The Social Security Board of Trustees today released its annual report on the long-term financial status of the Social Security Trust Funds. The combined asset reserves of the Old-Age and Survivors Insurance, and Disability Insurance (OASDI) Trust Funds are projected to become depleted in 2033, unchanged from last year, with 77 percent of benefits still payable at that time. The DI Trust Fund will become depleted in 2016, also unchanged from last year's estimate, with 81 percent of benefits still payable.
In the 2014 Annual Report to Congress, the Trustees announced:
The combined trust fund reserves are still growing and will continue to do so through 2019. Beginning with 2020, the cost of the program is projected to exceed income.
The projected point at which the combined trust fund reserves will become depleted, if Congress does not act before then, comes in 2033 – the same as projected last year. At that time, there will be sufficient income coming in to pay 77 percent of scheduled benefits.
The projected actuarial deficit over the 75-year long-range period is 2.88 percent of taxable payroll -- 0.16 percentage point larger than in last year's report.
"The projected depletion dates of the Social Security Trust Funds have not changed, and three-fourths of benefits would still be payable after depletion. But the fact remains that Congress can ensure the long-term solvency of this vital program by taking action," said Carolyn W. Colvin, Acting Commissioner of Social Security. "The Disability Insurance Trust Fund's projected depletion year remains 2016, and legislative action is needed as soon as possible to address this financial imbalance."
Other highlights of the Trustees Report include:
Income including interest to the combined OASDI Trust Funds amounted to $855 billion in 2013. ($726 billion in net contributions, $21 billion from taxation of benefits, $103 billion in interest, and $5 billion in reimbursements from the General Fund of the Treasury—almost exclusively resulting from the 2012 payroll tax legislation)
Total expenditures from the combined OASDI Trust Funds amounted to $823 billion in 2013.
Non-interest income fell below program costs in 2010 for the first time since 1983. Program costs are projected to exceed non-interest income throughout the remainder of the 75-year period.
The asset reserves of the combined OASDI Trust Funds increased by $32 billion in 2013 to a total of $2.76 trillion.
During 2013, an estimated 163 million people had earnings covered by Social Security and paid payroll taxes.
Social Security paid benefits of $812 billion in calendar year 2013. There were about 58 million beneficiaries at the end of the calendar year.
The cost of $6.2 billion to administer the program in 2013 was a very low 0.7 percent of total expenditures.
The combined Trust Fund asset reserves earned interest at an effective annual rate of 3.8 percent in 2013.
The Board of Trustees is comprised of six members. Four serve by virtue of their positions with the federal government: Jacob J. Lew, Secretary of the Treasury and Managing Trustee; Carolyn W. Colvin, Acting Commissioner of Social Security; Sylvia M. Burwell, Secretary of Health and Human Services; and Thomas E. Perez, Secretary of Labor. The two public trustees are Charles P. Blahous III and Robert D. Reischauer.
The 2014 Trustees Report will be posted at www.socialsecurity.gov/OACT/TR/2014/ on Monday.
Tuesday, September 02, 2014
Friday, August 08, 2014
VA Proposes Removal of Employees Who Manipulated Data
July 29, 2014 – The Department of Veterans Affairs (VA) today proposed a series of disciplinary actions against six employees at Department facilities in Cheyenne, Wyo., and Fort Collins, Colo. These actions are a part of VA’s effort to rebuild the trust of America’s Veterans.
“Employees who have been found to have manipulated data, withheld accurate information from their supervisors, and affected the timeliness of care Veterans receive do not reflect VA’s values, and their actions will not be tolerated,” said Acting Secretary Sloan D. Gibson. “VA must earn back the trust of Veterans. Part of earning back that trust is holding people accountable when there is documented evidence of willful misconduct and management negligence. We depend on the dedicated service of VA employees and leaders who live by our core values. Those who have not delivered results honestly have and will be held accountable.”
Based on a review by the Inspector General and other Department investigations, VA today proposed disciplinary actions against six employees at the Cheyenne VA Medical Center and Fort Collins Community-Based Outpatient Clinic.
As a result of these findings, VA proposed disciplinary actions against the Director of the Rocky Mountain Network (VISN 19), and the Director and Chief of Staff of the Cheyenne VA Medical Center.
Certain supervisors in these facilities were found to have personally manipulated data, instructed their subordinates to manipulate data, and withheld accurate information from their superiors. VA today proposed two of the supervisors be removed from Federal service.
Additional proposed penalties for other supervisors include two proposed suspensions, a demotion, and admonishments.
“Employees who have been found to have manipulated data, withheld accurate information from their supervisors, and affected the timeliness of care Veterans receive do not reflect VA’s values, and their actions will not be tolerated,” said Acting Secretary Sloan D. Gibson. “VA must earn back the trust of Veterans. Part of earning back that trust is holding people accountable when there is documented evidence of willful misconduct and management negligence. We depend on the dedicated service of VA employees and leaders who live by our core values. Those who have not delivered results honestly have and will be held accountable.”
Based on a review by the Inspector General and other Department investigations, VA today proposed disciplinary actions against six employees at the Cheyenne VA Medical Center and Fort Collins Community-Based Outpatient Clinic.
As a result of these findings, VA proposed disciplinary actions against the Director of the Rocky Mountain Network (VISN 19), and the Director and Chief of Staff of the Cheyenne VA Medical Center.
Certain supervisors in these facilities were found to have personally manipulated data, instructed their subordinates to manipulate data, and withheld accurate information from their superiors. VA today proposed two of the supervisors be removed from Federal service.
Additional proposed penalties for other supervisors include two proposed suspensions, a demotion, and admonishments.
Tuesday, July 15, 2014
Veterans Benefits Administration Processes One Millionth Claim in FY 2014
July 14, 2014
Agency Expects to Process 1.3 Million by Year’s End
The Department of Veterans Affairs (VA) today announced that the Veterans Benefits Administration (VBA) has completed its one millionth disability claim in fiscal year 2014, and is on track to complete more than 1.3 million claims this year – ensuring that nearly 200,000 more Veterans will receive decisions on their disability claims than fiscal year 2013. Since 2011, VBA has been implementing the largest transformation in its history, fundamentally redesigning and streamlining the way it provides benefits and services to Veterans, their families and survivors.
“VBA has made significant progress toward eliminating the backlog, but there is more work to be done to reach our goal of processing all disability claims within 125 days at a 98-percent accuracy level in 2015.” said Allison Hickey, Under Secretary for Benefits. “VBA’s employees, half of whom are Veterans themselves, believe that Veterans should not have to wait for the benefits they have earned and deserve. While we work to drive down the backlog of disability claims, we must also improve productivity on other categories of non-rating work.”
In the past four fiscal years, VA surpassed one million completed claims by the end of each year. Passing the one-million mark this year in early July represents major progress in providing more Veterans and their family members with timely, accurate decisions. VBA has reduced the claims backlog by more than 55 percent from its peak of 611,000 in March 2013 – and Veterans with pending claims have been waiting, on average, 128 fewer days for a decision on their claim. At the same time, the accuracy of rating decisions continues to improve. VA’s national “claim-level” accuracy rate is currently 91 percent – an eight-percentage-point improvement since 2011.
These rating decisions often determine eligibility for other VA benefits and services, including non-rating claims, which are tracked and managed in other categories on the Monday Morning Workload Report. These categories also have increased as more rating claims are completed, but VBA has not lost focus on non-rating work. VBA has taken the following actions to automate and improve the timeliness and accuracy of non-rating claim decisions:
Online Dependency Claims – VBA developed a new Rules-Based Processing System (RBPS) to automate dependency claims. Since inception, self-service features in RBPS have enabled over 75,000 Veterans to add or change the status of their dependents online. Over 50 percent of the dependency claims filed through RBPS are now automatically processed and paid in 1-2 days.
Dependency Claims Contract – VA recently awarded a contract for assistance in entering data from paper-based dependency claims into VA’s electronic rules-based processing system. The contractor is entering the information from the paper-based dependency claims just as a claimant would enter information if filing the claim online. The contract calls for 40,000 dependency claims to be processed per month when operating at full capacity. The contractor is currently ramping up to that capacity.
Up-front Income Verification for Pension – A new data-sharing initiative with the Social Security Administration and the Internal Revenue Service enables VBA to verify the income of pension applicants before awarding benefits and eliminates the annual income reporting requirement for pension beneficiaries.
Burial Claims – VBA published a new regulation, effective July 7, 2014, that allows automatic payment of the one-time burial allowance to a Veteran’s spouse without requiring the surviving spouse to apply for the benefit. Under this new regulation, as many as 62,000 surviving spouses will now receive timely burial benefits each year.
