Claimant Dies After Disability Benefits Ceased
From
WATE:
A mother is mourning the loss of her daughter.
Amy Schnelle, 31, died of an epileptic seizure on February 17. She
died less than half a year after the government cut her benefits,
including medication....
On disability for several years, Amy Schnelle was receiving powerful
anti-seizure drugs and had been seizure free since 2015. Then the United
States Social Security Administration threw her a curve ball in
September 2016 when they informed her she was no longer sick. ...
She appealed the decision, but while her appeal was under consideration,
Amy Schnelle’s benefits stopped. Nevertheless, three of the drug
manufacturers provided her with sample drugs, but one did not. Sylvia
Schnelle, Amy Schnelle’s mother, said without the full supply of
prescription pills, her daughter relapsed in late October. ...
Writing to Congressman Jimmy Duncan, Amy Schnelle was able to convince
the government to resume her benefits. That happened in January 2017,
but in February 2017, from her apartment, she texted her mother she had a
“bad” seizure and asked her to “please” come. Her mother rushed to
Knoxville from her home in Dandridge.
“Amy was on her stomach and she had already died. She died from a seizure,” said Sylvia Schnelle through tears. ...
There are some jobs where if you screw up you could kill somebody. Some doctors have that level of responsibility. Also SSA adjudicators, especially in places where mistakenly denying benefits causes a person with significant medical needs to lose health care access. I'm curious. Do they drive that point home when they train adjudicators and ALJs? If not, they should.
ReplyDeleteNot sure why her medical coverage stopped. If she filed her appeal within 10 days, all benefits, including medical coverage, continues until the decision is made. Unfortunately incorrect decisions can get made, for a variety of reasons. However, SSA does provide benefit continuation as a safety net.
ReplyDeleteJust based on the brief facts in the post, seems like the cessation was proper. Mom admitted that seizures were controlled with medication. While she may have not been able to drive and should have stayed away from hazardous situations, seems like someone who is seizure-free (without other problems) is not disabled.
ReplyDeleteSocial Security disability is not a medical program, it is insurance for when you are unable to work.
It is so hard to prove anything using anecdotal evidence. The seizures were controlled with meds...she could work. There is more to this story than the libtards want you to know.
ReplyDelete@ 8:10 "Social Security disability is not a medical program"
ReplyDeleteReally??? Are you totally unaware that many states Medicaid is dependent on edibility for SSI? If you lose SSI and are deemed able to work, you also lose Medicaid. If you lose Medicaid, you lose medications, therapy and all those goodies that kept you alive. IN many cases, where a disabled adult lives with family, the SSI payment is nominal after reduction for "in-kind" support. $200 to 300 a month which pays for nothing. But the real benefits, and the reason for it is that it makes Medicaid presumptive. You take it away, people die. Happens every day. This is not an isolated story.
I have to laugh at the 10 day continuation thing. 10 days is up before people even get a letter in the mail. SSA can not mail anything on time.
And to think what the GOP wants to do to Medicaid through AHCA. You will see situations like this on steroids should it pass.
ReplyDelete9:35 Like it or not, 8:10 is correct. We are not discussing what is "right" but if a condition is disabling to the point that SGA cannot be maintained. The Claimant in this instance no longer met the requirements as the law has written. Don't blame SSA for this, blame Congress and your POTUS for never delivering affordable healthcare for the last 60 years. A single payer, universal coverage would have averted this type of tragic loss from occurring, but America does not believe in socialized medicine, except for Medicare.
ReplyDeleteOur profit-driven health care system is to blame. Everyone should have free coverage for certain classes of life-sustaining drugs. And it would helpful if we could approve just medication coverage in some disability cases. Since we cannot, there are perverse outcomes such as above. I had a case where a young person had a rare and deadly heart condition which resulted in DDS finding disability. It was treatable with a very expensive drug which was covered under Medicaid, and DDS found medical improvement, and proposed cessation. I suppose they were "technically" correct. But on appeal, the evidence showed that without the drug, which was unaffordable to most without insurance, the young man would not live for very long. Had I sustained the decision, drug coverage would end and the result would have been either death, or a revolving door of subsequent approvals and then cessations. I reversed the decision, basically saying that I found medical improvement did not occur because the underlying condition which caused the initial approval still existed. I don't know if that would've passed muster in an agency "own-motion" review, but I felt that common sense and fundamental decency dictated that result, and found a way to reach a just outcome that at least didn't ignore the underlying policy. That's what judges do sometimes.
ReplyDelete@10:05
DeleteAMEN!
732, 810, 901, 944
ReplyDeleteAll I can say is "WOW", so this is what the Agency has come to. You all make me ashamed of an Agency I was once proud to work for. Yes, I will be leaving soon, but that is not the point and you all know it.
