I got a letter stating my SSDI is stopping in December

[beckums70]

Basically what happened is that my TWP is up and I had a 3 paycheck month in September which caused me to make 200.00 over the amount they consider "gainful employment".   The letter they sent me claims I also made that same amount for the months of October and November, but I made FAR less, and will make far less in December and every other month in which I don't get 3 paychecks.  I get paid bi-weekly which means I get 2 months out of every year with 3 checks. 

Now I made over the limit in April too, but i didn't get this letter or get told I would lose my benefits.  My TWP was up in December of 2015 so basically this whole year was my extended benefit period.

I read online that the "can" continue to pay me and reapprove me to be paid for any months I do not make above the reasonable gainful employment amount (most months) without having to re-approve me for disability.  My question is what do I do now to make sure I don't lose my income for the month of December?  I will lose an average of 4 days of work in December (I only work 4 days per week 4 to 5 hours per day) so my income for the month will already be reduced drastically from my job.  I cannot make ends meet on the 8-900 per month I usually make from my job, and I can't survive on SSDI alone. 

I am so upset and worried right now that I can't even eat or sit still.  I don't know what I'm going to do.  I already had to dip into savings twice this past two months because my car broke down and then again when last week, the day before TG my refrigerator suddenly stopped working. I live well within my means, but even so, my rent and utilities are over 700 per month alone.  How do I cover the cost of everything else to care for myself and my son without SSDI to back up my income from my job?

Has this happened to anyone else?  WAs the issue resolved for you?

[Michael Murphy]

Look it's not hopeless,  you occasionally twice a year exceed the monthly amount but never exceeded the yearly amount.  Call social security make an appointment bring as many pay stubs as you have, explain how you are paid bi weekly so twice a year you are over for the month but you never exceed
The yearly amount. This is important do not volunteer any information other than the tree check answer.  Too many people I know have had problems with Social Security by saying things like Dialysis isn't so bad.  Well if it's not so bad why should we pay you.  The only other alternative is hiriring an attorney.  Problem there is the lawyer will take a cut of the back pay the SSA  pays you.  So if you are canceled you can then appeal.  Remember cheap clothes, life sucks to be you,  and unless asked don't volunteer info.  The key thing is to bring along as much documentation of wages including last years if you were working.  Good Luck.






sp mod Cas

[smartcookie]

I agree with Michael Murphy.  You need to call and get this settled.  You can even talk to your Social Worker and have him/her on the phone when you talk with Social Security.  I have done that with patients before.  If Social Security continues to not work with you over the matter, find a lawyer that will do an initial consultation for free.  The lawyer can give you some advice and, if his/her rates past the initial consultation are acceptable, help you fight back!  I have patients that make the same or even less as you and I have no idea how they make ends meet.  I have to help them with light bills a couple times a year and sometimes rent/mortgage.  I hope you find some resolution to this!

[Charlie B53]

Phone calls alone are not enough to protect your rights.  ALL SS Decisions may be appealed but need to be in writing and in a timely manner.  Youo cannot delay making an appeal.

As already stated, do NOT tell them anything other than a direct answer to any question.

If you file income tax take copies of past returns to prove your annual income, plus all pay stubs proving your monthly income.  As well as rent receipts, utility b ills , etc.  So you can clearly show your basic monthly living expenses.

Even if there is a decision to terminate there is a means to continue your monthly award while an appeal is made, but you need to make that request in writing in a timely manner.

[Simon Dog]

The lawyer can give you some advice and, if his/her rates past the initial consultation are acceptable, help you fight back!

Social Security disability attorney fees are limited to 25% of the back disability recovered up to $6000, with the ability to petition SS for a higher fee in some limited cases.

It is unlikely you fill find an attorney that charges less, so you can pick based on quality.

Remember also that Dialysis is an automatic qualifier so you should not need an attorney to help you get SS disability.   SSI is based on income once you have qualified for disability, and it could be more complicated proving you qualify.

[beckums70]

I just realized I never came back and followed up on this. 

I went to SS and spoke to someone about it back in November and she told me that I shouldn't have even gotten that letter because SS had not even finished my work evaluation yet.  She was able to confirm that I was on schedule to be paid for December and January.  I never got another letter from SSDI saying they were stopping payments but I did get 2 letters showing the amounts my son and I would be getting monthly for this year.  I got paid this month, so I suppose they figured it all out somehow.

My only other concern now is that I have another 3 paycheck month coming up in April.  The woman at SS told me that if I go over the 1040.00 in any month they will not pay me for that month, even if I only go over by a dollar.  I will not be able to get through the month on just what I make at my job even with a 3rd paycheck in there.  I'm not sure if I should take some time off to keep my income down for that month or if I should just work as usual and see how it pans out?  This whole thing is just scary to me. 

[Michael Murphy]

Ask at work if on the 3 check months if you can do something like have them hold a check and spread the amount over the next two months so you stay under the limit.. 

