A
few months ago a client came to my office to file for Social Security
disability. He had worked hard his entire life and had a legitimate
disability. I helped him file the claim and explained that 70 percent
are denied before they are approved. Sure enough, the examining agency
denied the claim several weeks later. The letter said, "We found that
you are not disabled according to our rules." I filed an appeal
immediately.
About
two months later I received an amazing telephone call. Someone at the
Office of Disability Adjudication and Review had reviewed the case,
reversed the original decision and awarded full benefits, including more
than $30,000 in back pay.
That's
why you can't afford to give up on a disability claim. Just because
someone at Social Security says you are not disabled doesn't mean that
you aren't disabled. I refer back to a recent study which found that 6
out of 10 denied claims could have been approved if they'd had a
different disability examiner. The system is far from perfect and
mistakes will be made. That's why you can't give up. Never take Social
Security's word for it the first time out! Push the case up the chain
of command one step and see what happens. You have nothing to lose.
And at that second step the odds of winning your benefits are much, much
better - especially if you have adequate representation.
May I quote the words of the great statesman, Sir Winston Churchill? "Never, never, ever quit!"
THE FORSYTHE FIRM Social Security Disability Counselors (256) 799-0297
Tuesday, December 11, 2012
CONTINUING DISABILITY REVIEWS: PROTECT YOURSELF
Social Security will conduct Continuing Disability Reviews (CDRs) periodically to determine whether beneficiaries continue to be disabled and whether they should continue to get disability payments and benefits. These reviews are typically held in two or three year intervals. The burden of proving that you are still disabled requires some forethought. Here are simple, effective things you can do.
If you cannot afford a professional to assist you with your CDR paperwork, consider a family member, close friend, a community organization or a social service organization that may be able to help. Finally, realize that most continuing disability reviews do not result in the termination of benefits. CDRs are quite routine and need not cause undue alarm as long as they are responded to appropriately. If a CDR does result in an unfavorable decision (stopping benefits), that decision may be appealed, as explained above.
- Continue to see your doctor(s) regularly and follow prescribed treatment regiments. Going 12 months or longer without seeing a doctor is sure to cause problems. Social Security's belief is, if you are sick you will seek treatment.
- Keep a journal or notebook in which you write down the exact dates you visit each doctor, what treatment (s)he prescribed, changes to your prescriptions, etc.
- Keep a record of the dates of any medical tests, MRIs, X-rays, etc. and where they were conducted. You will need this later in answering your review.
- Keep a careful record of any income you receive other than Social Security benefits--such as pension payments, investment income, annuities, bonuses, etc. Any substantial extra money that shows up under your name may need to be explained. It won't be a problem as long as it is not "earned income," i.e., substantial amounts of money you received as wages, tips or salary for work you performed. But you should be able to explain what the money was for.
- If you get a request in the mail from Social Security to provide them with information, don't ignore it. Complete all forms carefully and return them promptly. A continuing disability review will not go away because you ignore it. Just the opposite, ignoring it may cause your check to be terminated, at least temporarily.
- If, after a review, Social Security notifies you that you are not longer disabled and they intend to terminate your benefit, you have the right to appeal. There are two options for this appeal, as explained below:
- Option 1: Appeal the decision in writing within 60 days. This will NOT keep your check coming in during the appeal. Your check will stop but will be restarted later if you win the appeal. If you want to continue to receive your check during the appeal process, use Option 2 below.
- Option 2: Appeal within 10 days and ask that your benefit check continue during the outcome of the appeal. Your check will continue during the appeal process. However, if you are not successful in the appeal, Social Security may ask you to repay the benefits you received during the appeal. Note that the deadline for this appeal is 10 days, not 60 days. Also, you must specifically state in writing that you want to continue receiving your benefits during the appeal (This is not automatic).
If you cannot afford a professional to assist you with your CDR paperwork, consider a family member, close friend, a community organization or a social service organization that may be able to help. Finally, realize that most continuing disability reviews do not result in the termination of benefits. CDRs are quite routine and need not cause undue alarm as long as they are responded to appropriately. If a CDR does result in an unfavorable decision (stopping benefits), that decision may be appealed, as explained above.
