Social Security Disability News: 2015

Friday, December 18, 2015

Tips for Claimants as 2015 Wraps Up

The holidays are upon us. As 2015 draws to a close and 2016 gets ready to commence, we wanted to make a few suggestions to Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”) applicants who have cases pending with the Social Security Administration.

1. Make sure you have a health insurance plan in place that covers your needs.

As we enter a new calendar year, health insurance plans routinely change. You should review your policy to make sure that your health insurance plan still covers your medications, treatments and allows you to see your preferred specialists. Any time you are having a procedure, call your insurance company to make sure that your treatment is covered at the facility it is scheduled to be performed at. Sometimes the doctor performing the procedure may take your insurance, but the facility where the procedure is being performed at doesn’t accept your health insurance. You should be able to verify this information online or by calling the customer service number on the back of your insurance card.

2. Request a copy of your medical records for the last calendar year.

It is important to make sure that your medical providers are documenting what you tell them at your appointments. An excellent way to figure this out is by requesting and reviewing your medical records at the end of every calendar year. If important information is absent from your medical records, than discuss this with your provider, so he/she can start maintaining an accurate record of your health history.

3. Schedule important checkups.

It may sound like common sense, but going through the recommended routine medical evaluations every year can save your life. Besides having a general checkup with your family practitioner, make sure you schedule any recommended annual evaluations – whether it be a skin cancer check, a pap smear, a mammogram, a prostate examination, or a colonoscopy. Just like your car requires an oil change every year, performing the recommended basic health care maintenance is a crucial necessity.

Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 103.

Saturday, November 28, 2015

Questions To Expect at Your Social Security Disability Hearing

Many individuals who attend a Social Security Disability Insurance and/or a Supplemental Security Income hearing are nervous about appearing before an Administrative Law Judge. For many people, this is the first legal proceeding that they have ever attended and it can be very intimidating. To help you prepare for your upcoming hearing, we have made a list of questions that are commonly asked at your hearing.

1. What is you date of birth?

2. How old are you?

3. How far did you go in school?

4. When was the last date that you attended school?

5. Are you in school now?

6. Did you ever attend a trade school or have some other type of vocational training?

7. When did you last work?

8. What was your last job title?

9. What were your tasks and duties at this job?

10. How much weight did you lift at this job?

11. Was it a sitting or standing job?

12. What other work have you performed in the last 15 years?

13. What is preventing you from being able to work?

14. What are your symptoms?

15. What is your level of pain on a pain scale? Zero being no pain and ten being pain severe enough to force you go to the emergency room.

16. What types of treatment have you tried?

17. Have you had any surgeries?

18. Have you had any hospitalizations?

19. Are you able to concentrate while watching a television program?

20. Are you able to read and understand a page in a book?

21. How long can you sit?

22. How long can you stand at one time?

23. How long can you walk at one time in terms of minutes or city blocks?

24. How much weight can you lift at one time in terms of pounds?

25. Do you require an assistive device to help you walk or stand? Which device?

26. Where do you live?

27. Who do you live with?

28. Who does the chores in your household?

29. Who does the cleaning?

30. Who does the cooking?

31. Who does the grocery shopping?

32. Do you have any children? Who cares for them?

33. Have you traveled at all since you applied for disability? Where?

34. Why can’t you perform a sit-down job?

35. Why can’t you perform a job that allows you to sit and stand at will?

36. Have you ever abused alcohol or drugs?

37. How have you been supporting yourself since you stopped working?

While the Administrative Law Judge or your attorney may ask you additional questions based on your specific disability, the above questions are representative of many of the general types of questions that you will hear at your hearing. Be open and honest when answering these questions. Listen carefully to what the Administrative Law Judge or your attorney is asking you, so you stay on track when responding. Always answer questions succinctly.

Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 103.

Monday, November 16, 2015

Tips For Appearing In Front of An Administrative Law Judge

Most claimants have to attend a hearing in front of an Administrative Law Judge (“ALJ”) when pursuing Social Security Disability Insurance (“SSDI”) and/or Supplemental Security Income (“SSI”) benefits. This is because the majority of claimants are denied by the Social Security Administration (“SSA”) at the lower administrative levels of the Social Security Disability system. This necessitates an appeal, which is followed by a scheduled hearing. Here are some important tips to help you prepare for your hearing in front of an Administrative Law Judge.

1. Get to Your Hearing Early – It is important to arrive for your hearing at least 30 minutes before the scheduled time. Traffic in Southern California is unpredictable and chaotic. While it may normally only take you 30 minutes to get to your hearing site, even a slight traffic accident could back you up for hours. Thus, prepare for the worst case traffic scenario and leave your home with plenty of time to spare. Most ALJs will only wait a minute or two past your scheduled hearing time for you to appear. If you are not present, you run the risk of the ALJ dismissing your case.