Drill Pay Adjustments – Veterans cannot legally receive VA benefits and drill pay concurrently. VBA is working to streamline and automate the drill pay offset process through an upfront agreement from National Guard and Reserve members.
National Call Center Initiative – Effective July 14, employees at the St. Louis and Phoenix National Call Centers are now also processing dependency claims. The initiative begins on July 14 at the St. Louis and Phoenix Regional Offices and will be expanded to all of our Call Centers shortly thereafter.
Hiring Temporary Employees – VBA is in the process of hiring 200 temporary employees, who will be provided specialized training in processing the less complex non-rating claims and work actions.
VBA posts data on the disability claims backlog, the non-rating workload, and other publicly available data on our performance on a weekly, monthly, and annual basis through our reports web site: www.vba.va.gov/reports.
Tuesday, June 10, 2014
June 10, 2014
VA Meets With Healthcare Industry to Discuss Best Scheduling Practices
Kaiser, Gartner, Mayo Clinic to Share Insights on Access Innovation, Modernization
WASHINGTON – Acting Secretary of Veterans Affairs Sloan Gibson today announced that the Department of Veterans Affairs (VA) will meet with private healthcare industry leaders to discuss best practices and policies for scheduling patients.
“Our top priority is to get our Veterans off wait lists and into clinics,” said Acting Secretary Gibson. “We need to continue to examine the best practices of healthcare systems across the country to find immediate solutions for timely delivery of quality healthcare. VA must be at the forefront of access and innovation. Our Veterans deserve nothing less.”
Today, VA officials will meet on state-of-the-art health care access with industry leaders including Kaiser Permanente, Gartner and Mayo Clinic. Discussions will focus on improving Veteran access to quality health care and innovating measurement approaches to gauge short- and long-term access to care. Topics will also include recommended strategies and tools to help managers and providers best serve Veterans and provide a consistent patient experience.
VA Meets With Healthcare Industry to Discuss Best Scheduling Practices
Kaiser, Gartner, Mayo Clinic to Share Insights on Access Innovation, Modernization
WASHINGTON – Acting Secretary of Veterans Affairs Sloan Gibson today announced that the Department of Veterans Affairs (VA) will meet with private healthcare industry leaders to discuss best practices and policies for scheduling patients.
“Our top priority is to get our Veterans off wait lists and into clinics,” said Acting Secretary Gibson. “We need to continue to examine the best practices of healthcare systems across the country to find immediate solutions for timely delivery of quality healthcare. VA must be at the forefront of access and innovation. Our Veterans deserve nothing less.”
Today, VA officials will meet on state-of-the-art health care access with industry leaders including Kaiser Permanente, Gartner and Mayo Clinic. Discussions will focus on improving Veteran access to quality health care and innovating measurement approaches to gauge short- and long-term access to care. Topics will also include recommended strategies and tools to help managers and providers best serve Veterans and provide a consistent patient experience.
The above is a press release from the Veterans Administration. As anyone who has been through the VA disability process knows often VA disability cases are delayed due to waiting on VA examinations. Hopefully, with improvement in scheduling in the VA health system there will also be some improvement in VA disability wait times.
Tuesday, April 29, 2014
Disability Claims Backlog Reduced by 44 Percent
WASHINGTON – One year after the backlog of pending disability compensation claims peaked at over 611,000 in March 2013, the Department of Veterans Affairs (VA) has reduced that number by approximately 44 percent to 344,000 claims – a reduction of more than 267,000 – while at the same time improving the accuracy of the decisions being made on Veterans’ disability claims. Additionally, on average, Veterans are waiting 119 days less for a decision than they were at this time last year.
“No Veteran should have to wait to receive earned benefits. Through a combination of transformation initiatives and the hard work of our employees, we are making significant progress toward our goal of eliminating the claims backlog in 2015,” said Secretary of Veterans Affairs Eric Shinseki. “We still have more work to do, and no one is more committed than our Veterans Benefits Administration employees, over half of whom are Veterans themselves.”
The current backlog, defined as claims pending more than 125 days, is at its lowest point since March 2011, when the backlog spiked in part because of the need to readjudicate 150,000 previously decided cases involving exposure to the Vietnam-era defoliant, Agent Orange. The readjudication of these claims was mandated under the Nehmer court decision and followed the Secretary’s decision to add ischemic heart disease, certain leukemias, and Parkinson's disease to the list of conditions presumed to be related to exposure to Agent Orange. During this same time period, VA also received and processed over 100,000 new claims for these three conditions from Vietnam Veterans and survivors newly eligible for VA benefits as a result of this decision.
“We knew taking care of this ‘unfinished business’ for Veterans of previous wars would initially drive up the number of claims in our system. But it was the right thing to do,” said Secretary Shinseki.
Since establishing the goal in 2010 of processing all disability claims within 125 days at a 98-percent accuracy level, VA developed and is implementing a plan that transforms the decades-old, manual paper claim approach into a state-of-the-art electronic process that leverages digital data transfer and automated calculators to reduce processing time and input errors.
VA has also increased the productivity of its claims processing workforce through enhanced training, streamlined business processes and other initiatives such as mandating overtime and prioritizing the oldest claims, allowing VA’s 56 regional benefits offices to exceed monthly production records four times in fiscal year 2013.
At the same time, the accuracy of rating decisions continues to improve. VA’s national “claim-level” accuracy rate, determined by dividing the total number of cases that are error-free by the total number of cases reviewed, is currently 91 percent – an eight-percentage-point improvement since 2011. When measuring the accuracy of rating individual medical conditions inside each claim, the three-month accuracy level is 96.5 percent. VA’s accuracy measures are statistically valid and the process has been independently verified by the Institute for Defense Analyses.
“No Veteran should have to wait to receive earned benefits. Through a combination of transformation initiatives and the hard work of our employees, we are making significant progress toward our goal of eliminating the claims backlog in 2015,” said Secretary of Veterans Affairs Eric Shinseki. “We still have more work to do, and no one is more committed than our Veterans Benefits Administration employees, over half of whom are Veterans themselves.”
The current backlog, defined as claims pending more than 125 days, is at its lowest point since March 2011, when the backlog spiked in part because of the need to readjudicate 150,000 previously decided cases involving exposure to the Vietnam-era defoliant, Agent Orange. The readjudication of these claims was mandated under the Nehmer court decision and followed the Secretary’s decision to add ischemic heart disease, certain leukemias, and Parkinson's disease to the list of conditions presumed to be related to exposure to Agent Orange. During this same time period, VA also received and processed over 100,000 new claims for these three conditions from Vietnam Veterans and survivors newly eligible for VA benefits as a result of this decision.
“We knew taking care of this ‘unfinished business’ for Veterans of previous wars would initially drive up the number of claims in our system. But it was the right thing to do,” said Secretary Shinseki.
Since establishing the goal in 2010 of processing all disability claims within 125 days at a 98-percent accuracy level, VA developed and is implementing a plan that transforms the decades-old, manual paper claim approach into a state-of-the-art electronic process that leverages digital data transfer and automated calculators to reduce processing time and input errors.
VA has also increased the productivity of its claims processing workforce through enhanced training, streamlined business processes and other initiatives such as mandating overtime and prioritizing the oldest claims, allowing VA’s 56 regional benefits offices to exceed monthly production records four times in fiscal year 2013.
At the same time, the accuracy of rating decisions continues to improve. VA’s national “claim-level” accuracy rate, determined by dividing the total number of cases that are error-free by the total number of cases reviewed, is currently 91 percent – an eight-percentage-point improvement since 2011. When measuring the accuracy of rating individual medical conditions inside each claim, the three-month accuracy level is 96.5 percent. VA’s accuracy measures are statistically valid and the process has been independently verified by the Institute for Defense Analyses.
Tuesday, March 25, 2014
VA Removes Annual Income Reporting Requirement
March 24, 2014 – The Department of Veterans Affairs (VA) is eliminating the annual requirement for most Veterans enrolled in VA’s health care system to report income information beginning in March 2014. Instead, VA will automatically match income information obtained from the Internal Revenue Service and Social Security Administration.
“Eliminating the requirement for annual income reporting makes our health care benefits easier for Veterans to obtain,” said Secretary of Veterans Affairs Eric K. Shinseki. “This change will reduce the burden on Veterans, improve customer service and make it much easier for Veterans to keep their health care eligibility up-to-date.”
Some Veterans applying for enrollment for the first time are still required to submit income information. There is no change in VA’s long-standing policy to provide no-cost care to indigent Veterans, Veterans with catastrophic medical conditions, Veterans with a disability rating of 50 percent or higher, or for conditions that are officially rated as “service-connected.”
