Many Social Security disability claims are denied and go for a hearing before an Administrative Law Judge (ALJ). If the judge denies the claim, the next appeal is before the Appeals Council (AC).
The Appeals Council is a group of administrative law judges within the Social Security Administration, headquartered at Falls Church, Virginia.
Review by the Appeals Council will be a paper review; no hearing will be held. The AC will decide whether the Administrative Law Judge's decision was correct. If so, the decision will stand and the case remains denied.
If the AC concludes that the ALJ's decision was not correct, it has two options:
1. It remands the decision, returning it to the judge for further action, probably a second hearing. This occurs in less than 15 percent of cases before the AC.
2. The Appeals Council can overturn the judge's decision and award benefits on its own. This happens in less than 5 percent of cases before the AC.
In greater than 80 percent of Appeals Council cases, the judge's decision is considered proper and the AC leaves the decision standing without any change.
Is it worth appealing to the Appeals Council? It may be. However, you should have your denial reviewed by a competent professional. All cases should not be appealed to the AC. There should be at least one clear argument of impropriety in the Administrative Law Judge's decision or handling of the hearing. It isn't enough just to believe that you are disabled but the judge found otherwise. The AC will not reverse or remand a decision on this ground.
Monday, March 16, 2020
IS FIBROMYALGIA A DISABLING IMPAIRMENT?
In July 2012, the Social Security Administration issued SSR 12-2p, which details how Fibromyalgia is evaluated for disability benefits.
Based on this ruling and our experience representing claimants, we have made some suggestions for individuals suffering from Fibromyalgia who are considering a Social Security disability claim.
1. Seek treatment by a rheumatologist. There are two sets of guidelines concerning Fibromyalgia, both from the American College of Rheumatology (1990, 2010).
2. Get your rheumatologist to provide you with a Residual Functional Capacity (RFC), estimating specific functional limitations imposed by the disease.
The general requirement for Social Security disability is that you are limited to a point of not being able to sustain any full-time work that is available in the US economy. The easiest work, from an exertional standpoint, is sedentary work. If you are judged able to sustain sedentary unskilled work your benefit will usually be denied. Claimants age 50 and over may get a break because of the Medical-Vocational Guidelines.
SOCIAL SECURITY JUSTICE in HUNTSVILLE
Based on this ruling and our experience representing claimants, we have made some suggestions for individuals suffering from Fibromyalgia who are considering a Social Security disability claim.
1. Seek treatment by a rheumatologist. There are two sets of guidelines concerning Fibromyalgia, both from the American College of Rheumatology (1990, 2010).
2. Get your rheumatologist to provide you with a Residual Functional Capacity (RFC), estimating specific functional limitations imposed by the disease.
The general requirement for Social Security disability is that you are limited to a point of not being able to sustain any full-time work that is available in the US economy. The easiest work, from an exertional standpoint, is sedentary work. If you are judged able to sustain sedentary unskilled work your benefit will usually be denied. Claimants age 50 and over may get a break because of the Medical-Vocational Guidelines.
SOCIAL SECURITY JUSTICE in HUNTSVILLE
Thursday, March 12, 2020
HOW MUCH SOCIAL SECURITY BACK PAY CAN YOU GET?
Most claimants who get approved for Social Security disability benefits will receive some amount of back pay.
Social Security will owe you back pay when.....
1. You became disabled several months prior to filing an application for benefits, so benefits accumulated.
2. You had to wait months (or years) for Social Security to decide your case or carry on appeals.
3. Your disability lasted longer than mandatory 5-month waiting period for SSDI claims.
There is no SSDI payments for the first 5 full months of a claim, starting with the approved onset date. For example, if you are found disabled as of 2/10/20, you will lose March through July to the waiting period. Your first date eligible for a payment would be July. (This waiting period does not apply to Supplemental Income Security or SSI, which is a totally different program).
What is the maximum back pay possible? There really is no maximum in terms of a dollar amount. I have represented claimants with back pay of almost $100,000. This is a large, unusual amount but most claimants receive some back pay. Back pay of $15,000 to $40,000 is not uncommon at all.