2. Bring A Photo I.D. – SSDI/SSI benefits are administered through the Federal government. Thus, regardless of whether your hearing site is in a Federal building or not, the Office of Disability Adjudication and Review (SSA’s hearing location) is considered a Federal facility. Thus, a current photo identification card, such as a driver’s license, is required.

3. Dress Appropriately – You are appearing in front of Federal Administrative Law Judge. Show this Judge that you are taking the process seriously by dressing appropriately. This does not mean you need to wear a suit to the hearing. Conservative, business casual attire is appropriate. Do not wear shorts, jeans, tank tops, or t-shirts. Keep any makeup and hairstyling to a minimal.

4. Listen to the Questions the Judge Asks You – The ALJ will have specific questions he/she wants to ask you. Answer those questions succinctly. Do not go on tangents talking about erroneous information. You are given limited time to present your case. Usually, the Judge has anywhere from 5 to 10 hearings a day. Thus, you need to be brief and focus on the questions being asked of you. Straying off of topic will annoy the ALJ.

5. Be Honest With the Judge – Answer all questions truthfully. The ALJ is charged with assessing your credibility. If you exaggerate your condition or mislead the Judge, he/she may state that you were not truthful in the hearing decision.

6. Look at Judge When Answering Questions – You are at the hearing to tell an ALJ why you are unable to work. The Judge is the decision maker. Therefore, you should speak directly to the Judge when answering his/her questions. Speak directly to the Judge even if your attorney is asking you a question. Remember your attorney should already know why you are applying for disability. The hearing is your chance to tell your story to a Judge.

7. Be Polite to The Judge – Some ALJs can be aggressive. While unfortunate, you must remain professional and polite throughout the whole hearing. Should your claim be denied and you have to appeal the matter, transcripts and recordings will be available. You want the Appeals Council, the reviewing bureau that hears the appeal of ALJ denials, to see that you have conducted yourself appropriately during the hearing, even if the ALJ was out-of-line at times. It is also important to remain polite to all experts at the hearing.

These simple tips may seem basic, but preparing yourself for your hearing can make all the difference when it comes to the decision.

Tuesday, October 20, 2015

The Social Security Disability Backlog Grows

If you noticed that it is taking a long time to have your Social Security Disability claim heard by an Administrative Law Judge, you are not alone. It seems that there are one million cases waiting to be heard currently by the Social Security Administration (“SSA”). The Washington Post noted that this backlog is so long that it exceeds the population of 6 different states.

The average time to get a hearing before an Administrative Law Judge is at 450 days, though www.disabilityjudges.com estimated that the national average is closer to 461 days. Keep in mind that these time frames relate only to the hearing level stages at the Office of Disability Adjudication and Review. These estimates do not take into account the waiting periods at the initial application or reconsideration levels, which are the first two stages of the Social Security Disability and Supplemental Security Income claims process. It can take the Social Security Administration anywhere from 4 to 9 months to make a decision at each one of these two initial stages. Thus, it can take anywhere from close to 2 to 3 years from your initial filing date until you appear before an Administrative Law Judge currently.

The four main reasons for this dramatic backlog include an increase in the number of hearing requests, fewer overall judges, less-productive judges, and less attorneys and personnel to assist at the hearing offices.

The Social Security Administration replaced the two officials in charge of the hearing offices with new leadership. This changing-of-the guard is in the process of developing new ways to decrease the backlog. Hiring new judges, training attorneys and claim examiners employed by the hearing offices to screen the cases for possible early decisions, scheduling more video hearings, and eliminating duplicate evidence from the file to streamline the process, are all part of the plan.

Backlogs at SSA will always exist, but SSA is hoping to decrease the hearing waiting times to 270 days by 2020. For more information on the backlog, please see: https://www.washingtonpost.com/blogs/federal-eye/wp/2015/10/19/the-biggest-government-backlog-is-getting-worse-watchdog-says-but-social-security-has-a-plan/.

Thursday, September 17, 2015

Social Security Experts

The Social Security Administration (“SSA”) often utilizes expert witnesses when assessing a claimant’s disability. SSA may send a claimant to a physical or mental health doctor for an evaluation. SSA may also call a medical expert or a vocational expert to testify at a hearing.

The experts who appear at the hearing have never examined the claimant. These experts simply review the exhibit files and give their opinions based on the written evidence and reports. SSA pays for these experts to testify.