VA encourages Veterans to continue to use the health benefits renewal form to report changes in their personal information, such as address, phone numbers, dependents, next of kin, income and health insurance.
“Eliminating the requirement for annual income reporting makes our health care benefits easier for Veterans to obtain,” said Secretary of Veterans Affairs Eric K. Shinseki. “This change will reduce the burden on Veterans, improve customer service and make it much easier for Veterans to keep their health care eligibility up-to-date.”
Some Veterans applying for enrollment for the first time are still required to submit income information. There is no change in VA’s long-standing policy to provide no-cost care to indigent Veterans, Veterans with catastrophic medical conditions, Veterans with a disability rating of 50 percent or higher, or for conditions that are officially rated as “service-connected.”
VA encourages Veterans to continue to use the health benefits renewal form to report changes in their personal information, such as address, phone numbers, dependents, next of kin, income and health insurance.
Thursday, February 20, 2014
New Compassionate Allowances Conditions
The Social Security Administration just released the following press release about the compassionate allowance program. This program allows those with very serious medical conditions to get their benefits faster.
This month, Carolyn W. Colvin, Acting Commissioner of Social Security, announced 25 new Compassionate Allowances conditions, including a dozen cancers. This brings the total number of conditions to 225.
The Compassionate Allowances program expedites disability decisions for Americans with the most serious disabilities to ensure that they receive their benefit decisions within days instead of months or years. To date, almost 200,000 people with severe disabilities have been approved through this fast-track disability process.
“We are dedicated to providing vulnerable Americans with faster access to disability benefits through our Compassionate Allowances program,” said Acting Commissioner Colvin. “Social Security disability benefits are a vital lifeline for individuals who are facing severe diseases and we must ensure that they receive the benefits they rightly deserve.”
Learn more by reading the press release, where you’ll find a list of the new Compassionate Allowances conditions. www.socialsecurity.gov/pressoffice/pr/compassionate-allowances-0114-pr.html
For more information on the Compassionate Allowances program, including a full list of conditions, please visit www.socialsecurity.gov/compassionateallowances.
New Compassionate Allowances Conditions
Angiosarcoma
Atypical Teratoid/Rhabdoid Tumor
Chronic Idiopathic Intestinal Pseudo Obstruction
Coffin- Lowry Syndrome
Esthesioneuroblastoma
Giant Axonal Neuropathy
Hoyeaal-Hreidarsson Syndrome
Intracranial Hemangiopericytoma
Joubert Syndrome
Leptomeningeal Carcinomatosis
Liposarcoma- metastatic or recurrent
Malignant Ectomesenchymoma
Malignant Renal Rhabdoid Tumor
Marshall-Smith Syndrome
Oligodendroglioma Brain Tumor- Grade III
Pallister-Killian Syndrome
Progressive Bulbar Palsy
Prostate Cancer - Hormone Refractory Disease - or with
visceral metastases
Revesz Syndrome
Seckel Syndrome
Sjogren-Larsson Syndrome
Small Cell Cancer of the Thymus
Soft Tissue Sarcoma- with distant metastases or recurrent
X-Linked Lymphoproliferative Disease
X-Linked Myotubular MyopathyTo see the rest of the compassionate allowance medical conditions you can visit the SSA website or my page on Social Security compassionate allowance.
Monday, January 13, 2014
Change to Hematological Listings (proposed)
The Social Security Administration is proposing changes to the Hematological Listings which have not been updated since 1985. The proposed changes include: Expansion and reordering of introductory text, section 7.00. Using broad categories of hematological disorders. Four Categories will be included. Listing 7.05: Hemolytic anemias; Listing 7.08: Disorders of hemostasis; Listing 7.10: Disorders of bone marrow failure; and Listing 7.17 Hematologicl disorders treated by bone marrow or stem cell transplantation. Also a new functional-based listing, 7.18 would be added.
The new proposed functional listing 7.18 requires a marked level of functional limitations in one of the following areas. Limitations of activities of daily living, or limitations in maintaining social functioning, or limitations in completing tasks in timely manner due to deficiencies in concentration, persistence, or pace.
It should be interesting to see how the final listing comes out after SSA receives comments from the medical and legal community. The proposed listing change will not impact any present Social Security Disability cases until a final version is released. To see the present medical listing of impairments you can visit the SSA website listing page. You should also visit my web page on the medical listing of impairments.
The new proposed functional listing 7.18 requires a marked level of functional limitations in one of the following areas. Limitations of activities of daily living, or limitations in maintaining social functioning, or limitations in completing tasks in timely manner due to deficiencies in concentration, persistence, or pace.
It should be interesting to see how the final listing comes out after SSA receives comments from the medical and legal community. The proposed listing change will not impact any present Social Security Disability cases until a final version is released. To see the present medical listing of impairments you can visit the SSA website listing page. You should also visit my web page on the medical listing of impairments.
Monday, April 29, 2013
SSA Goes Back to Releasing Name of ALJ for Hearing
The Social Security Administration has changed its policy back to putting the Administrative Law Judges name on the SSDI hearing notice. This is a welcome policy change for representatives and claimants at the hearing stage. It is particularly important to SSDI lawyers who have become knowledgeable of what certain ALJs find important. As we all know no two people are the same and the same goes for Judges. Therefore, knowing what a certain ALJ finds to be important to a case can help a lawyer gather the right evidence and present that evidence in a way that is more helpful to the ALJ. I believe the decision to go back to including the name of the ALJ on the notice of hearing for Social Security Disability cases was the right thing to do. I think most people who are waiting for an SSDI hearing would like to know the name of the ALJ that will hear their case.
Thursday, November 15, 2012
Finding of Incompentency in VA Disability Case.
Generally, the VA will pay veteran's disability benefits directly to the veteran who is entitled to them. However, in cases where a veteran has been found to be incompetent, or is otherwise ineligible to receive benefits, the VA is authorized to appoint a fiduciary to receive the and spend funds on the veteran’s behalf.
When the VA first proposes to appoint a fiduciary, a veteran can object to a finding of incompetence. However, once a fiduciary has been appointed, the relationship falls solely within the jurisdiction of the VA. This means that veterans who were assigned irresponsible or incompetent fiduciaries have found themselves with no remedy. However, a recent decision from the Court of Appeals for Veterans Claims indicates that this may be changing.
On April, 26 2011, the Court of Appeals for Veterans Claims issued a decision in Henderson v. Shinseki stating that the assignment of a fiduciary is subject to judicial review. The Court explicitly authorized veterans to challenge the appointment of a fiduciary by filing a Notice of Disagreement and appealing to the Board of Veterans Appeals. While the extent of the right to appeal is unknown, this decision is a very encouraging sign for veterans who find themselves at odds with the VA’s Fiduciary Program.
When the VA first proposes to appoint a fiduciary, a veteran can object to a finding of incompetence. However, once a fiduciary has been appointed, the relationship falls solely within the jurisdiction of the VA. This means that veterans who were assigned irresponsible or incompetent fiduciaries have found themselves with no remedy. However, a recent decision from the Court of Appeals for Veterans Claims indicates that this may be changing.
On April, 26 2011, the Court of Appeals for Veterans Claims issued a decision in Henderson v. Shinseki stating that the assignment of a fiduciary is subject to judicial review. The Court explicitly authorized veterans to challenge the appointment of a fiduciary by filing a Notice of Disagreement and appealing to the Board of Veterans Appeals. While the extent of the right to appeal is unknown, this decision is a very encouraging sign for veterans who find themselves at odds with the VA’s Fiduciary Program.
Monday, July 09, 2012
The “Secret” Disability Program
Disabled Adult Child – someone who is disabled by Age 22
The two programs that come to mind when people think about Social Security Disability are Title II (“regular”) and SSI (needs-based). But there is also another less-known program: Disabled Adult Child (DAC).
How does someone qualify for Disabled Adult Child benefits? You need to prove to Social Security that the individual was disabled before his or her 22nd birthday. You must also have a parent who is collecting Social Security Disability benefits, or a parent who is on SS retirement benefits or a parent that has deceased. This does not mean that the decision must be made by the 22nd birthday, but just that Social Security accepts that the disability existed by that time.
Why would someone want Disabled Adult Child benefits? In a situation where a claimant has worked in the past, the amount of his or her disability benefit is based on what they had earned. (This is the Title II program.) Where there are no earnings or limited earnings, benefits are based on financial need. (This is the SSI program.) Younger people generally have no earnings or low earnings and so the cash amount of their disability benefits is low.
The DAC program calculates benefits based on a parent’s earnings. In most situations, the dollar amount of benefits from a parent will be greater than the amount paid by the SSI program. Medicare (rather than Medicaid) is included under the DAC program, as well.
