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SOCIAL SECURITY

The social security program is run by the United States government and is the program that provides benefits to more brain injury survivors than any other. Almost all survivors of a moderate or severe brain injury, with the proper representation and case presentation, should eventually be found to be entitled to social security benefits. Many mild brain injury survivors will also qualify for social security disability.

Here is the definition social security uses to categorize brain injured people as disabled: Organic Mental Disorders: Psychological or behavioral abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests demonstrate the presence of a specific organic factor judged to be etiologically related to the abnormal mental state and loss of previously acquired functional abilities. The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Demonstration of a loss of specific cognitive abilities or affective changes and the medically documented persistence of at least one of the following: 1. Disorientation to time and place; or 2. Memory impairment, either short-term (inability to learn new information), intermediate, or long-term (inability to remember information that was known sometime in the past); or 3.Perceptual or thinking disturbances (e.g., hallucinations, elusions); or 4.Change in personality;or 5.Disturbance in mood; or 6. Emotional lability (e.g., explosive temper outbursts, sudden crying etc.) and impairment in impulse control; or 7. Loss of measured intellectual ability of at least fifteen I.Q. points from premorbid levels or overall impairment index clearly within the severely impaired range on neuropsychological testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc; AND B. Resulting in at least two of the following: 1. Marked restriction in activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner (in work settings or elsewhere); or 4. Repeated episodes of deterioration or decompensation in work or work-like settings which cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms (which may include deterioration of adaptive behavior).

The problem is that social security routinely turns down, or unnecessarily delays, acceptance of even severely injured survivors.

The basis for such denial is almost always the standard that in order to be eligible for social security, the survivor must be totally disabled for a period of one year. Note: There are exceptions.

Typically, at the time social security first evaluates the claim, it will not have been one year from the date of injury. If, at that time, the doctors are saying anything like: "We will just have to wait and see," social security may turn the application down with the following language:

"We have determined that your condition is not expected to remain severe enough for 12 months in a row to keep you from working."

The doctors won't say how fast the survivor will improve, which leaves social security with the opportunity to conclude that some work will be possible within a year. Thus, the initial application gets turned down.

The good news is that social security takes so long to process applications, that by the time a hearing is finally heard, there should be no question that the disability has lasted a full year because a full year will have lapsed.

Simple rule for social security: don't give up. It is a three step process to get a hearing, but chances of winning at a hearing are excellent. The process can be summarized as follows:

A survivor applies for benefits, after several months of form filling and waiting for medical reports, social security will make an initial determination. If the bureaucrat handling the file finds some theory as to a quick recovery, the application will be denied. However, the denial will clearly explain how to request a reconsideration. 60 days is allowed for asking for a reconsideration, but do it as fast as possible.

On reconsideration, another bureaucrat will look at the initial medical evidence, as well as any new medical information. While in most cases, reconsideration doesn't result in reversal; with the increasingly clearer picture of the extent of recovery as time passes, it can make a difference with brain injuries. If the treating doctors are issuing clearer opinions, the application may be accepted at this point. Again, the delay increases the chance of success.

If the reconsideration results in another denial, then the survivor must again appeal. It is at this stage that the claimant gets a hearing. It is also at this point that it becomes compelling to consult with an attorney. Experienced social security attorneys have excellent track records of success at hearings.

Frankly, attorney fees in this area are a bargain. Fees are almost always done on a contingent fee basis and work out to be quite reasonable in amount. Most lawyers today are limiting their fees to 25%, with a maximum of $4,000. At the hearing, an administrative law judge will reexamine the medical evidence, as well as hear testimony presented by the applicant. Such testimony may include first hand descriptions of the survivors difficulties by family members, co-workers or employers.

Odds are that an administrative law judge, presented with the proper evidence, will find that the disability is severe enough to meet the social security standard. If you can get a neuropsychologist to testify, your chances go up considerably.

Eligibility for social security, whether it be through SSI or SSDI not only opens the door for monthly payments, it may also provide payment for medical bills and other benefits.

SSI is short for Supplemental Security Income. It pays monthly checks to people who are:

• 65 or older,
• or blind,
• or have a disability

and who don't own much or have a loss of income.

SSI isn't just for adults. Monthly checks can go to disabled and blind children, too.

People who get SSI usually get food stamps and Medicaid, too. Medicaid helps pay doctor and hospital bills.

SSDI is short for Social Security Disability Income.

Disability under Social Security is based on your inability to work. You will be considered disabled if you are unable to do any kind of work for which you are suited and your disability is expected to last for at least a year or to result in death.

You can receive Social Security disability benefits at any age. If you are receiving disability benefits at age 65, they become retirement benefits, although the amount remains the same. Certain members of your family may also qualify for benefits on your record. They include:

• Your unmarried son or daughter, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under 18 or under 19 if in high school full time.

• Your unmarried son or daughter, 18 or older, if he or she has a disability that started before 22. (If a disabled child under 18 is receiving benefits as a dependent of a retired, deceased, or disabled worker, someone should contact Social Security to have his or her checks continued at 18 on the basis of disability.)

• Your spouse who is 62 or older, or any age if he or she is caring for a child of yours who is under 16 or disabled and also receiving checks.

• Social Security Number,
• Medical Records from doctors, therapists, hospitals, clinics, and caseworkers,
• Laboratory and test results,
• Names, addresses, phone and fax numbers of your doctors, clinics and hospitals,
• Names of medications,
• Names of employers and job duties for the last 15 years,
• If you are filing for a child, you also need school records regarding your child's disability.

• IMPORTANT NOTE: Don't wait to file your claim for disability payments even if you don't have all this information.

The Social Security Administration has about 1,300 offices in cities and towns across America.

They may be reached at their toll-free number 1-800-772-1213. You can get recorded information 24 hours a day, including weekends and holidays. You can speak to a service representative between 7 a.m. and 7 p.m. on business days. Their lines are busiest early in the week and early in the month.

People who are deaf or hard of hearing may call their toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on business days.

• Non-Obstacles to Recovering for Your Injuries or Why these Buts Won't Hurt. But I didn't Hurt Right Away and Other Non-Issues. Injured persons often feel that certain things will prevent them from making a claim for compensation. Most these things are not problems.
• Concussions and Brain Injuries
• Neck, Back and Spinal Injuries
• Other Injuries

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