← MS Living Well: Key Info from Multiple Sclerosis Experts
MS Living Well: Key Info from Multiple Sclerosis Experts
Maintaining Employment with MS and Applying for Disability
00:43:04
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- [00:00]
Dr. Chaney Holloman
Foreign.
- [00:07]
Dr. Barry Singer
Hello, and welcome Back to the Ms. Living well podcast. I'm Dr. Jamie Holloman, Ms. Neurologist at the center for Innovations in Care at Missouri Baptist Medical center in St. Louis. I'll be your host for today's episode, maintaining employment with Ms. And applying for Disability. This episode is sponsored by TG Therapeutics. Employment is about more than just a paycheck. It offers a sense of purpose, connection, and independence, along with important practical benefits like income and health insurance for individuals with Ms. However, symptoms such as fatigue, cognitive changes, and mobility challenges can complicate employment, often forcing them to adapt to a new reality at work. In this episode, we'll hear from two experts who help people navigate this new reality and with employers and benefit agencies every day. Later in the show, I'll talk with attorney Jamie Hall. He'll talk us through how to plan ahead for your career, what to know before leaving the workforce, and share his tips and insights on applying for disability. But first, I'd like to introduce employment and disability expert Dr. Philip Rumrill. He is a Red Cedar Distinguished professor of Counseling and Counselor Education at Michigan State University. Over a career spanning more than three decades, his pioneering work on vocational outcomes has fundamentally changed how the medical and legal communities approach career longevity for people living with Ms. He has published hundreds of studies specifically focused on how people with Ms. Can successfully navigate the workplace, advocate for accommodations, and extend their professional lives. Dr. Rumrell, welcome to the podcast. Thanks so much for joining me.
- [01:48]
Dr. Philip Rumrill
Thanks for having me, Dr. Holland.
- [01:50]
Dr. Chaney Holloman
I think it's helpful to kind of imagine a common scenario. I encounter a lot in my clinic and in fact, saw a patient today who gets a new diagnosis of multiple cirrhosis. And then, in addition to treatment and symptom management and everything else that we're doing, starts thinking about, okay, how is this going to affect my career? How's this going to affect my family? And so, just interested in your take on how the condition affects their employment and the reasons they either are able to stay working or have to leave the workplace.
- [02:20]
Dr. Philip Rumrill
That is really the most common consideration that people have to make, at least at the point of diagnosis. Right. The most recent study we did, 82% of our respondents, people with Ms. Were employed at the time they were diagnosed. And that number actually seems to go up over time because we're able to diagnose Ms. Earlier in the disease process than used to be the case 30, 40 years ago. Right. So what's happened is they're getting diagnosed earlier in the disease process, sometimes before the symptoms are really that severe. So these folks are still employed, they may read up on it. They see all the symptoms. They see that Ms. Can affect your functioning in virtually every area of personal and social activity. And it's not long before that issue of employment comes up. And will I need to stop working as a vocational rehabilitation counselor? We like to initiate that conversation as quickly as we can. Understanding that people's symptoms can change eventually. For most people, Ms. Does turn into a progressive form as we understand it. So as time goes on, you tend to see a decline in health over time, but not necessarily. And so we always start with the current scenario. Where are you at right now? What information is your neurologist telling you about the course of Ms. You have? What do we need to be prepared for?
- [03:47]
Dr. Chaney Holloman
And I've noticed too, taking care of patients, that there's sort of a six month initial diagnosis period where kind of the symptoms tend to be most prominent. And then once kind of the body acclimates to this new diagnosis, things tend to stabilize, if not improve somewhat. Sort of important for patients not to make too many long term decisions just at that kind of first point. I don't know. Have you looked specifically at different types of occupations to see if there's any unique challenges, say if someone works in a position that requires manual labor versus kind of more of a cognitive job and whether or not that changes their ability to maintain employment with multiple sclerosis?