When can someone receive Disabled Adult Child benefits? DAC benefits are paid when a parent qualifies for Social Security benefits (either through retirement or the parent’s own disability), or if the parent is deceased. But this does not mean that people should wait to apply for disability benefits! An individual should apply for disability benefits as early as possible. Social Security will pay under the applicable program (Title II or SSI) until it is time to transfer the benefits to a DAC claim.
What should I do?
• Apply for disability benefits as soon as possible under all programs that you qualify for.
• Try to prove that you were disabled before you turned 22 years old.
Use medical records, school records, and letters from relatives, friends and clergy/youth group leaders, employers or volunteer opportunity supervisors, etc.
• Shortly before a parent retires, or when a parent begins receiving Social Security Disability benefits or dies, tell Social Security that you need to file a Disabled Adult Child’s Application. The Application is just a formality and does not involve as much paperwork as your first disability application. (You will need to know the Social Security number of your parent.) Make sure to file a DAC Application as soon as you can. If you wait, you might not get all the benefits you are entitled to, since Social Security looks at the date of the Application when it processes payments.
By Risa Rohrberger, Esq.
Risa is an attorney at Kazmierczak & Kazmierczak, LLP. a Social Security Disability law firm.
The two programs that come to mind when people think about Social Security Disability are Title II (“regular”) and SSI (needs-based). But there is also another less-known program: Disabled Adult Child (DAC).
How does someone qualify for Disabled Adult Child benefits? You need to prove to Social Security that the individual was disabled before his or her 22nd birthday. You must also have a parent who is collecting Social Security Disability benefits, or a parent who is on SS retirement benefits or a parent that has deceased. This does not mean that the decision must be made by the 22nd birthday, but just that Social Security accepts that the disability existed by that time.
Why would someone want Disabled Adult Child benefits? In a situation where a claimant has worked in the past, the amount of his or her disability benefit is based on what they had earned. (This is the Title II program.) Where there are no earnings or limited earnings, benefits are based on financial need. (This is the SSI program.) Younger people generally have no earnings or low earnings and so the cash amount of their disability benefits is low.
The DAC program calculates benefits based on a parent’s earnings. In most situations, the dollar amount of benefits from a parent will be greater than the amount paid by the SSI program. Medicare (rather than Medicaid) is included under the DAC program, as well.
When can someone receive Disabled Adult Child benefits? DAC benefits are paid when a parent qualifies for Social Security benefits (either through retirement or the parent’s own disability), or if the parent is deceased. But this does not mean that people should wait to apply for disability benefits! An individual should apply for disability benefits as early as possible. Social Security will pay under the applicable program (Title II or SSI) until it is time to transfer the benefits to a DAC claim.
What should I do?
• Apply for disability benefits as soon as possible under all programs that you qualify for.
• Try to prove that you were disabled before you turned 22 years old.
Use medical records, school records, and letters from relatives, friends and clergy/youth group leaders, employers or volunteer opportunity supervisors, etc.
• Shortly before a parent retires, or when a parent begins receiving Social Security Disability benefits or dies, tell Social Security that you need to file a Disabled Adult Child’s Application. The Application is just a formality and does not involve as much paperwork as your first disability application. (You will need to know the Social Security number of your parent.) Make sure to file a DAC Application as soon as you can. If you wait, you might not get all the benefits you are entitled to, since Social Security looks at the date of the Application when it processes payments.
By Risa Rohrberger, Esq.
Risa is an attorney at Kazmierczak & Kazmierczak, LLP. a Social Security Disability law firm.
Friday, May 18, 2012
Social Security Disability Eligibility Through Work Credits
Protect Yourself: Paying Taxes On Earnings of $4,520 A Year Secures Your Title II Social Security Disability Benefits.
By Tracey E. Cahn Esq. of Kazmierczak & Kazmierczak, LLP.As an attorney who works with a disabled clientele, I am writing to urge all of you who are healthy to work, at least part-time.
Why? Well, while there are many benefits to working, the sole reason I am encouraging you to work is to ensure that you will be eligible for Social Security Title II benefits if there is a substantial period of disability in your future.
What are the potential Social Security Disability benefits?
1. A monthly income,
2. Medicare after 29 months of disability, and
3. Additional monthly income for your minor-aged and/or disabled children
The amount you receive may not be enough to live on, but it will be helpful.
How does it work?
In general terms, if you have worked “enough” within five (5) years of becoming disabled, your Application for disability benefits can be considered by the SSA (Social Security Administration). Without “enough” recent work, the application will be denied outright at the very start of the process, without consideration of the nature and extent of your disability.
What is “enough” work?
In 2012, it means earning a little more than $4,500 a year. Social Security awards “credits” for earned taxable income. The maximum number of credits that can be earned in a year is four (4). In 2012, for every $1,130 you earn and pay taxes on, you receive one (1) credit; when you earn $4,520 in 2012, you will have earned the maximum number of credits allowed in that year. Just remember - You must report your income and pay taxes to get the credits!
These credits gradually expire. The general rule of thumb is that if the claimant has barely worked in the five (5) years prior to disability, the likelihood is great that she has a date last insured problem. (If in doubt, you can always contact your local Social Security Office and make an inquiry.)
Is the date last insured important?
The date last insured is critical because if you cannot prove that your medical condition has been substantially disabling, since before your date last insured, you will not be eligible for Social Security Disability benefits even if you are now obviously disabled. The situation is akin to dropping your fire insurance just before your house goes up in flames. There is no doubt of three things: 1. if you had fire insurance, you would get a check; 2. you no longer have fire insurance; and 3. you will not get a check.
Example:
• Janet last worked in 1999. She was 30 at the time, and had been working for 12 years. She had just gotten married, and her husband made a good income. The couple decided that she had “worked” enough. In 2006, Janet started to feel unwell. She started dragging her right foot, her hands were cramping up and she felt tired all the time. She was diagnosed with multiple sclerosis. This went on for several years, and Janet continued to decline. She finally filed for Social Security disability benefits in 2011.
Is Janet eligible for the benefit?
Short Answer: No. Janet will receive a letter from Social Security stating that her date last insured was in December of 2004, and there is nothing to support that she was disabled from working since before that date.
So what should Janet have done to keep her Social Security Disability Insurance from expiring? She should have continued to work, at least part-time. The current federal minimum wage is $7.25. At minimum wage, if one works about 12 hours a week, they will earn the maximum credits Social Security allows per year. And, even if you cannot work that much, if you can earn even one credit a year, that is still worthwhile as it will prolong the time till your date last insured expires.
Since Janet’s husband makes a nice income, and can provide medical insurance for her, does it really matter that she cannot get disability benefits?
I assert that it does. Financial independence is always preferable. While Social Security benefits are not overly generous, they help. And, then there are the “what ifs”:
• What if Janet’s husband loses his job, and with that, loses the critical medical insurance she heavily relies on;
• What if their financial situation changes for any number of other reasons?
• What if they get divorced?
Janet and her husband need to protect themselves. So do you. Therefore, while you are healthy, do your future self a favor, and find some work that you can do, pay your federal income tax obligation and earn some Social Security credits.
Monday, April 23, 2012
When to Apply for Workers Compensation and Social Security Disability
Workers Compensation or Social Security Disability? If you have been disabled by a work-related accident, and you have been advised or simply know that you will not be able to do any kind of substantial (full-time) work for at least twelve months, I urge you to consider applying promptly for Workers’ Compensation and applying for Social Security Disability benefits as well.
What brings me to this topic is the situation of two recent clients who postponed their Social Security cases thinking they needed to get through their respective WC case before applying for Social Security. Were they mistaken? I must start by conceding that I do not practice WC law. However, from my point of view, they did themselves a great disservice. Their delay cost them thousands in potential recovery from Social Security, delayed their potential Medicare benefits and likely weakened their Social Security cases.
Lost Benefits:
While there is commonly an offset between Social Security and WC benefits, the recipient of both benefits is ordinarily going to realize considerably more than the recipient of just one of these benefits.
For example, on 4/12/2012, say employee Ted herniates 3 lumbar vertebrae while trying to lift drywall into his employer’s truck. The injury prohibits him from lifting and carrying; he cannot stand up straight or stand at all for much of the day; and sitting causes shooting pains down his legs with numbness and tingling. He will be disabled from his work and all other substantial work for a minimum of 12 months.
He applies for WC on 10/12/2012, but does not apply for his SSA benefits until his WC case is settled three years later on 10/12/2015.
Question: Did the postponement of the SSA application cost Ted anything?
Answer: ABSOLUTELY. Social Security will only go back one year prior to the date of his application in affixing retroactive benefits. Waiting one year would not have cost Ted anything, but waiting three years cost Ted 2 years of SSA benefits.
