Social Security Disability News

Friday, October 25, 2013

The Importance of Medical Records and Mental Health Records in Establishing Social Security Disability Insurance and Supplemental Security Income Claims

Now that the government has reopened and all branches of the Social Security Administration (“SSA”) are back in full swing, Cari and I wanted to discuss the importance of documenting your disability for Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”) purposes. The bottom-line is that if the objective medical findings and clinical findings are not detailed and strong, it will be difficult to achieve SSDI/SSI benefits.

While SSA must consider an individual’s subjective complaints and credibility when assessing a claim, if an individual is not in consistent medical treatment with the appropriate medical provider, SSA will deny the claim. Think of it this way – the objective findings trump an individual’s subject complaints.

SSA also has certain rules in terms of evidence it will consider. SSA only gives controlling weight to the opinions of certain medical providers. These acceptable medical providers include: M.D.s, D.O.s, Ph.D.s, and Psy.D.s. SSA will not give controlling weight to the opinions of chiropractors, acupuncturists, nurses, physician assistants, social workers, or therapists. Thus, if you are not treating with the appropriate medical provider, you will want to get into treatment with a medical source that SSA deems “acceptable.”

You also want to make sure you are treating with the correct specialist for the impairment you are alleging. If you are claiming a psychiatric disability, you should be treating and receiving your medications from an actual psychiatrist, not a general practitioner, or an internist.

You also want to make sure your doctor is documenting all that you tell him/her in a clear and concise manner in the medical records. After all, if SSA cannot understand or read a doctor’s chart, it will be difficult for SSA to find an individual disabled.

Securing a narrative letter or a residual functioning capacity statement from your doctor can also be crucial. These documents in which a doctor lays out an individual’s impairments, symptoms, treatment, prognosis, and limitations can help SSA understand in a very simple summary why a claimant is unable to work. SSA will often have their paid consultative examiners complete these same reports. Since SSA is supposed to give more weight to the opinion of a treating doctor, than that of the opinion of their one-time consultative evaluators, the ability to secure opinion evidence from a treating provider will often make or break the claim.

Finally, if an individual does not have medical insurance and is not currently treating with a doctor, the chances of being awarded SSA benefits is slim to none. If you fall into this category, we recommend that you seek out treatment through County plans and facilities, or low-cost and free neighborhood clinics. Under the Federal government’s Health Care Reform, individuals who do not secure health insurance will soon be subject to financial penalties. Thus, we also recommend that you checkout the new exchanges set up by the Federal government to determine if you are eligible for any of their low-cost plans.

Got a question that you need answered? Please check out our website at www.westcoastdisability.com . We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot us an email at info@westcoastdisability.com or call us at (800) 459-3017.

Friday, October 4, 2013

How The Government Shutdown is Affecting the Social Security Administration

As you all are aware, the government shut down on October 1, 2013, due to Congress’ inability to come to a resolution on an appropriations bill. An agreement has not yet been reached. What this means is that non-excepted government employees (approximately 800,000) have been furloughed and certain Federal agencies are operating with only staff members who are deemed essential.

The good news is that part of the Social Security Administration remains operational. Social Security Disability Insurance and Supplemental Security Income (“SSDI/SSI”) beneficiaries will continue to receive checks. Individuals can still apply for SSDI/SSI benefits. SSDI/SSI claims can still be appealed. Most other work at the local SSA offices will be suspended. This includes requesting a duplicate Social Security card.

Hearings that were previously scheduled at the Office of Disability Adjudication and Review (“ODAR”) will still take place if the Judge’s clerk was able to prepare the hearing file before the shutdown occurred. No other hearings will be scheduled, however, and no decisions or other correspondences will be written. The ODAR will be operating with a skeletal staff.

The Appeals Council will not be reviewing any cases at all.

For more informational on the government shutdown and how it affects SSA, please visit:

http://www.ssa.gov/pressoffice/shutdown2013.pdf

Monday, September 23, 2013

Can I Work and Collect Social Security Disability Insurance ("SSDI") or Supplemental Security Income ("SSI") Benefits?