- [04:26]
Dr. Philip Rumrill
We have a few studies over the years. You probably wouldn't be surprised to know that you'll see what seem like over representations of people who work in fields like nursing, social work, teachers. These jobs are predominated by women, right? And women are more likely to get Ms. Than are men. It seems to be people who are engaged in public facing occupations that require college degrees. Because in our most recent study, 46% of all of our respondents had four year college degrees, 98% had high school diplomas. So we've got a well educated, well trained group of workers. So you'll see people working in professional, technical, managerial kinds of jobs in some of those industries. We have observed that people with Ms. Whose jobs require them to work out of doors, so working in the outside that require a moderate or heavy amount of lifting, standing, bending, twisting, stooping, those folks tend to have a harder time staying in the workforce. People who work in jobs that require more formal education and training tend to stay in their jobs longer. And we think it's because those kinds of jobs don't usually involve physical exertion to the extent that other jobs might also. If you're in a skilled professional, technical or managerial position, you might have more latitude, often even decision making authority, to determine what accommodations you might need. And we find folks who are required to do a lot of on the job travel are more likely to disengage from employment than people with Ms. Who aren't required to travel.
- [06:11]
Dr. Chaney Holloman
And if I'm putting myself in the shoes of someone who's newly diagnosed and planning out different career paths. Have you looked into the whole picture in terms of how things go for Ms. Patients for those who stay employed versus those who don't?
- [06:25]
Dr. Philip Rumrill
We have indeed. And if you have a lot of latitude in terms of setting your work schedule, if you have flexibility about working in the office and working at home, if you have ways to accommodate that and can still access technology and tools for your job, you're going to be more likely to stay in that particular position. People stay in jobs that they're more satisfied with. If you believe that your employer is receptive to your needs, is committed to equity and inclusion in the workplace, folks with Ms. Who retain the ability to travel independently, who can still drive back and forth to work, those folks have an easier time. It doesn't mean you can't do it. But these are the things that seem most amenable to job retention. And then, of course, the availability of workplace accommodations. It's a cooperative employer with the accommodations you need to do your job. There's almost no obstacle that really can't be overcome. And we find folks with ms, some of whom are dealing with really significant functional issues, continuing their employment over a long period of time. So there are these predictors. But having a particular disease profile or a certain occupational profile doesn't necessarily consign you to unemployment. It just means we may have to be even more creative in helping find ways to support you. I want to come back to one other quick thing, and that was the idea of what are the benefits of working? Okay, so I'm a rehabilitation counselor. We focus on employment as a conduit to mental health, to physical health, to financial security, to socialization. Right. We really emphasize identity formation, membership in a profession or a group, opportunities for travel and advancement, access to health insurance and therefore health care, social opportunities, being someone in the community, a reason, a purpose to get up out of bed every morning. We really believe that, generally speaking, people are better off working than not working for all of those reasons. It's a primary part of our identity. But most people with Ms. Tell us they want to continue working as long as they possibly can. When we Hear that? Then we roll up our sleeves, we bring in all the ammunition, the whole toolkit, right? To help people stay working as long as they wish to do so. And when it's time to stop, the person needs to make that decision for themselves. Rehab counselor shouldn't make that decision. Their physician should not make that decision. Family members shouldn't. That's a personal decision the person has to make on their own, informed by all these people who do care about them.
- [09:02]
Dr. Chaney Holloman
You mentioned the toolkit that you might roll out for those people then who get a new diagnosis of multiple sclerosis or having symptoms but are actively interested in trying to stay employed. What kind of tools and strategies would you counsel a patient to use?
- [09:17]
Dr. Philip Rumrill
One of the things we refer people with Ms. Systematically to is the state federal vocational rehabilitation program. It operates in all 50 states and all US territories. It is free of charge. It's not means tested. You don't have to qualify on an income threshold or anything like that. It's the largest provider of employment services for people with disabilities in the United States and they can help with all manner of job retention considerations or also job placement considerations. So we start with the state federal vocational rehabilitation program. You can google that in your own state. You can refer yourself. You would qualify automatically by having multiple sclerosis and they can help you with really all manner of employment related needs. The National Multiple Sclerosis Society has a website that has a good number of employment related resources including brochure that we develop on how to request workplace accommodations from your employer. It's called the Win Win approach to reasonable accommodations. We love the Job Accommodation Network at West Virginia University. It's a free service where workers with disabilities, employers and anyone else interested in workplace accommodations for the disabled workers can visit. You can put in your own information about your own job, what difficulties you might be having, what you'd like to learn about accommodations that would help people with your particular symptom profile. So you just google the Job Accommodation Network. You would find that the ADA Centers National Network, 10 regional centers across the United States who provide information free of charge having to do with all manner of implementation of the Americans with Disabilities Act. And so folks often really appreciate that resource as well if you're having issues related to access to employment or to your community. A very good resource there, the ADA Center's national network. Those are some of the ones in the front of the toolbox in terms
- [11:21]
Dr. Chaney Holloman
of the accommodations available. I imagine that this might change occupation, occupation and even specific employer to employer. But if you had to Describe some of the general occupational or accommodations that a person might request. What would those consist of?