To see such a high level of the lack of compassion is disgusting.
May your chickens come home to roost tenfold.
Very sad story but I also fundamentally disagree with the premise. The disability programs are not meant to be healthcare access programs. We are supposed to look at functioning with proper treatment. If your stable on meds then you're not disabled. We don't control state Medicaid eligibility or expansion. Don't blame SSA blame you're legislators or society. This doesn't happen in other developed countries with universal healthcare.
ReplyDeleteShe didn't die because her Social Security Disability was cut off. She died because she didn't have access to healthcare.
10:10 are you suggesting that people should have been kept on benefits, against the rules, regulation and law, effectively committing a criminal act? That sure is what it looks like in your post. Good thing you didn't use your name, you should be investigated for possible criminal activity.
ReplyDeleteI guess "Claimant Dies after Disability Benefits Briefly Ceased Then Restored" wouldn't have been as sexy of a headline...
ReplyDeleteThis story is missing all kinds of facts. Are they saying she properly filed for continuation of benefits and they were wrongly terminated during the pendency of the appeal? In that case, the Agency really is to blame. Also, why would a "congressional inquiry" from some congressman cause the "government to resume her benefits?" That makes no sense. What do they mean by "resume her benefits?" Does that mean the continuation of benefits during the appeal was reinstated or that she received a favorable determination from the Agency on appeal? The information here is totally insufficient to determine whether the Agency was at fault in any way.
ReplyDelete@10:59
ReplyDeleteAn inability to afford treatment is a reasonable excuse for not following prescribed treatment. The Administration was fully aware of her inability to follow prescribe treatment due to indigency. The Administration concluded despite this, that termination of benefits was appropriate, regardless of the clear evidence that she would not be able to afford treatment absent disability benefits.
It is fully within the rules to have continued her benefits on the basis that her residual functional capacity would preclude her from actually engaging in work, taking into account the obvious forthcoming lack of treatment due to indigency.
@3:04
DeleteBRAVO!
@3:04 She was probably terminated for medical improvement or insufficient evidence. Failure to follow prescribed treatment has absolutely nothing to do with what is happening in this case. That would be a situation where a person is currently disabled with a curable or treatable ailment, but simply refuses to follow prescribed treatment.
ReplyDeleteThere is no such thing as the Agency finding that if they cease benefits, the person will lose health coverage, and therefore become disabled again and her failure to follow prescribed treatment would be excusable. That is just total gibberish. The Agency reviews medical records. If the person has medically improved or they have something like a seizure disorder that is well-controlled with medications, then the person can return to work and they are not disabled under the Act. Period. What might happen in the future if they lose health coverage has nothing to do with the analysis.
There are a few more considerations in the real world. As @9:35 pointed out--the 10 day period to request continuation of benefits pending appeal begins WHEN SSA SENDS the cessation letter. Given time for the USPS to deliver, you actually have only 4-5 days--if you are home to immediately receive it and there are no holidays intervening.
ReplyDeleteAlso, consider how the letter is written. After the bad news, the 60 day limit for appeals is stated, but the 10 day notice has always been buried elsewhere in the letter. The now emotionally upset claimant, whose literacy skills are often limited, usually doesn't notice or consider this on the first reading. Luckily, I'm in the process of retiring, so I won't have to deal with SSA any longer(except for my own benefits). Only a minority of my clients ever recognized the 10 day limit until it was too late. Were they perfect? Heck no, but they were human!
1059, you are an a$$, why don't you take you automaton self and go explain your reasoning to that girl's grieving mother
ReplyDeleteMay your chickens come home to roost tenfold, but then again someone like you might not even notice
The 10 day period starts from when the clmt receives the initial notice of determination, not when the letter is "sent." 20 cfr 404.1597a(f).
ReplyDelete"(f) What you must do to receive continued benefits pending notice of our reconsideration determination. (1) If you want to receive continued benefits pending the outcome of your request for reconsideration, you must request reconsideration and continuation of benefits no later than 10 days after the date you receive the notice of our initial determination that your physical or mental impairment(s) has ceased, has never existed, or is no longer disabling. Reconsideration must be requested as provided in § 404.909, and you must request continued benefits using a statement in accordance with paragraph (d) of this section."
Too many details missing. Did she miss a CDR or fail to cooperate with the agency?
ReplyDelete4:05 - We have laws in this country, which apparently you believe apply only to some. Either ALJs follow those laws, or the whole system is just a corrupt roulette game. If an individual is capable of working at SGA levels, he/she is considered to not be disabled. Period. Second-guessing what happens after that determination is like playing god with other people's money.
