(a true Social Security Disability story)
A young man came to me for help getting Social Security disability. He had a condition that caused both physical and mental symptoms. His doctor told him there was no cure, and eventually he would die from the disease.
He had applied for SSDI and SSI a couple of years before I met him. Both claims were denied, as usual. He had correctly filed an appeal and asked for a hearing. He had no attorney or representative at that time.
The problem is, a hearing was scheduled but the claimant says he never got the message. Not knowing about the hearing, he failed to appear. The judge sent him a letter. The claimant says he never got that letter, either. We don't know why. So, the judge dismissed the claim. The claim ended, terminated right there. There would be no hearing; the case was dead.
Now, we would usually file a new claim and start over. It would be a long delay but it would get us back in the game. The problem was, this young man had not been able to work in a long time. His SSDI eligibility period had expired. He wasn't eligible to file a new claim. Old claim dead, new claim not possible. Game over, or so it appeared.
The administrative law judge who dismissed the claim had no power to reinstate it, even if he had wanted to. It was now out of the judge's hands.
I decided to file an appeal of the judge's dismissal with the Appeals Council, a body that sits in Falls Church, Virginia. I argued that the claimant suffered from severe physical and mental impairments and that he either did not receive his notice of hearing, or he didn't know what it was due to his severe impairment. I argued that the withdrawal should be reversed and the claimant's hearing should be rescheduled. Evidence was submitted to support my pleadings.
After about 120 days, the Appeals Council ruled: It would rescind the dismissal and remand the case back to the administrative law judge for a hearing. A "dead" case had literally been resurrected. Not only did my client get his day in court, he also got to potentially keep all of his retroactive benefits--just as they would have been in the original application. In short, he wasn't going to be penalized just because his case had been dismissed. He was back in the game at the same place as when he got kicked out.
But, of course, we still had to win at the hearing. About 3 months after the Appeals Council remanded the case, we attended a hearing. It went well. About 1 month after the hearing, the judge issued a Fully Favorable decision. My client got a substantial amount of back pay, a monthly benefit, and Medicare to help pay for the complex treatment he needed.
This could be one of the most satisfying cases I've handled. A lot of clients in this young man's shoes would have given up, seeing this situation as hopeless. A lot of representatives would never have taken this case because it just involved too much work and very little chance of a payday. Today, I'm thankful that neither of us gave up. A long, hard fight rewarded this claimant with the benefits he needs and deserves.
The moral of the story: Never, never, ever quit!
Saturday, February 29, 2020
IS YOUR DISABILITY CLAIM STALLED?
Stalled can refer to something which is moving abnormally slow, or isn't moving at all.
Social Security disability claims are often stalled. They can be stalled by numerous factors, sometimes by the simplest of things. And once they lose momentum they can linger in limbo for months and months.
The Social Security disability system is very slow to begin with. It's designed to be measured in terms of months and years, not days and weeks. But when your claim is moving even slower than usual, you have been stalled.
Common reasons for stalls:
1. Incomplete paperwork. You haven't returned all the requested forms.
2. Your doctor hasn't sent in the requested records.
3. You didn't keep your consultative medical exam appointment.
4. You failed to give Social Security a detailed and accurate job history.
5. You are administratively stalled in the system.
6. You are waiting on an appeal which moves at a snail's pace
7. You were medically approved but waiting on Social Security to determine your financial qualifications for SSI.
8. You have been approved for both SSDI and SSI but Social Security won't pay either until they get their accounting worked out for both claims. One claim delays the other.
One of the things I try to do when I take a new case is to figure out why it is stalled. What can I do to get the case moving again? What is the next step? Who has the paperwork on their desk right now? Who do I need to call?
At best, the disability process is slow and laborious. But if you are stalled out, it can just go on forever. A stalled out can can eventually be denied or dismissed because Social Security won't wait forever.
Are you stalled? Call me. Let's see if I can help.
Social Security disability claims are often stalled. They can be stalled by numerous factors, sometimes by the simplest of things. And once they lose momentum they can linger in limbo for months and months.
The Social Security disability system is very slow to begin with. It's designed to be measured in terms of months and years, not days and weeks. But when your claim is moving even slower than usual, you have been stalled.