Question: Since there is an offset between WC and SSA, doesn’t that mean that Ted would have gotten the same amount even if he had gotten the award from SSA?
Answer: No. WC is governed by the individual states, and the offset is not commonly 100%. In every state I am aware of, there is still a considerable percentage given above the offset. In general, a beneficiary of both programs should expect to receive a 15% better benefit if he is receiving from both programs. Furthermore, SSA ordinarily offers more than WC.
Other benefits – Medicare and Dependent Benefits:
• If disabled for greater than 29 months, the SSA beneficiary will be offered an option to enter the Medicare system; and
• If the SSA beneficiary has a disabled or minor-aged child or children, those dependents may also be eligible to receive benefits. [These additional benefits are not part of the WC system.]
Question: So, what if Ted had two minor aged children and earned $50,000 a year; what would he expect to receive?
Answer: If he was found to be fully entitled to WC benefits, he may expect to receive $32,000 annually. However, if he received from both programs, after the offset, he could expect to receive considerably more, likely around $40,000 a year for himself. And, since he has two minor aged children, they may also expect an award of benefits as well.
Weakened Case:
Another critical factor is that the strength of the SSA case will likely weaken as time goes on. Getting benefits from insurance companies and from the government takes time and proof. In both the WC and SSA case, the Claimant has the burden of proof. Prior to the settlement of the WC case, the injured worker is generally given some level of medical care through his employer’s insurer. While I find that these doctors commonly dictate reports that are heavily slanted to the benefit of the employer, at least their treatment provides some medical assistance to the claimant, and it also serves to document the disabling conditions. But, once the WC case is settled, the insurer will stop providing access to care. When this happens, the treatment stops and so does the documentation of the disability, at least until new doctors are secured; sadly, many in such a predicament, cannot afford to continue any form of treatment. Thus, even though the Claimant’s condition has remained unchanged, the SSA case has been substantially weakened by the delay in filing.
For all these reasons and more, I urge those of you who have potential claims for both WC and SSA to consider your options and resources, and file wisely: file timely applications for both benefits.
By: Tracey E. Cahn, Esq.
What brings me to this topic is the situation of two recent clients who postponed their Social Security cases thinking they needed to get through their respective WC case before applying for Social Security. Were they mistaken? I must start by conceding that I do not practice WC law. However, from my point of view, they did themselves a great disservice. Their delay cost them thousands in potential recovery from Social Security, delayed their potential Medicare benefits and likely weakened their Social Security cases.
Lost Benefits:
While there is commonly an offset between Social Security and WC benefits, the recipient of both benefits is ordinarily going to realize considerably more than the recipient of just one of these benefits.
For example, on 4/12/2012, say employee Ted herniates 3 lumbar vertebrae while trying to lift drywall into his employer’s truck. The injury prohibits him from lifting and carrying; he cannot stand up straight or stand at all for much of the day; and sitting causes shooting pains down his legs with numbness and tingling. He will be disabled from his work and all other substantial work for a minimum of 12 months.
He applies for WC on 10/12/2012, but does not apply for his SSA benefits until his WC case is settled three years later on 10/12/2015.
Question: Did the postponement of the SSA application cost Ted anything?
Answer: ABSOLUTELY. Social Security will only go back one year prior to the date of his application in affixing retroactive benefits. Waiting one year would not have cost Ted anything, but waiting three years cost Ted 2 years of SSA benefits.
Question: Since there is an offset between WC and SSA, doesn’t that mean that Ted would have gotten the same amount even if he had gotten the award from SSA?
Answer: No. WC is governed by the individual states, and the offset is not commonly 100%. In every state I am aware of, there is still a considerable percentage given above the offset. In general, a beneficiary of both programs should expect to receive a 15% better benefit if he is receiving from both programs. Furthermore, SSA ordinarily offers more than WC.
Other benefits – Medicare and Dependent Benefits:
• If disabled for greater than 29 months, the SSA beneficiary will be offered an option to enter the Medicare system; and
• If the SSA beneficiary has a disabled or minor-aged child or children, those dependents may also be eligible to receive benefits. [These additional benefits are not part of the WC system.]
Question: So, what if Ted had two minor aged children and earned $50,000 a year; what would he expect to receive?
Answer: If he was found to be fully entitled to WC benefits, he may expect to receive $32,000 annually. However, if he received from both programs, after the offset, he could expect to receive considerably more, likely around $40,000 a year for himself. And, since he has two minor aged children, they may also expect an award of benefits as well.
Weakened Case:
Another critical factor is that the strength of the SSA case will likely weaken as time goes on. Getting benefits from insurance companies and from the government takes time and proof. In both the WC and SSA case, the Claimant has the burden of proof. Prior to the settlement of the WC case, the injured worker is generally given some level of medical care through his employer’s insurer. While I find that these doctors commonly dictate reports that are heavily slanted to the benefit of the employer, at least their treatment provides some medical assistance to the claimant, and it also serves to document the disabling conditions. But, once the WC case is settled, the insurer will stop providing access to care. When this happens, the treatment stops and so does the documentation of the disability, at least until new doctors are secured; sadly, many in such a predicament, cannot afford to continue any form of treatment. Thus, even though the Claimant’s condition has remained unchanged, the SSA case has been substantially weakened by the delay in filing.
For all these reasons and more, I urge those of you who have potential claims for both WC and SSA to consider your options and resources, and file wisely: file timely applications for both benefits.
By: Tracey E. Cahn, Esq.
Wednesday, April 04, 2012
Investigating the wide disparity in allowance rates from Social Security Disability hearings
One of the most frustrating aspects of the Social Security disability process, particularly at the hearing level, is the inconsistency of administrative law judge decisions. The average allowance rate for 2010 was 67% at the hearing level. However, the hearing level approval rate for administrative law judges ranged from 8.6% to 99.7%. The difference between the judge with the lowest percentage of approvals and that of the judge with the highest percentage of approvals is enormous. The Social Security Administration Office of Inspector General, also called OIG, has looked into the situation. It is not all that clear what the OIG plans to do or can do about the situation. One of the reasons there is an appeals Council is to review decisions by ALJ's to make sure the decisions follow Social Security guidelines. One problem I see with this is with the new rules that do not allow a claimant to file appeal to the appeal council and a new application at the same time it is forcing many claimants to make a choice whether or not to appeal their case and many are not appealing the hearing decision in hopes of getting a quicker decision with the new application. It will be interesting to see what steps are taken to correct this problem without interfering with an ALJ's decisional independence. For those of you at the hearing stage, unfortunately, due to new rules from Social Security you will not know which ALJ you will be in front of until the day of the hearing. However, after you have your hearing it may be a good idea to try and find out your particular ALJ's approval rating so that in case you were denied it can help you decide whether or not to appeal or file a new application.
Thursday, March 01, 2012
Medical Conditions and Social Security Disability Claims
I am frequently asked what someone's chances are of winning a Social Security disability claim if they have a certain medical condition. You can be found disabled for almost any medical condition if it is severe enough and limits your ability to work to the required degree. However, in this post I will discuss some of the most common medical conditions that are awarded SSDI and SSI benefits. The most common medical conditions found in people who are awarded SSDI benefits are in the musculoskeletal system and connective tissue category. As of 2010, this category amounted to 32.5% of people awarded benefits had a musculoskeletal or connective tissue condition. This category includes conditions of the lumbar spine, thoracic spine, cervical spine, arthritis of the joints, amputations, soft tissue injuries and many more. According to the same report, mental disorders were found in 21.4% of those awarded SSDI or SSI benefits. The mental disorders can be broken down further into different types of mental medical conditions. Mood disorders amounted to 11.2% and this includes depression and bipolar disorder. Organic mental disorders amounted to 2.9% this includes mental disorders such as dementia and mental retardation and can be caused by traumatic brain injury, strokes, brain tumors, and getting older. Schizophrenic and other psychotic disorders was 2.1% of those awarded benefits. This category includes among others schizophrenia. Intellectual disability is 1.8% with autistic disorders, developmental disorders, childhood and adolescent disorder not elsewhere classified, and other mental conditions amounting to the remaining 3.4%. So musculoskeletal system and connective tissue and mental disorders combined accounts for 53.9% of those awarded SSDI or SSI benefits. Of those awarded benefits 10.2% had a medical condition involving circulatory system. This category includes heart attacks, strokes and others. Neoplasms were found in 9.0% of awardees. Neoplasms include different types of cancers and tumors. Medical conditions involving the nervous system and sense organs was found in 8.2% of those awarded benefits. All other impairments made up the remaining 18.7% of those awarded Social Security disability benefits. Like I said earlier you can be found disabled based on many different medical conditions if you can document the severity of your condition and how it limits you from being able to work. I felt this statistical information on medical conditions and Social Security disability claims would be interesting to my readers.
