Susan Needs Disability Benefits

Things were going pretty well for Susan, at least in her professional life. She had a decent job at an architectural firm. She made about $50,000 per year, which was pretty good in her mind, but not enough to make the 33-year-old single mother rich. The downside of the job was that she worked really hard and didn’t have much money or time left at the end of the day for her 13-year-old son, Griffin. It had been just the 2 of them since her husband’s death 10 years before and while things got better little by little, she had only been able to save up about $15,000 in the bank over the years and $5,000 in a retirement account — better than nothing, but not enough to live on if she lost her job.

While Susan felt the job was taking her in the right direction for her long-term career goals, it didn’t come with benefits. Susan knew that employer-provided benefits like health coverage and private disability insurance would be nice, but it had been so hard to find a job in the first place that she had given up on finding one with benefits. Instead, she just got individual health coverage for herself and her son through Healthcare.gov, which was surprisingly affordable because she and her son qualified for tax subsidies from the federal government to buy coverage. Since both she and Griffin were healthy, she had signed them up for the cheapest bronze-level plan they could get.

Health Coverage After an Accident

Driving home from a late night at work one unusually rainy evening, Susan was in a great mood. She really felt like she was finally hitting her stride at work. The next thing she knew, she couldn’t control the car and it sailed into the median. By the time the paramedics arrived, she was unconscious.

Susan sustained serious head and spine injuries in the crash. After a series of operations that kept her in the hospital for 2 months, she was moved to a long-term care facility. While Susan was in the hospital, her son Griffin went to stay with his grandparents, who lived an hour away.

Susan found it hard to remember names and suffered terrible migraines. She also lost movement of her legs. Then there were the financial problems. Susan’s health insurance was the cheapest bronze-level plan available, and it had a $5,000 deductible. That meant she had to pay the first $5,000 in medical bills before her insurance would pay anything. And, even after she had paid the $5,000, she had to keep paying high co-insurance for her treatment.

The bills for her care were astronomical, but thanks to her plan’s out-of-pocket maximum, she only ended up paying $7,350 for her care. Before the accident, Susan thought she had planned well for the future, but now she could see that this accident was wiping out her savings account.

Looking into Disability Benefits

Susan now wished she had had short-term disability insurance to pay for these expenses, but it was too late to think about. Now her task was to figure out how to survive without using up all of her retirement savings. She knew that she had to see if there were any disability-based benefits she could get, because if there were, she needed to get moving on the paperwork. She also could tell that she wouldn’t be going back to her job — there was no way she would be able to concentrate on work with everything she had gone through mentally and physically. It would be a long road to recovery.

When Susan started feeling a bit more up for it, she spoke with Teresa, a social worker at the hospital, about her financial situation. Teresa knew that Susan and her son had a private insurance plan through Healthcare.gov, so she started explaining what Susan needed to do to get started.

“The first thing you can do after leaving your job is to update your information on Healthcare.gov. Once you aren’t working, your income will be down to zero, which means that both you and Griffin will qualify for free AHCCCS coverage. Healthcare.gov will let you switch right over from your current private insurance plan to AHCCCS. It’ll be a really good deal for you, because you won’t have to pay for a monthly premium for AHCCCS.”

Susan relaxed a bit about the medical expenses, but was still worried about all of her other bills — rent, credit cards, electricity, water, and everything else that adds up without you even noticing. Now that she couldn’t work, she had no idea what she would do to pay them. Susan asked Teresa if there were any cash benefits she could get.

“You could be eligible for some Social Security benefits,” Teresa told Susan. “Unfortunately, that’s not my expertise. What I recommend is that you call a Work Incentive Consultant. That’ll let you talk to somebody who understands all these different programs.” Susan’s eyebrows wrinkled. She remembered trying to get Social Security Child’s Benefits for Griffin after her husband had died and learning that her husband hadn’t worked long enough to qualify. Susan had spent a lot of money on a lawyer and in the end, Griffin didn’t get any benefit.

Teresa thought she knew what was on Susan’s mind. “Don’t worry, you can get help from a Work Incentive Consultant for free.”

When Susan called Benefits 2 Work Arizona at 1-866-304-WORK (9675) to find a Work Incentive Consultant, she spoke with Tom. Tom explained that Susan wouldn’t qualify for Supplemental Security Income (SSI) because her retirement account was over the SSI resources limit. However, since she been working and paying Social Security taxes for many years, he thought she would probably qualify for Social Security Disability Insurance (SSDI).

“Susan, do you have access to a computer and the Internet?” asked Tom.

“Yes, I’ve got my laptop here at the hospital and there’s Wi-Fi access,” replied Susan.

“That’s good, because there are a couple of good steps for you to take online,” said Tom. “First, go to the Social Security website and sign up for an account. Once you’ve done that, you’ll be able to see how much Social Security estimates you’ll get each month in SSDI benefits. And, with your account, you can also start an online SSDI application.”

“Wow, that’s pretty useful,” commented Susan. “Will I be able to do the application all on my own? And what about Griffin’s Child’s Benefits, is that a separate application?”

Tom said that it would be great for Susan to get her application started online, but that she would have to give Social Security additional information, like medical evidence of her disability, proof of citizenship (like a birth certificate), and other necessary documentation. More paperwork would be needed for Griffin, too. So, he suggested that she start her application now, just to get the claim into Social Security’s system, but that she come meet him in person in person after leaving the hospital, so that he could help her with the remaining paperwork.

A couple of weeks later, Susan had adjusted to using her power wheelchair and was ready to leave the hospital and head home. One of the first things she did after getting home was call up Tom again and schedule an appointment to finish her SSDI application and request Child’s Benefits for her son. After Tom helped her submit the applications, he said that if they were approved for benefits, they would start getting them about 5 months after her car accident. “Since SSDI is intended to be a long-term disability benefit, there is a 5-month waiting period,” explained Tom. Susan was thankful that her parents could keep helping her and Griffin out with their expenses for a few more months.

Getting Benefits

Social Security approved the application and sent a letter stating that Susan would get $1,004 a month in SSDI benefits each month based on her earnings record and that Griffin would get $488 in Social Security Child’s Benefits, which was given to the family based on Susan’s disability. Tom had also explained that Griffin’s benefits would actually get sent to Susan, because he was still a minor, and that she would act as his representative payee, which just meant that she would manage his benefit for him.

Seven months after her disability began, Social Security started direct-depositing $1,492 each month in Susan’s bank account for her SSDI and Griffin’s Child’s Benefits. By this time, Susan’s $15,000 in savings had gone down the drain in a matter of months. Her only consolation was that at least she hadn’t had to touch the $5,000 in her retirement account.

Meanwhile, the doctors told her she wouldn’t be able to go back to work for the foreseeable future. That meant that she and Griffin were going to have to survive on the $1,492 in benefits they got each month. Things were going to be tight. Both she and Griffin would have to make sacrifices.