Common reasons for stalls:
1. Incomplete paperwork. You haven't returned all the requested forms.
2. Your doctor hasn't sent in the requested records.
3. You didn't keep your consultative medical exam appointment.
4. You failed to give Social Security a detailed and accurate job history.
5. You are administratively stalled in the system.
6. You are waiting on an appeal which moves at a snail's pace
7. You were medically approved but waiting on Social Security to determine your financial qualifications for SSI.
8. You have been approved for both SSDI and SSI but Social Security won't pay either until they get their accounting worked out for both claims. One claim delays the other.
One of the things I try to do when I take a new case is to figure out why it is stalled. What can I do to get the case moving again? What is the next step? Who has the paperwork on their desk right now? Who do I need to call?
At best, the disability process is slow and laborious. But if you are stalled out, it can just go on forever. A stalled out can can eventually be denied or dismissed because Social Security won't wait forever.
Are you stalled? Call me. Let's see if I can help.
Friday, February 28, 2020
SLEEP DISORDERS AND DISABILITY
Many of my clients who file for Social Security disability have severe sleep disorders. The question is, do these sleep problems equate to disability?
The answer is, how do the sleep problems restrict the ability to perform full-time work? What are the symptoms? How frequent and how severe are the symptoms.
Symptoms of insomnia, obstructive sleep apnea, narcolepsy or other sleep disorders often include:
Usually, a claimant with sleep issues will also have other problems. For instance, a person may have back problems, diabetes or a psychiatric problem, plus sleep problems. All of these problems may combine to make him or her disabled.
The longer I practice the more I realize that just being diagnosed with a particular disease will not win benefits (unless, of course, it is a terminal or catastrophic illness). It is the combined affects of all the claimant's symptoms that usually win disability benefits.
The bottom line for any impairment is: How does it keep you from working?
The answer is, how do the sleep problems restrict the ability to perform full-time work? What are the symptoms? How frequent and how severe are the symptoms.
Symptoms of insomnia, obstructive sleep apnea, narcolepsy or other sleep disorders often include:
- excessive daytime sleepiness
- fatigue
- loss of memory
- lack of concentration, persistence and pace
- irritability - unable to get along with supervisors, co-workers or customers at work
Usually, a claimant with sleep issues will also have other problems. For instance, a person may have back problems, diabetes or a psychiatric problem, plus sleep problems. All of these problems may combine to make him or her disabled.
The longer I practice the more I realize that just being diagnosed with a particular disease will not win benefits (unless, of course, it is a terminal or catastrophic illness). It is the combined affects of all the claimant's symptoms that usually win disability benefits.
The bottom line for any impairment is: How does it keep you from working?
WHY BEING AGE 50+ HELPS WIN DISABILITY CASES
It's true that age 50 is the sweet spot for disability claims.
That is due to the Medical Vocational Guidelines or "grid rules" that can help older claimants get approved.
The grids combine the following factors to determine a decision:
A person with the same medical condition and the same functional limitations may not qualify for a benefit at age 49, but may get a benefit at age 50. That's the difference the grid rules can make.
Let me emphasize, a 55 year-old claimant must still prove disability with medical evidence. It's just that it's a little easier to prove at 55 than it is at 35.
Another factor that may help the older claimant is work history. He or she may have a long, steady work background that argues for credibility. A person who has worked for 30 years or more will be unlikely to give up the work just to get a meager Social Security check.
That is due to the Medical Vocational Guidelines or "grid rules" that can help older claimants get approved.
The grids combine the following factors to determine a decision:
- Age
- Education
- Past work experience
- Residual Functional Capacity (functional limitations)
A person with the same medical condition and the same functional limitations may not qualify for a benefit at age 49, but may get a benefit at age 50. That's the difference the grid rules can make.
Let me emphasize, a 55 year-old claimant must still prove disability with medical evidence. It's just that it's a little easier to prove at 55 than it is at 35.
Another factor that may help the older claimant is work history. He or she may have a long, steady work background that argues for credibility. A person who has worked for 30 years or more will be unlikely to give up the work just to get a meager Social Security check.