Thursday, January 26, 2012
Is The SSDI Program Sustainable?
Congress recently had hearings on the sustainability of the Social Security disability program. Chairman Johnson in his opening statement provided some interesting statistics. "The continuing growth of the program is striking. At a time when workers paying into the system has increased nearly 70% between 1970 and 2010, the number of people receiving disability benefits increased by almost 300%, from 2.6 million to nearly 10 million." The chairman continued by stating: "according to the 2011 trustees report, without congressional action, the disability insurance trust fund will be unable to pay full benefits beginning in 2018, just a little over six years from now. The path we are on is unsustainable, and we are putting individuals with disabilities at risk if we do not accept soon." There would appear to only be a few solutions to this problem. There would either have to be a reduction in benefits or an increase in revenues. I am guessing that we may see a combination of these two. It is a shame that we've gotten to this point of a crisis situation. Congress has been punting this problem for years and years and as usual because of the delay we are now at a point where the changes will be painful to taxpayers and possibly the disabled as well. It is my hope, that our government will take this issue seriously and find a way to make the Social Security disability system sustainable for the long haul. Social Security disability benefits are a crucial safety net for society's disabled. This is a system in which those that are eligible have been paying into, through their taxes from work, with the understanding that if they become disabled or when they retire there will be benefits available to them. All of us who have paid into the system deserve the protection it provides and hopefully Congress can find a solution to this urgent problem.
Tuesday, September 20, 2011
Veterans and Social Security Disability Benefits
In this article, I will address the two questions I get asked the most by veterans considering applying for Social Security disability benefits. The question I get asked the most is whether or not you can receive both Social Security disability and VA compensation benefits at the same time? You can receive VA compensation and Social Security disability at the same time. That being said, it is important that you know that VA pension benefits and supplemental security income (SSI) are handled differently than VA compensation and Social Security disability (SSDI). So as long as you are sure you're getting VA compensation and applying for Social Security disability then you can get both benefits. However, if your receiving VA pension and getting or applying for SSI this is not the same since these benefits are based in part on financial need.
Probably, the second most common question is if getting 100% VA compensation will result in a favorable Social Security disability decision? It is also frequently asked in the reverse, does winning a Social Security disability claim mean you will get 100% VA compensation? It is important to know that a favorable Social Security disability decision or a 100% VA compensation rating is not binding on the opposite agency. If you are applying for Social Security disability benefits and you have a 100% VA compensation rating or individual unemployability this is good evidence that you are disabled, but it is not automatic. If you are applying for individual unemployability through VA compensation a favorable Social Security disability decision can be helpful in many cases. I say it can be helpful in many cases and not all cases because individual unemployability is determined by the VA by only considering your service-connected disabilities. Social Security disability will look at all of your disabilities when determining if you are disabled. So it is very possible you may be disabled under Social Security disability rules but not be entitled to individual unemployability under VA compensation rules. For more information on VA compensation visit my website on the subject. If you're looking for more information on Social Security disability you can visit my website on that subject. If you would like to speak to somebody on the phone about VA disability or Social Security disability feel free to call me at 1-877-527-5529.
Wednesday, September 14, 2011
How to Prepare for a Social Security Disability Hearing
For most claimants the most intimidating part of a Social Security disability claim is the hearing before the adminstrative law judge. In this article, I will explain some simple tips to help get you through the hearing process. Probably the most important thing is to make sure your file contains all your medical evidence and opinion evidence from your treating doctors. Opinion evidence can come in the form of RFC's or doctors report. Good opinion evidence will explain your medical conditions and how these conditions limit you in your ability to work. A letter from your Dr. stating that you are totally and permanently disabled with no clarification is basically useless. At the hearing stage, you will have an opportunity review your file. Take this opportunity to make sure all of your medical evidence and opinion evidence is in your file. You will also be able to see what Social Security doctors have said about your condition and your limitations. It also helps to understand what type of questions will be asked at your Social Security disability hearing. To get an idea of the questions that will be asked follow the link to my page on SSDI hearings. You may also want to consider hiring an SSDI lawyer because if you hire an experienced disability lawyer they will have handled many Social Security hearings. This will not only help you understand what to expect, but your lawyer should be skilled in the ability to ask questions and cross examine. They will also be able to present the theory of your case as to why you are disabled. If you choose not to get a lawyer then you should make sure you understand exactly what you have to prove to win your particular claim. Once you understand what you have to prove, you should then go through your file and make notes about the exhibits that help show you are disabled under Social Security rules. One thing to remember, is that Social Security hearings are informal hearings, which means you do not have to worry about rules of evidence. A Social Security disability hearing is fairly straightforward, with the ALJ or your lawyer if you have one asking questions of you. It is also possible there may be a medical expert or vocational expert or both at your hearing. In this situation, I strongly recommend getting an experienced SSDI lawyer since it would be nearly impossible for me to be able to explain how to cross examine these witnesses. One other thing you should know about the hearing is that most of the time you will not get a decision the day you have your hearing. It usually takes a couple of months to get a decision from the hearing office. For more information on SSD or SSI hearings follow link above to my page on the subject.
Sunday, June 12, 2011
Social Security Disability: Don't Sabotage Your Case
The following true story is from Tracey E. Cahn a very experienced SSDI lawyer who works for my law firm. This story illustrates how someones disability can sometimes hurt their case. It is also an example of how it takes a big heart as well as a sharp mind to practice as a Social Security Disability lawyer.
There are disabled clients who are so desperately ill that they sabotage their Social Security Disability cases. Fortunately it is a rare occurrence, but it is a situation that definitely exists. Who would sabotage their case? I am not a fan of the generalization, but here it goes – these are people who are scared beyond reason, and often it has to do with an irrational fear of losing their children.
Today, I am going to discuss a woman I represented at her Social Security Disability Hearing yesterday. Ms. X has been diagnosed with fibromyalgia, hypertension, obesity, degenerative disc disease, depression and anxiety. These conditions can certainly be disabling. However, in this instance, I believe Ms. X has another condition that has yet to be diagnosed. I believe she has an organic brain disease. I do not know what happened, but I believe something has happened that has caused her IQ to decline drastically.
Ms. X has a college education and served in the military. She is twice divorced and has two children; both children are mentally challenged and receive disability benefits. Ms. X filed for disability benefits several years ago and previously appeared at an SSDI hearing. The Administrative Law Judge (ALJ) ruled that she was not severely disabled, and he based his decision primarily on the Claimant’s testimony regarding her tremendous care of her sons.
Her sons do need a great deal of attention, and she gives them all she can. However, what she did not tell the ALJ at that initial hearing is that most of their care is performed by aides supplied to her children in the morning, in the afternoon and in the evening, seven days a week. I did meet one of her sons. He is a sweet boy who behaves much like a well-spoken four year old; he is a teenager.
The first ALJ never heard about the extraordinary help she has for the children, never heard of her limited responsibilities for her children, never heard about the fact that she worked many part-time jobs around her sons’ schedules, never heard that even after her hours were reduced at her last job, she was still missing days due to pain and making many mistakes. Why did the ALJ not hear all the evidence? She left the ALJ with a false impression of her abilities because she was afraid he had the power to take away her children. She was too fearful to tell the full truth, and sabotaged her initial case as a result.
I was assigned to Ms. X’s new case for disability benefits about a month ago. I reviewed the file, and called her. I explained who I am, and reminded her of her upcoming SSD hearing. She had forgotten. I found her to have a very distracted mind, but I had no idea of her fear that she might lose her children. I had many medical records to review. I also had a report from a doctor, a primary care physician, stating that she has severe problems with concentration. This report was my only hint of what might be going on with her.
During the last few days before the hearing, I spoke to Ms. X no less than three times. I did my usual preparations for myself and the client. Together we filled out some forms that she had forgotten or neglected to complete. I was set for the hearing, but unsure of how she was going to get there. Especially since I was driving nearly 200 miles to get to her disability hearing, I wanted to make sure she would be present. I knew she could not tolerate a drive of that distance; I needed to make sure she had a ride.
The day before the hearing, I called Ms. X, we had another pleasant conversation. She tried to assure me that she would get a ride from a neighbor. Luckily the hearing was in the afternoon. I told her I would call her the next day at 9am, while I was on my way to her hearing, to see whether she did in fact have a ride.
I called. She did not answer the telephone. I called a half hour later, she did not answer. I called at least three more times. She did not answer the telephone. At that point in my journey, I had to make a choice. I could continue my drive and get to the hearing 2 hours early, or I could detour an hour and look for my client at her home. I detoured.
