A great many things will be reviewed at your Social Security disability hearing. These include your age, education, past work and medical conditions. Of all these factors, I think the most crucial is the medical record.
Here's what I look for in the medical record:
1). Is it complete? Does the judge have records from all of your treating sources, such as doctors, hospitals, clinics, counselors--and in some cases--school records?
2) Are medical records current? Do they include your most recent doctor's visits, hospital admission, ER visit, etc.?
3). Are there objective tests, such as an MRI, CT Scan, X-ray, etc. which clearly show the nature and severity of your impairment?
4) Is there opinion evidence from your doctor? This would be a letter or form from the doctor stating what your specific restrictions and limitations are and how they would affect the ability to do work-related activities.
5). Is the medical record consistent with the symptoms you report?
Finally, I need to make the claimant aware of what's expected of him or her during the hearing. What type of questions will be asked? What is the best approach to answering questions? What are some of the pitfalls to avoid? Is the judge likely to have concerns from reading the medical records?
Our goal at the hearing is to give the judge, as decision maker, a clear and understandable picture of why the claimant is disabled. We want to answer any concerns or questions the judge may have. Having attended hundreds of hearings helps me to prepare for a smooth hearing. Hopefully, I can help eliminate some of the tension or anxiety the claimant may have when walking into the hearing.
Friday, March 31, 2017
WILL MY HEARING BE HELD HERE IN ATHENS?
Social Security judges hold hearings all over North Alabama. If you live in Athens or Limestone County, there are 3 possible locations where your hearing may be held.
Florence, AL is the ODAR office or hearing office. The hearing could be held there.
There is also an office in Huntsville where hearings are scheduled.
Finally, if your case gets assigned to the Franklin,TN hearing office (which some from our area do) - then your hearing will be held in Decatur, AL.
So, chances are your hearing will be either in Florence, Huntsville or Decatur. You will receive a letter telling you the date, time and location of your hearing well in advance. Plan to arrive at least 30 minutes before the hearing is scheduled to start. (If the judge gets ahead of schedule, your hearing may begin early).
Florence, AL is the ODAR office or hearing office. The hearing could be held there.
There is also an office in Huntsville where hearings are scheduled.
Finally, if your case gets assigned to the Franklin,TN hearing office (which some from our area do) - then your hearing will be held in Decatur, AL.
So, chances are your hearing will be either in Florence, Huntsville or Decatur. You will receive a letter telling you the date, time and location of your hearing well in advance. Plan to arrive at least 30 minutes before the hearing is scheduled to start. (If the judge gets ahead of schedule, your hearing may begin early).
WILL SOCIAL SECURITY ACCEPT EVIDENCE FROM A D.O. OR ONLY AN M.D.?
There are fundamentally two types of medical degrees that doctors may get. One is the traditional Doctor of Medicine (MD) degree. The other is Doctor of Osteopathic Medicine (DO).
The training required for the MD and DO degrees are very similar. According to the Mayo Clinic, the doctor of osteopathic medicine (DO) may have some training on manual manipulation, such as spinal adjustments or accupuncture, in addition to the traditional medical training.
Social Security regulations recognize both doctors equally as "acceptable medical sources." 20 CFR 404.1513
The regulation has recently been revised to include licensed physician's assistants as "acceptable medical sources." However, nurse practitioners are not considered acceptable medical sources by Social Security as of this writing.
With many people now getting their medical care from non-traditional providers, it is important to know how seeing someone other than an MD or DO may affect evidence for a potential Social Security disability claim.
The training required for the MD and DO degrees are very similar. According to the Mayo Clinic, the doctor of osteopathic medicine (DO) may have some training on manual manipulation, such as spinal adjustments or accupuncture, in addition to the traditional medical training.
Social Security regulations recognize both doctors equally as "acceptable medical sources." 20 CFR 404.1513
The regulation has recently been revised to include licensed physician's assistants as "acceptable medical sources." However, nurse practitioners are not considered acceptable medical sources by Social Security as of this writing.
With many people now getting their medical care from non-traditional providers, it is important to know how seeing someone other than an MD or DO may affect evidence for a potential Social Security disability claim.
