Social Security Disability

SSD--Can I get other benefits while I wait for SSD?

It usually takes several months-and can at times take years--to finally collect Social Security Disability ["SSD"] benefits. While you are waiting, you may be eligible for other benefits. Here are some of the possibilities.

MANDATORY SHORT TERM DISABILITY BENEFITS

New York employers are required to provide short term disability ["STD"] insurance coverage. If you: (1) were employed for at least four weeks at the time you became disabled; (2) became disabled within four weeks after leaving your last job; or (3) were collecting unemployment insurance benefits at the time you became disabled, you may be eligible to collect STD benefits.

If eligible, you can collect a weekly benefit equal to 50% of your weekly wage or $170.00, whichever is LESS. There is a one week waiting period. You can collect STD benefits for up to 26 weeks. There are no associated medical benefits. STD benefits are taxable.

You can collect up to 26 weeks of unemployment insurance OR STD benefits. You CANNOT collect 26 weeks of BOTH types of benefits.

Here is a general description of these benefits:
http://www.wcb.ny.gov/content/main/offthejob/IntroToLaw_DB.jsp

Practical Advice

Apply for these benefits as soon as possible. Complete the appropriate form and secure the required information from your treating physician.

If you were employed at the time you sustained your disability, complete form DB-450. You can get that form at:
http://www.wcb.ny.gov/content/main/forms/db450.pdf

If you sustained a disability within four weeks after you left your last job, or if you were collecting unemployment insurance benefits at the time you sustained your disability, complete form DB-300. You can get that form at:
http://www.wcb.ny.gov/content/main/forms/db300.pdf

Will Receipt of STD Benefits Affect SSD?

No. SSD benefits do not start until AFTER STD benefits stop.

GROUP "ENHANCED" STD & LONG TERM DISABILITY BENEFITS

If you were employed at the time you became disabled, you might be eligible for group "enhanced" short term disability benefits (which exceed the mandatory STD benefit discussed above). If your disability has lasted (or is expected to last) 26 weeks or more, you may be eligible for group long term disability ["LTD"] insurance benefits.

These benefits are provided under a written agreement which will often define important terms such as "disability." Employers are NOT required to provide these benefits, however, many larger employers do so. As a general rule, these benefits are taxable.

Practical Advice

Contact your employer immediately, get the appropriate claim form and complete it as soon as possible. Do NOT rely on oral representations by human resource/employee benefit staff who work for your employer. Request a copy of the disability benefits insurance policy/plan AND the Summary Plan Description (lay person's description).

Most disputes concerning group LTD policies are subject to a federal pension law (known as ERISA). Under ERISA, a Court can overturn an adverse decision from an LTD carrier ONLY if their conduct is "arbitrary and capricious" (that is, irrational). This is a VERY difficult standard to meet.

Will Receipt of SSD Affect a Group LTD Benefit?

Usually. Most group LTD policies allow the insurance carrier to reduce the amount of the LTD benefit owed to you by the amount of your SSD benefit. This includes a reduction for the amount of SSD benefit received by your MINOR CHILDREN.

These and other offset provisions are contained in the LTD policy. Request a copy of the LTD policy.


INDIVIDUALLY PURCHASED LTD BENEFITS

You may have purchased a LTD insurance policy on your own or through a group (e.g., Chamber of Commerce). Contact your agent and/or the insurance company to get the appropriate claim form. These benefits are provided pursuant to a written agreement which will often define important terms such as "disability."

Practical Advice

Disputes concerning individual LTD policies are NOT subject to ERISA. The reviewing court applies a standard (called de novo which means "all over again") which is more favorable for someone seeking benefits.

Will Receipt of SSD Benefits Affect an Individual LTD Benefit?

Usually NOT. If you paid the LTD policy premiums with after tax dollars, the LTD benefits are NOT taxable. Request a copy of the individual LTD policy.


DISABILITY PENSION BENEFITS--PRIVATE SECTOR EMPLOYEES

If you were employed at the time you became disabled, you might be able to draw your pension early and without a penalty (like SSD). Some private employers and labor unions offer disability pension benefits. These benefits are generally taxable. These benefits are provided pursuant to a written agreement which will often define important terms such as "disability."

Practical Advice

Contact your employer or union immediately, get the appropriate claim form and complete it as soon as possible. Many employers and labor unions will not provide a disability pension unless and until you are awarded SSD benefits.

Do not rely on oral representations by human resource/employee benefit staff who work for your employer or union. Request a copy of the pension plan and Summary Plan Description (lay person's description).

Will Receipt of SSD Benefits Affect a Private Sector Disability Pension Benefit?

Usually NOT, however, you must check the Pension Plan to be sure.


DISABILITY PENSION BENEFITS--PUBLIC SECTOR EMPLOYEES

If you worked in the public sector at the time you became disabled, you might be able to draw a disability retirement pension from one of the eight retirement systems for public employees in the State of New York. Three are statewide pension systems (Teachers; Police & Fire; State & Local Government workers).

There are different types of disability pension benefits including ordinary (non-work related), accidental and performance of duty. These benefits generally are tax free IF the pensioner lives in New York.

To qualify for ordinary disability pension benefits, you have to prove that you are "permanently incapacitated" from performing your particular job. To qualify for "performance of duty" disability pension benefits, you have to prove that you are "physically or mentally incapacitated for performance of gainful employment as the natural and proximate result of an accident not caused by [your] own willful negligence sustained in the performance of [your] duties." It is VERY difficult to qualify for an "accidental" disability pension benefit under the language of the relevant statutes and judicial interpretations of that language.

Practical Advice

Contact your employer immediately, get the appropriate claim form and complete it as soon as possible.

Navigating the various retirement systems is very complex. Public sector labor union officials are usually good sources of information.

There are very short deadlines for taking action. There are many quirky notice provisions. Stated simply, there are many traps for the unwary.

Will Receipt of SSD Benefits Affect a Public Sector Disability Pension Benefit?

Sometimes. For example, for New York State Retirement System cases, your "Tier" of participation may determine whether your benefit is reduced by SSD benefits.


MISCELLANEOUS DISABILITY BENEFITS

By virtue of your disability, you may be eligible for certain additional benefits. For example, you may be entitled to defer or waive your obligation to: (1) repay a student loan; (2) pay life insurance policy premiums; and (3) make automobile, mortgage, credit card or other payments. These benefits are provided pursuant to a written agreement which will often define important terms such as "disability."

Practical Advice

Examine all "important" papers (loan agreements, life insurance policies, etc.) for possible disability benefits.

Do not rely on oral representations by customer service representatives who work for credit card and similar companies. Request a copy of all relevant documents and read them. Get the appropriate claim form and complete it as soon as possible.

Will Receipt of SSD Benefits Affect Receipt of Miscellaneous Disability Benefits?

Usually NOT, however, you must check the "contract" that provides the benefit. Request a copy and read it.


HEALTH INSURANCE

Maintaining health insurance coverage--and getting appropriate medical treatment--is very important, particularly until you are eligible for Medicare.  We encourage you to explore whether you are eligible for "affordable" health insurance coverage under a federal law known as the Affordable Care Act.  Residents of New York can learn more by visiting http://nystateofhealth.ny.gov/

Let us know if we can help on any of these issues.

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