Getting Back to Work: SSDI Employment Supports

triage-cancer-blog-return-to-workReturning to work after being out because of a serious medical condition can be a scary prospect.  It usually takes a person quite a long time to get approved for SSDI benefits, so the thought of giving up those benefits is alarming if you are not 100% sure you’re ready to work.  The Social Security Administration understands that fear, and has you covered, with what they call “employment supports.”

This is a quick overview of SSDI employment supports and how they work together:

Step 1. The Trial Work Period (TWP)

This is an opportunity for you to test your ability to work, during which time you will continue to receive SSDI payments, no matter how much you earn as long as you still have a disability and are reporting your work to the SSA.  The details:

  • The TWP lasts for 9 months
  • The 9 months do not have to be in a row
  • The 9 months must take place within a 60 month timeframe

Step 2. The Extended Period of Eligibility (EPE)

This period begins the month after your TWP ends.  So, if you’ve worked and received benefits for 9 months, on your 10th month you would be in your EPE.  This means you might be eligible for another 36 months of benefits depending on how much you are earning. This one is a little trickier:

  • During your EPE, you will receive benefits for any month you work and your earnings are not considered a substantial gainful activity (SGA).
  • During your EPE there is a grace period. Meaning, if you suddenly get a raise or get more hours at work and your earnings are considered substantial, you will receive benefits for that month and the following 2 months.
  • Your benefits will end if your earnings are substantial in any month after the EPE ends.

Step 3. Expedited Reinstatement (EXR)

Step 3 only comes into play if you have returned to work and your SSDI benefits have ended because your earnings are considered substantial.  EXR is a safety net, meaning it’s there for you when everything is going great, you’re back to work, and then all of a sudden your medical condition flairs up.  The details:

  • If your benefits ended within the last 5 years due to an increase in your earnings, but you still have your original medical condition, you do not have to reapply for benefits.
  • Instead, you will receive 6 months of temporary benefits while your case goes under medical review. Also, if you are found not to be eligible for benefits after that review, you don’t have to pay back the temporary benefits you received.

Please visit www.ssa.gov/redbook/documents/TheRedBook2016.pdf to get a full understanding of the rules surrounding going back to work.

Working for Yourself, Retiring with Uncle Sam: Social Security for the Self-Employed

triage-cancer-blog-self-employedAnyone who has ever worked for someone else has likely seen the Social Security deduction on their paystub (there are some employees who pay into a private retirement system). This is the tax that is automatically deducted from your pay check each pay period for Social Security retirement benefits. This money (6.2% from your employer and 6.2% from you) goes directly into the Social Security pot. We contribute now and then in retirement we receive a Social Security retirement benefit.  It’s a pretty seamless process.

But what if you’re self-employed?  If you operate a trade, business, or profession either by yourself or with a partner, you may be considered self-employed. Working for yourself can feel quite liberating, but it can be very confusing when it comes to paperwork.  Now that you’re writing the paychecks, you need to report your earnings and pay taxes to the IRS and Social Security Administration.  But how?

The simple answer is that you report your earnings for Social Security when you file your federal income tax return. If your net earnings are $400 or more in a year, you have to report your earnings on Schedule SE, in addition to the other tax forms you have to file.  And now that you’re working for yourself, you have to pay the entire 12.4% tax on up to $118,500 of your net earnings.

Don’t despair!  As a self-employed person, paying into Social Security allows you two income tax deductions.

  1. You can reduce your net earnings from self-employment by half the amount of your total Social Security tax. This means that you can take 6.2% off your net earnings (net earnings are you’re your gross earnings, minus any allowable deductions and depreciation). So if you report net earnings of $100,000, you can take $6,200 off that before you figure your Social Security tax.  This is similar to the way employees are treated under the tax laws, because the employer’s share of the Social Security tax is not considered wages to the employee.
  2. You can also deduct half of your Social Security tax on IRS Form 1040. But the deduction must be taken from your gross income in determining your adjusted gross income.