THINGS THAT "WON'T FLY" IN A SOCIAL SECURITY HEARING
"Some things fly like a lead balloon." When you know something just won't fly, it's best not to leave the ground with it.
Here are some statements that won't fly at a Social Security disability hearing. I've given a brief explanation of why they don't fly.
1). "The only job I can get is a minimum wage job and I simply can't live on minimum wage." Why it won't fly? This has absolutely nothing to do with being disabled. How much a job pays has nothing to do with Social Security disability. It is largely a vocational problem. The problem might be solved by job training or education but Social Security will not award disability benefits on this basis.
2). "Everything was going well until one day my boss laid me off (or fired me, or something like that). Since then, I've never been able to work." Why it won't fly? Here, the claimant doesn't even claim to be disabled. There is no medical issue. There is no disability issue.
3). "I used to drive a truck, and loved my job, but now my sugar is so high that I can't pass my CDL test and so I can't work." Why it won't fly? It leaves open the possibility that you could do several other jobs. Also, Social Security does not consider the inability to get a license or certification to be a disability. If a lawyer can't get a license to practice law, it doesn't mean that he is disabled. It might be effective to argue that diabetes makes you so sick that you can't drive a truck, but I'd leave out the CDL argument.
4). "Several employers whom I asked for a job told me that because of my physical condition I would be a liability to the company and they would not hire me." Why it won't fly? Several reasons. First, employers are not allowed to decide whether or not you are disabled. Second, your argument is that no one will hire you, not that you are legally disabled. Third, the argument is more of a legal argument than a medial argument supported by medical evidence).
5). "I haven't been to a doctor in 5 years because I don't have any medical insurance. Even so, I just know that I'm not able to work." Why it won't fly? It's really an unfortunate position to be in, and lots of folks are in this situation. And this person may really be disabled. However, a disability decision must be based on objective medical evidence. If there is none, the case just can't be approved. Perhaps this claimant should try to be seen at a community medical clinic which has reduced fees or even a free clinic.
6). "All of my medical care has been from a nurse practitioner, chiropractor, counselor or nutritional expert. I think that care is as good as any and should be good enough for Social Security." Why it won't fly? In today's society, many people do get medical care from someone other than a medical doctor (MD) or doctor of osteopathic medicine (DO). However, Social Security regulations are very strict about what they call "acceptable medical sources." While there are some exceptions, generally Social Security requires medical evidence from an MD or DO to establish that you have a severe medical condition. Recently, physician's assistants have been added to the list of "acceptable medical sources." As of now, nurse practitioners and chiropractors are not on that list. It is simply not a question of whether your care is good or not, it is a matter of what Social Security regulations recognize.
7). "Uncle Ned got on disability when he was 19, never worked a day in his life and is as healthy as an army horse." Why it won't fly? Several reasons, the first of which is, Uncle Ned's case is not under consideration. The second is, it has nothing to do with why the claimant can't work. Perhaps the biggest reason, it will irritate the judge.
Here are some statements that won't fly at a Social Security disability hearing. I've given a brief explanation of why they don't fly.
1). "The only job I can get is a minimum wage job and I simply can't live on minimum wage." Why it won't fly? This has absolutely nothing to do with being disabled. How much a job pays has nothing to do with Social Security disability. It is largely a vocational problem. The problem might be solved by job training or education but Social Security will not award disability benefits on this basis.
2). "Everything was going well until one day my boss laid me off (or fired me, or something like that). Since then, I've never been able to work." Why it won't fly? Here, the claimant doesn't even claim to be disabled. There is no medical issue. There is no disability issue.
3). "I used to drive a truck, and loved my job, but now my sugar is so high that I can't pass my CDL test and so I can't work." Why it won't fly? It leaves open the possibility that you could do several other jobs. Also, Social Security does not consider the inability to get a license or certification to be a disability. If a lawyer can't get a license to practice law, it doesn't mean that he is disabled. It might be effective to argue that diabetes makes you so sick that you can't drive a truck, but I'd leave out the CDL argument.