Claimants often inquire about the objectivity of these expert witnesses, given that their appearances are being paid for by the government. As one of my clients put it, “Why would a doctor bite the hand that feeds him?” It is a good question and there is no perfect answer.

Some expert witnesses do make a significant income off of their testimony for SSA, but that alone does not necessarily mean they will compromise their ethics and testify in a biased manner. Thankfully, your attorney is given the opportunity to cross-examine these witnesses. Thus, if the testimony is inaccurate and does not align with the medical evidence and clinical findings, we are able to poke holes in the expert’s theories.

Additionally, SSA is supposed to give controlling weight to the opinion of your treating physician over that of the expert witness. This is because the government recognizes that your own doctor is better-suited to assess your capabilities, rather than a doctor who does not have a longitudinal history with you. Thus, there are strategies that we use to combat expert witnesses who do not testify objectively.

Thursday, September 3, 2015

What Does Social Security Mean by Ambulating Effectively?

There are a variety of conditions, diseases and impairments that may qualify a person for Social Security Disability Insurance or Supplemental Security Income (“SSDI/SSI”) benefits. Cancers, orthopedic conditions, heart disease, mental health issues, and autoimmune disorders are among the diagnoses that may qualify an individual for these Federal benefits. What is important to understand is that the Social Security Administration (“SSA”) is not as concerned with the diagnosis itself as they are with the limitations that an impairment may impose on an individual’s ability to work. Certain impairments, like lower extremity joint disorders, require SSA to look at a person’s ability to “ambulate effectively” when assessing disability. SSA defines effective ambulation in specific terms.

To order to ambulate or walk effectively, an individual must be able to walk without a hand-held device that would prevent an individual from using at least one upper extremity to carry items. For example, a person must use his/her hands to operate a walker or a manual wheelchair. Thus, a person using a manual wheelchair or walker can have difficulty with ambulation because such devices require the use of both hands to be operational. Conversely, a person who relies on a cane to walk has an available hand to carry items. A person reliant on a cane can ambulate effectively under SSA’s definition.

To ambulate effectively, SSA also indicates that a person must be able to walk at a reasonable pace over sufficient distance to carry out activities of daily living. Effective ambulation further requires that a person be capable of walking at a reasonable pace on rough or uneven surfaces for a full block. A person must be capable of walking up a few steps at a reasonable pace with the use of a single hand rail to be considered ambulatory. Finally, a person must be able to use public transportation to carryout routine ambulatory activities like shopping to meet SSA’s requirements for effective ambulation. For more information on SSA’s definition of “effective ambulation,” please see: http://www.ssa.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm .

Monday, August 24, 2015

Missing Man From Norwalk

I wanted to send a quick post about a missing man named David Ku, who disappeared on Friday sometime between 6 pm and 8 pm. He has Alzheimer's and may not respond to his name. He is 60 years of age and approximately 5 foot 7 inches and weighs 170 lbs. Below please find a Facebook page with photos and additional details about Mr. Ku. If you have any tips at all, please contact the Norwalk police at (562)863-8711.

https://www.facebook.com/pages/Missing-Person-David-Ku/154181698252461?pnref=story

Thursday, August 20, 2015

What is An AutoImmune Disorder?

An autoimmune disorder occurs when the body’s immune system mistakenly attacks healthy body tissue. The white blood cells in an individual’s body are meant to protect against harmful substances like bacteria and toxins. Sometimes the immune system becomes confused and begins to target the healthy tissue in the human body and systematically destroys it.

No one knows what triggers an autoimmune disorder, but it is theorized that an infection, certain medications or even a person’s genetic makeup could have something to do with it. Autoimmune disorders can result in tissue, organ or joint damage.

Some common autoimmune disorders include Multiple Sclerosis, Rheumatoid Arthritis, Celiac Disease, Graves’ Disease, and Systemic Lupus Erythematosus. It is not unusual for an individual with an autoimmune disorder to develop other autoimmune disorders simultaneously. Common symptoms that are associated with many immune disorders are fatigue, weakness, skin disorders, and severe joint pain.

Treatments options for autoimmune disorders include physical therapy and immunosuppressant medications like steroids and biological treatments. Doctors and pharmaceutical companies are constantly developing new treatment options to help curb the symptoms of these illnesses. The goal of treatment is often to send these conditions into remission for extended durations. Most autoimmune disorders are chronic, but some of these disorders do resolve over time.