One of the benefits to paying into the Social Security retirement system in addition to having retirement benefits, is that if you are no longer able to work because of a medical condition, you may qualify for Social Security Disability Insurance.

This is an introduction to a complex topic, so we encourage you to talk to a tax or accounting professional.  You can also visit the Social Security Administration site, where they have a guide on this topic.

Congratulations on being your own boss and best of luck to you!

Cancer & Employment: International Series – Canada

After years of advocating for a national disabilities act in Canada, the calls from triage-cancer-blog-canada-employmentdisability-rights activists and persons with disabilities have been answered.

Carla Qualtrough, minister of sport and persons with disabilities, initiated a pending national act for people with disabilities that will be enacted sometime within a year and a half. The law will establish a standard for federally regulated employers and service providers, such as banks, telecommunications, trains, and airlines, in order to ensure accessibility and fairness in the workplace for Canadians with a disability.

According to an interview with the Free Press, Qualtrough has placed this law as her “No. 1 deliverable to the prime minister.” This push for the national law was deeply rooted in the displeased voices of people with disabilities, for half of all the complaints received by the Canadian Human Rights Association were filed by people with disabilities.

Although Canada has the Charter of Rights and Freedoms, a principle that provides some protection for people with disabilities, one has to challenge a violation (if one arises) with the Canadian Human Rights Association. This creates an additional barrier that can discourage a person with disability from challenging a potentially harmful situation. “A national disabilities act could make the process more proactive,” Qualtrough said.

Additionally, some provinces in Canada provide some protections, but this national act would extend protections to all Canadians.

The new legislation will is expected to be introduced in the fall of 2017 or spring 2018. In the meantime, the more than 4 million Canadians with disabilities can look forward to a more equitable society.

For more information about employment rights in Canada, visit: http://www.monster.ca/career-advice/article/employment-law-knowing-your-employee-rights.

Getting Back to Work: Ticket to Work Program

triage-cancer-blog-return-to-workIf you are receiving disability benefits because of a cancer diagnosis, you may be considering going back to work. You may even be eager to get back to the normalcy of working.  As Americans, we get a great sense of worth and identity from our jobs.  Work is also a great social outlet for a lot of people.  After a cancer diagnosis, working can mean more than financial independence.  It can also mean moving beyond your diagnosis.

Well, when you’re ready to return to work, the Social Security Administration is ready to help.  They have a robust program designed to assist you to find work after a disability: the Ticket to Work Program.

Ticket to Work
If you are receiving SSI or SSDI, and are between the ages of 18 and 64, you qualify for a program called Ticket to Work.  This is a free and voluntary service that can help you go to work, get a good job that may lead to a career, and become financially independent.  Essentially, this program matches you with career planners and vocational rehabilitation services that will help you make a plan for getting back to work, and then help you execute that plan.  They will review your resume, set up interviews, conduct job training, and much more.  They will also provide information about your disability benefits and what they will look like when you go back to work.  Here are some things you should understand about the Ticket to Work program:

  • Opening a Ticket to Work does not mean you will automatically lose your SSDI or SSI benefit. If you open a Ticket to Work and make timely progress with either an employment network or a state vocational rehabilitation counselor, your medical condition will not be reviewed and you will continue to receive you normal benefit until you start actually working.
  • Opening a Ticket to Work will not cancel your Medicare benefit. Even if you go back to work and make enough to stop your SSDI benefit, you are still eligible to keep Medicare Part A (hospital insurance) for up to 93 months.
  • Opening a Ticket to Work will not necessarily cancel your Medicaid benefit. If you make enough to stop your SSI benefit, but are still under the earnings threshold set by your state, you could still be eligible for Medicaid.  Even if you make more than your state earnings threshold, you could be eligible for a Medicaid buy-in program.  You need to speak with your state Medicaid office to find out what that threshold is in your state. Click here to find your state Medicaid agency.