SSDI claimants may receive retroactive payments for up to 12 months prior to filing their claim (assuming they were disabled for this entire period and not working). They get back payments for each month Social Security delays in processing and deciding their claim.
We always look for ways to get our clients the maximum back pay awards. Back pay will also be tied to eligibility for Medicare coverage. As a general rule, the further back your pay goes, the earlier your Medicare can begin.
Social Security will owe you back pay when.....
1. You became disabled several months prior to filing an application for benefits, so benefits accumulated.
2. You had to wait months (or years) for Social Security to decide your case or carry on appeals.
3. Your disability lasted longer than mandatory 5-month waiting period for SSDI claims.
There is no SSDI payments for the first 5 full months of a claim, starting with the approved onset date. For example, if you are found disabled as of 2/10/20, you will lose March through July to the waiting period. Your first date eligible for a payment would be July. (This waiting period does not apply to Supplemental Income Security or SSI, which is a totally different program).
What is the maximum back pay possible? There really is no maximum in terms of a dollar amount. I have represented claimants with back pay of almost $100,000. This is a large, unusual amount but most claimants receive some back pay. Back pay of $15,000 to $40,000 is not uncommon at all.
SSDI claimants may receive retroactive payments for up to 12 months prior to filing their claim (assuming they were disabled for this entire period and not working). They get back payments for each month Social Security delays in processing and deciding their claim.
We always look for ways to get our clients the maximum back pay awards. Back pay will also be tied to eligibility for Medicare coverage. As a general rule, the further back your pay goes, the earlier your Medicare can begin.
WHAT IS THE NEW "RECONSIDERATION" PROCESS IN ALABAMA?
Something new called "Reconsideration" came upon the disabled community in Alabama starting October, 2019.
"Reconsideration" is a new step in getting your Social Security disability approved.
Prior to October last year, when Social Security denied your claim, you could go straight to a hearing. Now, you can't.
Now, you have to ask for "Reconsideration." This first appeal does not send you to a judge. It sends your denied claim back to the state agency that denied it. The state gets to look at the claim again to see if they can approve it the second time. Of course, they can't.
So, after wasting about 60 more days of your time, you get another denial (98 percent of the time)! Only then can you file an appeal which will take you before an Administrative Law Judge (ALJ).
Alabama was one of 10 states that did not use "Reconsideration" prior to October, 2019. These 10 states were called prototype states. But last year Social Security began bringing those 10 states into line with the other 40. Now, Alas, all states waste your time with "Reconsideration."
Is "Reconsideration" required before you can apply for a hearing? Yes, it is. There is no way to skip it.
Does "Reconsideration" ever result in a getting you a better decision? Rarely. The numbers I am seeing are literally a 98 percent denial at this stage. That's because nothing really new happens at this step. It's almost a rubber stamp of the first denial.
So, you apply and get denied. You appeal and get denied again at "Reconsideration." What do you do? File another appeal, which sets you up for a hearing with a judge.
I fear that many claimants misunderstand "Reconsideration." I fear they think, "I was denied. I appealed, and my appeal also was denied. So, I am finished."
This is not the case. The 'real' appeal is at the hearing level, which is actually the second appeal. This is where a judge comes in, and this is where something actually different happens with your case.
What's different about a hearing with a judge?
"Reconsideration" is a new step in getting your Social Security disability approved.
Prior to October last year, when Social Security denied your claim, you could go straight to a hearing. Now, you can't.
Now, you have to ask for "Reconsideration." This first appeal does not send you to a judge. It sends your denied claim back to the state agency that denied it. The state gets to look at the claim again to see if they can approve it the second time. Of course, they can't.
So, after wasting about 60 more days of your time, you get another denial (98 percent of the time)! Only then can you file an appeal which will take you before an Administrative Law Judge (ALJ).
Alabama was one of 10 states that did not use "Reconsideration" prior to October, 2019. These 10 states were called prototype states. But last year Social Security began bringing those 10 states into line with the other 40. Now, Alas, all states waste your time with "Reconsideration."
