Questions & Answers

 

Hi, Steve

This is the perfect question for me!  I have been unsuccessfully been searching for an answer and do hope you can help.

I thought I found the proper information, but no positive results.  I am on my 3rd appeal which will bring me before the administrative law judge.  I’ve been trying to hire an attorney to represent me, but can’t seem to find one with adequate knowledge – what a shame.  I’ve spoken to several attorneys, all but one were unaware that there is any way of qualifying for Medicare without receiving SSDI benefits.

****Citation needed

Even more frustrating is the fact that I feel like I’ve been stripped of my right to representation!  The standard fee, set by law, is up to 25% of the benefit awarded by the court. Since Medicare appeals have no monetary award,

***Citation needed.  That makes sense.

 these attorneys insist they can’t represent me.  Of the 20-25 I’ve interviewed, I’ve met only 2 who know the court will approve an hourly fee in lieu of their standard 25%,

****But it’s limited to $6k and must be approved (in advance?)

Right to Representation - Attorney SSDI
Right to representation

pubs/10075

 

 but even they refuse to consider deviating from the norm.  All 8 attorneys recommended by the Office of Adjudication have also refused to consider my case just based on the fee issue.  I’ve been told to just represent myself – bad idea!  Please, Steve, if you have any ideas I would love to hear them.

Thus far, I have found a couple of statements to support my position but there must be something more extensive that I am missing. First, SSA 10024 states, ” Others qualify because they are government employees not covered by Social Security who paid the Medicare tax.”

****Please provide the URL if you have it.

 The other statement from Medicare publication 05-10043 says

Medicare
Medicare Publication 10043

Medicare

, “Before age 65, you are eligible for free Medicare Hospital insurance if….You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program.”

****What is your disability?   How old are you?

(Not an easy thing to do, especially with older medical records.  However, Social Security is even refusing to accept a letter from my doctor of 10 years as verification.)

***Please review this page….

Medicare Disability Evaluation
Blue Book Listing Impairments

bluebook/listing-impairments

 Unfortunately, I don’t have access to law books or legal precedents to support my case.

***Have you been to your local Law Library?

  I do need a lawyer or a very talented advocate!

***I’m talented, but not experienced.

Advocate Appointment
SSA 1696 – Appoint Advocate

ssa-1696

 

In 2002, I had to take disability retirement after teaching full-time for just over 10 years.

***What about medical benefits from your school district?

 Until this past January, I was covered by my husbands outstanding private health insurance so I never bothered applying for Medicare.  Now we are covered by a very expensive and mediocre COBRA plan so the Medicare Benefits are suddenly looking very attractive.

Our Cobra runs out in 12 months.

  After that, I will not be able to qualify for private insurance.

***Yes you do!  HIPAA_after_COBRA

 

 I’ve just been advised that there is a 1-year backlog of cases for the Santa Barbara Adjudication office, and then, if I’m lucky enough to win, I’m told they will start the 2 year waiting period from the date of the decision despite the fact that I’ve been disabled for 9 years and was kind enough to provide my own insurance and not leach off the public system for that entire time.  Guess I can either go broke or die waiting for a decision – a bit of an extreme statement but, yes, that’s about how I’m feeling right now.

So, Steve, PLEASE HELP if you can. Do you know of someone who can help with this crazy situation?

***Try the attorney’s on this page?

 

  I would truly appreciate receiving some good suggestions and/or referrals.  Thank you so much for taking the time to read this rather lengthy appeal.  I look forward to hearing from you soon.

Best regards,
J. L.

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