I was with a client in a disability hearing before an administrative law judge last week. Five minutes into the hearing, the judge asked, "Mr. Forsythe, what is the legal theory of this case?"
I responded: "Judge, the claimant has 3 severe impairments, the combination of which has caused him to be unable to sustain work. You will find evidence of these impairments and their limitations in Exhibits 2F, page 10; 6F, pages 8-17, and in 9F, pages 79, 90 and 112. In addition, considering the claimant's age, education and past work experience, a finding of disabled is directed by Medical-Vocational Guideline 201.01."
The judge seemed satisfied that I had given him the facts he needed to approve the claim.
After we left the hearing, my client said to me: "I'm glad I didn't have to answer that question."
The truth is, every Social Security disability claim rises or falls on the legal theory of the case. If you don't know what your legal theory is, you don't need to be handling a hearing.
Many times, judges believe the claimant is disabled. However, they must justify their decision legally. The "legal theory" is simply the body of facts that support a finding of disability based on the federal rules and regulations that govern Social Security. It isn't enough just to convince the judge that you are disabled. You have to tell him where the regulations supports that conclusion.
_________
Need help with a Social Security disability claim or appeal? Contact the firm that has been successfully handling disability cases for years. Call the Forsythe Firm for a free consultation or case evaluation. (256) 799-0297 or (256) 431-1599.
Thursday, March 30, 2017
DECATUR: THE SOCIAL SECURITY DISABIITY PROCESS - GETTING BENEFITS
What is the process for applying for Social Security disability benefits in Decatur, AL?
1. File a complete application. You may do this by contacting the Social Security office at 717 McGlathery Lane, Dectur, AL 35601. Phone 1-888-289-9185. You may also file online at www.socialsecurity.gov. Or, you may choose to have an advocate or attorney help you file the application.
After you file, it will take 3 to 4 months to get an initial decision. Unfortunately, 7 out of 10 claims are denied at this level, many times erroneously. If you are denied, you must appeal by asking for a hearing before an administrative law judge within 60 days of the denial letter. This is a strict, unforgiving deadline. Miss it and your appeal is dead.
If you must appeal, you will normally wait 16 to 18 months to get before a judge. Once you are there, however, your odds of winning jump to about 48 percent, based on state averages. Your odds may be better or worse, depending on the facts of your individual case and depending on other factors, such as which judge hears your case.
If you win your appeal, you will probably receive back pay covering the months you have been waiting for Social Security to process the appeal. Some of my clients have received lump sum back pay settlements of over $70,000 in addition to their monthly checks which are continuing.
Social Security, for most people, is the only financial lifeline when disability strikes. Be sure you understand the peculiar requirements of Social Security, what evidence you must submit, and how the process works.
It can be a long process and can be overwhelming. You are more likely to lose than to win. I think having a professional advocate or representative to help you is a good idea. You won't have to pay your representative unless you win. And the fee comes only out of back pay. So, if you win but don't recover back pay, no fee is due.
The Forsythe Firm has been helping hundreds of Social Security claimants in North Alabama for years. You will receive committed, personal attention. You won't be just a number in our system. Free consultations and case evaluations. Contact us at (256) 799-0297 or (256) 431-1599. Visit Us on the Web to tell us about your case.
1. File a complete application. You may do this by contacting the Social Security office at 717 McGlathery Lane, Dectur, AL 35601. Phone 1-888-289-9185. You may also file online at www.socialsecurity.gov. Or, you may choose to have an advocate or attorney help you file the application.
After you file, it will take 3 to 4 months to get an initial decision. Unfortunately, 7 out of 10 claims are denied at this level, many times erroneously. If you are denied, you must appeal by asking for a hearing before an administrative law judge within 60 days of the denial letter. This is a strict, unforgiving deadline. Miss it and your appeal is dead.
If you must appeal, you will normally wait 16 to 18 months to get before a judge. Once you are there, however, your odds of winning jump to about 48 percent, based on state averages. Your odds may be better or worse, depending on the facts of your individual case and depending on other factors, such as which judge hears your case.
