What Is Considered Blindness or Low Vision?

Under SSDI definitions, someone is considered legally blind if his/her vision cannot be corrected more than 20/200 in either eye, or if a person’s visual field (peripheral vision) was 20 degrees or less in the better eye during the previous 12 months or is expected to last at least that long. In addition, even if the person does not meet the definition of legal blindness, he/she could still qualify for disability benefits if the person has low vision. The vision deficit must be severe enough alone, or in conjunction with other medical issues, to prevent the person from working. Note that the SSA looks at someone’s total visual capacity, so if one eye has good vision disability benefits under SSDI are unavailable.

Work Credits

Generally, in order to qualify for SSDI benefits, the applicant must work and pay Social Security taxes for a certain number of years. Working and paying into the Social Security system allows a person to accumulate a minimum number of work credits that entitle him/her to receive specific government benefits. However, with blindness, credits may be earned during any working year, including years worked after the onset of blindness if a person does not have a sufficient number of credits when the blindness first occurs.

Working While on Disability

The SSA wants to encourage disabled individuals to work and earn income to the extent possible, and does so by offering work incentives to those receiving benefits. As long as the person’s monthly earnings do not rise above the set amount ($1,170 for most SSDI recipients), benefits are still paid. However, for those receiving benefits due to blindness, the amount a recipient is permitted to earn each month and still receive SSDI payments is significantly higher – $1,950 as of 2017. In addition, if someone with blindness is self-employed, he/she is permitted to do a substantial amount of work for the business and still keep SSDI benefits as long as monthly profits do not exceed $1,950. Finally, once an individual with blindness reaches the age of 55, the rules for monthly earnings change further by allowing a blind person to earn more than $1,950 per month and not completely lose SSDI benefits. Instead of terminating benefits, which is the standard action taken if someone’s work earnings exceed the monthly thresholds, those with blindness over age 55 will have benefits suspended during any month earnings are too high. During months when earnings come in at or below the allowable amount, benefits will be paid.

Talk to a Disability Attorney

Dealing with any type of disability is a challenge that often limits a person’s ability to work and earn money. If you are facing a disabling condition that prevents you from working, consult a disability attorney about qualifying for SSDI benefits. Farrell Disability Law helps clients throughout Florida and South Georgia qualify for disability benefits, and can help you get the benefits you need and deserve. Contact the office today for a free consultation.

Resources:

ssa.gov/planners/disability/dqualify8.html

ssa.gov/planners/disability/dqualify2.html

Advantages of Private Disability Insurance

The biggest drawback to SSDI is the strict definition of disability that all applicants must meet in order to be approved. Specifically, only those unable to return to previous work or adjust to new work for at least one year will qualify. Thus, individuals who are partially or temporarily disabled will be automatically excluded from this insurance program. Private disability insurance covers this gap for individuals in this in-between situation, and almost always offers a much more liberal definition of what is considered a disability so more people qualify. Further, SSDI benefits are calculated based on a person’s average lifetime earnings, which is subject to a cap of $2,639 per month as of 2016. Private disability insurance often pays much more, up to 70 percent for some policies, and is tied to a claimant’s income at the onset of the disability, which can vary widely depending on a person’s age and profession.

Important Benefit Options

Returning to the definition of ‘disability,’ which controls how likely an individual is to be approved for benefits, private disability insurance offers policyholders the ability to select from a number of disability definitions. The three most common include:

• Own-Occupation Coverage – This is the most liberal type of disability coverage and offers benefits for a policyholder unable to perform the duties of his/her occupation. Thus, it does not require the policyholder to seek other types of employment or show total disability to obtain benefits;
• Own-Occupation Coverage with Time Limits – This option gives policyholders the same coverage described above for conditions that affect performance of that person’s job, but only for a limited time (one, two or five years is most common). After this period, most policies convert to an any occupation definition of disability; or
• Any Occupation Coverage – This coverage is substantially similar to the SSDI definition of disability, and requires the policyholder to be unable to perform any type of work to qualify for benefits.

