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February 23, 2017

Terminal Illness or TERI cases and Social Security Disability

One of the unfortunate realities of my job is that some of my clients are diagnosed as terminal. While being diagnosed with a terminal illness may seem like an obvious favorable decision for the Social Security Administration (SSA) to make, that may not always be the case. Even with this diagnosis the SSA may need more information and can be slow in making a determination.  Hopefully your medical provider, family, and Social Security attorney or representative can gather the information to make it easier for the SSA to make the right decision quickly.   The Social Security Administration avoids the words “terminal illness” and instead calls these cases TERI cases. The SSA defines a TERI case as “a medical condition that is untreatable and expected to result in death.”  Once this type of designation exists, the SSA attempts to expedite the case in the early and later stages of processing.  The SSA has guidelines for identifying these cases and processing them in a particular way.   Getting a medical source statement from your treating physician can be very important. Not only a statement saying the individual is terminal, but also supporting medical evidence establishing a clear diagnosis.  Objective testing and progress notes should be submitted to the SSA to show the severity of the condition.  Many physicians are hesitant to make such statements until all medical avenues have been exhausted.  If you find yourself in this situation it may be in your best interest to let your physician know you are dealing with the Social Security Administration.   If you or a family member finds themselves in this situation, I urge you to contact the SSA as soon as possible to start this process. Qualified Social Security disability attorneys and representatives can also provide guidance on filling out paperwork and … Continued

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January 31, 2017

Social Security Disability and the Durational Requirement

As a Social Security Disability Attorney, I see the Social Security Administration (SSA) turn people down for a variety of reasons. One of the common ways you may be turned down for Supplemental Security Income (SSI) and/or Social Security Disability Insurance (SSDI) is because the SSA states you do not meet its Durational Requirement.  This is a fairly easy way for them to turn down your claim, but you can appeal this decision and many times find yourself with a favorable outcome in the long run.   What is the “Durational Requirement”? The language the SSA uses requires that you must have an impairment lasting or expected to last at least 12 months.  As you can tell, this can be a pretty subjective standard.  The SSA makes this determination on the current medical records they have on hand.  Unfortunately, your medical record may be incomplete when they make this determination.  You can appeal this decision and if you believe you are unable to work and will continue to be unable to work it is most likely in your best interest to file a Request for Reconsideration or Request for Hearing to move your case along.  You have approximately 60 days to file these appeals and it is very important to do so in a timely manner so you do not have to file another initial application.   It is also important to note your impairment must prevent you from performing Substantial Gainful Activity (SGA) for at least 12 months in a row. What this essentially means is that you cannot receive disability benefits when your wages are over SGA.  This is a monetary amount establishing a cap you cannot go over.  Many of my clients have difficulty grasping this concept when they are holding down a full time job while … Continued

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November 18, 2016

Do You Know Why You Are Disabled?

That seems like a strange question doesn’t it? My clients tell me they are disabled, but many have a hard time saying it in a way the Social Security Administration (SSA) understands. Many people have Social Security disability questions.  There can be many reasons why it is hard to explain your inability to work.  You may have a rare condition the SSA is not very familiar with; you may have a combination of impairments that, all added together, make you unable to work; you may have to argue you meet special rules the SSA recognizes; or you may just simply be unable to work a full time job.  Trust me, claiming you are disabled to the SSA can be confusing and difficult, or it can be as easy as they want to make it for you.  That’s why knowing what to tell them can possibly create a make or break situation.   In my experience, you need to be careful how you phrase things to the Social Security Administration. First of all, being disabled is not a joke.  Going to physical and mental examinations the SSA sends you to and taking it lightly may result in that particular examiner noting your attitude to the SSA.  All the way through the process, you need to express accurately to the SSA what you are experiencing.   Fill out the forms the SSA gives you truthfully and in their entirety. Some claims can be processed favorably without much human interaction by giving the SSA ALL of the information they request.  Be proactive in your claim, especially at the initial level, to ensure the SSA gets all pertinent information.  Unfortunately, after initial denials, while waiting for a hearing, your claim may not be looked at again until you find yourself in front of an Administrative Law … Continued

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August 3, 2016

What is a Contingent Fee Agreement?