If you win your appeal, you will probably receive back pay covering the months you have been waiting for Social Security to process the appeal. Some of my clients have received lump sum back pay settlements of over $70,000 in addition to their monthly checks which are continuing.
Social Security, for most people, is the only financial lifeline when disability strikes. Be sure you understand the peculiar requirements of Social Security, what evidence you must submit, and how the process works.
It can be a long process and can be overwhelming. You are more likely to lose than to win. I think having a professional advocate or representative to help you is a good idea. You won't have to pay your representative unless you win. And the fee comes only out of back pay. So, if you win but don't recover back pay, no fee is due.
The Forsythe Firm has been helping hundreds of Social Security claimants in North Alabama for years. You will receive committed, personal attention. You won't be just a number in our system. Free consultations and case evaluations. Contact us at (256) 799-0297 or (256) 431-1599. Visit Us on the Web to tell us about your case.
TERMINAL ILLNESS AND SOCIAL SECURITY DISABILITY
Unfortunately, I sometimes deal with clients who have terminal illnesses. You might think that having a terminal illness would automatically qualify for Social Security disability benefits but this is not always the case. The agency will want certain objective medical evidence, which must meet their specific requirements before they will approve a claim.
Social Security avoids the term "terminal illness." They refer to such cases as TERI claims - "a medical condition that is untreatable and likely to result in death."
Your attorney or disability representative will know what evidence must be submitted. If the claimant or a family member is handling the claim themselves, here is what must be done.
Have your doctor submit a letter stating that the patient has a severe illness that is likely to result in death. Doctors will usually resist writing this kind of letter until all medical treatment has been exhausted.
Further, ask the doctor to submit all objective medical evidence, including laboratory tests, imaging and treatment notes. If cancer is involved, Social Security will want a copy of the biopsy report or medical test which confirms the diagnosis.
A terminal illness may qualify for disability benefits under the following statutory guidelines:
LISTING LEVEL IMPAIRMENT: The medical condition is so severe that it meets or equals a published listing and automatically qualifies for benefits.
COMPASSIONATE ALLOWANCE: Social Security has listed over 200 diseases which, upon diagnoses and confirmation, automatically meet their requirements for disability benefits. You can view the list of medical conditions that qualify for a compassionate allowance award at the following link:
https://www.ssa.gov/compassionateallowances/cal_faqs.htm
For personal help with a Social Security disability claim, please contact us at the Forsythe Firm. (256) 799-0297 or (256) 431-1599.
Social Security avoids the term "terminal illness." They refer to such cases as TERI claims - "a medical condition that is untreatable and likely to result in death."
Your attorney or disability representative will know what evidence must be submitted. If the claimant or a family member is handling the claim themselves, here is what must be done.
Have your doctor submit a letter stating that the patient has a severe illness that is likely to result in death. Doctors will usually resist writing this kind of letter until all medical treatment has been exhausted.
Further, ask the doctor to submit all objective medical evidence, including laboratory tests, imaging and treatment notes. If cancer is involved, Social Security will want a copy of the biopsy report or medical test which confirms the diagnosis.
A terminal illness may qualify for disability benefits under the following statutory guidelines:
LISTING LEVEL IMPAIRMENT: The medical condition is so severe that it meets or equals a published listing and automatically qualifies for benefits.
COMPASSIONATE ALLOWANCE: Social Security has listed over 200 diseases which, upon diagnoses and confirmation, automatically meet their requirements for disability benefits. You can view the list of medical conditions that qualify for a compassionate allowance award at the following link:
https://www.ssa.gov/compassionateallowances/cal_faqs.htm
For personal help with a Social Security disability claim, please contact us at the Forsythe Firm. (256) 799-0297 or (256) 431-1599.
Wednesday, March 29, 2017
WILL BEING REPRESENTED HELP YOU GET BENEFITS?
Yes, every indication is that being represented in a Social Security disability case increases your odds of winning benefits.
If you think about it, it's just common sense. A Social Security hearing is a legal proceeding before an agency of the United States government, presided over by a federal administrative law judge. It is governed by federal rules and regulations. The claimant needs someone who knows and understands these rules. You also need someone who knows how to prepare and present your case.