Another concern you may have about returning to work too early is sacrificing the SSDI or SSI benefit that took you so long to get in the first place.  Social Security has a work incentive program called Expedited Reinstatement.  Basically this means that if your benefits ended within the last 5 years due to an increase in your earnings, and you still have your original medical condition, you do not have to reapply for benefits.  Instead, you will receive 6 months of temporary benefits while your case goes under medical review.  If you are found not to be eligible for benefits after that review, you don’t have to pay back the temporary benefits you received.

Don’t be afraid to get back out into the workforce if you are able.  Cancer can be very isolating and working can be just the thing you need to feel better and move on from your diagnosis.

Cancer & Employment: International Series – China

Navigating employment after a cancer diagnosis is a challenges issue for many employees triage-cancer-blog-chinabecause of the balance between money, time, and abilities.  In the US, the Americans with Disabilities Act (ADA) provides legal protection against employment discrimination and access to reasonable accommodations.

While the ADA is more than 16 years old, many employers in the US do not comply with the law.  A similar situation exists in China, as exemplified by the recent death of a Chinese teacher battling cancer.

After teaching at the Lanzhou Jiaotong University’s Bowen College for two years, 32-year-old English teacher Liu Lingli was diagnosed with ovarian cancer. Instead of receiving medical accommodations from the university, however, Ms. Liu was fired for absenteeism.

Chinese law prohibits employers from firing employees while on medical leave. But according to legal experts, many firms don’t abide by this rule, ultimately leaving numerous individuals sick and unemployed. And this unfortunate event is exactly what happened with Ms. Liu, for her firing was indicative of the disability stigma looming within modern Chinese society.

Aware that this was a clear violation of the labor law, Ms. Liu filed a lawsuit against the university shortly after her dismissal. She eventually won the lawsuit, consequently ordering Lanzhou University to restore her employment. The school, however, did not comply and appealed the decision. The school later lost the appeal.

Despite the court’s siding with Ms. Liu, she was drowning in medical debt. The chemotherapy and other treatments totaled more than $60,000, an amount far above what her father, who also has cancer, and mother could afford.

As a result, she began to sell clothes on the streets to make ends meet. Nie Ting, a tour agency employee who befriended Ms. Liu outside a shopping mall, expressed her admiration for her friend’s willpower to sell clothes even after she began using a wheelchair. “She was a strong woman,” said Ms. Ting.

Ms. Liu kept her dismissal private because, according to her friends, she felt humiliated. The reason the case went public was because the university later extended their deepest apologies and agreed to pay the wages they had previously denied her after her death. The Chinese news site The Paper reported that Lanzhou University would pay Ms. Liu’s family nearly $11,000, $2,200 of the payment to cover the cost of her funeral, and that it had suspended the human resources director where Ms. Liu was working.

Hopefully, Ms. Liu’s story has, and will continue to, positively impact the responses of Chinese employers to their employees with serious medical conditions.

2017 Raise for Social Security & SSI

Triage Cancer Blog SSA Disability Insurance

The Social Security Administration (SSA) recently announced that the cost of living adjustment (COLA) for 2017 will be a 0.3 percent increase for Social Security and Supplemental Security Income (SSI) benefits.

That means that the SSI federal benefit rate in 2017 will increase by $2 to $735 per month for an individual, and by $3 to $1,103 per month for an eligible couple.

The estimated average monthly Social Security benefit payment will increase by $5 to $1,360 for retired workers, and by $4 to $1,300 for surviving spouses.

This marks the first COLA in two years, as there was no adjustment in 2016.

We will have to wait until next month to learn what the Medicare premiums for 2017 will be.