Friday, July 31, 2015

Ticket To Work Program

I have been getting a lot of questions about the Social Security Administration’s Ticket to Work program. The Social Security Administration’s Ticket To Work program provides Social Security Disability and Supplemental Security Income beneficiaries the opportunity to explore career development programs, while remaining on benefits. The program is available to both Social Security Disability and Supplemental Security Income recipients between the ages of 18 to 64 years who want to work. It is a free and voluntary program.

The goal of the Ticket-To-Work program is to help people with disabilities achieve financial independence. The Ticket to Work program provides a variety of service providers, employment networks and State vocational rehabilitation agencies to help a beneficiary achieve concrete work goals. A Ticket can allow an individual to obtain education, training or job support. In return, the Social Security Administration expects that a Ticket-holder achieve specific earnings levels, education or training goals within a timely manner. Thus, the Ticket To Work program requires a working partnership between the Social Security Administration and the Ticket-holder.

For more information about the Ticket To Work program, please call (866) 968-7842 or visit the Ticket To Work website at: http://www.chooseworkttw.net/about/index.html.

Thursday, July 23, 2015

Special Olympics World Summer Games Come To Los Angeles

The 2015 Special Olympics World Summer Games have come to Los Angeles! Athletes from around the world have descended on various host cities throughout Los Angeles to prepare for competition. Multiple LA-based athletic complexes will host over 6,500 athletes from 165 nations competing in 25 sports. Some of the sports include aquatics, track and field, equestrian events, basketball, soccer, gymnastics, judo, triathlon, and bocce. Opening ceremonies commence on July 25, 2015 and the games continue through August 2, 2015. The World Games is a chance for extraordinary athletes with intellectual disabilities to demonstrate their talents and achievements in the sporting community. For more information, please visit http://www.la2015.org/. For a schedule of events, please visit this link: http://www.la2015.org/schedule. Tickets are free (with the exception of opening ceremonies) and spectators are welcome!

Wednesday, July 15, 2015

Social Security Disability Insurance and the Medicare Waiting Period

Winning a Social Security Disability Insurance claim not only entitles an individual to cash benefits, but it also entitles a beneficiary to Medicare insurance. Due to the rising costs of medical treatment and insurance premiums, Medicare entitlement is often the primary reason that claimants apply for Social Security Disability. When planning to apply for Social Security Disability Insurance, however, one must keep in mind that Medicare has a 24 month waiting period for entitlement after an individual becomes entitled to cash benefits through the Social Security Administration (“SSA”). What does this mean exactly you may ask? Let me tell you.

Let us take an individual whose onset of disability is July 1, 2015. The Social Security Administration has a standing rule that every individual must be disabled for a full five months before he or she becomes entitled to a cash benefit. Thus, in this example, the individual’s entitlement date for cash benefits is December 1, 2015. Add two years to this date-of-entitlement for cash benefits and you have the Medicare entitlement date of December 1, 2017.

As you can imagine, this two year waiting period can be devastating to individuals who desperately need medical insurance to treat chronic conditions. The Medicare waiting period developed due to the impression that COBRA insurance from the former employer would fill in the gap of medical insurance while a claimant waited for Medicare entitlement.

Federal COBRA regulations allow a former employee to stay on his or her employer’s insurance plan for a maximum of 18 months. While COBRA does have an extension program that allows COBRA insurance to be extended up to a maximum of 29 months, if an individual is found disabled by the Social Security Administration, it fails to take into account two major problems. First, in order to be entitled to a COBRA extension, a claimant must be found disabled by the Social Security Administration within the initial 18 months that an individual is entitled to COBRA insurance. Most individuals who apply for Social Security Disability are required to attend a hearing in front of an Administrative Law Judge (“ALJ”). On average, it takes 2 to 2 ½ years to have a hearing with an ALJ. Thus, many individuals do not get their favorable determination from Social Security Disability within the 18 month window that COBRA requires. Second, the COBRA premiums are often so high that they are cost-prohibitive for a former employee to afford. Many former employers do not elect to take the COBRA insurance due to the high monthly costs. Thus, COBRA insurance and COBRA extensions are not always realistic options for medical insurance during SSA’s Medicare waiting period.

There are two exceptions to the Medicare waiting period with SSA. The usual 24 month waiting period for Medicare has been eliminated for SSDI recipients diagnosed with Amyotrophic Lateral Sclerosis (“ALS”), sometimes referred to as Lou Gehrig's disease, and individuals diagnosed with end-stage renal disease or kidney failure. These two exceptions are due to the poor prognosis of these diseases and the result of extensive lobbying efforts by support groups and advocates who work with individuals from these populations. In spite of the countless other life-threatening diseases out there, no other groups have been successful in eliminating the waiting period for Medicare.

