DON'T MESS UP YOUR DISABIITY CLAIM

FRAGILE.  HANDLE WITH CARE.  EASILY BROKEN.

Those may sound like terms you would use when shipping glassware, but they apply equally to Social Security disability claims.

Far more claims are denied than paid.  In fact, recent statistics show that over 70 percent of disability claims are denied for one reason or another.  The most common reason is failure to prove disability according to the federal rules.

What kind of things can break your disability claim?  Here are a few:

• Failing to turn in all your doctors, hospitals and other medical providers.  Social Security only contracts the medical providers you tell them about.  You should provide each doctor's name, address, phone number--and approximate dates of treatment.
• Failing to complete all the forms they send you promptly and completely.  You will get a big package of forms in a brown envelope after you apply.  Most claimants either ignore these forms or fill them out in the most skimpy manner--leaving out the details that could get them approved.
• Failing to provide exact details about your past work on the Work History Report.  It's one of those forms that come in the big brown envelope.  If you are age 50 or over, getting a benefit depends largely on whether you can still perform any of your past work.  To decide this, Social Security needs to know a lot of details about the jobs you have done during the past 15 years.  How much walking, standing, lifting, bending, kneeling, crouching, crawling, handling, etc. did you do on each job.  The Work History Report form gathers all this detail.  If you leave this information blank, Social Security will draw their own conclusions in a way that will not benefit you.
• Working after the date you say you became disabled.  Social Security, by law, is for persons who are no longer able to work.  If you work after claiming to be disabled, it is taken as proof that you are not disabled.  File your claim AFTER you have stopped working, not before.
• Putting false information on any form or to any Social Security employee.  Credibility is tremendously important and it is lost when you give false information.  I often tell my clients that Social Security knows more about us than we know about ourselves and it is not only useless to lie to them, it is harmful. For example, they have a record of every penny I earned from my after-school job as a teenager right up to this month!  If I ever drew unemployment benefits or workers compensation, they know it, the dates, and the exact amounts.
• Failure to file a timely appeal to a denial or unfavorable decision.  Nearly all Social Security decisions can be appealed and it is usually the appeal that pays the claim.  However, there is a strict 60-day deadline to file an appeal.  Miss the deadline and your appeal is deader than a roadkill.  Almost no excuse will do. 
•  Failing to prepare for your appeal hearing.  I'm amazed at individuals who walk into a hearing alone and think it will go well.  Then, the judge begins to talk about transferable skills, past relevant work, residual functional capacities or amended onset dates and the claimant panics.  They don't even speak the language.  So, by all means, take someone to the hearing with you who can at least formulate a legal plan to present to the judge as to why you meet the federal requirements for a benefit.  Otherwise, you waste the best opportunity you will ever have to be approved and paid.  Going in alone and unrepped doesn't save you money, it costs you everything.

There are dozens of qualified attorney and non-attorney representatives in the local area.  Get in touch with one of them and give yourself a fair chance.  By the way, you won't pay your representative a cent (not one red cent) unless you are approved and get your back pay, too.  If you go it alone, you may keep 100 percent of your back pay.  Problem is, 100 percent of $0 is $0. 
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The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806

CALL US:  (256) 799-0297    The call is free.

Email us:   forsythefirm@gmail.com

CHECK US OUT ON THE WEB 

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WHAT SOCIAL SECURITY DISABIITY CAN DO FOR YOU

Many Americans don't fully understand what a value they have in Social Security's disability program.  It is the largest and most available source of income when a disability destroys the means of earning a living.  Most individuals who have worked regularly and recently are covered, having had FICA tax deducted from their paychecks.  FICA is just another name for Social Security tax.

If you can get approved, Social Security provides you with:

• A monthly check of up to (maximum) $2,867.  The average check in 2019 is $1,250.

• Medicare health insurance to pay hospital and doctor bills and allow you to get good medical treatment. 

• Potentially, an additional monthly check for each of your dependents who are under age 19 and still in school.

It's a wonderful program; however, there are some problems with it that you need to be aware of and plan for:

1)  It's often quite difficult to convince Social Security that you meet their rules to get a benefit.  They often deny claims, which then require a complicated appeal.