For more information on the other benefit changes for 2017, visit https://www.ssa.gov/news/press/factsheets/colafacts2017.pdf

How to Find Legal Assistance

how-to-find-an-attorneyTriage Cancer tries to give you information to help you navigate the system without an attorney, but sometimes you may need more help.  It can be overwhelming, on top of everything else, to try and figure out where to find a reputable attorney.  Here are some tips to hopefully make things easier!

How do I find an attorney? 

There are quite a few ways, ranging from a recommendation from your Uncle Earl to certified lawyer referral services.

  • Recommendations – If you’re friendly with any lawyers, these lawyers may be able to refer you to other lawyers who have experience with your type of problem. You can also ask your friends, co-workers and employers if they know any lawyers. Business owners and professionals such as bankers, ministers, doctors, social workers and teachers might also be able to give you the name of a lawyer.
  • Certified lawyer referral services – Most state and local bar associations have lawyer referral services. With these services you can typically search by practice area and location to narrow down your options. This type of service refers potential clients to attorneys. After interviewing you, the referral service staff will match you with a lawyer who is experienced in the appropriate area of the law. There is usually a small charge for the initial consultation with a lawyer and this will vary based on service.  However, you should be informed of this fee prior to the consultation.
    • One of the benefits of using this type of service is that they may be able to provide an attorney at a reduced rate. Lawyer referral services are required to make arrangements to serve people with limited means.
    • Another benefit is that they will screen your call to determine whether you in fact have a legal claim — or need some other type of assistance. If you do need another type of assistance, the referral service can refer you to government agencies or other organizations that may be better suited to assist you.

The American Bar Association has complied all of the Lawyer Referral Programs by state.

LawHelp.org may also be a useful resource.  This website is designed to provide individuals that have lower incomes with referrals to local legal aid and public interest law offices, basic information about legal rights, court forms, self-help information, court information, and links to social service agencies.

How much will an attorney cost?

Each attorney operates different, but generally, for issues like employment discrimination or disability claims, attorney’s work on contingency. This means the attorney will get a percentage of the settlement if you win the case.  If you enter into this sort of agreement, make sure you get it in writing and that it includes, among other things, the agreed-upon percentage.

  • Employment attorneys usually work on a contingency, with no cap.
  • The maximum a disability attorney can charge, by law, is 25% of your past-due benefits for his or her services, up to a maximum of $6,000. Past due benefits is the amount owed to you based on the date the Social Security Administration rules your disability began.  If you lose your claim, the attorney gets nothing except court costs and certain other expenses – out of your pocket.
  • Legal aid agencies – Depending on your income and the nature of your legal problem, you may be able to get free or low-cost legal help in non-criminal cases from a legal services program. Check the Internet or white pages of your telephone book to see if such an organization is located in your area. A State Bar-certified lawyer referral service or local bar association may be able to refer you to a legal services program. A law school clinic may also be able to assist you.

For other types of attorneys make sure you understand what they are going to charge you and when they will expect a payment, before you sign any sort of written contract. Don’t be afraid to ask questions to ensure you understand each charge.

Also, remember that after an initial consultation, you are under no obligation to hire that attorney.  If you don’t feel comfortable with that lawyer or don’t think that they can adequacy represent you, you should keep shopping around!

It may also be the case that the attorney suggests that you first go through a governmental agency, like a state fair employment agency.  In that case, you can find the contact information for those agencies in your state at http://triagecancer.org/resources/stateresources.

Medical Certification – Don’t Let It Disclose For You

If you choose to keep completely mum about your cancer diagnosis at work, you’ll be in triage-cancer-blog-medical-certificationgood company.  Grover Cleveland had a surgery for oral cancer in 1893, while serving as President of the United States, and nobody heard anything about it until 1917. President Woodrow Wilson had a serious stroke in 1919, and the country was basically run by First Lady Edith Wilson for the next two years. JFK flat out denied having Addison’s disease during his 1960 bid for the White House. Just like you, presidential candidates have no legal obligation to tell their employers (their constituents) about their medical health.