Working and how it affects SSDI and/or SSI benefits is an extremely complicated matter. SSA affords people a limited opportunity to work, but people must pay close attention to the rules and regulations regarding work attempts, as the parameters are adjusted every year.

Currently, SSA does not consider an individual to be disabled if he/she can earn $1,040 per month. If an individual is blind, SSA will not consider the individual to be disabled if he/she can earn $1,740 per month. These figures reflect SSA’s current standards for 2013, but could likely change for 2014.

However, even if people are working under these above limits, they still could find themselves earning more than SSA allows. For instance, the maximum monthly rate that SSA pays in benefits for the SSI program in California for 2013 is $866.40. If an individual is blind, this amount is increased to a maximum rate of $921.40 in SSI benefits. These figures include the Federal rate of $710, as well as the State supplement of $156.40. Thus, if an individual receiving SSI is able to work and can achieve more than the 2013 SSI benefit rates, this individual may no longer qualify for the SSI program.

On a different note, the SSDI program allows people to test their ability to work for a nine month period. It is called a Trial Work Period (“TWP”). An individual is entitled to one TWP in his/her lifetime. A TWP allows an individual to attempt to work for a nine month period (does not have to be consecutive) over a 60-month rolling period. For 2013, any month that individual can earn $750 counts as a month that an individual performed services for the purpose of a TWP. If an individual earns above $750 for over 9 months (even if it is not consecutive) in a rolling 60-month period, he/she would no longer be considered disabled. If the individual does not achieve nine months of earnings over the $750 level in a rolling 60-month period, he/she could still be considered to be under a disability.

Regardless of whether you are a SSI or a SSDI recipient, an individual MUST notify SSA as soon as he/she returns to work. Failure to do so can amount to fraud and result in an overpayment. We suggest that you notify SSA by a certified letter, so you have physical proof that you are notifying SSA of a return to work. If you speak to a SSA employee about a work attempt, write down the name of the individual you spoke with and the employee’s phone extension in case you need to refer to it in the future.

Additionally, if you have returned to work and know you should not be receiving benefits from SSA anymore, return any and all subsequent monthly checks to SSA. If you are registered for direct deposit and receive an improper deposit, do not spend the money and immediately notify SSA of their mistake. After all, SSA will eventually catch their error and ask you for the improper payments back.

Friday, August 30, 2013

Unemployment vs. Social Security Disability Benefits

It is important that our clients disclose to us what other type of benefits they are receiving if they are applying for Social Security Disability (“SSDI”) or Supplemental Security Income (“SSI”) benefits. This is especially true if an individual is receiving Unemployment Insurance (“UI”) benefits.

The Social Security Administration (“SSA”) is suspect of anyone who is receiving or is attempting to receive SSDI and UI benefits simultaneously. The reason concurrent applications for these two benefits are questionable is because each program has its own unique definition and qualification standards. In order to qualify for SSDI, you must be unable to work for at least 12 months or more due to a physical or mental impairment, or combination of impairments, or your impairment (s) must be likely to result in death. Thus, people applying for SSDI are not actively looking for work, due to the fact that their impairments prevent them from working. On the other hand, in order to qualify for UI benefits, individuals must show that they are able, willing and ready to work and that they are actively seeking employment. Thus, applying for UI and SSDI benefits concurrently can cause Social Security to question the credibility of the applicant.

Currently, there is no law precluding individuals for applying for both types of benefits simultaneously. SSA has acknowledged that filing concurrent applications may appear to be facially inconsistent, but they haven’t gone as far as to preclude people from filing dual applications. Instead, SSA has historically used it as a factor to weigh in consideration as to whether someone is disabled. As you can imagine, many Judges cite to the receipt of UI benefits as a basis for a SSDI denial.

Currently, a group of bipartisan Senators have introduced a bill that would reduce SSDI benefits for any month in which UI were received. The proposed bill named, S. 1099 - “The Reducing Overlapping Payments Act,” was introduced on June 6, 2013. The bill proposes that SSDI benefits would be reduced for any month in which an individual was receiving UI benefits. The policy behind this proposal is similar to the other offsetting benefit programs like California State Disability and the Worker’s Compensation system. Individuals who receive State Disability or Worker’s Compensation often see their SSDI benefits reduced until their State Disability and/or Worker’s Compensation benefits are exhausted or reduced themselves. It is the government’s way of preventing what they call “double-dipping.”

