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Showing posts from 2012

IS THERE A FEE FOR DISABILITY REPRESENTATION?

Attorneys and other advocates who help individuals collect their Social Security disability (SSDI) or Supplemental Security Income (SSI) benefits are entitled to a fee under federal law in some cases.  A fee can be charged if: The representative has been duly appointed in writing and a fee agreement has been signed (or a fee petition submitted), The claimant's claim has been approved, Back pay or retroactive pay has been collected by the claimant, The amount of the fee does not exceed the allowable maximum, and The reviewing judge has approved the Fee Agreement or Fee Petition.   Most claimants are delighted to receive expert help with their Social Security disability or SSI claim and do not object to the rather modest fee they are charged if they win.  Those who object to the fee usually do not understand what is involved in winning a disability or SSI claim. The representative will spend many hours preparing the claim.  If it is not approved on the application level (onl

IS YOUR DISABILITY INSURANCE PAID UP - SSDI?

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Social Security disability is an insurance plan mandated and paid for by the US Government under the Social Security Act.  Like any other insurance plan, it is funded by "premiums" or payments made to the Social Security Trust Funds.  In the case of disability insurance, it is paid for by FICA taxes.  The employee has taxes deducted from his/her wages, then the employer matches that tax and pays into the Social Security Disability Trust Fund.   In order to have current disability insurance with Social Security, the worker must have worked long enough and paid enough FICA taxes to be insured.  The worker must have accumulated a sufficient number of "Quarters of Work" to be insured.  For most workers over age 40, the worker must have worked at least 4 out of the last 10 years to be covered.  Rules are different for very young workers. Social Security disability insurance (SSDI) is often referred to as Title II (two).  SSDI does not require a claiman

EARLY EVIDENCE, EARLY REVIEW!

There is usually a wait of several months to obtain a hearing after a Social Security disability appeal is filed.  However, there are plenty of reasons to submit all your evidence in the case as early as possible. I recently appealed a Social Security decision and asked for a hearing.  I filed the request for hearing in September in the routine manner.  In December the case was reviewed and approved without a hearing.  The appeal was thus resolved in less than 90 days.   It doesn't always happen that way, obviously, but when there is plenty of evidence, it is always best if you can submit it right away.  In fact, I find there are at least two advantages to submitting medical evidence early: One, it provides a more likely opportunity for an early review of the case.  Two, it gives the representative or attorney an opportunity to write a thorough brief for the Office of Disability Adjudication and Review (ODAR). Often, the early bird gets the.....review!  

SHOULD YOU APPEAL OR FILE A NEW APPLICATION?

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When your application for Social Security disability or SSI is denied, should you appeal the decision or file a new application? Many claimants make the mistake of filing a new application - or starting over.  While this may be justified in a small percentage of cases, it is usually a bad mistake.  It is nearly always better to appeal the original claim than to "start over" by filing a new claim. By filing a new claim you lose your original application date and past due benefits that are based on the application date are also lost. Unless you have significant new medical evidence, there is a high probability that your new application will also be rejected. By filing a new application you remain in the "realm" of 70 percent denials; whereas, in the appeal "realm," there is a better than 50 percent chance of approval (at a hearing). Thus, in nearly every circumstance, it is better to appeal your initial decision than to file a new claim. The appeal

ONSET DATE EQUALS MORE BACK PAY FOR YOU

By:  The Forsythe Firm, Huntsville, AL  (256) 799-0297 The alleged onset date or AOD is the date you claim to have become unable to work.  The importance of that is that it establishes the amount of back pay you can receive.  When Social Security accepts your alleged onset date, it is then called "the established onset date" and your back payments will be based on that date. Like all government agencies, Social Security is being pressured with budget cuts, hiring freezes and the need to save money.  One result is that Social Security adjudicators are challenging alleged onset dates, trying to move the date of disability forward to save money.  For instance, if an alleged onset date can be moved from March 2012 to August 2012, Social Security has just eliminated most or all of your backpay (because of the 5-month waiting period between the onset date and the payment of the first monthly benefit). You protect your back pay in two ways: Demonstrating with medical evidenc

ALABAMA SOCIAL SECURITY - TRIAL WORK PERIODS

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Through its "Ticket to Work" program, Social Security tries to encourage people on disability or SSI benefits to return to work.  You can try to work without immediately giving up your disability or SSI benefits - and without losing your Medicare coverage (if you are covered by Medicare). You are allowed 9 "trial work months" within a five-year period.  The months do not have to be consecutive. You will continue to get full disability or SSI benefits during the trial work periods until you accumulate 9 months of successful work.  Any month in which you earn at least $720 will be considered 1 month of successful work.    Once you have accumulated 9 months of successful work, your disability or SSI benefits will be stopped for as long as you continue to work.  However, if you again become unable to work within a 5 year period, you can request expedited reinstatement of benefits without filing a new application.  While Social Security makes a decision

DOES ALCHOHOLISM QUALIFY FOR DISABILITY?

