent of the deceased worker’s basic amount;
  • Disabled widow or widower aged 50 through 59 — 71½ percent;
  • Widow or widower, any age, caring for a child under age 16 — 75 percent.
  • A child under age 18 (19 if still in elementary or secondary school) or disabled — 75 percent.
  • Dependent parent(s) of the deceased worker, age 62 or older:
    • One surviving parent — 82½ percent.
    • Two surviving parents — 75 percent to each parent.

If you are the divorced spouse of a worker who dies, you could get benefits just the same as a widow or widower, provided that your marriage lasted 10 years or more.  Also, note that if you remarry after you reach age 60 (age 50 if disabled), the remarriage will not affect your eligibility for survivors benefits.

In addition to the above benefits, a surviving spouse may receive a special lump-sum death payment of $255 if they were living in the same household or:

  • were already receiving benefits on the worker’s record; or
  • became eligible for benefits upon the workers death.

 

How Failing To Seek or Continue With Treatment Could Hurt Your Disability Case

Disability benefits are available for workers with impairments that preclude substantial gainful activity (SGA) for at least twelve months.  To qualify, an applicant for benefits must prove that they have a severe impairment that impairs their ability to work.  During the evaluation process, Social Security Administration (SSA) will review medical records, treatment notes and any other evidence that may assist with making a determination in regards to the ability or inability to work.  For obvious reasons, a claimant’s lack of treatment may cast doubt on the severity of injuries or limitations affecting work capacity.  Similarly, failing to follow prescribed treatment could negatively affect a claimant’s disability decision.

According to SSA, a failure to follow prescribed treatment determination may be made only where all of the following conditions are met:

  1. The evidence establishes that the individual’s impairment precludes substantial gainful activity (SGA) (or, age-appropriate activities for SSI children).
  2. The impairment has lasted or is expected to last for 12 continuous months from onset of disability or is expected to result in death;
  3. Prescribed treatment is clearly expected to restore capacity to engage in SGA (or gainful activity, as appropriate).
  4. The evidence of record discloses that there has been refusal to follow prescribed treatment.

There are certain circumstances where failing to follow prescribed treatment may be excused.  Acceptable justifications for failing to follow prescribed treatment include, but are not limited to the following:

  1. The specific medical treatment is contrary to the established teaching and tenets of the individual’s religion.
  2. The individual is unable to afford prescribed treatment, which he or she is willing to accept, but for which free community resources are unavailable.
  3. An individual’s fear of surgery is so intense that it is a contraindication for surgery.
  4. The prescribed treatment is cataract surgery for one eye, when there is severe visual impairment of the other eye that cannot be improved through treatment.
  5. Major surgery was previously performed with unsuccessful results and additional major surgery is prescribed for the same impairment.
  6. The treatment because of its magnitude (e.g., open heart surgery), unusual nature (e.g., organ transplant), or for some other reason is very risky.
  7. The treatment involves amputation of an extremity, or a major part of an extremity.
  8. An individual with a severe mental impairment is clearly unable to understand the consequences of failing to follow prescribed treatment.
  9. A treating source advises against the treatment prescribed for the currently disabling condition.

Dependent Benefits For Your Children When You Qualify for Social Security Disability

Workers who have sufficient work credits and are deemed disabled by the Social Security Administration will receive a monthly benefit under the Social Security Disability Insurance (SSDI) program.  As a result, certain family members may also receive dependent benefits.

Eligible children will receive benefits based on your work record if you are approved for SSDI benefits.  Your eligible child can be a biological child, adopted child or step-child.  In certain cases, a dependent grandchild may also be eligible for benefits.  To receive benefits, the child must be unmarried and:

  • Under 18 years old; or
  • 18-19 and a full-time student;  or
  • Over 18 years with a disability that started before age 22.

In most cases, benefits cease at age 18, unless the child is disabled or a full-time student, as noted above.

How much will  your child receive?

Generally speaking, your child will get one-half (1/2) of your benefit split equally between your eligible children up to the family maximum.  For example, if your monthly benefit is $2,000 a month and your family maximum is $3,000, you would receive your monthly benefit ($2,000) and your eligible children would receive the $1,000 balance split equally.

 

 

Why Is There A Vocational Expert At My Disability Hearing?

You have received a notice that your Social Security Disability hearing has been scheduled.  A vocational expert (VE) is scheduled to appear and give testimony at your hearing.  Should you be concerned?  What is the role of the vocational expert?

A vocational expert is a witness routinely called by an Administrative Law Judge (ALJ) to give testimony in Social Security Disability hearings.  The VE is an authority regarding job availability and vocational capacity in the current job market as well as the skills that are needed to perform specific jobs.  The vocational expert assists the ALJ so that he or she may make a determination into a claimant’s eligibility for benefits.

