Navigating the Benefits System after a Brain Injury

PERA, ERISA, SGA, SSDI vs. SSI, LTD vs. STD! It’s an alphabet soup when it comes to applying for benefits after an injury, and it’s especially puzzling negotiating the system when a head injury is involved.

The Brain Injury Hope Foundation presented a panel of professionals who work with the “system” to help guide traumatic brain injury survivors and their families and caregivers through the maze of government and legal bureaucracies.

The panel at the free BIHF Survivor Series on April 12, 2019, at the West Metro Denver Fire & Rescue Training Center in Lakewood, Colorado, consisted of:

Harold Lasso
Ability Connection Colorado

Mary Susan L. Kern
Attorney, McDermott Law, LLC

James Noel
Attorney, Noel & Krieger

“It’s hard to prove head injuries with Social Security regulators. An MRI or CT scan doesn’t show a TBI,” said Noel, who specializes in Social Security disability claims. “2.5 million SSDI claims are filed every year, and two/thirds of those get denied right off the bat. The success rate is 60-70 percent. It’s not a user-friendly system. It’s a difficult road to go alone. ”

If you work in the private sector when you are injured you might be covered under ERISA, and if you are a teacher, law enforcement officer, or are an employee of more than 500 government agencies and public entities in Colorado you might be covered under PERA.
“The type of law determines how to handle your claim,” said Kern, who has extensive experience in handling ERISA, PERA, and private disability insurance claims, including internal insurance appeals and litigation.

Harold Lasso helps people with benefit counseling, including housing assistance, energy assistance, health insurance, along with what to do when you are seeking employment and after you become employed, as there are limits on how much a person can make while on Social Security Disability Insurance.

“Before applying for SSDI you cannot make more than $880 GROSS a month,” Lasso said.

Social Security Administration has established a SGA – Substantial Gainful Activity – requirement and if you make more than $1,220 per month in 2019 ($2,040 if blind) you cannot collect SSDI, but there are exceptions and work incentives. Lasso and his team can talk to you about Trial Work Period, Unsuccessful Work Attempt, Impairment Related Work Expenses, Subsidy, etc., etc. Work Incentives make it easier for people with disabilities to work and still receive medical benefits and sometimes cash benefits also. Oh and then there is CDBI – Childhood Disability Benefit Insurance – where children tap into their parent’s benefits.

Lasso and Ability Connection Colorado can help you through this employment and benefits labyrinth and see what programs apply to your situation. Lasso related a story of a young man, 22 years old, who he helped go to school to become a dental assistant, and now the young man makes $35 an hour and is contributing to society at a higher level than working a minimum-wage job. He now has a career instead of just a job.
If you are working when the injury occurs, Kern suggests you contact your human relations department and get all the documents relating to your plan.

“Get documents on short-term disability, long-term disability, life insurance plans,” she said. “And if you are on PERA, you have 90 days from termination to apply. AND keep all your pay stubs.”
All the panel members suggest having someone to help you fill out any forms and to bring along a support person to doctor appointments. It’s also crucial to document your symptoms, especially with brain injuries, which have been described as the “invisible injury.”

“Keep a headache log,” Noel said. “People understand migraines, but not brain injuries and a CT scan or MRI is not going to detect one.”
Relating your symptoms to your doctors is so important because of the brain injury. Keep a log of depression and anger issues, loss of concentration, attention-span difficulties, balance issues, light sensitivity and hearing problems, and a pain log, along with any other symptoms you are experiencing – such as putting the milk in the cabinet instead of the refrigerator or sleep problems.

“Do NOT say you are fine if you are not,” Noel said. “The doctor’s appointment starts as soon as they come through the door. They are not niceties when they ask, ‘How are you?’”

Bring along a list of symptoms and questions, as with a TBI, it can be difficult to remember all your issues, especially if you are having one of those good days. Also know that HIPAA – the privacy in medical data act– does NOT apply to disability claims.

Yes, it’s a bewildering system, and having people such as Lasso, Kern and Noel in your corner will help as you fight for your benefits.

-- By Eliza Marie Somers