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Posted by:  The Forsythe Firm, Social Security Disability Advocates A question we often get is, "Will alcoholism qualify me for Social Security disability benefits?" Or, "Will alcoholism disqualify me for Social Security disability benefits?" The answer to both questions is, No. A person may not qualify for Social Security disability merely on the basis of alcoholism or other substance abuse.  On the other hand, a person  who is otherwise eligible should not necessarily be disqualified merely on the basis of alcoholism or substance abuse. The definitive legal ruling on that is found in 20 CFR §404.1535:  "The key factor we will examine in determining whether drug addiction or alcoholism is a contributing factor material to the determination of disability is whether we would still find you disabled if you stopped using drugs or alcohol."  That determines whether substance abuse is material to the disability or not. So an individual can

SOCIAL SECURITY GIVING AWAY TOO MUCH MONEY?

It seems everyone is loading up to take aim at the integrity of the Social Security disability program.  Senate investigations into Social Security are nothing new but usually they are held by the Senate Finance Committee.  NOSSCR's Social Security Forum reports in their September 2012 edition that on September 13 2012, the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs held a 3 hour hearing on the quality of favorable disability decisions handed down by Administrative Law Judges.  Here is what disturbs me about this "investigation": The Senate subcommittee "investigated" only favorable decisions.  This reinforces the idea that Social Security's main focus is not making sure that everyone who deserves Social Security disability gets it; the main focus is making sure that nobody gets Social Security disability that isn't supposed to. Rarely, if ever, does a government committ

WHEN WILL MY DISABILITY MONEY ARRIVE?

Under 20 CFR 404.1805, Social Security says:  "As soon as possible after we have made a determination or decision that you are entitled to benefits, we certify to the Secretary of the Treasury, who is the Managing Trustee of the Trust Funds--your name and address...the amount of the payment(s) to be made and...the time at which the payment(s) should be made in accordance with 404.1807." In reality, if often takes up to 60 days after a decision has been made for the claimant to receive the first check from the US Treasury.  I have seen checks arrive in less than 30 days - but 60 days is more realistic. Monthly payments are assigned a due date based on the day of the month on which the insured claimant was born.  While there are exceptions, here are the usual payment due dates for Social Security benefits: DAY OF THE MONTH YOU WERE BORN                 PAYMENT DUE DATE 1st - 10th                                                    Second Wednesday of each month 11th - 2

RATIONAL DISABILITY DECISIONS

Social Security uses a 5-step sequential process to determine whether you are disabled.  Those 5 steps are governed by rules and regulations (thousands of them).  The point is, we know what is required at each step.  Therefore, we should know how to prepare for each step to get a favorable decision.  That's what I mean by "rational disability decisions." The crucial steps are steps 4 and 5, I believe.  At step 4 you must prove that you cannot do any of your past relevant work.  That's any of the work you performed during the past 15 year period.  The work is "relevant" if you performed it at "substantial gainful activity," and if you did it long enough to know how to perform the work. At step 5, Social Security must show that there is "other work" which you could do.  Notice the burden of proof shifts in step 5 and SSA carries the burden.  You do not have to show that there is no work you can do, SSA has to show that there is work you

WHY SO MANY GET DENIED FOR DISABILITY

Being denied for Social Security disability is the rule, not the exception.  The latest Alabama statistics show that 74.9 percent of all initial applications will be rejected at the first level.  The reason is that the review of a disability application on the first level is rather mechanical.  A disability specialist, who is not a doctor, compares your medical file with the "disability handbook."  And very few applications will meet a listing for disability.  All kinds of things can go wrong in this approach: The medical evidence may not be complete.  All it takes sometimes is for one doctor to fail to send in your file. The medical evidence may not be legible.  I get medical records all the time that neither I or anyone on my staff can read. The medical records usually do not give the vocational implications of your condition:  they will not say that you are limited to lifting 10 pounds, sitting for 1 hour at a time, or standing for only 10 minutes at a time.  That may

IS SOCIAL SECURITY WATCHING YOU ON FACEBOOK?