Please keep in mind that these Medicare waiting periods only apply to Social Security Disability recipients. Individuals found eligible for SSA’s Supplemental Security Income program and MediCal/Medicaid insurance, are not subjected to any waiting periods.

Wednesday, July 1, 2015

The Federal Government Reports a Security Breach

The Office of Personnel Management (“OPM”) reported a cybersecurity breach that may have exposed Federal employees’ personal information and data. To deal with the breach, the OPM sent out contact emails beginning June 8, 2015 through June 19, 2015, notifying current and former employees of the data breach. The Federal government is offering these employees complimentary credit monitoring and recovery services for 18 months. So far, there is no indication that the personal information has been exploited by the hacker, but the largest Federal employee union, the American Federation of Government Employees, filed a class-action negligence lawsuit against the OPM on Monday.

While the breach may have compromised the private and personal information belonging to Social Security employees, there is no indication that any private information belonging to Social Security claimants has been accessed.

We will update you in regards to any additional information that is made available to us.

Wednesday, June 17, 2015

Continuing Disability Reviews and Overpayments

It seems that we are getting a record of number of calls from claimants saying that their Social Security Disability benefits are being reviewed, ceased or that they have received overpayment notices. The Social Security Administration (“SSA”) is supposed to review claims every three to five years. In certain circumstances, reviews are performed more frequently than this. For instance, if you had a lumbar fusion, the Social Security Administration may request that your case be reviewed in one year from the date of the decision to see if you have improved enough to return to work.

Reviews are very important. While some individuals suffer from unfortunate impairments that may result in lifelong disability, others do not. Social Security Disability and Supplemental Security Income are designed to help an individual who is going to be disabled from work for a full year support oneself. Once an individual’s impairment improves enough so that the individual can return to work, the Social Security Administration rightfully expects that person to return to work.

Historically, the SSA has struggled to keep up with continuing disability reviews. However, a government watchdog reported this month that SSA has overpaid close to 17 billion dollars in disability benefits over the last decade: http://www.businessinsider.com/social-security-17-billion-in-overpayments-2015-6. These benefits were reportedly being paid to those who no longer met SSA’s definition of disability, were earning too much, had died, or were incarcerated. While the information at how the 17 billion dollar overpayment number was arrived out isn’t clear, I suspect the increasing number of reviews taking place currently have something to do with this study.

I recommend that if you are currently receiving benefits, you should continually do a self-assessment to determine whether you are improving and may be able to enter the workforce again. More importantly, I think it is crucial that you speak to your doctor every year to touch base to see if he/she thinks you are able to return to work.

If you do continue to remain disabled, stay in consistent treatment with your doctors. If SSA selects your case for review, provide SSA with updated medical records and a letter from your doctor which explains why you remain disabled. Remember, if you are collecting disability, SSA expects you to remain in treatment with appropriate medical providers. Please also remember to complete any review paperwork that SSA sends you in a timely manner.

If you have improved enough to return to work, notify SSA immediately. If you are receiving Social Security Disability, SSA will allow you to test your ability to work for nine months (total – the nine months do not have to be consecutive). Every year, SSA changes the amount of earnings that trigger a trial work period, so it is important to familiarize yourself with the rules and regulations regarding the program. It is also important that you notify SSA as soon as return to work. Failure to do so can result in an overpayment, which the Social Security Administration will require you to pay back.

Thursday, June 4, 2015

Self-Employment Income

It has come to our attention that there is some confusion as to whether self-employment income constitutes work activity for the purpose of determining disability through the Social Security Administration. It does.

Being self-employed encompasses a growing percentage of the United States workforce. More workers are working from home and trying to develop home-based businesses and internet businesses. Please note that money you earn selling items on Ebay, Craigslist or Etsy can constitute work to the Social Security Administration if your income from these sales arises to a certain level.

Substantial gainful activity (“SGA”) is the performance of significant physical or mental tasks that are “productive” in nature, resulting in income that equals or exceeds an amount set annually by SSA. For non-blind individuals, the monthly SGA amount for 2015 is $1,090.00. The monthly SGA amount for statutorily blind individuals for 2015 is $1,820.00. If your self-employment earnings are over the monthly SGA limits set by the Social Security Administration, you will be precluded from Social Security Disability benefits.

Thus, it is crucial that you tell your lawyer about any self-employment or internet sales activity that you performing. If you do not report this type of income to the Social Security Administration, they can saddle you with an overpayment and ask you for all the disability benefits back. If the government thinks that you intentional misled them about your work activity, they can also prosecute you for fraud.