Continuing Disability Reviews (CDRs)
Continuing disability reviews (CDRs) are becoming more of a topic these days among attorneys and the Social Security disability claimants they represent. When you are awarded a disability benefit, Social Security schedules a future CDR in the computer. It may be one year in the future or three years, but it will be coming along. The purpose of a CDR is to determine whether you are still eligible to receive disability benefits. If Social Security determines that there has been significant medical improvement which allows you to return to work it will terminate your benefits after providing a written notice. Usually it gives at least a 60 day notice before the checks stop.
Beneficiaries have 60 days in which to appeal cessation of benefits. However, they only have 10 days to request that their benefits continue pending the outcome of the appeal. So it is vital that all beneficiaries under the claim give written notice to Social Security that they want their benefits to be paid pending the final outcome of the appeal. This request must be in writing.
Then what happens?
Beneficiaries (persons receiving benefits) will file a request for reconsideration and give Social Security any evidence they have to support their position that they are still disabled. You have the right to ask for a face-to-face appearance with Social Security before your reconsideration decision is made. If the decision is unfavorable, you may ask for a hearing before an administrative law judge.
If your final decision is unfavorable, Social Security can ask you to repay all of the money you received during the appeal (or after your "last regular" benefit check). However, you may ask for a waiver of the repayment. If you can prove that your need all of your income for necessities of living, Social Security may waive any overpayments.
As you can see, being the subject of an unfavorable CDR can be quite painful and serious. Unfortunately, it is often difficult to find an attorney or representative who will help you appeal an unfavorable CDR decision because there is no back pay involved and it is difficult for the representative to be paid for his or her service. What usually happens is that the claimant agrees to set aside a percentage of the ongoing benefit in an escrow account. When the appeal is over, the representative can petition Social Security for permission to use money in the escrow account toward his or her fee. Since representatives often bill $250 per hour or more, unfavorable CDRs can become expensive burdens for Social Security disability beneficiaries. Fortunately, the majority of continuing disability reviews do not result in an attempt to terminate benefits.
I will be posting a second article on this blog site about what you can do to prevent problems with a CDR. Look for it on this site, as it contains practical things you can do to prevent problems when (not if) your claim gets reviewed for continuing disability eligibility benefits.
Beneficiaries have 60 days in which to appeal cessation of benefits. However, they only have 10 days to request that their benefits continue pending the outcome of the appeal. So it is vital that all beneficiaries under the claim give written notice to Social Security that they want their benefits to be paid pending the final outcome of the appeal. This request must be in writing.
Then what happens?
Beneficiaries (persons receiving benefits) will file a request for reconsideration and give Social Security any evidence they have to support their position that they are still disabled. You have the right to ask for a face-to-face appearance with Social Security before your reconsideration decision is made. If the decision is unfavorable, you may ask for a hearing before an administrative law judge.
If your final decision is unfavorable, Social Security can ask you to repay all of the money you received during the appeal (or after your "last regular" benefit check). However, you may ask for a waiver of the repayment. If you can prove that your need all of your income for necessities of living, Social Security may waive any overpayments.
As you can see, being the subject of an unfavorable CDR can be quite painful and serious. Unfortunately, it is often difficult to find an attorney or representative who will help you appeal an unfavorable CDR decision because there is no back pay involved and it is difficult for the representative to be paid for his or her service. What usually happens is that the claimant agrees to set aside a percentage of the ongoing benefit in an escrow account. When the appeal is over, the representative can petition Social Security for permission to use money in the escrow account toward his or her fee. Since representatives often bill $250 per hour or more, unfavorable CDRs can become expensive burdens for Social Security disability beneficiaries. Fortunately, the majority of continuing disability reviews do not result in an attempt to terminate benefits.
I will be posting a second article on this blog site about what you can do to prevent problems with a CDR. Look for it on this site, as it contains practical things you can do to prevent problems when (not if) your claim gets reviewed for continuing disability eligibility benefits.
Sunday, December 2, 2012
EARLY EVIDENCE GETS 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 and my client received checks before Christmas!
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).
Incidentally, this also points out how unfavorable decisions are often bad decisions to start with. When ODAR can review a claim that was denied and approve it within 90 days, it was a poor decision to begin with. So, never accept the first denial. Appeal - always.