ReplyDeleteShoot, based on you apparent ideology, everyone should get disability benefits in the off-chance that their health decreases post-hearing. I've seen medical records of people overdosing after receiving disability benefits. Maybe you think they should have been denied benefits to keep them from having easy access to opioids?
@3:38
ReplyDeleteI agree that she was probably terminated based on medical improvement. I think you missed my point, and I didn't mean to spout "total gibberish." If I wasn't clear, this is an argument, not my reading of agency policy, but an argument well in-line with the purpose of the Social Security Act, and even most of the regulations as they stand. Here's my thought process:
1. She initially got benefits which allowed her to afford treatment.
2. Medical treatment improved her RFC to the point SSA found she was no longer disabled.
3. Benefits being terminated means indigency would return, as would her disabling RFC given there is no suggestion of medical improvement independent of prescribed medication, which she could no longer afford.
4. Given prior RFC was found disabling, new claim would be awarded.
See, the agency could send recipients through this 4-step cycle, resulting in a massive waste of administrative resources and time, or they could conclude that medical improvement is unlikely to be sustained.
Don't get me wrong. Termination due to medical improvement is reasonable, if the improvement is likely to be sustained and allow a recipient to engage in SGA. My issue is that given the circumstances of this case, medical improvement was almost certainly not going to be sustained given her prior indigency and prior RFC finding. The end result of this action would be a restoration of benefits in 2-3 years with her receiving a large underpayment.
In sum, terminating someone's benefits due to medical improvement, improvement which will end due to termination of benefits is illogical. I am not complaining the agency acted contrary to agency policy. I am complaining that agency policy appears to shove recipients (under the unusual circumstances present here) into a cycle of administrative waste and abuse as a matter of policy.
@4:34
DeleteAMEN!
431, you take the argument to the edge of absurdity, you have my pity if you cannot see what is wrong with this situation. 434 has made a very eloquent argument and yet you will find fault with it, have a nice life
ReplyDelete@4:34 that is a fair point and you are asking for a change in policy. However, you are assuming that the termination of benefits is illogical because the person is going to return to indigency and remain disabled, so they shouldn't be ceased in the first place. However, by definition, they have the ability to return to work at SGA level in the eyes of the Agency. Thus, the indigency is of their own volition under the law, not a natural result of a cessation. By definition they were ceased because they medically improved to the pain they can return to work and obtain their own insurance.
ReplyDeleteI can understand where your coming from, and frankly I believe Medicare should just be available to the entire population. However, from a legal standpoint, I think the regulations already address your concerns because the Agency will only terminate payment if they believe someone can work.
4:50 - Thank you for wishing me a nice life. Same to you and your psychologist.
ReplyDeleteyou have reached the catch 22 of social security disability. Its the classic argument: Clt: Judge, I'm disabled! Judge: Prove it! burden is on you. Clt: I can't I don't have insurance. Judge: Sry, regs demand I base my decision on objective evidence, would you like a 1 time CE?
ReplyDeleteThe entire program sort of assumes an ability to access proper medical care that doesn't exist in this country. There are flimsy regs that say lack of treatment due to financial resources is okay, that's what the outlier pay judges use but in reality any poor person could just say their disabled and can't afford treatment. Fundamentally, the program assumes you can properly treat your impairments. If you show improvement with treatment you're done. You have to degrade again to a disabling condition without treatment to get benefits back its a ridiculous cycle but there is no such thing as a foreseen disabling RFC based on an assurance that if benefits are cut you will lose insurance and degrade. How about take your disability health insurance benefits, improve, get a job that offers insurance or get a job and buy insurance. I concede its not an approach in child cases.
@4:51
ReplyDeleteFair enough. I am making a lot of assumptions. Also, I recognize willful indigency by definition is not indigency. I was just presuming she would not be capable of earning enough to afford treatment prior to return of her debilitating seizures. Then again...I have the benefit of hindsight and it might be mildly unfair on my part to suggest the Agency should be expected to determine how quickly a recipient could return to work, obtain insurance coverage, and pay for medical treatment. That would require significant medical and vocational evidence to say the least.
Medicare for all would be great. Actually, it would benefit both the agency as it could lead to medical improvement (even the medicare expansion under the ACA has in a few of my cases to the degree we have withdrawn claims), and claimants as it provides medical documentation of severe impairments.
4:34 - Thank you for presenting a logical argument. But your argument seems circular: if someone is disabled, they deserve disability benefits; if those benefits are taken away, they will be disabled again. But how does an ALJ or the agency ever really know that someone's medical improvement will not be sustainable absent disability benefits? The reality is that people do improve and go back to work. I think the agency created the review process to encourage people to return to work, if possible.