You must prove that you are disabled according to Social Security's rules. If you don't know those rules, how can you prove your case?
Here are some important things your representative will do for you:
1. Figure out how you are disabled under the law.
2. Gather evidence to prove your disability according to the law.
3. Tell the judge where to find the evidence needed to approve you claim under the regulations.
4. Anticipate and solve problems in the case before the hearing.
5. Answer the judge's questions relating to the technical aspects of your claim, such as: alleged onset date, income after alleged onset, impact of unemployment benefits, failed work attempts, listings, medical-vocational guidelines, etc.
6. Protect your back pay, helping you get past due payments to which you are probably entitled.
7. Assure you and help you not to be overly stressed out or overwhelmed by the Social Security ordeal.
8. Make sure your benefits get paid in a timely fashion.
If you think about it, it's just common sense. A Social Security hearing is a legal proceeding before an agency of the United States government, presided over by a federal administrative law judge. It is governed by federal rules and regulations. The claimant needs someone who knows and understands these rules. You also need someone who knows how to prepare and present your case.
You must prove that you are disabled according to Social Security's rules. If you don't know those rules, how can you prove your case?
Here are some important things your representative will do for you:
1. Figure out how you are disabled under the law.
2. Gather evidence to prove your disability according to the law.
3. Tell the judge where to find the evidence needed to approve you claim under the regulations.
4. Anticipate and solve problems in the case before the hearing.
5. Answer the judge's questions relating to the technical aspects of your claim, such as: alleged onset date, income after alleged onset, impact of unemployment benefits, failed work attempts, listings, medical-vocational guidelines, etc.
6. Protect your back pay, helping you get past due payments to which you are probably entitled.
7. Assure you and help you not to be overly stressed out or overwhelmed by the Social Security ordeal.
8. Make sure your benefits get paid in a timely fashion.
WHAT ARE MY ODDS OF GETTING DISABILITY BENEFITS?
I am going to give some numbers which represent average state statistics. These numbers are the average number of claims approved and, of course, are not your numbers. Your odds may be better or worse than average based on the facts of your case.
ALABAMA AVERAGES: INITIAL APPLICATION
At the application or initial level, a resident of Alabama has a 30% chance of being approved. 70% of claimants will need to appeal.
ALABAMA AVERAGES: HEARING LEVEL
At the appeal or hearing level, a resident of Alabama has a 48% chance of being approved. However, award rates vary from hearing office to hearing office and from judge to judge. The differences between judges can be staggering.
If there is one main point to take away from these numbers it is: appeal, appeal, appeal. You only have 60 days, by law, to file an appeal after your disability claim has been denied. Wait longer than that and you cannot appeal.
ALABAMA AVERAGES: INITIAL APPLICATION
At the application or initial level, a resident of Alabama has a 30% chance of being approved. 70% of claimants will need to appeal.
ALABAMA AVERAGES: HEARING LEVEL
At the appeal or hearing level, a resident of Alabama has a 48% chance of being approved. However, award rates vary from hearing office to hearing office and from judge to judge. The differences between judges can be staggering.
If there is one main point to take away from these numbers it is: appeal, appeal, appeal. You only have 60 days, by law, to file an appeal after your disability claim has been denied. Wait longer than that and you cannot appeal.
WHEN SHOULD YOU FILE FOR DISABILITY BENEFITS?
You should file an application for Social Security disability benefits as soon as you have a disabling condition that is expected to keep you off work for at least 12 consecutive months or more.
QUESTION: I've heard about waiting periods. Is there a certain time I need to wait before I file?
ANSWER: No. If you expect to be unable to work for at least 12 consecutive months because of a serious physical or mental medical condition, you should file now.
There are two primary dangers in waiting to file your application. One, time is obviously wasted. Social Security is a S-L-O-W process, so don't waste unnecessary time by failing to file promptly. Two, Social Security insured status can expire after you stop working. If you lose your insured status because you waited too long to file, it can be difficult or impossible to get benefits.
How Can I File A Disability Claim?