A final but vital tip: Always try to get a Medical Source Statement (MSS) from your doctor. This is a special form that lists specific functional limitations--such as restrictions in sitting, standing/walking, lifting, bending, etc. It is up to the claimant or his representative to obtain this form. Social Security will not try to obtain it for you. The MSS can provide an excellent basis to ask for an early review of your claim.
Often, the early bird gets the.....review!
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 and my client received checks before Christmas!
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).
Incidentally, this also points out how unfavorable decisions are often bad decisions to start with. When ODAR can review a claim that was denied and approve it within 90 days, it was a poor decision to begin with. So, never accept the first denial. Appeal - always.
A final but vital tip: Always try to get a Medical Source Statement (MSS) from your doctor. This is a special form that lists specific functional limitations--such as restrictions in sitting, standing/walking, lifting, bending, etc. It is up to the claimant or his representative to obtain this form. Social Security will not try to obtain it for you. The MSS can provide an excellent basis to ask for an early review of your claim.
Often, the early bird gets the.....review!
Friday, November 23, 2012
IMPORTANCE OF YOUR 'ALLGED ONSET DATE"
First, let's define two terms that will be used in this post.
Alleged Onset Date (AOD) is the date on which the applicant claims to have first become disabled.
Established Onset Date (EOD) is the date that Social Security sets as the first date on which the claimant became disabled. (A disability examiner or administrative law judge may change the alleged onset date to a later date, which becomes the EOD).
On an approved claim, back benefits are paid from the Established Onset Date. Of course, the goal is make the AOD and the EOD the same - whereby the claimant receives maximum benefits.
For instance, if a claimant alleges that he became disabled on February 1 and Social Security accepts that date, back pay will be eligible back to February 1. (However, there is a 5-month waiting period for Title 2 disability claims, so actual payment will not be made until August).
There are no waiting periods pr retrpactove nemefots for SSI claims, so payments can begin the month following the application. Back pay can still occur in an SSI claim because it often takes months to get a claim approved, especially when an appeal becomes necessary.
It is vital to present medical and vocational evidence going back to the alleged onset date (AOD). The claimant wants to prove that he/she was disabled as of the AOD and that he/she has not engaged in substantial gainful activity since the AOD.
An experienced Social Security disability advocate is your best bet in protecting your AOD and the back pay that comes with it. Remember that Social Security is under tremendous pressure to challenge alleged onset dates and move the date forward, when possible, to reduce or eliminate back pay. Representation fights to get you the entire "value" of your claim, including back pay. In fact, the representative cannot be paid a fee unless back pay is collected.
- - - - - - - - - - - - - - - - - - - - - - - -
Alleged Onset Date (AOD) is the date on which the applicant claims to have first become disabled.
Established Onset Date (EOD) is the date that Social Security sets as the first date on which the claimant became disabled. (A disability examiner or administrative law judge may change the alleged onset date to a later date, which becomes the EOD).
On an approved claim, back benefits are paid from the Established Onset Date. Of course, the goal is make the AOD and the EOD the same - whereby the claimant receives maximum benefits.
For instance, if a claimant alleges that he became disabled on February 1 and Social Security accepts that date, back pay will be eligible back to February 1. (However, there is a 5-month waiting period for Title 2 disability claims, so actual payment will not be made until August).
There are no waiting periods pr retrpactove nemefots for SSI claims, so payments can begin the month following the application. Back pay can still occur in an SSI claim because it often takes months to get a claim approved, especially when an appeal becomes necessary.
It is vital to present medical and vocational evidence going back to the alleged onset date (AOD). The claimant wants to prove that he/she was disabled as of the AOD and that he/she has not engaged in substantial gainful activity since the AOD.
An experienced Social Security disability advocate is your best bet in protecting your AOD and the back pay that comes with it. Remember that Social Security is under tremendous pressure to challenge alleged onset dates and move the date forward, when possible, to reduce or eliminate back pay. Representation fights to get you the entire "value" of your claim, including back pay. In fact, the representative cannot be paid a fee unless back pay is collected.