- [11:38]
Dr. Philip Rumrill
Well, we finished the study about a year ago. This was in the COVID era. 32% of all workplace accommodations used by people with Ms. Involve scheduling modifications. It's an extra hour at lunch where you might rest and regain your strength. Literally go out in your car and take a nap or something, right? To finish off the shift, it's cutting back your hours, maybe spreading the hours out over more days. It's being able to take work home. And then you add another 15 to 18% of accommodations that have to do with the manner in which work is performed, particularly home based employment, telecommuting. We all did this with COVID So about half of all workplace accommodations used by folks with Ms. Don't require any expenditure on the part of the employer at all. And they have to do with allowing them to do the work in a different way or on a different schedule than they were before. It really is that simple. We will see mobility aids. A lot of times folks with Ms. Will have their own. So it's just the employer granting permission for someone to have a motorized scooter to explain why you have a quad cane, Glare guards for the computer screen, voice activation for folks who may have fine motor issues as far as keyboarding and things like that, changing some of the job duties, reassignment to another position doesn't happen as much as some of the other accommodations, usually as a last resort, but limiting travel, working from home more often, using technology and tools in a different way. And then of course, all the technological aids and advances. If you just think about how technology has made our lives easier in all kinds of ways. The same is true for employment and daily living for that matter. Right. For folks with Ms. And other disabling conditions. So these are the ones we see over and over. But isn't it interesting? Half of it is when you work and how you work. I want to also say that our friends at the Job Accommodation Network tell us that 57% of all accommodations used by workers with disabilities nationwide have no initial cost. 0. They cost nothing to implement to start with. And of the 43% of accommodations that do bear a cost, the average cost mean is $517.
- [13:59]
Dr. Chaney Holloman
Oh man.
- [13:59]
Dr. Philip Rumrill
Now what employer would not spend 517 bucks to keep a good worker going for an indeterminate amount of time as opposed to the cost of turnover, having that job open and trying to fill it. It's a no brainer. And employers do get it to take
- [14:17]
Dr. Chaney Holloman
a slightly Trickier situation. If you imagine a person recently diagnosed with multiple cirrhosis who, unfortunately, due to their symptoms, even with reasonable accommodations, can't continue the same type of job they're doing, there's still the possibility of different types of positions or different types of work that you could keep employed. I don't know if you have any guidance for people who might find themselves in that kind of a situation.
- [14:39]
Dr. Philip Rumrill
Oh, most certainly. You're talking about a product of rehabilitation counseling, a very common service that rehabilitation counselors provide. It's called transferable skills analysis. And you can call the state federal voc rehab office in your community and you could say, I'm working in this field now. I don't know if I'm going to be able to continue, and I'd like to see if I could get a transferable skills analysis. We can take into account what your work history has been, what you were doing in the job that you were doing most recently or your current job, a functional capacities evaluation or a list of restrictions from your physician or physical therapist or a neuropsychologist. Right. And we look at the issues that you're having with your symptoms. We determine what things from the job that you currently have are you still able to do even though you have MF and there might be quite a few things or what things you can't do. So the ideal is we find you a very closely related job and move you into that one. But before we give up on your employer altogether, okay, the first thing we do, if someone's off work for a period of time, whether it's Ms. Or any other disability, we have what's called a return to work hierarchy. And the first priority is the same job with the same employer. So you're working as a nurse, you're having trouble doing it. We say, are there any accommodations that will allow you to keep your job? Can we put into place things that will help when that doesn't work? We say, is there a different job within this employer organization that we could place you in? That's step two. If we can't find that, no, different job with the same employer. We go to the same job, but with a different employer. And then as we work our way down, different job, different employer, now we got to restructure your entire career. Almost nobody wants that. It's more costly, it takes more time, and the outcomes are not as good. So here again, the more closely correspondent the new job is to the one you had, the more likely it's going to be successful.