2)  SSDI does not cover the first 5 months of a disability.  The waiting period eliminates benefits for the first five full calendar months.  So, a person becoming disabled on 1/15/20 can't expect a benefit until at least July, 2020. That assumes he or she is approved quickly.

3)  It takes about 4 months to process an average disabiity case.  Up to 75 percent of these get initial denials and require appeals.

4)  The first appeal is called "Reconsideration" and can take about 6 more months.  It is often unsuccessful.

5)  The second appeal is your best chance.  This is where you get a hearing before a judge.  You should seriously consider legal representation for this part of the process, even if you have not been represented in the previous stages.

6)  Once you finally get approved, probably as the result of a hearing, you may claim past due benefits and often receive a lump sum check for past benefits that were delayed during the appeal process.  

7)  Your Medicare coverage automatically begins 24 months after you become eligible for an SSDI payment.  That is correct, there is a 24 month waiting period for Medicare.

IN SUMMARY: Social Security is a great program for persons who have worked all their lives but become disabled.  It can be difficult to qualify for, and it usually takes a while to get benefits started.

When Should You File?  As soon as you believe you have a disabling condition that is going to last for at least 12 straight months.  Social Security does not pay for short-term disability (those lasting less than 12 months).

How to Get More Information:  Contact your local Social Security office or call the Forsythe Firm in Huntsville at (256) 799-0297.  This is a free call and your initial consultation will be free. 
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The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806

CALL US:  (256) 799-0297    The call is free.

Email us:   forsythefirm@gmail.com

CHECK US OUT ON THE WEB 

RFC: WHAT IT MEANS AND HOW IT GETS YOU APPROVED FOR DISABIITY

RFC stands for "Residual Functional Capacity." It is the most you are able to do in terms of work-like activity--such as lifting, standing, walking, bending, crawling, etc. 

Social Security divides work into 5 categories: sedentary, light, medium, heavy and very heavy. Each category has a matching RFC. For example, a sedentary job requires you to be able to sit for a maximum of 6 hours per 8-hour workday, stand and/or walk up to 2 hours, and lift and carry a maximum of 10 pounds occasionally. If you are unable to do these things, your RFC is "below sedentary" and you are disabled. 

The maximum lifting/carrying abilities are gradually increased for light, medium and heavy work.  For example, a person doing medium level work must be able to occasionally lift and carry up to 50 pounds.

Establishing your RFC is, therefore, crucial to winning your disability benefits. We try to use medical evidence from your doctors to prove that you cannot perform any of your past relevant jobs. Then, depending on your age, we may need to also prove that you can't perform any other work. If you can't understand why you were denied, it's probably because your RFC was wrongly decided. But you never know that.  Only your attorney or advocate will understand what really got you denied.

I hear individuals say, "I told Social Security that I can't stand more than 30 minutes and that I can't lift more than 5 pounds, and they still denied me.

The problem is, they don't go by what you say.  You must present acceptable medical evidence that PROVES your maximum RFC.

Call us for a free consultation. (256) 799-0297. We can often help.  If we can't get you approved, we never charge you a fee._
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The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806

CALL US:  (256) 799-0297    The call is free.

Email us:   forsythefirm@gmail.com

CHECK US OUT ON THE WEB 

 

UNDERSTANDING SOCIAL SECURITY'S DISABILITY APPLICATION PROCESS

The first thing you do to seek Social Security disability (SSDI) benefits is to file a complicated application.  Once all the forms are completed, your case goes to a state agency called the Disability Determination Service, or DDS for short.  DDS will order medical records from all your doctors and treatment providers.  They will analyze your education, past work history and other factors to see if you are obviously eligible for benefits.  A DDS employee will consider such factors as:

• Does your medical condition meet the severity required for a Listing--a published criteria that automatically pays a benefit.  Less than 1 percent of applications meet a Listing.
• Does a Medical-Vocational Guideline ("grid rule") direct a finding of disabled?  This applies to persons 50 years of age or older, never to younger persons.
• What is the claimant's Residual Functional Capacity or RFC?  In short, what is the maximum amount of work-like activity the claimant can perform based on his/her age, education, past work experience and medical limitations?
• If a claimant is believed to be able to perform any job that he or she has performed during the last 15 years, the claim will be denied.  Also, if the claimant is under age 50 and is believed able to perform any job which exists in the US economy, the claim will be denied.