In addition to choosing how strict or expansive the definition of disability is, private policies may also offer:

• an option to choose how long a disability must exist before benefits will be paid. For example, a 13- or 26-week waiting period;
• an annual cost of living adjustment that is almost guaranteed to be higher than that granted by SSDI; or
• a rehabilitation program designed to help disabled individuals determine if a return to previous work is possible, as well as job skills training, job placement and relocation assistance as necessary.

Get Legal Assistance

If you are someone dealing with a disability that will not allow you to work, talk to a disability insurance attorney about qualifying for benefits. Your life is stressful enough, and a firm such as Farrell Disability Law, can take away some of the struggle by handling the approval process and any necessary appeals. Farrell Disability Law represents clients throughout Florida and South Georgia, and can help you get the benefits you deserve. Contact the office for a free consultation.

Resources:

bloomberg.com/news/articles/2017-01-27/trump-freeze-seen-worsening-526-day-disability-case-backlog

ssa.gov/planners/disability/dqualify4.html

Most people are familiar with the disability benefits offered through the Social Security Administration, but an entirely separate arm of disability coverage is employer-sponsored private coverage that comes with its own set of regulations. One federal law that particularly impacts how employer-sponsored disability policies are handled is the Employee Retirement Income Security Act (ERISA). While ERISA regulations mainly address retirement plans, the law also has provisions related to other employee benefits, including disability insurance. Note that ERISA only applies to employer-sponsored disability policies, and not those purchased by someone separately. Some employers even offer some level of disability coverage to employees at no cost to the employee, with the option to add additional levels of coverage at the employee’s discretion. ERISA’s complicated regulations affect almost every aspect of an employer-sponsored disability insurance plan, and therefore need to be understood by any employee with this type of coverage. While employees hope it is never necessary to file a claim against a disability policy, knowing about the key provisions in ERISA that govern such coverage beforehand will prevent a mad scramble to gather all necessary information in the event a claim must be filed.

Filing a Claim

Understandably, what most people care about with employer-sponsored disability insurance is how to file a claim, but before one gets to that step, every employer who offers this benefit is required to provide each covered employee with specific information on the substance of the disability insurance policy. Specifically, the employer must supply documents explaining the following:

• detailed descriptions of what is and is not covered by the policy;
• instructions on how to file a claim once an employee becomes disabled; and
• how to appeal if a disability claim is denied.

With respect to filing a claim, ERISA explicitly regulates how claims are processed, the time restrictions on deciding claims, and the employee’s rights if a claim is denied. Insurance companies must issue a decision on disability within 45 days, though providers can extend the decision time up to 60 days. In order to get an extension, the provider must give notice before the initial 45-day period expires, ask for additional information if necessary to process the claim, and state when a decision will be made.

If a claim is denied, the provider must notify the employee of this decision in writing or via email. The employee is entitled to a detailed explanation of the basis for the denial and how to file an appeal. Employees have at least 180 days to appeal, though some plans give employees more time. In addition, the employee has the right to request any documentation the provider used in making its decision, as well as the names of any medical professionals consulted during the analysis of the disability claim. Employees can file for an appeal on their own, but this process is extremely complex, and has a better chance of success if handled by an experienced disability insurance attorney.

Lawsuits

If an employee exhausts the appeals process, he/she does have the right to file a lawsuit to obtain disability benefits. However, ERISA provisions limit a judge’s review to whether the insurance company abused its discretion when denying the claim. Effectively, this restriction makes it very difficult to succeed at this stage. Further, the judge’s decision is based entirely on the insurance company’s records. Thus, if the employee failed to provide any supporting documents during the administrative stage, the judge cannot consider this information, which is likely to influence the outcome.

Get Help

If a disabling condition has forced you to stop working, contact a disability insurance attorney about the most effective way to file a claim. These benefits are crucial to the financial stability of most individuals, and you want to give yourself the best possible chance at approval. An experienced disability insurance attorney can guide through the process, taking away some of the burden of your situation. Farrell Disability Law helps clients throughout Florida and South Georgia on a variety of disability issues, and is available to assist you with your case. Contact us for a free consultation.

Resource:

dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/filing-a-claim-for-your-health-or-disability-benefits