During the hearing, the ALJ will pose questions to the vocational expert using a hypothetical individual’s age, education, and limitations.  The VE will then testify as to whether there are any jobs the individual would still be able to perform.  Your attorney will cross-examine the vocational expert with any additional limitations that you may suffer from in an attempt to reduce the number of jobs to the point the VE testifies that the hypothetical individual is not employable.  Although your testimony is critical, care should be taken to ensure your record is complete and properly documents your limitations.  The ultimate goal is for the ALJ to find that your limitations are similar to the hypothetical employee that the VE testified was not employable.

Like any other legal proceeding, you should be well prepared for your hearing.  If a vocational expert is called as a witness, preparation should be taken to pose appropriate and reasonable questions to ensure all of your limitations are factored in when the VE testifies as to job numbers.

 

Disabilty Insurance

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Applying For Children’s Disability With Brachial Plexus Injury

The brachial plexus is the network of nerves that sends signals from your spine to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.

There are two ways that children can get an injury to the brachial plexus:

  • During birth: A brachial plexus injury occurs in 1.5 of every 1,000 live births. It is often caused when an infant’s neck is stretched to the side during a difficult delivery. This injury results in partial loss of sensory and/or motor function of the involved arm.
  • Trauma: Traumatic brachial plexus injuries may occur due to accidents. Nerve injuries vary in severity from a mild stretch to the nerve root tearing away from the spinal cord.

To qualify for SSI or SSDI benefits claimants must either meet or equal a listing in the SSA listing of impairments. The SSA listing of impairments is a listing of conditions and symptoms considered automatically disabling by the SSA.  Listing 101.08 covers brachial plexus injury in children with unilateral injuries.

101.08 Soft tissue injury (e.g., burns) of an upper or lower extremity, trunk, or face and head, under continuing surgical management, as defined in 101.00M, directed toward the salvage or restoration of major function, and such major function was not restored or expected to be restored within 12 months of onset. Major function of the face and head is described in 101.00O.  For bilateral injuires, listings 111.08, spinal cord disorders and 111.14, peripheral neuropathy must involve two extremities.

In children’s disability cases, if the child’s impairment is not severe enough to meet a Social Security “listing”, meaning an approval for disability benefits, then an assessment must be done to determine if the impairment functionally equals a listing.  For functional equivalence, the child must have one “extreme” or two “marked” limitations in the six domains of functioning.

The six domains of functioning are:

  1. Acquiring and using information
  2. Attending and completing tasks
  3. Interacting and relating with others
  4. Moving about and manipulating objects
  5. Caring for oneself, and
  6. Health and physical well-being.

The evaluation of how functioning is affected will be done during all of the child’s activities; meaning activities done at home, at school, and in the community.   First, Social Security will identify which of the child’s activities are limited, and which domains are involved in those activities.  They will then determine whether the child’s impairment(s) could affect those domains and account for the limitations.  Second, Social Security will then rate the severity of the limitations in each affected domain(s).  If SSA finds one extreme limitation, or two marked limitations, the child will be approved for disability benefits.

Applying For Disability With Scoliosis

Scoliosis is a condition that causes the spine to curve to the side.  It can affect any part of the spine, but the most common regions are the chest area (thoracic scoliosis) and the lower section of the back (lumbar scoliosis).

Doctors don’t know what causes most common types of scoliosis, although it appears to involve hereditary factors.  Other types of scoliosis may be caused by:

  • Neuromuscular conditions
  • Birth defects affecting the development of the bones of the spine
  • Injuries to or infections of the spine

Symptoms of scoliosis include:

  • The head is slightly off center
  • The ribcage is not symmetrical – the ribs may be at different heights
  • One hip is more prominent than the other
  • Clothes do not hang properly
  • One shoulder, or shoulder blade, is higher than the other
  • The individual may lean to one side
  • Uneven leg lengths

Following an application submitted due to scoliosis, Social Security will evaluate the case to determine if the claimant meets or equals a listing.  A listing is a set of criteria specific to a condition that, if satisfied, would automatically qualify a claimant for disability benefits. Listing 1.04 is the listing specific to scoliosis and other disorders of the spine:

1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With:

A. Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine);

OR

B. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours;

or

C. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.

If you do not meet or equal the above listings, you can still qualify for disability benefits if the impairment prevents you from doing your past relevant work or other work that exists in significant numbers in the national economy.

Please call our office if we can be of any assistance or answer any questions you may have about filing for disability.