Between 70 and 80 percent of applications are denied at this first level.  It typically takes about 4 months to get an initial decision on an application.  Sometimes it takes longer.

Once the application has been denied, it must be appealed within 60 days.  This first appeal sends the claim back to the Disability Determination Service (DDS) for "Reconsideration."  The same agency that denied the claim (but a different person) will review the claim again.  In more than 90 percent of cases, the DDS will once again deny the claim.  (Honestly, Reconsideration is pretty much a waste of time; however, it is a required step in the appeal process).  Reconsideration often takes 6 additional months. So, by the time DDS denies the claim for the second time, the claimant has about one year invested.

The second appeal takes the claim before a special Social Security judge called an Administrative Law Judge (ALJ), who will hold a hearing with the claimant and his/her attorney present.  Prior to the hearing, the claimant may submit new or additional evidence.  The claimant may go to other doctors or have more tests performed and submit those records to the judge prior to the hearing.  Once the second appeal is filed, it may take 12 months or longer to get before the judge.  So by now the claimant has about 2 years invested in the claim.

At the hearing, 5 individuals will meet in a small hearing room that looks like a conference room (not a courtroom).  These 5 individuals are:  the presiding judge, the claimant, the claimant's representative, a vocational witness and a hearing reporter.  The judge will take oral testimony from the claimant, consisting of questions asked by the judge and by the claimant's attorney (called a representative).  The judge will also hear testimony from the vocational witness.

Once the hearing is completed, the judge will review all the evidence, including the hearing testimony and arguments.  A new written decision will be issued within 2 to 6 months following the hearing. The judge may issue three possible rulings:

FULLY FAVORABLE DECISION:  Finds the claimant disabled as of the alleged onset date (the date claimed in the application) and pays a benefit back to that date, minus the mandatory five-month waiting period.

PARTIALLY FAVORABLE DECISION:  Finds the claimant disabled at a later date than alleged in the application and pays a benefit only back to that date.  Thus, a partially favorable decision results in less back pay than a fully favorable decision.  Note:  The claimant is NOT partially disabled.  There is no partial disability with Social Security; it is all or none.  However, the decision can be partially favorable in the sense that it is less favorable than a fully favorable decision.  (It pays less in back pay).

UNFAVORABLE DECISIONS deny all benefits because Social Security finds that the claimant is not disabled or otherwise does not meet all of the rules of the Social Security Administration.

The third appeal can take the case before a group of judges in Falls Church, Virginia--known as the Appeals Council, or AC for short.  These judges will review the way the ALJ handled the hearing to decide if any procedural problems or regulations were violated.  It typically takes the AC about one year to render a decision.  If the AC finds a problem with the way the ALJ handled the hearing, the case may be "remanded," sent back to the ALJ for another hearing.

Two things to consider about the Appeals Council:

1. Neither the claimant nor his/her attorney gets to appear before the AC.  This is a paper review only.

The AC does not try to decide whether the claimant is disabled or not.  The AC only considers whether the claimant received a fair hearing.  If so, no action will be taken and the decision made at the hearing becomes the administration's final decision (that is, the case remains denied).  By this time, the claimant has invested  about 3 years in the case.

The final appeal is to file a lawsuit against the Commissioner of Social Security in Federal District Court (FDC).  Only about 1 percent of all disability claims wind up in Federal District Court.  But if a case goes there, it will take at least 12 more months to be adjudicated.

So, at what stage does the claimant have the best chance of being approved?  The answer clearly at the second appeal when the case goes to a hearing before an Administrative Law Judge.  The case never again has a chance this good.  That's why it is so important to prepare for the hearing well and to have good counsel.  

I cringe to hear that claimants went to their hearing unprepared and unrepresented, thus wasting their best opportunity to win their case.  And this opportunity never, ever comes along again.  You only get one hearing and must make the most of it.  

