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Things to Consider If You Are Thinking About Going "Back to Work"

February 1998

To be successful, you must avoid a "cookie cutter" approach. Each situation is unique. Before you leap, think your situation through carefully, starting with an analysis of your specific benefits. Go slow here, and proceed with extreme caution. You may feel better now, have more energy, etc., but can you be sure it will last? And what if it doesn't? That will not be the end of the world, but just know where you're going to the extent possible.

Before you leap, think your way through the following issues as carefully as you can:


Preliminary Practical Issues.

Does your job still exist? In light of your experience, could you go back to the same job? Do you understand the realities of today's marketplace? Can you work a full schedule? Are you doing as well as you are because you're not working? How will you explain a several-year gap on your resume? Analyze your benefits one at a time:

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Private Disability Coverage.

Start with policy's definition of disability (if you're still unable to do your job, you may be O.K.). In order to encourage return to work, most policies provide for a period of recurrent disability, or define periods of disability, so that no new waiting period (elimination period) will be imposed if you again become disabled within a certain period of time. Note: an important distinction exists on this point between individual policies (contracts between you and insurer) and group policies (contracts between your former employer and insurer).

With an individual policy you bear no risk of losing the policy as long as you keep paying premiums. In the latter case, however, once you've gone back to work long enough the original insurer's obligations will be extinguished. Keep in mind: since your "doorway" to that insurance was through your prior employment, and you've now severed those ties by entering new employment, you may have let the insurer off the hook. If that is the case, and you get sick again, you may be out of luck.

If you're thinking about giving work a try, consider the option of residual, or partial disability. Such options are often made available if your disability leaves you unable to work to the same extent you used to, but possibly able to work to a lesser extent. Why go all or nothing if you don't have to? If you're thinking about giving work a try, think about this. Your insurer will be happy, they will remain on the hook, and your income will increase.


Social Security Disability Benefits ("SSDI").

Benefits begin 5 months after finding of eligibility, Medicare kicks in after 2 years. If you're on line, visit the SSA's web site at www.ssa.gov. Understand work incentives built into the system, especially trial work period. You have the right to work for 9 months (that time need not be consecutive) and earn any amount of money without affecting your benefits. If you earn less than $200 in a month, as reported to the SSA, it doesn't count.

At the end of the work period, SSA assesses whether you have reached level of substantial and gainful activity ("SGA"), meaning a pattern of earning at least $500 a month. (Certain disability-related expenses can be set-off against that figure if necessary to allow you to work.) If you've reached SGA, you will receive a grace period of 3 more month's benefits, and then the checks will stop. (But your Medicare coverage won't. See below.) If you become sick again and your income drops within 5 years, no new waiting period for benefits will be imposed. Within first 3 years immediately after trial work period, known as extended period of eligibility, no new application will be required. Just a call to your local SSA office.


Medicare Coverage.

Medicare coverage includes Part A (hospital care, etc., premium either $187 or $311, depending on your work history) and Part B (doctor's services, premium now $43.80). If you are covered at the time your SSDI benefits stop, coverage will remain in force for 3 years without payment of premiums. After that time, if you're still working but medically disabled, you can keep coverage in force indefinitely by paying premiums yourself. If you financially qualify (current phase out level gross income of $2,717 a month), your state welfare office will pay premiums for you.

Keeping the coverage is usually a good idea, as a second "safety net" of coverage beyond any primary coverage you get in the future. Federal rules establishing priorities of payment between overlapping insurance will usually protect you; minimizing your co-payments, deductibles, etc.

If you're still in the 2 year waiting period for Medicare coverage when you return to work, you'll be given full credit for the months you've received benefits (against the 24 month wait) at any time you again become disabled, so long as the causes of disability are the same. Otherwise, if the new period of disability is caused by a new impairment, that clock will start running anew after 5 years, and you'll have to wait another two years for Medicare coverage.


Supplemental Security Income ("SSI").

Unlike SSDI, this is a means-based benefit (meaning that too many assets or too much income can disqualify you.) If you're found eligible for SSI, you are immediately entitled to Medicaid health insurance coverage. As with SSDI, the SSA has an interest in encouraging your return to work. Thus, the following work incentives have been put into place to help point you in that direction:


Continuation of SSI.

If you return to work and start earning an income, you will not necessarily lose benefits. However, the amount of your check will decrease as you earn income. Note: This is different than during the SSDI trial work period. In calculating your benefit, the SSA excludes the first $85 earned by you, and 1/2 of the remaining amount. Even if you earn enough to completely reduce your benefit to 0, your Medicaid coverage will not stop if you're still disabled.

If you relapse into disability and your income decreases, your benefit will go back up. If that happens more than 12 months after SSI payments have stopped, a new application may need to be filed in order for you to receive benefits.


Plan for Achieving Self-Support ("PASS").

If you are able to come up with a plan custom tailored to allow you to return to work based upon the unique circumstances of your situation (which may include acquiring special equipment, job training, education, etc.), or at least pointing you in that direction, and the SSA approves the plan, some of your earnings or resources may officially be set aside for that purpose. In that event, additional earnings may not reduce your SSI benefit.


Medicaid Coverage.

Even if you earn above SSI limits and thus no longer qualify for benefits, you will remain covered by Medicaid so long as (1) you're still disabled, and (2) you cannot afford similar coverage and depend on the coverage to work. Check on the level of income that would be required by your state before a loss of coverage would result.

If you've been off SSI and Medicaid for 12 months or more, you may need to apply again before you relapse into disability.


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This article was provided by Paul Hampton Crockett, Esq.. It is a part of the publication A Snapshot of an Epidemic in Flux: A Survey of Effective Legal Strategies for Survival in Changing Times.
 
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