Case Spotlight – January 2022

Attorney Erika Riggs was contacted by a family from Allen Park, Michigan, who had been referred to her for help with their disabled adult daughter. Prior to contacting Attorney Riggs, the family had gone through a long, complicated battle on their own for the daughter’s disability benefits. She has autism and severe, congenital oral apraxia. Her father was a retired psychiatrist and had been previously told that the only benefit available for his daughter was called Supplemental Security Income (SSI). However, he was first told that she would not qualify for SSI as the account in her name placed her just over the resource limit. Therefore, after a Special Needs Trust was properly established for her, the family submitted an application for SSI to the Social Security Administration (SSA).

To be eligible for SSI, the claimant must be under the resource limit and considered “disabled” under SSA’s strict definition for disability. Specifically, the claimant must be under resources which is about $2,000.00 for an individual or $3,000.00 for a married couple. SSA takes a strict approach to evaluating the claimant’s resources, and will closely examine all assets when determining eligibility. These assets include, for example, money in bank accounts, pension, 401K, stocks, and more, and considers all other kinds of support (e.g. alimony, child support, settlement funds, etc.). Thankfully, his daughter was 32 years old when her SSI claim was approved, meaning that SSA agreed that she was both disabled since she filed at age 32, and that she met the resource-threshold to qualify.

However, her father wondered if this was the right disability benefit for her, and he became worried about what would happen upon his passing; he knew that his disabled daughter may not be able to sustain on the SSI amount alone. He discovered another disability program that could be available for his daughter, called Disabled Adult Child (DAC) benefits, also known as Child’s Disability Benefits. For DAC eligibility, as opposed to SSI, resources and assets (other than income from work), are not considered. The DAC benefit provides Social Security Disability (SSD) benefits to a disabled adult – based on the work record of their qualifying parent – who can prove that the disability began prior to attaining age 22. Additionally, a qualifying parent would need to have acquired sufficient work credits before one of the following triggering events: retirement, disability, or death.

In this case, the disabled daughter would be eligible for DAC benefits based on her parent’s qualifying work record and upon her father’s retirement, triggering technical eligibility. Therefore, the family decided to file for DAC disability benefits on their own since they also already had a determination that the daughter was disabled from SSA as she continued to collect SSI payments. Further, with her father being a psychiatrist, and a wonderful advocate for his daughter, he figured he would be able to help her win on their own without a disability attorney. Unfortunately, however, they received a denial for her DAC benefit claim. The reason for her denial was that SSA determined that her conditions, autism and severe oral apraxia – although currently considered to be severe – were not found to be severe enough under the rules to find her “disabled” and unable to work prior to her reaching age 22 (ten years prior). At this point, he knew he needed to call an experienced disability attorney to help with an appeal.

When he called Disability Law Group, he was met with kindness and expertise. Attorney Erika Riggs took careful time to review all of the records and talk with the family to understand how to best advocate for her client. She decided that she would take the case and help win DAC benefits for his daughter, knowing that it would not be an easy fight; she was up for the challenge. Our team ordered all missing and updated medical evidence to help support disability since before her client turned age 22. Attorney Riggs also drafted detailed Medical Source Statements and Residual Functional Capacity (RFC) report for her client’s doctors to complete to help add more evidence. She then obtained letters in support from her client’s family, adding further support to her case. Team DLG submitted all evidence, and diligently followed up on her case. Erika argued that her client met the new listing for Autism, under SSA Listing 12.10, showing that she met all the criteria required since well before she turned age 22. The Autism Listing 12.10 requires medical proof of both qualitative deficits in verbal and nonverbal communication as well as social interaction, and at least a marked limitation in two (or extreme limitation in one) of the following criteria:

  • Understand, remember, or apply information
  • Interact with others
  • Concentrate, persist, or maintain pace
  • Adapt or manage oneself

Within just 6 months, after filing an appeal called a Request for Reconsideration, SSA agreed that Erika’s client had truly been disabled under the rules, and unable to work, for at least the last 10 years. Therefore, SSA overturned their initial decision and approved DAC benefits for her client. As a result, she is now receiving thousands of dollars more in benefits, and their family has peace of mind in knowing that she is now collecting a more substantial benefit, preservation of her assets, as well as Medicare insurance to help with her ongoing medical care.

If you or someone you know has severe autism, or other serious problems that keep you from being able to work and affect your ability to function normally, contact Disability Law Group today for your free consultation. Our attorneys and staff specialize strictly in disability benefits, and we will fight to help you win every benefit you deserve. We pride ourselves on helping disabled individuals receive disability benefits as quickly as possible. Whether you have been denied, or if you would like advice from the very start, contact us today and speak with an attorney for a free consultation to understand your rights and get the representation that you deserve.