NO 2 FINGERPRINTS ARE ALIKE. NEITHER ARE DISABIITY CASES
You are a unique individual, not duplicated by any of the 5.5 billion people living on earth. Your fingerprints are unique, your smile is unique, and every cell in your body is unlike those of any other person.
Likewise, every Social Security disability claim is unique.
Your claim is not like anyone else's claim.
That's why I cringe when I hear someone comparing their claim to someone else's. No! It just isn't possible.
"My sister's claim was approved in just 24 days!"
"Uncle Albert's claim was paid without having a hearing."
"My neighbor said his hearing only lasted 5 minutes!"
Never, ever take what happened in somebody's else's case to be any indication of what will happen in yours. No two cases are alike.
I just made a list of all the things can be different between two Social Security disability cases. This list probably isn't complete, but it will give you an idea:
The best 15 minutes you ever spend may be talking to an experienced disability advocate or attorney. Someone who has set before a judge hundreds (or thousands) of times and seen how the unique set of facts in a case determines the outcome.
Let an advocate analyze your facts on your case.
A "one size fits all" approach is no good at all.
And the fact that Uncle Albert won his case should give you absolutely no comfort at all.
Likewise, every Social Security disability claim is unique.
Your claim is not like anyone else's claim.
That's why I cringe when I hear someone comparing their claim to someone else's. No! It just isn't possible.
"My sister's claim was approved in just 24 days!"
"Uncle Albert's claim was paid without having a hearing."
"My neighbor said his hearing only lasted 5 minutes!"
Never, ever take what happened in somebody's else's case to be any indication of what will happen in yours. No two cases are alike.
I just made a list of all the things can be different between two Social Security disability cases. This list probably isn't complete, but it will give you an idea:
- different ages
- different past work experience
- different medical conditions
- different medical treatment
- different doctors
- different judge hears the case (no they are not all alike)
- different residual functional capacity
- diffferent lifting limits
- different education level
- different job skills
The best 15 minutes you ever spend may be talking to an experienced disability advocate or attorney. Someone who has set before a judge hundreds (or thousands) of times and seen how the unique set of facts in a case determines the outcome.
Let an advocate analyze your facts on your case.
A "one size fits all" approach is no good at all.
And the fact that Uncle Albert won his case should give you absolutely no comfort at all.
Sunday, December 9, 2018
IS IT HARD TO GET SOCIAL SECURITY DISABILITY APPROVED?
Social Security's normal response to a new disability claim is to investigate for 4 or 5 months, then DENY the claim. A very small percentage of claims get approved on the application level. So, a denial is to be expected--unless you are over age 50 and have a catastrophic or terminal illness.
WHY IS THIS TRUE?
1. Because of Social Security's very narrow definition of disability. You are not disabled under Social Security's rules unless you are unable to perform all (and I do mean "all") work that is available in the US economy. If you can still perform an unskilled, sedentary (minimum wage) job, you are not considered disabled.
2. Because of Social Security's exacting rules of evidence. Social Security depends primarily on medical records from doctors, not nurse practitioners, social workers, counselors, chiropractors or healthcare professionals. And they prefer records from specialists. They also want objective evidence, such as X-rays, MRIs, CT scans or laboratory tests to prove your conditions. Many claimants simply don't have the medical evidence to convince Social Security that they cannot work at any job.
3. Because Social Security is a very skeptical agency. Social Security assumes that people will lie to them in order to get benefits. So, they don't take your word for anything. When there is a gray area, and the decision about disability is not cut-and-dried, the agency will rule against you and deny the claim. Their attitude seems to be, "If we are wrong, let the judge sort it out in the appeal."
4. Because many Social Security disability claims are weak to start with. When it comes time for an appeal, I examine disability claims to see what went wrong. You'd be amazed at what I find. Here are some typical problems.
Once Social Security has made a decision not to pay benefits (a denial), the claimant is present with a wonderful new opportunity--but only for 60 days. The claimant may file an appeal and point our why the denial is in error. New evidence may be submitted, including more evidence from doctors or healthcare providers. The claimant's attorney may point out errors of law or procedure made by the state's agency (DDS) in denying the claim. Finally, the claimant gets to appear in person before an administrative law judge to re-state his or her case an get a completely new decision. All of this depends, however, on filing an appeal within 60 days of the denial letter.