If you are interested in following the progress of this bill, here is a link that will provide you status:

http://www.govtrack.us/congress/bills/113/s1099

Wednesday, August 14, 2013

How Does the Supreme Court's Defense of Marriage Act Ruling Affect SSDI and SSI Benefits?

We have been getting a lot of questions about how the Unites States Supreme Court’s decision regarding the Defense of Marriage Act (DOMA) will affect Social Security Disability (“SSDI) and Supplemental Security Income (“SSI”) benefits for same-sex partners. As most of you are aware, on June 26, 2013, the Supreme Court held that Section 3 of DOMA is unconstitutional as it deprives same-sex spouses equal protection under the Fifth Amendment.

What this now means is that same-sex spouses, and their children, are able to file claims for various types of SSDI benefits, including Disabled Widow’s/Widower’s benefits, Disabled Adult Children benefits, Survivor benefits, and Children’s benefits. In order to file a claim, however, the following conditions must be met:

The same sex couple must have a legally valid marriage. Couples in civil unions will not be qualified at this time.
The couple, and their children, must reside in a state that recognizes same-sex marriages.

While the Supreme Court’s ruling opens the door for same-sex spouses, and their children, to SSDI entitlement, the impact on SSI benefits could have the opposite effect. As SSI benefits take into account the income of a spouse to determine eligibility, same-sex spouses may find that their SSI benefits are reduced or discontinued.

To read the Supreme Court’s decision in entirety, please visit the link below:
http://www.supremecourt.gov/opinions/12pdf/12-307_6j37.pdf

Friday, August 2, 2013

Social Security Disability Time Frames

We often get asked, “How long does the Social Security Disability (“SSDI”) process take?” The honest answer is it varies by jurisdiction. Unfortunately, the weak economy, budget cuts, and the fact that the baby-boomer generation is at retirement age, have all negatively affected the time frames of the SSDI process.

There are five potential stages that an individual may go through in the SSDI process, including the initial application, reconsideration, hearing, Appeals Council, and Federal Court levels. The majority of individuals will be required to attend a hearing in front of an Administrative Law Judge (“ALJ”).

After filing an initial application, it will take the Social Security Administration 120 to 270 days to make a decision, or approximately 4 to 9 months. If denied, these same time frames are applicable at the reconsideration stage, though we do get a majority of the reconsideration determinations back within 180 days, or 6 months. If you are denied at the reconsideration stage, you must request a hearing. At the hearing level, it takes SSA anywhere from 236 to 547 days to schedule a hearing (National Ranking Report By Average Processing Time dated 4/26/13). Keep in mind, the time period that a claimant will wait to have a hearing scheduled is in addition to the time frames at the initial application and reconsideration levels.

Below are the time frames for the local Southern California SSA hearing offices, which are technically known as the Office of Disability Adjudication and Reviews or “ODARs” (National Ranking report dated 4/26/13):

Los Angeles Downtown = 275 days

Orange = 305 days

San Bernardino = 309 days

Moreno Valley = 322 days

Long Beach = 328 days

Pasadena = 330 days

Los Angeles west = 340 days

Santa Barbara = 358 days

Norwalk = 428 days

San Diego = 475 days

As you can see, the time frames associated with the hearing level are varied. After a hearing is held, it will take an Administrative Law Judge anywhere from 30 to 90 days to make a decision, or 1 to 3 months. If the claim is awarded, it can take the local SSA office up to another 90 days, or 3 months, to process the monthly benefits. Retroactive benefits can take the local SSA offices longer to process.

If the claim is denied, however, an individual must file an appeal with the Appeals Council in Falls Church, Virginia. On average, it will take the Appeals Council anywhere from 12 to 36 months, or 1 to 3 years, to rule on the claim. If denied, the only option left is to file a claim to Federal Court. Appeals to Federal Court can also take anywhere from 12 to 36 months, or 1 to 3 years, to receive a determination.