- [16:40]
Dr. Barry Singer
And what about Those people who perhaps didn't have those conversations with their employers early on and reach a point where the stress of the situation just gets to be too much. Often I'll see folks in the clinic who at a certain point just say, I'm done, I can't work anymore.
- [16:55]
Dr. Philip Rumrill
Everyone, if you live long enough, has to contend with that decision about when is it time to stop working. Most people stop because their health doesn't allow them or their energy doesn't allow them to continue working any longer. Right. So this happens and making that decision is a difficult one. No matter when you make it, you don't want to make it too soon, you don't want to wait too long. But there are times in life the disease really makes it so work isn't the best thing for them right now. And at that point we want to help them. And I'm sure you deal with this in your practice, Dr. Hallman, helping them document disability for long term disability insurance, for example, if they're not of retirement age, Social Security Disability insurance or ssdi. The federal government has a provision for people who were working but now can't and who are under the age of 65. Right. We do have provisions for this and you can receive those benefits. And sometimes that is really the perfect and right choice for a person. What we do see is a phenomenon where people with Ms. Choose to leave the workforce earlier than they really should. From even from their own point of view, they leave too early. And so we would say don't leave too early. A lot of folks with Ms. End up regretting that decision. Make sure if it's time to stop working, that you've exhausted all other avenues. It's much easier to help someone keep a job they have than it is to help them find a job later. If you disengage from the workforce, if you want to be in the workforce until retirement age, do everything you can to stay in it.
- [18:33]
Dr. Chaney Holloman
Dr. Rummel, thanks so much for talking with me today. Thanks so much for all the work you do for people living with Ms.
- [18:39]
Dr. Philip Rumrill
Likewise, thank you for everything you do and for this opportunity. Be well, everyone, and thanks for your time and attention.
- [18:54]
Dr. Barry Singer
Joining us next is a lawyer who has dedicated his career to helping the Ms. Community navigate one of the most stressful transitions a person can make, stepping away from work when health demands it. Jamie Hobby. Jamie hall is a disability insurance attorney who specializes in representing individuals with complex neurological conditions. Over the years, his firm has helped hundreds of Ms. Patients work with Social Security and private insurance companies to secure the long term disability benefits they deserve. Thanks so much for joining us, Jamie.
- [19:23]
Jamie Hall
Thank you for having me. I appreciate that.
- [19:26]
Dr. Barry Singer
First, can you tell our listeners a little bit about what you do day to day?
- [19:30]
Jamie Hall
So from the time I step into the office to when I go home, I'm working on disability claims. It runs the gamut from private claims that we'll talk about in a bit under long term disability and short term disability as well as Social Security disability claims as well. I do that work on a nationwide basis. Our goal is to help the EMS community really get their hands around this issue and give them the best shot we possibly can at getting a positive result at the end of the day.
- [19:55]
Dr. Barry Singer
A situation I encounter pretty commonly in the clinic is I'll be talking with a patient who is dealing with symptoms related to their multiple cirrhosis that's affecting their employment day to day. Do you typically offer anybody advice when they're sort of at the phase where they're thinking that disability or disability benefits may be a necessity sometime in the near future?
- [20:15]
Jamie Hall
Yeah. So the favorite calls that we get in my office, they're from folks who are applying for disability maybe a year from now. They're in the planning stages, they're looking ahead, trying to find what signposts point towards disability. One of the focuses is what they've done to remain in the workforce and if they've exhausted all options to stay employed. Because as we both know, the longer Ms. Patients work, the better off their outcomes typically are. And if you're exhausting FMLA with time off with work modifications, shifting activities at home and things like that, when that's no longer enough to allow you to continue working, that's when you want to start looking at a disability claim.
- [20:54]
Dr. Barry Singer
Could you tell listeners a little bit about FMLA and how that's a resource to use as you're starting to navigate living with ms?
