June 07, 2016

Approximately 66% of disability claims are being denied at the initial claims level.  Considering the importance of Supplemental Security Income (SSI) and Medicaid to a special needs child and the new pilot program governing the appeals process in New York, some parents may want to consider enlisting a Disability Specialist to help in the process.

All else being equal, we can easily make the following assumptions regarding the Disability Analyst reviewing your child’s case:

  • The more severe and long-term your child’s disability, the more likely it is that you will receive a favorable determination. Example:  Your child has an intellectual disability with an IQ under 50 and meets all of Social Security’s criteria, including financial restrictions.
  • The more borderline your child’s disability, the more likely the possibility of receiving an unfavorable determination.

It is essential that the application be completed and submitted with the necessary documents to support a favorable decision.

It is also important to be aware that New York now operates under a pilot program which no longer allows for a reconsideration hearing.  If your application is rejected, your only option now is the appeals process which is currently averaging 15 months and will often require an attorney.  This places an even greater importance on submitting the application correctly the first time.

If you decide to hire a professional to assist you, I would suggest using an Accredited Disability Representative (ADR).  An ADR has the experience and knowledge of Social Security regulations to know which documents to include and which ones can and should be left out—legally and ethically.  In addition:ADR-Logo-Web

  • He can act as your representative at the Social Security Administration so that you don’t have to spend your valuable time there.
  • He has the capability of looking at the same documents that the Disability Analyst at Social Security is reviewing. If any documents are missing, he can resubmit them so that the decision is made based on all of the appropriate documentation.

An Accredited Disability Representative can advise you on other issues as well, such as how your SSI and Medicaid benefits will be impacted by private medical insurance, unearned income, wages and so on.  He may also be able to provide information regarding Medicaid programs and opportunities that you may be eligible for—yet unaware of—such as the reimbursement of a portion of your monthly premium for your private health insurance coverage.

Applying for SSI/Medicaid is usually a once-in-a-lifetime event, and the determination by Social Security is often of vital importance to your special needs child who will depend on both the SSI income and the access to adult services that Medicaid provides.  Depending on your circumstances, it may therefore be worth considering the use of a specialist to ensure that you achieve the best possible outcome.

Note:  I am not an Accredited Disability Representative.  You can find one by searching online at www.NADR.org.  If you call my office, I can refer you to someone who is an ADR in the Suffolk/Nassau county area.