Generally, while you have no obligation to disclose, there are some instances where you might find it beneficial to share some information about your medical condition with an employer or potential employer. This is a very personal choice. The important thing to realize is that you have a choice. Triage Cancer participated in a free webinar about disclosure, privacy, and online brand.

There are also some instances where you could inadvertently stumble into a disclosure. For instance, if you want to use the ADA, or the Americans with Disabilities Act to request a reasonable accommodation at work, your employer will likely ask you to have your doctor fill out a medical certification form. Employers can create their own medical certification forms and can ask you about your diagnosis.  If you are not interested in sharing a cancer diagnosis with your employer, you only need to share enough medical information to show that you are eligible for the reasonable accommodation that you are asking for.  So you could talk about side effects that you are experiencing without talking about a cancer diagnosis.  But it is important to talk with your health care team about your disclosure decisions, before you ask them to complete your form.

Another law you might want to use is the FMLA, or Family and Medical Leave Act.  This law allows to take time off, unpaid, without the fear of losing your job. This law also allows an employer to ask for a medical certification form to be filled out by a member of your health care team. Even though the U.S. Department of Labor has created a model form for employers to use, some employers create their own forms and may ask for more information than they are entitled to have.

To help you navigate these decisions, Triage Cancer has some created some new, informative Quick Guides:

Quick Guide to Disclosure, Privacy, & Medical Certification Forms

Extended Quick Guide to the Family and Medical Leave Act (FMLA)

As always, knowledge is power, so get informed.

Are You a Veteran & Applying for Disability?

Then you should know about the ABA Veterans Claims Assistance Network . . .

The American Bar Association Veterans’ Claims Assistance Network (ABA VCAN), along VCANwith the U.S. Department of Veterans Affairs (VA), is providing a program where volunteer lawyers work with unrepresented veterans with pending disability claims.

With the help of legal assistance, veterans will complete their claim packages for expedited review by the VA and will receive disability compensation.

The ABA’s goal is to help address the VA claims backlog and get veterans the disability benefits to which they are entitled.

For more information about ABA VCAN, click here.

Medical Marijuana: A Guide to Navigating Employment

A few months ago, we posted a blog about the legal and practical issues of medical Triage Cancer Blog Medical Marijuanamarijuana. This blog follows up on the challenges facing employees who are using medical marijuana to address their side effects from cancer treatment.

Legal Cases, Updated Laws, and Employment Issues

Currently, 25 states and the District of Columbia allow for the use of medical marijuana. In an article written by Jon Woodruff, a legislative attorney for the National Alliance for Model State Drug Laws, it is estimated that about 70-80% patients using marijuana are between the ages of 18 and 60. These numbers indicate that many of those patients are currently in the workforce. With more and more state laws increasing the availability of medical marijuana and recreational marijuana, new legal issues are occurring at the workplace between employers and employees.

Despite the state-by-state legalization, the fact remains that marijuana is still illegal under federal law. This makes treading the employment waters very tricky for both employers and employees.

This leads to the biggest question, can an employee be terminated or have a job offer rescinded based on their use of medical marijuana? The answer is . . . it depends. Under most state laws, an employer is not required to accommodate an employee’s use of medical marijuana, but there are some exceptions to this.

Breakdown of Requirements for Employers to Accommodate Employee Use of Medical Marijuana by State

  States
State law does not explicitly address employer accommodation Hawaii, Louisiana, Maryland, New Mexico, Vermont, and the District of Columbia
Employers are NOT required to accommodate Alaska, California, Colorado, Maine, Massachusetts, Michigan, Montana, New Jersey, New Hampshire, Oregon, Pennsylvania, Rhode Island, and Washington
Employers cannot discriminate against or terminate a registered patient (other than a federal employee) Arizona, Delaware, Minnesota, and Connecticut*
Employers are required to make attempt to accommodate use Nevada, New York, and Illinois
Pending bills requiring more employer accommodation Hawaii, Michigan, New Jersey, and Rhode Island

*Connecticut statute does not address accommodation, but states that employer cannot refuse to hire based on status as a “patient.”