- [21:00]
Jamie Hall
Yeah, FMLA is a fantastic resource specifically for the Ms. Community. FMLA allows people to take time off of work, and it does that in two ways. You can take your FMLA consecutively, which is you're having a flare. You want a month off of work to try to recover. Let your body regain what you had before. But also of note, what people don't often realize is you can take FMLA time intermittently as well. I see a lot of clients have good success with taking, say, every Wednesday off for a period of time. They can work Monday, Tuesday, they can have a recovery Wednesday, come back in and push through Thursday, Friday, and maintain work a little bit longer in that Kind of scenario gives you a lot of different ways to manage the condition as far as that goes. And I would even add to that, if you're sitting in front of a judge and you're able to tell the judge, your honor, here's all the steps I took to remain at work, you can explain to them that you were taking every Wednesday off, that you modified your workplace activities, et cetera, et cetera. The judge can see the attempts you've made to stay in the workforce, and it does give you more credibility as a claimant, especially in an Ms. Case where it's not orthopedic. And a lot of times Ms. Is not something that'll show up directly on test testing. It's a lot more credibility based than we often see. So again, showing all these different steps to keep working makes a big difference in these claims.
- [22:21]
Dr. Barry Singer
Is there any specifics that change employer to employer in terms of, like, flexibility of the fmla, how much time you can take off, or is it relatively standard across jobs?
- [22:31]
Jamie Hall
So FMLA varies a bit. States have their own requirements. Federal government has their requirement as well. I believe smaller employers do not have FMLA requirements there. But if it's a larger employer, you will typically get significant time off you can take each year. For fmla, it will generally recalculate at the end of each year, but it does vary based upon the state and federal guidelines there, based upon your employer and location. And that's something where it's really helpful to get an expert on the line in your area to confirm what's going on and what your allowance is and make sure you're on the right path and everything.
- [23:08]
Dr. Barry Singer
And would that expert be someone in hr, in the job, a legal professional like yourself, who is typically the best person to reach out to for those specifics?
- [23:17]
Jamie Hall
Oftentimes it's a legal professional. Could also be a job accommodation specialist as well. There are several volunteer groups out there that do that as well. You can go to hr, but one of the concerns is, and this is the bugaboo for all Ms. Patients that would likely require some kind of disclosure. Generally, I recommend speak with someone, have a plan, then go to HR to present that plan, not to develop that plan. Generally speaking, it might be in your best interest to share the least amount of information possible to prove the need for the accommodation requested there. So instead of saying, I have Ms. And I take this infusion every month, need a day off or two for the infusion instead, it's a neurological condition and I simply have some treatment, I have to get and leave it at that. Honest is always a good thing. Open. You want to be a bit careful with that generally just to protect yourself, especially in the vulnerable position at the end of your career as an Ms.
- [24:13]
Dr. Barry Singer
Patient, say it's Ms. Patient kind of using fmla. They're starting to reach a point where they feel like that's not enough. Then what other options do they have to consider from a benefit standpoint?
- [24:25]
Jamie Hall
One of the things you want to consider is should I look at a different kind of job? Am I working a job that's too physical, that is too cognitively demanding, or that is just unique and not a good fit for my condition anymore? If you look at your scenario and there's not alternative work that you can do, it's probably time to go ahead and look at a formal disability claim. Now, when we say a disability claim, we're talking about a few different things depending on your options there and there's private disability and there's public disability. Public disability plans would include state based short term disability benefits and those are plans that cover you typically during the first six months that you're out of work. If you look at your pay stub, you will typically see you're paying taxes into the state based short term disability plan. Now most states don't have that coverage. Some of the major ones do, California, New Jersey come to top of mind. There's and those plans typically look at can you do your past work before you left work, so your immediate past employment. There's also state based long term disability, which is a Social Security disability program out there. Social Security disability is the primary program that Ms. Patients look at that's funded and managed by the federal government and again paid for based upon your tax contributions to the federal government. One of the important catches is if you, if you don't have state based short term disability and all you have is Social Security disability. Social Security will not pay a benefit for the first five full months after you left work. No matter how quickly you apply, no matter how quickly you're approved, you're going to have a gap of five or six months of your income, if not longer. If they take longer to make a decision. That's something really important to point out to individuals. Those are your two public plans, government based plans for other individuals, especially your white collar employees with a higher income level. There are likely private coverages and private plans as well. And that includes both private short term disability and private long term disability. Private short term disability typically covers those first six months that you're out of work in the the sole focus there is going to be can you do the work you were doing immediately before you left the workforce after short term disability is exhausted, you would then typically convert to long term disability if you have that coverage. And again, it's really helpful to ask HR or find out if you have short or long term disability coverage well before you need that coverage. And the duration of long term disability really depends upon the plan itself. Many plans these days will cover a person to age 65 or 67. Some of the cheaper plans out there may cover a person for just two years. What's important to know about private long term disability is typically when you first get on private long term disability, the sole focus is going to be can you do your past work before you left work. However, after a period of time, typically two years after you leave work, it changes from looking at your own occupation to looking at any occupation. So you picture an individual who has, say, just limitations in hand function. That may eliminate a lot of jobs, but not every job. Now what's important is once that standard converts from your own occupation to any occupation, they'll look at other jobs. But there is some wage protection in there as well. So for very high earners, the other jobs they look at have to pay something similar to what you were making prior to going out on disability. So that can be somewhat of protection. It is less of a protection if you're making less money.