Fortunately, she did not live in a bad neighborhood. In fact, she lives in a relatively new townhouse community. It was very pleasant. I found her apartment, and rang the bell. I did not have much hope of an answer, but I felt that I had to give her the best opportunity to be heard. She did answer the door.
I arrived at her home an hour and a half before her hearing. Her hearing was to be held in a city an hour’s drive away. She appeared at the door wearing a bathrobe; I had awoken her from her nap. Her son was in the living room crowded with stacks of laundry, a bicycle and a bounty of other materials I was not interested in identifying. He was playing with pictures from a child’s movie from 10 years ago. I told her I was there to drive her to the hearing. She was not grateful. She was fearful. I told her to get dressed, we needed to be at the hearing in an hour. She agreed. She called a neighbor who was luckily available to watch her son.
As she dressed, I spoke with her son. We talked about the pictures he was playing with. I remembered the movie because my daughter, a year older than this boy, had loved that movie when it came out ten years before. Like this boy, she played with pictures of these characters, but she was five at the time.
Ms. X took about ten minutes to ready herself, and we left. Usually when I do a favor for a client, they are overly appreciative. Here, Ms. X did not appreciate my efforts in any way. She seemed frightened of me. I was annoyed at first. She had hired our firm to represent her in her Social Security disability claim, and she was not even going to have the courtesy to call me to let me know that she was not going to be there. I thought it was amazingly rude that she had known that I would be calling her and that she would not pick up the telephone. I kept my temper, and inquired how she had intended to get to the hearing had I not arrived. She said that she had planned to call the cab company to pick her up. I was in disbelief. Then, I learned what fear and misunderstanding had done to her. She started crying that the judge was going to take her kids away from her. She thought I was from the government and that I was dragging her to family court to have her children removed from her home.
I was shocked. I had spoken to this woman several times, others from my office had spoken to her, and she had hired us to represent her. But, she had become deluded and fearful and was panicked. I tried my best to calm her. I explained that the ALJ was not charged with making a decision about her children. I explained that my understanding is that she is a very good mother, and that she gets a lot of support to care for her children. I told her that I would tell that to the ALJ, but that the ALJ’s primary concern is whether she is disabled from working under the Social Security rules. No more, and no less.
She seemed to relax a bit. At least, she stopped crying for a while. She was scared that the ALJ would ask her too many questions and that she would not remember dates and times. I told her that all she is expected to do is tell the truth, and remember to the best of her ability.
We got to the hearing office. Generally I do not drive clients to their hearings. I only do it when I feel safe with the person, when they do not smoke and when they absolutely have no other way of getting there. I did not feel safe with Ms. X, but she does not smoke, so with 2 of out three of my rules met, I drove her. When I do drive clients to their hearing, I generally will drop them off at the front door of the building and then I find parking. Here, I did not trust that Ms. X would be safe alone. I thought she might wander off.
We made it to the 5th floor, and met the security guard. He instructed us to make use of the coat rack. My client put down her bag. Within moments she was thrown into a panic. She had forgotten what she did with the bag, and starting crying and screaming that someone had stolen it. Fortunately, I found it quickly under her coat and gave it to her. Nevertheless, she kept insisting someone had stolen it.
When called, I asked to speak with the ALJ alone. The ALJ was receptive. Before the ALJ started questioning my client, I wanted her to understand what I had observed that morning. The ALJ was very understanding. We had never met before but she struck me as the type of judge you always hope for – kind, patient and intelligent.
My client came in. Questioning began. My client asked the ALJ twice during the hearing what this proceeding was about and where she was. We gave her a full explanation both time. I am not sure whether she forgot or whether she just did not trust our answer. Questioning continued. The ALJ ruled from the bench that she would award benefits. The client remained impassive, but was glad to be allowed to leave.
I had already told Ms. X that I would be driving her home, but she still cried that she had no way of getting home. I explained to her what the decision meant. She did not trust what I said. I bought her sons their favorite candy bars. She was happy about that. I drove her home. She slept most of the way.
I was happy the day was over. I hope Ms. X will improve. I am glad we prevented her from sabotaging her case again.
There are disabled clients who are so desperately ill that they sabotage their Social Security Disability cases. Fortunately it is a rare occurrence, but it is a situation that definitely exists. Who would sabotage their case? I am not a fan of the generalization, but here it goes – these are people who are scared beyond reason, and often it has to do with an irrational fear of losing their children.
Today, I am going to discuss a woman I represented at her Social Security Disability Hearing yesterday. Ms. X has been diagnosed with fibromyalgia, hypertension, obesity, degenerative disc disease, depression and anxiety. These conditions can certainly be disabling. However, in this instance, I believe Ms. X has another condition that has yet to be diagnosed. I believe she has an organic brain disease. I do not know what happened, but I believe something has happened that has caused her IQ to decline drastically.
Ms. X has a college education and served in the military. She is twice divorced and has two children; both children are mentally challenged and receive disability benefits. Ms. X filed for disability benefits several years ago and previously appeared at an SSDI hearing. The Administrative Law Judge (ALJ) ruled that she was not severely disabled, and he based his decision primarily on the Claimant’s testimony regarding her tremendous care of her sons.
Her sons do need a great deal of attention, and she gives them all she can. However, what she did not tell the ALJ at that initial hearing is that most of their care is performed by aides supplied to her children in the morning, in the afternoon and in the evening, seven days a week. I did meet one of her sons. He is a sweet boy who behaves much like a well-spoken four year old; he is a teenager.
The first ALJ never heard about the extraordinary help she has for the children, never heard of her limited responsibilities for her children, never heard about the fact that she worked many part-time jobs around her sons’ schedules, never heard that even after her hours were reduced at her last job, she was still missing days due to pain and making many mistakes. Why did the ALJ not hear all the evidence? She left the ALJ with a false impression of her abilities because she was afraid he had the power to take away her children. She was too fearful to tell the full truth, and sabotaged her initial case as a result.
I was assigned to Ms. X’s new case for disability benefits about a month ago. I reviewed the file, and called her. I explained who I am, and reminded her of her upcoming SSD hearing. She had forgotten. I found her to have a very distracted mind, but I had no idea of her fear that she might lose her children. I had many medical records to review. I also had a report from a doctor, a primary care physician, stating that she has severe problems with concentration. This report was my only hint of what might be going on with her.
During the last few days before the hearing, I spoke to Ms. X no less than three times. I did my usual preparations for myself and the client. Together we filled out some forms that she had forgotten or neglected to complete. I was set for the hearing, but unsure of how she was going to get there. Especially since I was driving nearly 200 miles to get to her disability hearing, I wanted to make sure she would be present. I knew she could not tolerate a drive of that distance; I needed to make sure she had a ride.
The day before the hearing, I called Ms. X, we had another pleasant conversation. She tried to assure me that she would get a ride from a neighbor. Luckily the hearing was in the afternoon. I told her I would call her the next day at 9am, while I was on my way to her hearing, to see whether she did in fact have a ride.
I called. She did not answer the telephone. I called a half hour later, she did not answer. I called at least three more times. She did not answer the telephone. At that point in my journey, I had to make a choice. I could continue my drive and get to the hearing 2 hours early, or I could detour an hour and look for my client at her home. I detoured.
Fortunately, she did not live in a bad neighborhood. In fact, she lives in a relatively new townhouse community. It was very pleasant. I found her apartment, and rang the bell. I did not have much hope of an answer, but I felt that I had to give her the best opportunity to be heard. She did answer the door.
I arrived at her home an hour and a half before her hearing. Her hearing was to be held in a city an hour’s drive away. She appeared at the door wearing a bathrobe; I had awoken her from her nap. Her son was in the living room crowded with stacks of laundry, a bicycle and a bounty of other materials I was not interested in identifying. He was playing with pictures from a child’s movie from 10 years ago. I told her I was there to drive her to the hearing. She was not grateful. She was fearful. I told her to get dressed, we needed to be at the hearing in an hour. She agreed. She called a neighbor who was luckily available to watch her son.
As she dressed, I spoke with her son. We talked about the pictures he was playing with. I remembered the movie because my daughter, a year older than this boy, had loved that movie when it came out ten years before. Like this boy, she played with pictures of these characters, but she was five at the time.
Ms. X took about ten minutes to ready herself, and we left. Usually when I do a favor for a client, they are overly appreciative. Here, Ms. X did not appreciate my efforts in any way. She seemed frightened of me. I was annoyed at first. She had hired our firm to represent her in her Social Security disability claim, and she was not even going to have the courtesy to call me to let me know that she was not going to be there. I thought it was amazingly rude that she had known that I would be calling her and that she would not pick up the telephone. I kept my temper, and inquired how she had intended to get to the hearing had I not arrived. She said that she had planned to call the cab company to pick her up. I was in disbelief. Then, I learned what fear and misunderstanding had done to her. She started crying that the judge was going to take her kids away from her. She thought I was from the government and that I was dragging her to family court to have her children removed from her home.