Is "Reconsideration" required before you can apply for a hearing? Yes, it is. There is no way to skip it.
Does "Reconsideration" ever result in a getting you a better decision? Rarely. The numbers I am seeing are literally a 98 percent denial at this stage. That's because nothing really new happens at this step. It's almost a rubber stamp of the first denial.
So, you apply and get denied. You appeal and get denied again at "Reconsideration." What do you do? File another appeal, which sets you up for a hearing with a judge.
I fear that many claimants misunderstand "Reconsideration." I fear they think, "I was denied. I appealed, and my appeal also was denied. So, I am finished."
This is not the case. The 'real' appeal is at the hearing level, which is actually the second appeal. This is where a judge comes in, and this is where something actually different happens with your case.
What's different about a hearing with a judge?
- It's the first time you meet with a decision maker face-to-face.
- It's the first time you bring your lawyer with you.
- You get to submit any new evidence you have or can get.
- You can produce your doctor's opinion about your abilities to perform work-like activities.
- Your lawyer can set forth legal theories about your case and make arguments.
- You have a chance to dispute erroneous statements, facts or suppositions about your case.
FATE OF DENIED SSDI CLAIMANTS
The fate of claimants denied for Social Security disability benefits is unfortunate, according to a recent study. The study finds that older Americans denied due to stringent government standards go on to struggle with difficulty earning a living, poor medical care and poor prospects in the job market.
Most applicants are denied because of Social Security's nearly impossible standards for proving disability. Without an appeal, these applicants face dim prospects going forward.
Of the sample group studied, over 50 percent of them eventually received SSDI benefits. However, nearly all of them required an appeal. And most of them had to endure a long wait to get benefits approved. All of the applicants in the study were at least 50 years old. Nearly all of them used a lawyer to get their benefits.
A Government Accountability Office (GAO) study confirmed that few individuals who have been denied for disability benefits ever worked again.
So, when you have been denied Social Security disability benefits, what should you do? 4 things:
1. File an appeal and be sure to do it within 60 days.
2. File a second appeal if your first one is denied. (The second appeal, called "Reconsideration," is also commonly denied).
3. Prepare to attend a hearing before an administrative law judge (ALJ). This is your absolute best chance.
4. Whatever you do, get representation for this hearing. Do not attempt it alone. It's your best chance, don't mess it up.
The government has done one thing right. They have fixed it so you can get good legal representation with no upfront cost, and not even any future cost to you unless you win.
Most applicants are denied because of Social Security's nearly impossible standards for proving disability. Without an appeal, these applicants face dim prospects going forward.
Of the sample group studied, over 50 percent of them eventually received SSDI benefits. However, nearly all of them required an appeal. And most of them had to endure a long wait to get benefits approved. All of the applicants in the study were at least 50 years old. Nearly all of them used a lawyer to get their benefits.
A Government Accountability Office (GAO) study confirmed that few individuals who have been denied for disability benefits ever worked again.
So, when you have been denied Social Security disability benefits, what should you do? 4 things:
1. File an appeal and be sure to do it within 60 days.
2. File a second appeal if your first one is denied. (The second appeal, called "Reconsideration," is also commonly denied).
3. Prepare to attend a hearing before an administrative law judge (ALJ). This is your absolute best chance.
4. Whatever you do, get representation for this hearing. Do not attempt it alone. It's your best chance, don't mess it up.
The government has done one thing right. They have fixed it so you can get good legal representation with no upfront cost, and not even any future cost to you unless you win.
Wednesday, March 11, 2020
WHO IS ALLOWED TO DECIDE IF YOU ARE DISABLED?
Who is allowed to decide whether you are disabled? Your doctor? Your lawyer? Someone else?
I am speaking of disability from the legal perspective.
Social Security Rule 96-5p states that the question of whether you are disabled is "reserved to the Commissioner of Social Security."
The claimant cannot say that he/she is disabled. Your lawyer cannot say. Your doctor cannot say. Only the Commissioner can make that determination.
So, how does the Commissioner make that determination?