- [28:09]
Dr. Barry Singer
And that's a great distinction between that own occupation and any occupation shift that happens at the two years. Is that common with most private long term disability plans?
- [28:19]
Jamie Hall
So if your employer offers short and or long term disability, virtually every one of those long term disability plans converts after about two years or so. If you're getting it privately, those plans probably about 50% of the time allow you to keep your own occupation standard throughout the entire claim period. And that's certainly something to ask about when you obtain one of these policies to make sure you know what kind of policy you're buying into.
- [28:46]
Dr. Barry Singer
If we were to imagine a scenario, maybe someone was newly diagnosed with multiple cirrhosis, they have pretty mild symptoms, but they see long term the implications that the disease might progress. Things might get worse after a diagnosis. Are they eligible to try to seek out a private benefit plan?
- [29:03]
Jamie Hall
When you get a private disability plan, the coverage is for future conditions, for the most part, not currently existing conditions. There are some limited exceptions there, but generally speaking speaking, you typically can't get coverage for a condition that already exists. It's also a nice segue to something a lot of people don't take into account. If you're an Ms. Patient and you're working and you're covered by a private disability plan for long term disability coverage, you want to be careful if you're going to look at a new job. Because if you jump from job A to job B, job B may not cover you for a period of time for Ms. Based disability. And I've seen this happen numerous times. So if you're switching jobs, you want to avoid doing so at the very end of your work career as an Ms. Patient.
- [29:52]
Dr. Barry Singer
And so if I was to throw out another scenario, I'll see a patient either newly diagnosed or after a pretty severe exacerbation. And it's a pretty strict cutoff in terms of now they're having new symptoms that within the course of a couple weeks pretty much prohibited them from returning to work. What are the kind of first steps to take for those kind of patients who are in what I describe as a crisis situation?
- [30:13]
Jamie Hall
So those individuals just take a deep breath before they make any major decisions as far as that goes. Taking a deep breath is also helpful from a claim perspective, because when the exacerbation happens, we don't know what that person's condition will be long term. And that's one of the major challenges we have, especially for Social Security disabilities. So for Social Security disability, when you file that claim, their job is not to figure out if he can work today. Their job is to figure out if he can work a year from now. So when that exacerbation occurs and the patient files an application for disability the day after the exacerbation occurs, they put themselves in a difficult spot. It makes things really difficult to be approved. And when you file for Social Security disability, you typically get three bites at the apple. You get an initial application, the approval rate's under 50%. You get a reconsideration appeal, the approval rate's around 15% nationwide, then you can go to a hearing. The approval rate there is just over 50%. If you file your claim prematurely, you're going to be denied at those initial levels. And you need those bites at the apple to be as strong as they possibly can so you're not playing roulette on what judge is assigned at the hearing level and everything. So what I would say to those patients, typically waiting about five months to let your body and your doctors do their work and recover. So you can then tell the SSA where your baseline is at is your best way to maximize your odds for these claims.
- [31:47]
Dr. Barry Singer
Sounds like too that also starting that track record of working with your employer for accommodations, working, trying to come back to work even if eventually you're not successful, would then increase your chance long term of getting those benefits.
- [32:01]
Jamie Hall
That's exactly right. I mean, judges want to approve benefits for people who want to work but can't. So from any angle you look at it, using every single tool in your box to extend your work timeline is going to be assisting to you long term.
