While the Social Security disability program is meant for those are going to be long-term disabled from working, as a Social Security lawyer handling disability claims and appeals throughout Massachusetts, New Hampshire and Maine, we’re many times asked what one should do once they’ve just gone out of work from a disabling condition and it simply remains unclear if they will remain longer term disabled from working. There are a number of suggestions we provide to our potential clients.\
First and foremost, if you work for a company that employs more than 50 workers, you may be entitled to the protections of the Family Medical Leave Act (assuming you have worked for the company more than 12 month, and you have worked more than 1250 hours in the 12 months prior to becoming disabled). Assuming this is the case, you may be entitled to the protections afforded under FMLA, which include the ability to take up to 12 weeks of unpaid leave during a 12 month period to attend to any serious health condition you may have: thus protecting your job in the event you do recover so as to be able to return to work.
Two, you may be entitled to recover ongoing lost wage benefits under the terms of a short term disability policy, or if you have suffered a work-related injury, under the workers’ compensation laws of your state for indemnity (or lost wage benefits). Most short term disability policies only run for a period of 3 to 5 months and provide a standard that is much easier than the Social Security laws when attempting to receive such a monthly benefit, only requiring one to prove that they currently remain totally disabled from performing the usual and customary duties of their ordinary occupation (rather than the need, under Social Security’s rules, that one remain totally disabled from performing all forms of gainful employment for what has been or is expected to be a year or longer).
Three, ensure that one has maintained ongoing health insurance coverage: this is important not only from a personal health standpoint (and the obvious need to get the treatment you need to get better), but also from the standpoint of having to potentially apply for benefits under a long term disability policy you might have through your employer or for that matter file a claim with the assistance of a lawyer for Social Security disability benefits. One may find just a month or two of going out of work that they are losing their employer provided health insurance. Options remain available to continue such coverage in the event the employer has notified you they are discontinuing your coverage as a result of your inability to return to work in what they consider a timely manner. You may be entitled to continue your coverage through what are called your COBRA coverage rights (whereby, one is allowed to continue their coverage for a limited amount of time assuming they are willing to pay what can be up to 102% of the cost of the plan). Such continuation of health insurance coverage option is required to be provided by employers who employ 20 or more employees. Assuming one is not able to afford such continued coverage, one may be able to obtain coverage through the provisions of the Affordable Care Act (ACA, otherwise known as Obamacare). This program would deem the termination of coverage as a qualifying event, and would allow for application for health insurance coverage through their marketplace. The government may indeed subsidize the cost of the health insurance assuming either you have some manner of recurring income or you and your spouse is applying for health insurance through the marketplace and the spouse has an income that would qualify for tax-subsidized assistance through their program.
Assuming, however, that one remains incapable of qualifying for a tax subsidy under the ACA, one may need to apply for health insurance through their state Medicaid program (which is a Federal health insurance program for the indigent that is administered by each state). In Maine, one would apply for Mainecare. In New Hampshire, the program is called Medicaid. In Massachusetts, the program is called Mass Health. One would apply for this assistance through their Department of Human Services (in Maine and New Hampshire) and through the Massachusetts Department of Transitional Assistance.
The continuation of health insurance coverage is essential to those who are short term disabled for both personal and potential Social Security application-related reasons. For one, the ultimate goal remains to get better and return to work. And two, in order to provide one is entitled to Social Security disability benefits, one needs to show that they remain totally disabled from all forms of gainful employment despite prescribed treatment for a severe, medically determinable impairment. It is difficult to prove that one is even suffering from a severe medical impairment without treatment, nonetheless that it remains disabling despite prescribed treatment if treatment is not continuing.
If you are finding yourself in the position of being unable to return to work as a result of a disabling medical condition, there is no reason you need to go through it alone. Contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622 to obtain the advice and assistance you need to move forward.