If you have applied for Social Security disability benefits and have been denied, you may have been advised to hire an attorney to help you appeal your case.  However, you might be worried that you can’t afford an attorney – after all, aren’t lawyers famous for charging high hourly rates for every second they spend on each case?  Fortunately, if you hire an attorney or representative to help you with your disability appeal, your case will be handled with a “contingent fee agreement.” The Social Security Administration (SSA) has rules about how attorneys can charge clients for disability appeals.  Basically, if an attorney wants Social Security to approve his or her fee agreement, it must meet the following criteria: 1. You (the client) only have to pay the attorney if your claim is granted (if you “win” your appeal). 2. If you win, the attorney receives 25% of any back pay you receive. (“Back pay” is the money you receive from Social Security to cover the benefits you should have received while you were waiting for your claim to be processed and/or your appeal to go through.) 3. If your claim is granted at the initial application, request for reconsideration, or hearing level, the attorney can receive no more than $6,000, no matter how much back pay you receive. 4. If you lose at the hearing level and have to appeal your case to the Appeals Council or file a claim in federal court, most attorneys have a slightly different fee structure. Typically in those cases, the attorney receives 25% of your back pay without the $6,000 cap.  However, the attorney will likely have to submit a statement (called a “fee petition”) showing how much time he or she spent on your case in order for the fee to be approved. In … Continued

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April 11, 2016

What are ADLs, and why does Social Security care so much if I go on vacation or keep my house clean?

Many of my clients do not understand why the Social Security Administration (SSA) is so interested in their day-to-day activities.  It might help to think about it this way: since you are not able to work, Social Security can’t ask you how your current symptoms affect your work activities.  Therefore, they have to look instead at what you are actually able (or unable) to do in your daily life.  Social Security refers to these things as your “Activities of Daily Living,” or ADLs. During the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) application process, Social Security sends each claimant a questionnaire called an Adult Function Report.  This form asks specific questions about how your impairments affect your ability to do what you need to do to get through a typical day.  Similarly, the Administrative Law Judge (ALJ) at your hearing will ask questions about your ADLs, including your ability to: Clean your house (sweep, mop, dust, wash dishes, etc.) Shop for groceries Take care of your yard Drive a car Bathe, shower, and take care of your personal hygiene Dress yourself Do laundry Cook or prepare meals Care for children, other family members, or pets Participate in hobbies Spend time with friends Travel on vacations When you answer questions about your ADLs, it’s important to keep in mind why Social Security is asking them.  The ALJ is not trying to find out of you are a conscientious housekeeper or if you are an interesting person to hang out with.  It can be really hard – embarrassing, even – to admit that you aren’t able to take a shower or wash your dishes as often as you think you should.  It is painful for a lot of my clients to realize that it has been years since they … Continued

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July 17, 2015

If My Initial Application For Social Security Disability Benefits is Denied, Should I Reapply?

Should you appeal your initial application denial or reapply if you are denied disability benefits?  If the Social Security Administration (SSA) states your disability is not severe enough to receive benefits, appealing the decision is usually the right move.  Many individuals believe that by simply reapplying the SSA may approve their new application, but statistically this is not accurate.  In my experience, it is in your best interest to appeal the initial denial. After your initial application is denied you have sixty (60) days to file a Request for Reconsideration.  Many individuals refer to this as an appeal.  The Request for Reconsideration is basically saying to the SSA that they made a mistake and need to take another look at your claim.  When you file your reconsideration, the SSA should also gather any new evidence for your claim as well.  If you submit the appeal on your own, you should include the updated information when prompted.  If an attorney or representative completes your appeal for you, they should be in touch with you for updated information. Unfortunately, the majority of these requests are also denied.  Once again you will have sixty (60) days to file an appeal and request a hearing in front of an Administrative Law Judge (ALJ).  Some statistics have shown you odds of winning your claim will increase at this stage. The majority of successful disability claims ultimately end up in front of an ALJ.  An administrative Law Judge is not bound by prior decisions by the SSA and is supposed to take a fresh look at your Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) claim. In my experience as a Social Security Disability attorney it is very important to appeal your denied claim within the time limits set forth by the SSA.  It is also … Continued

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July 2, 2015

Will Hiring An Attorney Speed Up My Case?

Many Social Security disability claimants are under the impression that hiring an attorney will speed up the processing of their case with the Social Security Administration (SSA).  While hiring an attorney does not directly translate into a claim being processed more quickly by the SSA, there are many benefits of having an attorney on your case. Benefits at the Initial Application Stage Getting an attorney representative to help you with your initial application for benefits may help your chances of being found disabled.  As most disability claimants and attorneys know, the majority of people are denied on their initial application.  However, some benefits of our office helping a claimant complete an initial application may include: Helping you obtain a medical source statement from your doctor by providing questionnaires designed to get your doctor’s opinions on specific issues Social Security addresses: Social Security is supposed to give great weight to the opinions of your treating medical providers. Updating Social Security about changes in your condition and treatment: the more complete the medical records Social Security has, the more likely it will have enough evidence to make a favorable decision. Ensuring your application is complete: the application can be overwhelming to someone who has never done it before, but we are able to walk you through and ensure you provide complete and accurate information. Submitting medical records in support of your claim: while Social Security typically requests all of your medical records at the initial application stage, we are able to help follow up with providers Social Security cannot reach. Keeping track of your claim to make sure it is processed in a timely manner: we regularly follow up on each claim to make sure Social Security has everything it needs and to make sure the case is moving forward. While Social … Continued