- [32:14]
Dr. Barry Singer
I don't know if you could speak on to someone maybe with an average type of position, what they could expect if they eventually do get approved, what that financial support looks like for them.
- [32:24]
Jamie Hall
So Social Security disability. There are primary benefits for the disabled individual and there are auxiliary benefits for their children as well. Social Security will pay up to just over $4,000 a month for the individual based upon their lifetime earnings history. The majority of claims we see in my office probably pay between $1,700 and $3,000 per month. There are some high earners who get more, there are some lower earners who get less. But most people fall in that rubric. And in fact you can go online and pull up your benefit statement and that will give you the number on there as well. Which if I'm an Ms. Patient, I want to know that number today. So if I file in a year or two, I can plan accordingly for that number. What's really important for most people, typically when you have children under the age of 18, there is a 50% additional benefit on behalf of your children combined. So if your benefit is $2,000 per month, you'll get your $2,000 plus an additional $1,000 divided among all the children there until they turn 18. So that's 3,000 in total, not 2,000, which is a big difference as you're trying to make ends meet as a family in a everything. The thing we often talk about in Social Security disability claims is drawing a distinction between people under age 50 and people over age 50. It's a key demarcation point in the Social Security claim process because of the standard for disability they use for people under age 50. The question is, can they do any kind of work on a full time competitive basis? So when a person is under age 50, they don't just ask can they do their past work? From Social Security's perspective, it's can they do any work full time? Now when we see those claims come through, there are some things we look at. We focus on hand function. If you can't use your hands, there's Almost no jobs you can do. Regardless of what type of work it is, we look at fatigue if you need breaks throughout the day. If you need to miss days regularly, that's a major factor as well. We also look at significant cognitive dysfunction. Over age 50 is a bit different. Over age 50 is can you do your past work before you left work or other light duty work that has you on your feet? Typically six hours per day. So over age 50 is where ambulatory issues come in. Are you using a cane, are you using other support or things like that. So again, based upon the age, we look at different factors there as to when to file a claim, what their perspective may be once they do.
- [35:00]
Dr. Barry Singer
So I think it'd be helpful if you wouldn't mind talking through what an application process looks like in terms of when you apply versus when you expect to hear back versus opportunities. You have to either appeal or support your claim further.
- [35:13]
Jamie Hall
In my office, what we recommend to folks is typically file a claim around five months after you left work. Once they file on day one, the SSA will ask for some additional information about your work history, your daily activities, your treatment history, all important information to make the right decision so they know who to give that monthly check to and who not to give it to. Again. Good data makes for good claims and it's going to be time consuming to an extent, confusing to an extent, but it's there for the right reason. It's also where council can help demystify that process and simplify it a bit for individuals there. When you file that initial claim, the timeline for decision varies greatly across the country. We're seeing resolution times from the short end, about three to four months in places like Pennsylvania. The high end is places like Florida and Texas where you may see 12 to 15 months for the initial application decision. And as I mentioned earlier, the approval rate there is less than 50%. So just because you're denied doesn't mean it's not a good claim. We file appeals of decisions every day. We win appeals every day. Do not file a brand new claim. If you file a brand new claim, you give up your right to the time that's gone by through that date. Typically, reconsideration takes maybe three or four months. But you've got to go through that hoop to get to the hearing level and the hearing levels where most cases are approved, where you can literally sit in front of the decision maker and plead your case. You can have someone like me develop your file, develop the medical records, develop medical opinions to support your claim, and Literally make the argument in front of the judge based upon the document and what's in the file and everything. And again, the approval rate varies from anywhere from about 20% to 80% based upon which judge is assigned. There's appeals beyond that as well, but those get very challenging. Those are your three bites at the output you're typically looking at.
- [37:12]
Dr. Barry Singer
It certainly seems like, given the complexity inherent in the application, working with a professional like yourself is hugely beneficial. Can you talk through whether you'd recommend working with a lawyer? If so, what kind of support you could offer and what the fee structure looks like?