- - - - - - - - - - - - - - - - - - - - - - - -
The Forsythe Firm, 7027 Old Madison Pike (Research Park) Huntsville, AL fights for our claimants' rights in Social Security disability and SSI claims. Never a fee until we collect your benefits, including back pay. (256) 799-0297
We are local members of: Visit the Forsythe Firm's Website
Established in 1979, the National Organization of Social Security Claimants' Representatives is an association of over 4,000 attorneys and other advocates who represent Social Security and Supplemental Security Income claimants. Our members are committed to providing high quality representation for claimants, to maintaining a system of full and fair adjudication for every claimant, and to advocating for beneficial change in the disability determination and adjudication process.
Wednesday, November 21, 2012
SOCIAL SECURITY & TRIAL WORK PERIODS
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 on whether you have become unable to work, you qualify for provisional (temporary) benefits for up to 6 months.
Also, if you are receiving health care access through Medicare insurance coverage, you may keep your insurance coverage for at least 93 months after your last disability or SSI benefit check--even while you are working.
Ticket to Work is a volunteer program that gives Social Security disability or SSI beneficiaries incentives to go back to work. For more information contact your local Social Security office or call 1-800-772-1213.
- - - - - - - - - - - - - - - - - - - - -
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 on whether you have become unable to work, you qualify for provisional (temporary) benefits for up to 6 months.
Also, if you are receiving health care access through Medicare insurance coverage, you may keep your insurance coverage for at least 93 months after your last disability or SSI benefit check--even while you are working.
Ticket to Work is a volunteer program that gives Social Security disability or SSI beneficiaries incentives to go back to work. For more information contact your local Social Security office or call 1-800-772-1213.
- - - - - - - - - - - - - - - - - - - - -
The Forsythe Firm (256) 799-0297 is a local member of
Established in 1979, the National Organization of Social Security
Claimant's Representatives (NOSSCR) is a professional association of
over 4,000 attorneys and other advocates who help individuals with
disabilities obtain Social Security and Supplemental Security Income
benefits.
Learn More About the Forsythe Firm - Social Security disability specialists
Tuesday, November 20, 2012
IS SOCIAL SECURITY WATCHING YOU ON FACEBOOK?
Earlier this year, Social Security advised its administrative law judges that they cannot use the internet to investigate disability claimants. Sen. Tom Coburn (R-Oka) disagreed, stating that it deprives judges of a valuable tool for determining Social Security fraud.
Senator Coburn used this illustration, which I have paraphrased. Suppose a person has applied for disability benefits. A judge looks this person up on Face Book and finds there photos or a discussion of that person playing football or participating in his bowling tournament. If the claimant had alleged severe back problems on his disability application, his credibility is called into question.
I have long advised my clients to avoid the social media. I believe that to be good advice. The internet remains the first place that investigators will look when checking up on your personal affairs. This includes private insurance companies who may be paying out on a disability claim. Though you are not involved in fraud, why give the insurance company ammunition to shoot at you with - or to make allegations that you have to refute?
Use common sense but don't become paranoid. It isn't necessary to avoid normal activities like vacations or going out to eat. There's no need to stop going to church or to the grocery store. As a rule, nobody from Social Security is going to follow you around to see what you're doing.
Naturally, disability claims should be based on honesty. If you don't have medical evidence to support your claim, you should not make false or misleading statements to make your case stronger. Besides, that rarely works, anyway. But it can cause you a lot of problems.
Senator Coburn used this illustration, which I have paraphrased. Suppose a person has applied for disability benefits. A judge looks this person up on Face Book and finds there photos or a discussion of that person playing football or participating in his bowling tournament. If the claimant had alleged severe back problems on his disability application, his credibility is called into question.
I have long advised my clients to avoid the social media. I believe that to be good advice. The internet remains the first place that investigators will look when checking up on your personal affairs. This includes private insurance companies who may be paying out on a disability claim. Though you are not involved in fraud, why give the insurance company ammunition to shoot at you with - or to make allegations that you have to refute?
Use common sense but don't become paranoid. It isn't necessary to avoid normal activities like vacations or going out to eat. There's no need to stop going to church or to the grocery store. As a rule, nobody from Social Security is going to follow you around to see what you're doing.
Naturally, disability claims should be based on honesty. If you don't have medical evidence to support your claim, you should not make false or misleading statements to make your case stronger. Besides, that rarely works, anyway. But it can cause you a lot of problems.
Subscribe to:
Posts (Atom)