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March 19, 2015

Objective Testing and Your Social Security Disability Claim

Proving you are disabled to the Social Security Administration (SSA) is not always easy.  Before the SSA will even consider how your symptoms affect your ability to work, you must show that you have a “medically determinable impairment.”  Telling Social Security that you have pain or fatigue or memory loss is not enough, by itself, to establish a medically determinable impairment.  You must also be able to provide objective evidence that explains why you have those symptoms. The most direct evidence you can provide is objective test results.  These tests might include: Magnetic Resonance Imaging (MRI) and X-rays: these tests show the location and severity of physical damage to your musculoskeletal system that might cause symptoms such as pain. Electromyography (EMG) and nerve conduction studies: this type of test shows whether you have nerve damage that might cause symptoms such as pain, numbness, or weakness. Electroencephalography (EEG): this test helps to show abnormal activity in your brain that might cause symptoms from seizures or sleep disorders. CT Scans: these tests show damage to your organs that might cause symptoms such as pain, shortness of breath, or fatigue. Blood tests: these tests can show the presence or absence of different substances in your blood, which in turn can help prove that you have certain anti-immune disorders or other diseases. Stress tests: these tests measure the effects of exertion on your heart and can help quantify the severity of your cardiovascular symptoms. Echocardiograms: the results of these tests can show abnormalities in your heart that might cause symptoms such as chest pain, shortness of breath, weakness, or fatigue. Not all medical conditions can be proven using objective testing, though. Mental health disorders, migraines, fibromyalgia, and pain disorders are notoriously difficult to prove because there are no reliable tests available to confirm them … Continued

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March 6, 2015

Common Questions Concerning Children’s SSI Claims

In my Social Security disability practice, I meet many parents of children with special needs.  They have heard that Social Security has a program for children with disabilities, but they do not know how to find out more about it.  Here are some answers to some of the most common questions I hear from parents of disabled children. How do I know if my child meets the requirements for SSI? Qualifying for SSI is a two-step process.  SSI, or Supplemental Security Income, is a needs-based program; therefore, your household must fall below a certain amount of income and resources to qualify at the first step.  Unfortunately, there is no hard-and-fast number that I can say, “If you make XX amount of money, you are over the limit” because Social Security’s formula is more complex than that – it depends on the size of your household, your expenses, and the like.  Similarly, there is a limit (currently $2,000 for a single person; $3,000 for a couple) on household resources (the value of the things you own), but there are exemptions for some things like your home and sometimes your vehicle.  Really, the only way you can definitely determine whether you meet the income and resources limits is to talk directly to Social Security. Once you qualify financially, Social Security determines whether your child meets the medical requirements.  This determination is much less black-and-white than the resources test.  They look at your child’s medical records and determine how her impairments limit her ability to function in six different “domains”: Acquiring and Using Information, Attending and Completing Tasks, Interacting and Relating with Others, Moving About and Manipulating Objects, Caring for Yourself, and Health and Physical Well-Being. Is it best to work with a lawyer in the process? In theory, Social Security’s process is … Continued

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December 24, 2014

Time Constraints on Appealing Your Indiana Social Security Disability Case

All too often, people call me for help in appealing their Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) claims, only to find out they have waited too long.  If Social Security denies your claim for Social Security disability benefits, you have sixty days to appeal that decision.  (Actually, Social Security allows five extra days for mailing time, so you have a total of sixty-five days from the date of your denial letter.)  If you have not submitted the appropriate forms before the deadline, Social Security will very likely dismiss your claim.  If that happens, you will probably have to start all over with another initial application. There can be times when the Social Security Administration (SSA) will accept an appeal filed after the deadline, but they will only do so if there is “good cause” for the late filing.  If you forgot the deadline, lost the paperwork, or just didn’t get the forms filled out on time, Social Security probably will not find that you have good cause.  On the other hand, if you were hospitalized, had a death in your immediate family, or never received the denial letter because Social Security sent it to the wrong address, there is a good chance that the SSA will accept your late filing.  Social Security makes a decision about good cause on a case-by-case basis.  The best thing to do is to file the appeal as soon as possible after you receive the denial. How can you make sure you don’t miss Social Security’s filing deadlines?  Here are some tips: Keep your Social Security office informed about changes in your address and/or telephone number. Follow up with Social Security regarding your claim.  In my office, we follow up about once a month during the initial application and reconsideration stages … Continued

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