[nursey66]

I don't think being on dialysis is an automatic qualifier for SSDI, if you are able to make a " gainful " amount of money working , you would not qualify. SSDI is income based as well as being based on a disability.  Being on dialysis automaticity makes you eligible for Medicare right away.  For SSDI you have to be completely unable to work for 5 months to qualify, then you get the first check on the 6 th month. The ticket to work is a tricky program , if you make more than the allowable amount, it's counted as a " gainful " month of employment. The months don't have to be in a row and I don't think they start counting over each year. I believe it's 6 "gainful " months that they need to disqualify a person. I haven't read anything about this subject recently but think it is still pretty much the same rule. I think the amount you can make goes up every year or two. I did do some extensive research on this a while back, if I am wrong please tell me.

[Simon Dog]

I don't think being on dialysis is an automatic qualifier for SSDI, if you are able to make a " gainful " amount of money working , you would not qualify. SSDI is income based as well as being based on a disability.  Being on dialysis automaticity makes you eligible for Medicare right away.  For SSDI you have to be completely unable to work for 5 months to qualify, then you get the first check on the 6 th month. The ticket to work is a tricky program , if you make more than the allowable amount, it's counted as a " gainful " month of employment. The months don't have to be in a row and I don't think they start counting over each year. I believe it's 6 "gainful " months that they need to disqualify a person. I haven't read anything about this subject recently but think it is still pretty much the same rule. I think the amount you can make goes up every year or two. I did do some extensive research on this a while back, if I am wrong please tell me.

1.    Dialysis is an automatic qualifier.  See Medicare disability rule 6.00 and 6.03.   Of course, if you earn over the limit, you are disqualified.

2.    You are eligible for Medicare the first day of your 4th month of dialysis unless you are a home care patient, in which case you are eligible immediately.   If you have private insurance, you will generally be  moved over to Medicare primary after 30 months.

[Michael Murphy]

I would like to add that when I went to apply several members of the clinic I go,to had just applied and were turned down, they had to get a attorney and eventually they won but the attorney to a portion of their back payments.  Since I firmly believed I was going to be turned down I decided to apply for disability online.  I figured it would be faster and I could hire a attorney sooner.  Much to my suprise I was accepted without any problem,  what I think was happening e people who applied in person did what I would have done when I describe dialysis to non dialysis people I minimize the bad aspects,  didn't talk to anyone so my medical records carried the day..  since then iI have cautioned others about only answering questions and if possible apply on line so only your medical records are considered.

[nursey66]

Simon Dog , thanks , l did not know you had to be on dialysis 4 months before qualifying for Medicare . My husband didn't go on Medicare for a couple of years because he was on my work insurance and his work insurance chose to let him stay with their insurance as well so he already had 2 insurance plans. He got right on SSDI when the waiting period was over because he was hospitalized for 5 of those first months October to February . Unreal but true , used up over 1 million $ of insurance. So people need to worry about parts of the ACA the Republican are trying to dismantle.

[Simon Dog]

There are a boatload of attorneys out there who help with disability applications and appeals.  The "take" is limited to $6000 or 25% of the back payments received.

It should not be necessary to use representation for a dialysis disability application since dialysis is a "listed disability" (see 6.03 in the ssdi disability manual).  What you do need to either be good at self-representation, or use an attorney for, is getting a "renal non-dialysis disability" approved.   The social worker at my clinic tells me she has never seen one of the dialysis patients turned down.

When you applied online, were you summoned to the SS office for an interview or was it all done by paperwork?

[Michael Murphy]

There is a additional rule, three months after you start dialysis a 30 month period begins.  After this perio 33 months from the start of dialysis you must go on Medicare and you insurance becomes secondary.

[Shaks24]

When you start dialysis your clinic files a form with medicare cms2728  https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS2728.pdf  This form is accepted by Social Security as evidence of having ESRD and being on dialysis. You could get a copy of this form from your clinic and submit it with your application or drop it off at your local SSA office. Thats what I did. Of course you have to meet the non medical requirements for SSDI which are having the work credits and being a U.S. citizen. If you lack the work credits you can qualify for SSI which is a needs based program.

[beckums70]

When you start dialysis your clinic files a form with medicare cms2728  https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS2728.pdf  This form is accepted by Social Security as evidence of having ESRD and being on dialysis. You could get a copy of this form from your clinic and submit it with your application or drop it off at your local SSA office. Thats what I did. Of course you have to meet the non medical requirements for SSDI which are having the work credits and being a U.S. citizen. If you lack the work credits you can qualify for SSI which is a needs based program.

I did all that 3 years ago.  I do not get ssi, just SSDI and am on the "ticket to work" program.

[iketchum]

I understand the hardship of having SSDI stop. I notified SS that I was gainfully employed and wanted the clock to start for the trial period. I didnt hear from them  after a month , so I called again to ensure they got the measage. No problem they said, your all set they said. 5 months later I get a letter from them saying ' you can start worrying now, we over paid for 5 months and you owe us 7,538 dollars, you can pay with easy installments.