Earlier IN 2012, the US Social Security Administration told US administrative law judges (ALJs) that they cannot use the internet to investigate disability claimants.  Senator Thomas Coburn (R-OK) responded by saying this ban removes a valuable tool to investigate fraudulent applications for disability benefits. Sen. Coburn used this example, which I have paraphrased.  Suppose an ALJ looks up an applicant on Facebook.  There he finds pictures and discussion of the applicant playing sports or participating in his bowling league.  If the applicant has claimed severe back problems on his application, his credibility is suddenly called into question. I caution my clients to stay off of Facebook and the social media and I believe that is still very good advice.  It remains probably the first place investigators look when trying to deny benefits (including disability claims with private insurance companies). Use common sense but don't become paranoid.  For example, it's normally

THE SOCIAL SECURITY DISABILITY PROCESS

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I want to use this space to briefly discuss the process a person goes through in obtaining Social Security disability.  You may also want to view  our main website to learn more about us. The first step is to file an application for disability and/or SSI benefits at a local Social Security office - or by calling 1-800-772-1213.  (SSI cannot be filed by phone). Allow 4 to 6 months for a decision and be aware that about 75 percent of initial applications are denied.  That is not the final say - so don't stop there! The next step will be an appeal.  In 40 states, there is a "Reconsideration" stage, which is the second step.  The results in this stage are usually poor, also.  In 10 states (Alabama included), you may skip Reconsideration and appeal directly to an administrative law judge. It takes several months to get a hearing scheduled, up to a year or more, in fact.  You cannot draw benefits while waiting for the hearing.  However, if the judge eventually approves you

FIBROMYALGIA GETS NEW DISABILITY RULING

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In July 2012 Social Security issued Ruling SSR 12-2p on fibromyalgia.  This ruling states that fibromyalgia may be a medically determinable impairment when established by appropriate medical evidence and it can be the basis for a finding of disability.  Social Security has instructed all its administrative law judges and other adjudicators to follow SSR 96-7p to evaluate a claimant's statement about symptoms and functional limitations. For years, fibromyalgia was a little understood disorder and some Social Security judges did not consider it to be a "medically determinable impairment," for purposes of disability benefits.  Judges often ruled that disability could not be established merely on the basis of symptoms and that a medically determinable impairment must be deomonstrated by medical signs and laboratory findings.  There is no laboratory test for fibromyalgia.  It is usually diagnosed by exclusion of other disorders and by locating tender "trigger points.&q

USING VOCATIONAL EVIDENCE IN A DISABILITY CLAIM

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Vocational evidence in a Social Security disability case is to be ignored or minimized at your own peril.  I think sometimes so much emphasis is placed on medical evidence that the vocational evidence is neglected.  Here are examples of what is meant by "vocational evidence." What is your level of education and training? What kind of work have you done for the last 15 years? How was the past work categorized:  skilled, semi-skilled or unskilled? What is your exertional level:  sedentary, light, medium, heavy or very heavy? What kind of jobs, if any, are you still able to perform? Those things are important because of the very definition of the word  disability  used by Social Security.  Under Social Security law, you are disabled if you have a serious medically determinable impairment that keeps you from working, or is expected to keep you from working for 12 months or more--or is expected to end in death. In a nutshell, if Social Security finds that you are abl

MEDICAL EVIDENCE IN SOCIAL SECURITY DISABILITY

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When your Social Security disability claim is denied, you ask for a hearing.  That sends your claim to a special judge within the Social Security administration.  The judge may ignore all decisions previously made and render a new decision on your claim.  As  a disability advocate , I find that two kinds of medical evidence is important to present to the judge at a hearing: One type of evidence is what I call "raw medical data."  This would include notes from doctor's office visits, laboratory tests, X-rays, MRIs or other imaging studies, etc.  The purpose of this  raw data  is to prove that you have the conditions you claim to have. However, this data is often not sufficient to win your disability claim.  The second type of medical evidence I want to submit is what I call "opinion evidence."  A doctor reviews the patient's medical data and draws conclusions about it.  In particular, I want the doctor to state how the patient's medical condition restr

GETTING DISABILITY BENEFITS FOR MENTAL ILLNESS

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Social Security will consider mental impairments or illnesses on an equal basis with physical impairments when it comes to awarding disability benefits.  Any number of psychological impairments may qualify.  A few of the more common ones include bipolar disorder, anxiety, depression, panic disorder, schizophrenia, retardation or delayed development, obsession-compulsive disorders, and many more. Social Security is required to use the same sequential process to evaluate mental or psychological disorders.  Very briefly - and without explanations - here is an outline of the five-step sequential process. Is the claimant now working (earning at least $1,010 per month before taxes)? Does the claimant have a severe and medically determinable impairment? Does the claimant meet a listing?  If not, what is his/her residual functional capacity? Can the claimant perform any of his/her past relevant work (work done in the past 15 yrs.)? Is there any other work that a claimant of that age,