So, that's a little synopsis of the life of a Social Security disability application.  Denial is common in the first two stages and the best chance to win is at the third step (the hearing).
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The Forsythe Firm
Practice Limited to Social Security Disability
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
Call us:  (256) 799-0297

E-mail us:  forsythefirm@gmail.com

SOCIAL SECURITY JUSTICE STARTS HERE 

SOCIAL SECURITY DOCTORS: WHY THEY WON'T HELP YOU WIN

Social Security often sends claimants to one of their own contracted doctors for an examination.  These examinations seldom help to get disability claims approved.  These "consultative exams" usually do nothing for the claimant at all.

In fact, the purpose of these examinations is not to get information that allows Social Security to pay the claim.  The purpose of the examination is to allow Social Security to finish the claim, usually by a denial.

I'll spend a little time explaining why these exams do you, the claimant, no good.  Then, I will talk about things that can do you some good, in terms of your disability claim.

First, the consulting doctor knows nothing about you.  He or she has never seen you before you walk into the office for a very brief exam.  And the exam is typically brief.  Some of my clients tell me that the doctor spends less than fifteen minutes with them.

Secondly, there are usually no diagnostic tests.  No X-rays, laboratory studies or CT scans.  The doctor will make observations like, "Patient could get on and off the exam table without assistance."  Or, "Patient was in no apparent distress."  A recent exam that I read said, "The patient could walk the 120 feet required for the gait evaluation without limping." The exam is so general that only the most obvious deformities would be found. 

The real question that should be determined by a consultative examination is:  "Can this individual perform sedentary, light or medium level work activity 8 hours per day, 5 days per week on a regular and continuing basis?"  Walking 120 feet, getting on/off the exam table and appearing to be in no immediate distress have nothing to do with whether a person can work all day.

Since these consultative exams are of little or no value to you, what do you need to advance your disability case and improve the odds of getting a benefit?  In short, you need good medical records from your own, treating physicians.

There are reasons, I guess, why persons don't go to the doctor.  Some people just hate going to the doctor and avoid it when they can.  Fine, except it really hurts your chances of winning a disability claim because there is no (or very little) evidence to work with.

Many people lost their health insurance when they had to stop working and can't afford medical treatment.  While this is unfortunate, it still prevents Social Security from obtaining enough medical evidence to justify paying benefits.  It is up to the claimant to find a way to see a doctor.  Community free clinics may be the answer.  My office provides a list of doctors and clinics who offer free or reduced cost medical treatment for the uninsured.  (Call me to get a copy of the list--free).

Medical evidence from your own doctor is the key that unlocks the door.  Without it, you are extremely unlikely to get approved for any Social Security disability benefit--because a medical condition must be "medically determinable."  And the burden of proof is on the claimant, not on Social Security.
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The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
Call us:  (256) 799-0297

E-mail us:  forsythefirm@gmail.com

SOCIAL SECURITY JUSTICE STARTS HERE 

A GOLDMINE (MIRACLE) FOR DISABLED PERSONS WAITING ON SOCIAL SECURITY

Social Security and the US government do not have any short-term or temporary relief for disabled persons while they try to get approved for disability benefits.

You must wait through the long, arduous Social Security application process before you can receive a check.  And that process may take up to 2 years, or more.

However, many workers have a "goldmine" in disability benefits that they may not be aware of, just waiting to be discovered.

I'm talking about your employer's short term and long term disability insurance plans.  Many employers, especially the larger ones, buy a group disability policy from an insurance company and cover the employees of the company.  The company's personnel director or director of human resources is the one who will now about this plan, if it exists.

Here are some typical (common) points about employer's disability insurance plans.  Keep in mind, I haven't seen your plan; therefore, I don't know what your policy provides, so I am speaking only in terms of what is common or often seen.  Don't rely on what I say here; go and see your company's human resource director.

1.   Employer's disability plans are usually purchased by the employer from a private insurance company--not from the government.

2.  Employer's will have different eligibility requirements that must be met before an employee can become covered under the plan.  For example, some companies require you to work at the company for 90 days before you are covered.  This varies from company to company.

3.  If you become disabled while employed at the company, you will generally be placed on "Short-Term disability" (STD) for a period of 3 to 6 months.  Then, if you remain unable to go back to work, you may ask for "Long-Term Disability" (LTD). 