We recognize that these time frames can be shocking. However, it is important for every claimant to come up with a plan to support himself/herself, while he/she applies for these benefits, as the Social Security process has some significant timeframes associated with it.

For more information on the Social Security Disability process, please visit our website at http://www.westcoastdisability.com/The-Social-Security-Disability-Claims-Process/

Tuesday, July 23, 2013

The Consultative Examination

Clients often call us with questions concerning a letter they receive indicating that they have been scheduled for a “Consultative Examination”. Most clients want to know what the exam is and if they have to attend. Clients are also curious as to who has scheduled this exam and what doctor they will be seeing. Here is some basic information and insight about Social Security medical exams.

What is the Consultative Examination?

A fairly high percentage of individuals who file for either Social Security Disability benefits or Supplemental Security Income benefits will be required to go to a medical examination by the Social Security Administration. Social Security Disability exams are called Consultative Examinations (“CE exam”). CE exams can be physical in nature, psychological (IQ testing), or psychiatric in nature. They can also include ophthalmological exams, blood work, and the taking of x-rays. The Disability Office that schedules your exam also pays for the CE exam and any necessary tests. The exam is scheduled with a doctor closest to your home zip code, so it is important that you always notify your attorney when you move or change addresses.

Why is a Consultative Examination being scheduled in my case?

Sometimes your medical records don’t say as much about your condition as you might think they should. For example, your doctor’s notes might only say that you complained of low back pain and you were prescribed a pain medication. In other instances, your medical records are hand written and impossible to read, or information from your doctor may be incomplete. In some cases, clients have not been to see a doctor recently. Limited documentation such as this does not give the disability examiner reviewing your case sufficient information about how your condition limits your ability to function and work.

CE exams are requested by disability examiners (examiners handle initial disability applications) and also by Administrative Law Judges at the disability hearing level. The purpose of these exams is to obtain additional medical information and documentation for an adjudicator (a disability examiner or a judge) to arrive at a decision. Disability examinations that are scheduled by a disability examiner or a disability judge are mandatory and failure to attend can result in a decision based on existing evidence, or the closure of a case for failure to comply. However, if you miss a scheduled exam and have a valid reason for this happening, an examiner will usually allow for the examination to be rescheduled.

Who performs the exam?

CE examinations are performed by independent physicians and psychologists who have contracted to examine disability claimants and provide written reports afterwards. The doctors who perform these exams are not Social Security doctors. They are not employed by the Social Security Administration, rather they are independent contractors who are paid for their services. In addition to performing an examination, physicians and psychologists who perform CE exams are required to submit the written results of an examination. Please keep in mind that Social Security CE exams are not for the purpose of rendering medical treatment or making the decision on your claim. The purpose of these exams is to provide a recent snapshot of your conditions and various limitations.

How long does the exam take?

One of the most common complaints among our clients who have gone to CE examinations is that the duration of the exam was only 5-10 minutes. The length of the exam will vary depending on the type of exam a claimant is sent to. Examinations for physical allegations can be relatively brief (10-15 minutes is not abnormal), while a mental exam can take considerably longer due to the nature of psychological or psychiatric testing.

What should I do to prepare for the exam?

Being required to go to a medical exam by Social Security is no cause for alarm. Getting an appointment letter for a CE examination means, at the very least, that your claim is actively being worked on.

Here are some important tips to keep in mind when attending your CE examination:

Arrive a few minutes early for the exam. If you show up late, the doctor may refuse to see you, and the exam would have to be rescheduled. This can add further delay to the processing of your claim.
If you have children, leave them with someone during your exam so that you will be able to give the doctor your full attention.
When you go to the exam, always bring a government issued picture ID, like a driver’s license.
Take any medications or pill bottles with you to the exam, and any necessary braces, canes, eyeglasses, or hearings aids that you use.
Have someone go with you to the examination and observe.
Takes notes during and after the examination. How long did the doctor see you? What questions were asked? Were any tests performed?
Cooperate to the best of your ability during the exam. The doctor may ask you to do something that is uncomfortable. Not trying or refusing to do something the doctor asks, can make a difference in how your disability is viewed.
Be honest and don’t pretend to be better or worse than you are.