MARVIN'S $20,000 SOCIAL SECURITY MISTAKE

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The Forsythe Firm in Huntsville represents the disabled in their attempt to get Social Security disability benefits. Marvin is a 44 year-old construction worker who has herniated cervical and lumbar discs and recently underwent a cervical fusion surgery, which will not eliminate all his pain and symptoms. He applied for Social Security disability in late 2010 and was denied in April of 2011. Social Security agreed that Marvin* could no longer do construction work but stated that he "can do other work." Marvin believed them. He looked for other work for months but couldn't find anything that he could do. In September of 2011, Marvin came to my office looking for help. Here is how I figure it: Marvin  is  indeed  disabled, in spite of what Social Security said in their letter. Marvin almost certainly could've won his claim with back benefits if he had appealed within the time limit. His 60 days for appeal had expired back in July - so his claim is now as dead as

BACK PAY FOR BACK TROUBLE - SOCIAL SECURITY PAYS

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Back trouble is one of the leading causes of disability.  It comes in many forms, including degenerative disc disease caused by arthritis, osteoarthritis, bulging  or herniated discs, stenosis or a variety of other back related problems.  Back pain can also affect the use of upper and lower extremities and severely limit the ability to lift, bend, reach, stoop, walk or sit. Social Security recognizes serious back disorders as disabling conditions and with the proper evidence may award disability benefits - including back pay (no pun intended). An experienced disability expert may be able to help you file a disability claim or appeal a claim that was recently denied.  Preparing evidence for a  Social Security disability claim  can be a complicated and time consuming chore.   A professional firm such as  the Forsythe Firm of Huntsville AL  will offer free consultations and represent qualified claimants on contingency, meaning that no fee is charged unless the case is won and cash is

TOOL BELT FOR SOCIAL SECURITY DISABILITY CLAIMS

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An affective craftsman will always have the proper tools on his tool belt.  The Social Security disability advocate is no different.  He or she must have the proper tools and know how to use them effectively to win your disability case.  Let's talk about a few of the tools that your disability case will require. Medical Evidence.   This is a record of your treatment from doctors, psychologists, therapists, hospitals, clinics or other providers who have treated or examined you.  It should include a diagnosis, prognosis, level of severity, treatment procedures, dates, etc.  Acceptable medical sources for Social Security are medical doctors and licensed clinical psychologists.  Evidence from other sources may also be used. Vocational Evidence (VE).   Here is another useful item in our tool belt. Vocational evidence includes your age, level of education or training, skills and work history - especially work you did during the past fifteen years; and evidence of jobs in the nationa

DISABILITY QUESTIONS & ANSWERS

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Q.  Who makes the decision whether I am disabled or not? A.  Social Security hands off that decision to a state agency known as the Disability Determination Service. Q.  If my claim is denied what should I do? A.  File a written request for a hearing within 60 days of the denial--if you live in Alabama.  If you live in Tennessee, file a written request for "Reconsideration," which is different than a hearing.  Procedures differ between Alabama and Tennessee but the 60 day rule applies in both states. Q.  If I hire an attorney or representative, how is he or she paid? A.  If you win the case, Social Security will withhold an approved fee out of your accrued back pay and pay the representative.  The typical charge is 25 percent of back pay, which is the maximum amount allowed by law.  If you don't win there is no fee. Q.  What's the timetable for Social Security disability decisions? A.  Times vary by location but here is the general time frames:  You will get a

ALABAMA DISABILITY NEWS - CAN YOU GET SOCIAL SECURITY?

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The past 18 months have brought a rapid change in the Social Security disability environment. Award rates among US administrative law judges have fallen dramatically since the last quarter of fiscal year 2010. Judges that once averaged 60 percent favorable decisions may now average 40 percent or less. That is a drastic change. The result is very simple - it is now more difficult to get Social Security disability benefits. If a case is borderline it is probably going to be denied, whereas a year ago the same case might well have been awarded. What's to blame to this downturn in Social Security disability awards? Everyone has a theory, so here is mine. First, I think there is a psychological impact of being told day in and day out that the Social Security trust funds are going broke. The latest projection now gives the disability trust fund only until 2016 before it starts paying out more than it brings in. In other words, by 2016 the reserves will have been used up. Most experts s