1. You may contact your local Social Security office to file.
2. You may file online at www.socialsecurity.gov. Click on the Disability tab and it will guide you to the application.
3. You may get an attorney or non-attorney representative to help you file. They cannot charge you a fee just for filing the application.
QUESTION: I've heard about waiting periods. Is there a certain time I need to wait before I file?
ANSWER: No. If you expect to be unable to work for at least 12 consecutive months because of a serious physical or mental medical condition, you should file now.
There are two primary dangers in waiting to file your application. One, time is obviously wasted. Social Security is a S-L-O-W process, so don't waste unnecessary time by failing to file promptly. Two, Social Security insured status can expire after you stop working. If you lose your insured status because you waited too long to file, it can be difficult or impossible to get benefits.
How Can I File A Disability Claim?
1. You may contact your local Social Security office to file.
2. You may file online at www.socialsecurity.gov. Click on the Disability tab and it will guide you to the application.
3. You may get an attorney or non-attorney representative to help you file. They cannot charge you a fee just for filing the application.
NEW REGULATIONS: WILL DISABILITY BENEFITS BE HARDER TO GET?
Social
Security is changing the regulations concerning how they will consider
medical evidence from doctors. The new regulations may make it even
harder for new claimants to receive Social Security disability benefits.
Up until now, Social Security decision makers were required to give more weight to opinions from a claimant's treating physician. For new claims filed after March 27, 2017, this will no longer be true. Now, Social Security decision makers may decide how much weight to give medial evidence, regardless of whether the doctor has treated the patient or not.
What concerns me about this new rule is this: Suppose my claimant has seen his doctor 4 or 5 times a year for the past 10 years. This treating physician has ordered multiple tests and has examined the patient multiple times. The patient then applies for disability and Social Security sends him to one of their doctors for a one-time examination. At least in theory, Social Security can give the same weight to the opinion of the doctor who did a one-time exam as they give to the doctor who has treated the patient for 10 years.
It is too early to be sure that this rule change will work against the claimant and make benefits more difficult to get. However, I cannot see how this change can possibly help the claimant or make benefits easier to get. (A Social Security claim is already plenty tough with denial rates around 70 percent at the application level).
It seems that for the past 6 or 7 years, Social Security has come under increasing pressure to cut benefits, reduce new awards and tighten the belt. The Congress is largely behind this drive but it is assisted by the misinformed media, which believe that Social Security is riddled with fraud and waste and that benefits are too easy to obtain. This is largely baloney; however, the media pieces I've seen simply didn't take time to do their homework.
A year or two from now we'll know the effect of the new regulations that went into effect yesterday. But if I were a betting man, I'd bet that award rates fall from where they are now--and they're already at the lowest point since 2010.
Up until now, Social Security decision makers were required to give more weight to opinions from a claimant's treating physician. For new claims filed after March 27, 2017, this will no longer be true. Now, Social Security decision makers may decide how much weight to give medial evidence, regardless of whether the doctor has treated the patient or not.
What concerns me about this new rule is this: Suppose my claimant has seen his doctor 4 or 5 times a year for the past 10 years. This treating physician has ordered multiple tests and has examined the patient multiple times. The patient then applies for disability and Social Security sends him to one of their doctors for a one-time examination. At least in theory, Social Security can give the same weight to the opinion of the doctor who did a one-time exam as they give to the doctor who has treated the patient for 10 years.
It is too early to be sure that this rule change will work against the claimant and make benefits more difficult to get. However, I cannot see how this change can possibly help the claimant or make benefits easier to get. (A Social Security claim is already plenty tough with denial rates around 70 percent at the application level).
It seems that for the past 6 or 7 years, Social Security has come under increasing pressure to cut benefits, reduce new awards and tighten the belt. The Congress is largely behind this drive but it is assisted by the misinformed media, which believe that Social Security is riddled with fraud and waste and that benefits are too easy to obtain. This is largely baloney; however, the media pieces I've seen simply didn't take time to do their homework.
A year or two from now we'll know the effect of the new regulations that went into effect yesterday. But if I were a betting man, I'd bet that award rates fall from where they are now--and they're already at the lowest point since 2010.
Subscribe to:
Posts (Atom)