Court cases in New Mexico, Colorado, and Oregon aren’t making it any easier to understand when and where it is acceptable to work as an employee using medical marijuana. In New Mexico, a court ruled that it would not require employers to accommodate the use of “a drug that is still illegal under federal law” (Garcia v. Tractor Supply Co.). Meanwhile, in Colorado, one of the states that has legalized marijuana for recreational use, a court ruled that termination of an employee is valid because marijuana is still classified as illegal under the federal Controlled Substances Act (Coats v. Dish Network). Brandon Coats, a quadriplegic, licensed to use medical marijuana after his painkillers used to treat muscle spasms had lost effectiveness, was terminated from his job when failing a mandatory drug test. The termination was deemed valid in Colorado’s Supreme Court. Finally, in a court case in Oregon, a state that does not require employers to accommodate medical marijuana use, an arbitrator reinstated a Lane county employee that was fired for medical marijuana use outside of the workplace, while off-duty.

A Lack of Research Findings

Medical marijuana has become a hot topic for legalization for a number of different reasons. The reported ability to help reduce pain and nausea and to increase appetite are the major contributing factors to its promotion, particularly in the cancer community. However, despite the attention, the research on marijuana’s ability to control pain, nausea, and stimulate appetite is severely lacking. In an article published in Cure Magazine, the author summarizes what studies have been conducted and why it has been so difficult to develop better studies in recent years. The major issue facing medical marijuana research is the classification of marijuana as a Schedule I substance with “no medical uses,” under the Controlled Substances Act. This makes it difficult to get funding or materials to conduct research or a clinical trial. The Journal of the American Medical Association (JAMA) and CA: A Cancer Journal for Clinicians have both published articles attempting to summarize the research that has been done, but combined found a total of nine studies that looked into the use of inhaled cannabis for pain and even less (only two) met inclusion criteria for studying the effect of inhaled cannabis on chemotherapy induced nausea and vomiting. While each of these studies did find that marijuana use decreased the effects of pain, the study size and duration leaves much to be desired in terms of power. Outside of established medical journals, trials have found that smoking cannabis does help chemotherapy patients with controlling nausea and vomiting better than a “no treatment” test group and the ingestion of a purified active ingredient of cannabis.

There are other concerns about the use of medical marijuana, including a lack of regulation of quality, dosage, and a lack of understanding of how it may interact with other treatments, such as chemotherapy.  Testing of available medical marijuana has found fungus, bacteria, and other ingredients which could be unhealthy.

The minimal research that has been done so far does show promising results with data concluding that inhaled cannabis helps with pain, nausea and vomiting, and increased appetite in chemotherapy and AIDS patients. Current FDA approval exists for pill forms of medical marijuana in Marinol (dronabinol) and Cesamet (nabilone), for the treatment of nausea and vomiting in patients with AIDS or who are undergoing chemotherapy, respectively. However, we now need higher quality studies of medical marijuana to fully understand its benefits and determine whether the benefits do outweigh the risks, such as paranoia, anxiety, irritability, lethargy, acute increase in blood pressure, cognitive impairment, and other possible side effects.

What Does This Mean for Employees and Patients?

As an employee, it is important to make sure that you know your employer’s policies on drug use. Some employers have a “zero tolerance” policy, because it makes managing employees simple or it may be a company that is in multiple states. Other companies take a more relaxed approach, by delegating certain “safety-sensitive” positions that do allow for termination if an employee is found under the influence. For example, you probably wouldn’t want your school bus drivers or your airline pilots to come to work under the influence.  Employers also need to know their legal responsibilities under relevant state laws or they may find themselves in violation of disability laws for not reasonably accommodating their employees. As always, if you have any questions, it is best to seek legal advice from a professional in your area.