4.  Your doctor must help you to qualify for STD/LTD by completing forms and/or doing an examination.

5.  When you are approved, your employer's insurance company begins to pay you a reduced portion of your wages or salary, typically 60 to 80 percent of your normal wages.

6.  When you are approved for STD or LTD the insurance company will usually require you to file for Social Security disability.

7.  When you are finally approved for Social Security disability (SSDI), the insurance company will usually reduce their payment by the amount of the SSDI award, according to the terms of their contract with your employer.

For example, if the LTD insurance payment is $2,400 per month and your SSDI benefit is $2,000 per month, the insurance company's payment will be reduced to $400 per month (the difference between $2,400 and $2,000).

As I stated, I have not seen anyone's insurance contract or policy, so the facts of your case may be different.  What I am quoting here is what is common or typical in may cases.  Your case certainly may be different.  Again, talk to your company's human resource director to find out about your company's provisions.

Try to find out if you can qualify for STD or LTD with your company's plan BEFORE you quit work or get terminated.  

It just may be that your employer's STD or LTD insurance benefits will pay you while you wait months, or years, to get Social Security disability benefits started.

If you have specific legal questions about your insurance provisions or problems, you should contact a licensed attorney in your state for advice.  Those questions are quite different than those handled in Social Security disability disputes.

ANSWER 3 QUESTIONS TO SEE IF YOU MAY QUALIFY FOR UP TO $2,868 PER MONTH IN BENEFITS

Answer the following 3 questions to see if you may qualify for up to $2,868 per month in Social Security disability benefits (SSDI):

Question 1:  Are you currently unable to work due to a physical and/or mental impairment?

Question 2: Has your medical impairment lasted for at least 12 straight months, or is it expected to last for at least 12 straight months OR to end in death?

Question 3:  Have you worked at least 5 years out of the most recent 10-year period at steady, substantial employment?

If you answered YES to all 3 of these questions, you may qualify for an SSDI benefit.

Below is some "fine print" or details you should also read:

You must have worked long enough, and recently enough to be covered by SSDI.  If you have worked at lest 5 full years out of the past 10 year period, you are probably covered.  You may call your local Social Security office and ask if you have enough "work credits" to be covered for SSDI.

You must have a "medically determinable" impairment, which means that there is sufficient objective medical evidence of your condition.  In short, you need sufficient medical records to show the beginning, severity and duration of your impairment. You must also prove that your medical impairment is severe enough to prevent you from performing any substantial (full-time) employment.

Your medical impairment must have lasted for at least 12 consecutive months, be expected to last at least 12 consecutive months OR to end in death.  Social Security does not cover disability that lasts less than 12 months.  This is called "the duration requirement."

QUESTIONS AND ANSWERS

Q.   Is it a simple, easy process to get approved for SSDI?
A.    No.  Up to 80 percent of applications are denied and require an appeal.

Q.    About how long does it take to get a new SSDI benefit approved and paying?
A.     While a few claimants will be approved in a few months, others may wait 2 years.

Q.     At what stage of the process do most claims get approved and paid?
A.     Most approvals occur at the second appeal, which is the hearing phase.

Q.     Am I allowed to have legal representation when trying to get SSDI?
A.     Yes.  Not only allowed, but encouraged to have representation.

Q.     Does Medicare automatically come with SSDI benefits to pay medical bills?
A.      Medicare automatically begins 24 months after you begin receiving SSDI. 

Q.     What is meant by the 5-month waiting period for SSDI?
A.      Social Security will not pay the first 5 months of disability under SSDI.

Q.      I know my disability must last at least 1 year.  But do I wait a year before applying?
A.      No, definitely not.  If your condition is expected to last one year, apply now.

Q.     Should I hire a local representative or call one of those out-of-state 800 numbers?
A.     It's your choice but if you hire locally, you can meet your representative now, not   
        on the day of the hearing.  Why would not want a local attorney/representative? 
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THE FORSYTHE FIRM
Practice Limited to Social Security Disability
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806

CALL US:     (256) 799-0297

EMAIL US:    forsythefirm@gmail.com

CHECK OUT OUR WEBSITE