ReplyDeleteYou would have ALJs assume that someone whom the agency deems is able to work would deteriorate in health if they were forced to go back to work. If that is the case, then disability benefits should continue perpetually for everyone. This story is unfortunate. But the person was found disabled due to seizures. Those seizures then stopped. Surely at this point we can all agree that she was no longer disabled and able to go back to work. Whether she might in the future not have access to medications is an issue for a medical insurance company, the Affordable Care Act, or Congress, not a disability judge.
@5:40
ReplyDeleteMy argument is not circular, but the circumstances are. Given the facts as presented, at the time of her death she qualified and at the time of termination she did not qualify. Although you suggest the agency or ALJ cannot ever really know that medical improvement will be sustained absent disability benefits, the structure is in place to make this determination already. They already do this whenever a claim is awarded when a claimant is experiencing a degree of medical improvement, but the longitudinal record suggests improvement is only temporary. This does happen, pretty regularly, and I see no reason why such a consideration wouldn't be possible in a termination case.
These questions are not for the insurance company, the affordable care act, congress, or a disability judge. They are for a consultative examiner, medical expert, or treating physician and a vocational expert. The question before the disability judge is whether substantial evidence supports the award of benefits, or the termination of benefits.
a story none of us ever want to see cause we don't want something this sad to happen.
ReplyDeletemy sincere condolences to this young lady's family.
It's a 15 day period, 5 days are afforded for mailing days.
ReplyDeletehttps://secure.ssa.gov/poms.nsf/lnx/0203101020
ReplyDeleteSometimes, as here, the person improves enough not to be in danger of dying but that doesn't mean they are ready to sustain full time employment. The person was doped up and probably concentrated on being okay but is probably still unable to maintain concentration, persistence, and pace during an 8 hour day.
ReplyDeleteI haven't had difficulty keeping the benefits going if the person made a good faith effort to get in within the 10 day period (but didn't make it). Some claimants get scared about the threats of having to repay the money if their hearing is denied even though they are likely disabled and need the benefits to keep the medical substantiation of their disability.
Hard cases make bad law -- legal maxim.
ReplyDeleteBad law makes cases hard.
ReplyDeleteBad law makes cases hard. Let me elaborate. The state I live in use to give judges wiggle room on traffic tickets. Got caught going 30 in a 25? The judge use to be able to reduce the ticket or even dismiss it, even if the person was technically guilty. So, the police and politicians, tired of not getting THEIR money, decided to change the state law. They required the judges to make people pay, regardless of the circumstances or consequences.
ReplyDeleteAfter this law change, I was driving home on an icy night when a car came flying up behind me. It was in a really dark area and I was coming up on a stale green light as a car pulled up on my left. I sped up a little, to get through the light and not be rear-ended. I realized it was a cop as I went through the light. I explained this to the cop, who didn't care, and to the judge, who said he had to follow the law (38 in a 35).
While waiting for my turn, a 20 year old woman with a baby came out, litterally in tears. She had been found guilty of driving without insurance for one day (fine of nearly $800). Her insurance was due on a Thursday, but she had to spend her insurance money to pay to replace a flat tire. On her way to pick up her check on Friday, a police officer pulled her over, claiming she was going 36 in a 35. He ticked her for lack of insurance, which the judge could not waive. I wonder if there is a special place in hell for the letter of the law club.
SSA is a federal agency that is overwhelmingly having a lot of irrelevant components, departments, and tax-wasting job positions, especially at its Headquarters in Baltimore and Regional Offices, like the one here in Boston.
ReplyDeleteI have no doubts that most do not really care about the people they serve by looking in at how they've treated their own. For example: The OCREO Offices, in-house EEOC version, would not assist but instead it has resorted to intimidation and personal attacks against Asian-American line employees who filed complaints against the managers in and around the Regional and Area Offices led by the irresponsible life-time bureaucrats, such as Commissioner Linda M. Dorn and her main henchman, Neil McLaughlin-the Boston Area Director who has let it be known as an ardent anti Asian-Americans. A bunch of hypocrites when it comes to racial inequality!! I am ashamed for anyone who has fever worked for this agency!!
Meanwhile, Mrs. Dorn's HR Department in downtown would contradictory touting the overused HR term "Diversity" by SSA field offices throughout the region.
Currently, the workplace environment at these local field offices is extremely hostile for less vocal minority ethnic groups of such and ironically, the AFGE Local Union 1164, led by Richard Couture-President, who is looking the other way on many occasions when it comes to its Asian-American rank and file. Very Sad!! It make the questionable terminology of "draining the swamp" becomes more logical and soon to be acceptable by some who otherwise might not !!
Malarky
ReplyDelete