YOUR DENIAL MAY HAVE MORE HOLES IN IT THAN SWISS CHEESE. BUT THERE'S ONLY ONE WAY TO FIX IT: APPEAL AND ASK FOR A HEARING.
"Won't the hearing take a long time to schedule?" Yes. It takes months to get before a judge. However, if I represent you, I will ask the judge to pay you past due benefits ("back pay") for all the months since your disability began. So, while you must wait for your money, you don't actually lose any benefits.
Can you afford legal representation? Yes. Social Security has provided that no legal fees can be charged while you wait on the outcome of your case. In fact, you can't be charged a fee at all unless you win your appeal and also collect past due benefits.
If you've been denied for disability benefits within the past 60 days, or if you have a hearing scheduled, call me for a free consultation. Let me develop a plan to win your case and get you maximum benefits. I will obtain the necessary medical records (at my expense) and prepare for your day in court. And I will do this without asking you a cent before your case is paid.
_______________
THE FORSYTHE FIRM
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
"Across from Bridge Street"
WHY IS THIS TRUE?
1. Because of Social Security's very narrow definition of disability. You are not disabled under Social Security's rules unless you are unable to perform all (and I do mean "all") work that is available in the US economy. If you can still perform an unskilled, sedentary (minimum wage) job, you are not considered disabled.
2. Because of Social Security's exacting rules of evidence. Social Security depends primarily on medical records from doctors, not nurse practitioners, social workers, counselors, chiropractors or healthcare professionals. And they prefer records from specialists. They also want objective evidence, such as X-rays, MRIs, CT scans or laboratory tests to prove your conditions. Many claimants simply don't have the medical evidence to convince Social Security that they cannot work at any job.
3. Because Social Security is a very skeptical agency. Social Security assumes that people will lie to them in order to get benefits. So, they don't take your word for anything. When there is a gray area, and the decision about disability is not cut-and-dried, the agency will rule against you and deny the claim. Their attitude seems to be, "If we are wrong, let the judge sort it out in the appeal."
4. Because many Social Security disability claims are weak to start with. When it comes time for an appeal, I examine disability claims to see what went wrong. You'd be amazed at what I find. Here are some typical problems.
- Social Security didn't get all the medical records.
- The claimant didn't fill out all his/her forms adequately or properly.
- The claimant's doctor did not provide his/her opinion about ability to work.
- Past relevant work was mis-classified.
- The claimant's residual functional capacity (RFC) was exxagerated by Social Security.
- The decision was made by a single decision maker and was never reviewed by a Social Security doctor.
Once Social Security has made a decision not to pay benefits (a denial), the claimant is present with a wonderful new opportunity--but only for 60 days. The claimant may file an appeal and point our why the denial is in error. New evidence may be submitted, including more evidence from doctors or healthcare providers. The claimant's attorney may point out errors of law or procedure made by the state's agency (DDS) in denying the claim. Finally, the claimant gets to appear in person before an administrative law judge to re-state his or her case an get a completely new decision. All of this depends, however, on filing an appeal within 60 days of the denial letter.
YOUR DENIAL MAY HAVE MORE HOLES IN IT THAN SWISS CHEESE. BUT THERE'S ONLY ONE WAY TO FIX IT: APPEAL AND ASK FOR A HEARING.
"Won't the hearing take a long time to schedule?" Yes. It takes months to get before a judge. However, if I represent you, I will ask the judge to pay you past due benefits ("back pay") for all the months since your disability began. So, while you must wait for your money, you don't actually lose any benefits.
Can you afford legal representation? Yes. Social Security has provided that no legal fees can be charged while you wait on the outcome of your case. In fact, you can't be charged a fee at all unless you win your appeal and also collect past due benefits.
If you've been denied for disability benefits within the past 60 days, or if you have a hearing scheduled, call me for a free consultation. Let me develop a plan to win your case and get you maximum benefits. I will obtain the necessary medical records (at my expense) and prepare for your day in court. And I will do this without asking you a cent before your case is paid.
