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Seeing a judge?

Discussion in 'Social Security / Disability Benefits' started by Jennannshear, Apr 11, 2010.

  1. Jennannshear

    Jennannshear Registered

    Ok so I applied for SSI and was denied.. no real shocker. I was told by medicaid I was covered only til the end of April.. so I have enough meds to last me until June 1st. I applied through medicaid for an extension but was told I had to appeal the denial through SSI and so I went to SSI that day and did the appeal paper work. I received a letter stating that I would need to update my papers and that I would be seeing a judge with in 20 days.. I thought when you appealed that it took a few denials before seeing a judge? Has this ever happened before to any one else? It also stated that depending on what else I send in, the judge may make a decision with out even seeing me in person?! hmmm. I wrote a letter stating I just want medical coverage and how I was going to have nothing come May 1st.. and how I can not drive or walk alone so I need medicaid bc I get free rides back and forth.. and how I am not concerned about the money, that I just really need coverage .. I wonder if that may have contributed???
     
  2. KarolH

    KarolH Registered

    Hi Jenna
    This same thing happened to my friend and she did not even see the judge.
    She sent in more info like you did and got an approval letter in the mail.
    I hope this happens for you.
    Keep us posted.
     
  3. Jennannshear

    Jennannshear Registered

    I hope so. I am struggling right now. My husbands supervisor position was such a good thing at first BUT now he makes 104 over the weekly limit for Family health coverage SO we are subject to Healthy NY or coverage through his job.. either way the law states that for 12 months while on that health coverage program they will not cover anything to do with my pre-conditions.. FOR 12 MONTHS!! WTH??? I wrote down all my options on paper.. and its not good. If I dont get approved for SSI then we will have to drop his pay to fight the guide lines for Family Health Plus... UGH when will this end? : (
     
  4. Pink Pearl

    Pink Pearl Registered

    Hi Jenn,
    I always advise people to be as verbose as possible. You may want to add to what you sent in. Go thru your day, identify how much trouble you are having due to sle and its related "hangers-on" Your doctors should have sent their info in, if not, they need to asap. Identify every little "ism" that lupus can throw your way. Track your activities for a week, how much trouble you are encountering. Include why you are not able to work due to sle. Be specific, be descriptive, how much does this impact your family.

    Unfortunately, the way the laws are written, you will not be eligible for medicare until you have been on disability, SSD, for 2 years. If you get the judge to move your SSD initial disability date back, to when you initially became disabled, not when you applied for SSD, you can meet that waiting period.

    Not sure if social security explained this to you:
    SSD - for those who are off work due to disability
    SSI - for those who have not had enough hours worked to qualify for SSD.

    One of the things that President Obama was fighting for in his health plan was to eliminate "pre existant condition" clauses for all insurance. What you are describing with not being eligible for coverage, is the pre existing condition (PEC). Should you develop something totally unconnected to lupus, you would then be able to have that specific condition covered. Many people are not looking at the benefits that will come from this program. It will save people, such as yourself, who are not considered "eligible" for standard health plan benefits. For many, it will give them coverage.

    I processed health insurance claims before lupus hit hard. So..... let me explain what the "12 mos" is about.
    Pre-existing conditions, something for which you are treated before you the effective date of your health coverage.
    If at any point in the first year, you are able to go 90 days treatment AND medication free, you will be deemed to not have a PEC. BUT, if this is not done you have to wait thru 12 months/1 year to be eligible for benefits. Such are the loopholes of insurance benefits.

    At the hearing, you will need to prove medical disability.......unable to be gainfully employed. To discount your disability benefits, and focus just on the medical coverage, will not provide the proof the judge needs.
    I trust you have a disability attorney. If not, you need to have one to represent you at the hearing. You will NOT have to pay for the attorney if you are found eligible. The payment for the attorney comes out of your "past" benefits.

    I hope I have cleared up a bit of the confusion for you. Any more questions, ask away.
    fyi: the LFA has a very good workbook for applying for SSD. I suggest you check it out.
    Sally
     
  5. Lily

    Lily Registered

    There are also some excellent resources pinned at the top of this forum which will help with disability claims.

    Good luck,

    love
    Lily
     
  6. Jennannshear

    Jennannshear Registered

    Thanks! I did not work enough hours to get SSD so I had to apply for SSI. I sent in all my paper work.. which works out bc they had added another medication and i am having a cystoscope with biopsy of my bladder today from having cystitis.. Plus my GFR was 60 and I have protein in my urine.. so I am hoping that will help my case.. I got some meds taken care of and today I will (I hope) get more.
     

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