In the original application process, the determination is usually made by a state agency called the Disability Determination Service (DDS). The DDS speaks for the Commissioner.
In the appeal process, the determination is usually made by an administrative law judge (ALJ) following a hearing. The ALJ speaks for the Commissioner.
I sometimes get clients who tell me, "I know I am disabled because my doctor says I am." It can be difficult to explain that doctors aren't permitted to make that decision for Social Security.
So, do doctors have a role in the disability decision-making process? Yes, they absolutely do. Doctors should provide two valuable things for a disability claim: (1) objective medical evidence, and (2) a professional opinion about the patient's residual functional capacity (i.e., restrictions and limitations of function).
Do lawyers have a role? Yes, they absolutely do. The role of your lawyer or advocate is to gather evidence and explain to the Commissioner's spokesperson how the claimant meets the guidelines that have been established for determining disability.
I am speaking of disability from the legal perspective.
Social Security Rule 96-5p states that the question of whether you are disabled is "reserved to the Commissioner of Social Security."
The claimant cannot say that he/she is disabled. Your lawyer cannot say. Your doctor cannot say. Only the Commissioner can make that determination.
So, how does the Commissioner make that determination?
In the original application process, the determination is usually made by a state agency called the Disability Determination Service (DDS). The DDS speaks for the Commissioner.
In the appeal process, the determination is usually made by an administrative law judge (ALJ) following a hearing. The ALJ speaks for the Commissioner.
I sometimes get clients who tell me, "I know I am disabled because my doctor says I am." It can be difficult to explain that doctors aren't permitted to make that decision for Social Security.
So, do doctors have a role in the disability decision-making process? Yes, they absolutely do. Doctors should provide two valuable things for a disability claim: (1) objective medical evidence, and (2) a professional opinion about the patient's residual functional capacity (i.e., restrictions and limitations of function).
Do lawyers have a role? Yes, they absolutely do. The role of your lawyer or advocate is to gather evidence and explain to the Commissioner's spokesperson how the claimant meets the guidelines that have been established for determining disability.
FINDING TIME TO MANAGE YOUR DISABILITY CLAIM
Handing your disability claim is a time consuming job. There are so many things to do, and so many deadlines to be met. Failure to meet deadlines will potentially cause your claim to be denied and send you back to the drawing board to start over.
First, you complete dozens of pages of forms. Then, more forms arrive in the mail. Second, you begin to obtain medical records from your doctors and other providers, a time consuming and expensive proposition.
There will be questions from Social Security, which must be answered quickly and accurately.
If you apply national averages to your case, there is a 7 out of 10 chance that your claim will be denied and require an appeal process. More forms, more questions, and more time invested.
It's no wonder that most people find Social Security disability to be confusing, demanding and overwhelming. Too many folks just give up and quit.
The answer may be to get a professional representative, like the Forsythe Firm, to handle your claim or appeal. We can do everything under one roof. When you turn your case over to us, it frees up your time to get on with your life.
Best of all, there is no fee unless you win and receive back pay. Even then, you won't need to write us a check. Social Security will determine our fee and send us a payment automatically.
SOCIAL SECURITY DISABILITY in HUNTSVILLE
First, you complete dozens of pages of forms. Then, more forms arrive in the mail. Second, you begin to obtain medical records from your doctors and other providers, a time consuming and expensive proposition.
There will be questions from Social Security, which must be answered quickly and accurately.
If you apply national averages to your case, there is a 7 out of 10 chance that your claim will be denied and require an appeal process. More forms, more questions, and more time invested.
It's no wonder that most people find Social Security disability to be confusing, demanding and overwhelming. Too many folks just give up and quit.
The answer may be to get a professional representative, like the Forsythe Firm, to handle your claim or appeal. We can do everything under one roof. When you turn your case over to us, it frees up your time to get on with your life.
Best of all, there is no fee unless you win and receive back pay. Even then, you won't need to write us a check. Social Security will determine our fee and send us a payment automatically.
SOCIAL SECURITY DISABILITY in HUNTSVILLE
Subscribe to:
Posts (Atom)