_______________
THE FORSYTHE FIRM
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
"Across from Bridge Street"
Friday, December 7, 2018
GETTING DISABILITY BENEFITS IN TENNESSEE REQUIRES A PLAN
Having a plan or strategy is very important to winning your Social Security disability appeal.
Judges have very limited time to spend on a case. They are required to issue up to 700 decision a year, or over 50 per month. One case may have thousands of pages of medical records and other documents to review. Your attorney or representative can help the judge, and your chance of winning, by pointing out what the judge needs to know.
A good representative will read and analyze the medical records, which are the foundation of every case. The important evidence will be pointed out to the judge. Are there MRIs or imaging studies to prove the alleged impairments? Where can they be found quickly?
Do any of the treating doctors provide an opinion on the claimant's ability to perform work-like activities? How do these opinions limit the claimant's residual functional capacity?
Then we come to the claimant's testimony. It's very important that the claimant has been prepared and knows what to expect--and how to answer. The testimony should match up with what the doctors say in the records.
Award rates among Social Security judges are lower now than at any time in the past 30 years. A lot of things have to line up and make sense for the judge.
I always provide the judge with a pre-hearing brief. That means that I give her a step-by-step view of the case and why the federal regulations allow benefits to be paid. The brief condenses hundreds (or thousands) of pages of medical evidence into 3 or 4 pages that can be read in about five minutes. So, I try to help the judge make efficient use of his/her time.
A lot of times I can answer difficult or technical questions for the judge. This can also help to get a favorable decision out more quickly.
It's risky to walk into a hearing and just hope for the best. Those kind of hearings often don't go well for the claimant. It's much better to have a legal roadmap of where you want to go and how to get there. That's worth paying the attorney/representative a fee when your case is successful.
So, talk to a representative early in the process. I think most people who appoint me to represent them decide after just a few minutes that I can add value to their case. I have to think so, too, or I won't take the case. The best of all worlds is when the claimant and representative work well together as a team.
______________
Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike NW, Site 108
Huntsville, AL 35806
"Across from Bridge Street"
CALL (256) 799-0297
https://forsythefirm.wixsite.com/website
Judges have very limited time to spend on a case. They are required to issue up to 700 decision a year, or over 50 per month. One case may have thousands of pages of medical records and other documents to review. Your attorney or representative can help the judge, and your chance of winning, by pointing out what the judge needs to know.
- Is this claimant insured for benefits?
- What kind of past work did the claimant do?
- Does he or she meet a Listing or grid rule?
- Are there any transferable skills?
- Does the medical record support the alleged onset date? If so, where?
A good representative will read and analyze the medical records, which are the foundation of every case. The important evidence will be pointed out to the judge. Are there MRIs or imaging studies to prove the alleged impairments? Where can they be found quickly?
Do any of the treating doctors provide an opinion on the claimant's ability to perform work-like activities? How do these opinions limit the claimant's residual functional capacity?
Then we come to the claimant's testimony. It's very important that the claimant has been prepared and knows what to expect--and how to answer. The testimony should match up with what the doctors say in the records.
Award rates among Social Security judges are lower now than at any time in the past 30 years. A lot of things have to line up and make sense for the judge.
I always provide the judge with a pre-hearing brief. That means that I give her a step-by-step view of the case and why the federal regulations allow benefits to be paid. The brief condenses hundreds (or thousands) of pages of medical evidence into 3 or 4 pages that can be read in about five minutes. So, I try to help the judge make efficient use of his/her time.
A lot of times I can answer difficult or technical questions for the judge. This can also help to get a favorable decision out more quickly.
It's risky to walk into a hearing and just hope for the best. Those kind of hearings often don't go well for the claimant. It's much better to have a legal roadmap of where you want to go and how to get there. That's worth paying the attorney/representative a fee when your case is successful.
So, talk to a representative early in the process. I think most people who appoint me to represent them decide after just a few minutes that I can add value to their case. I have to think so, too, or I won't take the case. The best of all worlds is when the claimant and representative work well together as a team.
______________
Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike NW, Site 108
Huntsville, AL 35806
"Across from Bridge Street"
CALL (256) 799-0297
https://forsythefirm.wixsite.com/website
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