- [37:28]
Jamie Hall
Yeah, and again, I'll note I'm a bit biased here. I do this for a living, but the proof is in the statistics. People who get good representation have a better outcome. If I'm one of your patients, I look for a few things. One, I want an attorney who just does disability work. Some attorneys will vacation in disability claims, which is no better than a doctor who vacations in neurology. I want to be able to sit a client down and say, I do cases in your state. Here's the timelines you're looking at. Here's your outcome you're looking at. Here's what we want to do because we handle cases differently in different states, because they look at cases differently in different states. I also want an attorney with good expertise in Ms. As well. And here's why. You know as well as I do Ms. Is a bit unique. It's not orthopedic. A lot of disability attorneys see orthopedic claims come through their office every day. Day. When I say orthopedic, I mean your bad knee, your bad back, things like that. We all know what those X rays look like. We all know how to argue those cases. Mississippi is a different animal. Knowing how to bridge that gap and knowing where the gaps in these claims are to prove these silent issues. How do you prove fatigue? We've been doing that for 17 years. So I think having an attorney who specializes in disability who knows Ms. Through and through makes a big difference. As far as attorneys fees go, everyone who does this work charges the same fee because that's how the government has it set up. And the fee is contingent. Nobody gets paid if the claimant doesn't get paid, and nobody gets paid until the claimant gets paid. Once that person's approved for benefits. The attorney's fee is based upon the past due benefit. So if they approve you, say, a year, year after you left work, they will owe you six months of benefits. After that, waiting Period. The attorney's fee is based upon that six months of outstanding benefits, and it's 25% of that up to a fee cap.
- [39:25]
Dr. Barry Singer
In your experience working with people with Ms. Applying for disability, you mentioned some of the potential pitfalls. Any other advice you'd give someone who's sort of thinking about the future, maybe on that cusp of feeling like they can't work anymore?
- [39:40]
Jamie Hall
One, talk with your neurologist, talk with your physical therapist. Make sure that they know what you're looking to do. Because sometimes your doctor may say it's not time yet for you. And that's okay. We all need that kind of feedback from now and then. And also make sure if you're looking at that path, make sure your doctor is aware and documenting everything that you're going through there, because I will be looking at that in the future as a disability attorney. Also make sure to walk your doctor through what is getting worse. What is the tipping point in your claim? Because we've got to tell the judge at some point. I could work on Monday, I couldn't work on Tuesday. Ms. Happens an inch at a time. But if the medical record can show what we call an acute event, where here's where the gate got too bad, and here's the doctors testing on that day, that helps. Leaving work when you have a neurological visit that reflects increased issues on testing is the best possible outcome for a disability claim. So again, it's working with your neurologist office. I would also tell folks, learn about what you have access to document those things so you can protect your family. Find out how much your benefit amount is going to be from these different programs. Find out about what the standard is for qualifying for these different programs. As I said, talk to your neurologist, talk to an attorney, because we may also say it's too early for you. Look at a different job or something like that. And just make sure that you have your ducks in a row before you take that leap. Because once you do leave work, as an Ms. Patient with limitations, it is really hard to undo that and get back in the workforce.
- [41:22]
Dr. Barry Singer
Jamie, thanks for joining us and for everything you do.
- [41:24]
Jamie Hall
Thank you for having me. And to those listening, I wish you all the best going forward here. Keep your head up. It's a long process, but you'll get there.
- [41:39]
Dr. Barry Singer
Thank you to Dr. Rumrell and Jamie hall for helping us better understand the many options available to people with Ms. As as they think about employment accommodations and disability benefits. If you're considering making some changes to your working life, remember that these decisions do not have to happen alone and with the right information, support and planning, you can make choices that protect both your health and your future. Thanks again to TG Therapeutics for sponsoring this episode. Keep in mind the topics we discuss on this show are strictly informational and not medical advice. Any change in your treatment should be discussed directly with your healthcare providers first. Our show is hosted by me, Dr. Chaney Holloman and Dr. Barry Singer and produced by Kari Ad Harmon. Our theme music is by Broke for free. If you like the episode please share it with others living with Ms. And we would love it if you could post a positive review on Apple Podcasts. It really makes a difference to us and helps more people find out out about the show. You can follow me on x rainboyneuro1 and Dr. Barry Singerberrysinger. More information about our guests and their websites can be found in the show. Notes for the episode in the blog section on ms.livingwell.org thanks so much for listening. This has been an Ms. Living well podcast.