I was shocked. I had spoken to this woman several times, others from my office had spoken to her, and she had hired us to represent her. But, she had become deluded and fearful and was panicked. I tried my best to calm her. I explained that the ALJ was not charged with making a decision about her children. I explained that my understanding is that she is a very good mother, and that she gets a lot of support to care for her children. I told her that I would tell that to the ALJ, but that the ALJ’s primary concern is whether she is disabled from working under the Social Security rules. No more, and no less.
She seemed to relax a bit. At least, she stopped crying for a while. She was scared that the ALJ would ask her too many questions and that she would not remember dates and times. I told her that all she is expected to do is tell the truth, and remember to the best of her ability.
We got to the hearing office. Generally I do not drive clients to their hearings. I only do it when I feel safe with the person, when they do not smoke and when they absolutely have no other way of getting there. I did not feel safe with Ms. X, but she does not smoke, so with 2 of out three of my rules met, I drove her. When I do drive clients to their hearing, I generally will drop them off at the front door of the building and then I find parking. Here, I did not trust that Ms. X would be safe alone. I thought she might wander off.
We made it to the 5th floor, and met the security guard. He instructed us to make use of the coat rack. My client put down her bag. Within moments she was thrown into a panic. She had forgotten what she did with the bag, and starting crying and screaming that someone had stolen it. Fortunately, I found it quickly under her coat and gave it to her. Nevertheless, she kept insisting someone had stolen it.
When called, I asked to speak with the ALJ alone. The ALJ was receptive. Before the ALJ started questioning my client, I wanted her to understand what I had observed that morning. The ALJ was very understanding. We had never met before but she struck me as the type of judge you always hope for – kind, patient and intelligent.
My client came in. Questioning began. My client asked the ALJ twice during the hearing what this proceeding was about and where she was. We gave her a full explanation both time. I am not sure whether she forgot or whether she just did not trust our answer. Questioning continued. The ALJ ruled from the bench that she would award benefits. The client remained impassive, but was glad to be allowed to leave.
I had already told Ms. X that I would be driving her home, but she still cried that she had no way of getting home. I explained to her what the decision meant. She did not trust what I said. I bought her sons their favorite candy bars. She was happy about that. I drove her home. She slept most of the way.
I was happy the day was over. I hope Ms. X will improve. I am glad we prevented her from sabotaging her case again.
Tuesday, May 10, 2011
How to Win a Social Security Disability Claim
There are many things you can do to win your Social Security Disability claim. I clearly cannot cover all of them in this one post, but I am going to explain two basic things that can help any disability claim. If you want to give yourself the best chance to win your SSDI or SSI claim you should read my full website on Social Security Disability. However, for those of you who preferred the abridged version I am going to explain the two basic ways you can win your claim and what you need to do it.
The first way you can be found disabled is if you meet or equal a listed impairment. To be found disabled under a listing it is extremely important that your doctor believes you meet or equal listing and is willing to write you a report explaining which listing by number and why. The report should include any medical evidence, tests, x-rays, MRIs or other medical evidence that the listing requires. It also helps if the doctor who is writing the report is a specialist in the area which you are claiming to meet a listing in. This sounds very easy, but the medical listing of impairments were written to be difficult to meet or equal, because if you are found disabled based on a listing they will not consider your age, education, or past work experience. The listing of impairments requires a severity of a medical condition that is so severe that anyone who meets the requirements is clearly disabled no matter what their age, education, or past work experience is. Most people applying for Social Security Disability benefits will not meet or equal a listed impairment. That being said, this should be the first place you look and if you feel you may meet or equal a listed impairment you should take a copy to your doctor to see if he or she feels the same way.
The second way you can be found disabled is if you can show the limitations caused by your medical conditions would prevent you from working. Your age, education, and past work experience are important here and dictate exactly how limited you must be to be found disabled but to be safe it is best to assume you have to show you cannot do any work. Nobody knows what limitations you have from your medical condition like you do. Unfortunately, Social Security cares more about what doctors believe your limitations are. This is why it is very important that you get opinion evidence from your treating doctors. In every case, Social Security examining and nonexamining doctors will give their opinion of your limitations from your medical conditions. You will need to get your treating doctor's opinions so that the Social Security doctor's opinions are not the only opinion of your limitations in your file. It is also important to know that your doctor's opinion is supposed to be given more weight than the opinion of the Social Security doctors if it is supported by the rest of the medical evidence. There are two ways to get your doctors opinion of your limitations. You can ask your doctor for a report explaining your medical condition and how it prevents you from working. The second way, and in my opinion the easier and better way, is to get RFC forms completed by as many of your treating doctors as you can. If you have an RFC completed by your doctor, and it shows limitations that would prevent you from working, and you have medical evidence that supports that opinion, then you have a real good chance of winning your Social Security disability claim. If you have two or more RFC's that show you have limitations that would prevent you from working and you have the medical evidence that supports these opinions then it would be very difficult for Social Security to deny your claim.
So, those are the to basic ways to prove you are disabled. You should always check if you meet or equal a listed impairment and get a report from your doctor if he or she believes you do to. Whether you are able to provide a report that states you meet or equal listed impairment or not, you should then try and get an RFC from each of your treating doctors. You cannot assume that Social Security will follow your treating doctors opinion, which is why you still need to get RFC's even if you have a report that states you meet or equal a listing. Also, if you have an RFC that shows you are unable to work, you should try and get another from one of your other treating doctors for the same reason. No matter what your medical condition is, if you can get a detailed report or RFC that shows you are disabled you will greatly increase your chances of winning your Social Security disability claim.
The first way you can be found disabled is if you meet or equal a listed impairment. To be found disabled under a listing it is extremely important that your doctor believes you meet or equal listing and is willing to write you a report explaining which listing by number and why. The report should include any medical evidence, tests, x-rays, MRIs or other medical evidence that the listing requires. It also helps if the doctor who is writing the report is a specialist in the area which you are claiming to meet a listing in. This sounds very easy, but the medical listing of impairments were written to be difficult to meet or equal, because if you are found disabled based on a listing they will not consider your age, education, or past work experience. The listing of impairments requires a severity of a medical condition that is so severe that anyone who meets the requirements is clearly disabled no matter what their age, education, or past work experience is. Most people applying for Social Security Disability benefits will not meet or equal a listed impairment. That being said, this should be the first place you look and if you feel you may meet or equal a listed impairment you should take a copy to your doctor to see if he or she feels the same way.
The second way you can be found disabled is if you can show the limitations caused by your medical conditions would prevent you from working. Your age, education, and past work experience are important here and dictate exactly how limited you must be to be found disabled but to be safe it is best to assume you have to show you cannot do any work. Nobody knows what limitations you have from your medical condition like you do. Unfortunately, Social Security cares more about what doctors believe your limitations are. This is why it is very important that you get opinion evidence from your treating doctors. In every case, Social Security examining and nonexamining doctors will give their opinion of your limitations from your medical conditions. You will need to get your treating doctor's opinions so that the Social Security doctor's opinions are not the only opinion of your limitations in your file. It is also important to know that your doctor's opinion is supposed to be given more weight than the opinion of the Social Security doctors if it is supported by the rest of the medical evidence. There are two ways to get your doctors opinion of your limitations. You can ask your doctor for a report explaining your medical condition and how it prevents you from working. The second way, and in my opinion the easier and better way, is to get RFC forms completed by as many of your treating doctors as you can. If you have an RFC completed by your doctor, and it shows limitations that would prevent you from working, and you have medical evidence that supports that opinion, then you have a real good chance of winning your Social Security disability claim. If you have two or more RFC's that show you have limitations that would prevent you from working and you have the medical evidence that supports these opinions then it would be very difficult for Social Security to deny your claim.
So, those are the to basic ways to prove you are disabled. You should always check if you meet or equal a listed impairment and get a report from your doctor if he or she believes you do to. Whether you are able to provide a report that states you meet or equal listed impairment or not, you should then try and get an RFC from each of your treating doctors. You cannot assume that Social Security will follow your treating doctors opinion, which is why you still need to get RFC's even if you have a report that states you meet or equal a listing. Also, if you have an RFC that shows you are unable to work, you should try and get another from one of your other treating doctors for the same reason. No matter what your medical condition is, if you can get a detailed report or RFC that shows you are disabled you will greatly increase your chances of winning your Social Security disability claim.
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