4). "Several employers whom I asked for a job told me that because of my physical condition I would be a liability to the company and they would not hire me." Why it won't fly? Several reasons. First, employers are not allowed to decide whether or not you are disabled. Second, your argument is that no one will hire you, not that you are legally disabled. Third, the argument is more of a legal argument than a medial argument supported by medical evidence).
5). "I haven't been to a doctor in 5 years because I don't have any medical insurance. Even so, I just know that I'm not able to work." Why it won't fly? It's really an unfortunate position to be in, and lots of folks are in this situation. And this person may really be disabled. However, a disability decision must be based on objective medical evidence. If there is none, the case just can't be approved. Perhaps this claimant should try to be seen at a community medical clinic which has reduced fees or even a free clinic.
6). "All of my medical care has been from a nurse practitioner, chiropractor, counselor or nutritional expert. I think that care is as good as any and should be good enough for Social Security." Why it won't fly? In today's society, many people do get medical care from someone other than a medical doctor (MD) or doctor of osteopathic medicine (DO). However, Social Security regulations are very strict about what they call "acceptable medical sources." While there are some exceptions, generally Social Security requires medical evidence from an MD or DO to establish that you have a severe medical condition. Recently, physician's assistants have been added to the list of "acceptable medical sources." As of now, nurse practitioners and chiropractors are not on that list. It is simply not a question of whether your care is good or not, it is a matter of what Social Security regulations recognize.
7). "Uncle Ned got on disability when he was 19, never worked a day in his life and is as healthy as an army horse." Why it won't fly? Several reasons, the first of which is, Uncle Ned's case is not under consideration. The second is, it has nothing to do with why the claimant can't work. Perhaps the biggest reason, it will irritate the judge.
Thursday, March 30, 2017
THE "LEGAL THEORY" OF YOUR CASE
I was with a client
in a disability hearing before an administrative law judge last week.
Five minutes into the hearing, the judge asked, "Mr. Forsythe, what is
the legal theory of this case?"
I responded: "Judge, the claimant has 3 severe impairments, the combination of which has caused him to be unable to sustain work for the last two years. You will find evidence of these impairments and their limitations in Exhibits 2F, page 10; 6F, pages 8-17, and in 9F, pages 79, 90 and 112. In addition, considering the claimant's age, education and past work experience, a finding of disability is directed by Medical-Vocational Guideline 201.01."
The judge seemed satisfied that I had given him the facts he needed to approve the claim.
After we left the hearing, my client said to me: "I'm glad I didn't have to answer that question."
The truth is, every Social Security disability claim rises or falls on the legal theory of the case. If you don't know what your legal theory is, you don't need to be handling a hearing.
Many times, judges believe the claimant is disabled. However, they must justify their decision legally. The "legal theory" is simply the body of facts that support a finding of disability based on the federal rules and regulations that govern Social Security. It isn't enough just to convince the judge that you are disabled. You have to tell him where the regulations permit that conclusion.
_________
Need help with a Social Security disability claim or appeal? Contact the firm that has been successfully handling disability cases for years. Call the Forsythe Firm for a free consultation or case evaluation. (256) 799-0297 or (256) 431-1599.
I responded: "Judge, the claimant has 3 severe impairments, the combination of which has caused him to be unable to sustain work for the last two years. You will find evidence of these impairments and their limitations in Exhibits 2F, page 10; 6F, pages 8-17, and in 9F, pages 79, 90 and 112. In addition, considering the claimant's age, education and past work experience, a finding of disability is directed by Medical-Vocational Guideline 201.01."
The judge seemed satisfied that I had given him the facts he needed to approve the claim.
After we left the hearing, my client said to me: "I'm glad I didn't have to answer that question."
The truth is, every Social Security disability claim rises or falls on the legal theory of the case. If you don't know what your legal theory is, you don't need to be handling a hearing.
Many times, judges believe the claimant is disabled. However, they must justify their decision legally. The "legal theory" is simply the body of facts that support a finding of disability based on the federal rules and regulations that govern Social Security. It isn't enough just to convince the judge that you are disabled. You have to tell him where the regulations permit that conclusion.
_________
Need help with a Social Security disability claim or appeal? Contact the firm that has been successfully handling disability cases for years. Call the Forsythe Firm for a free consultation or case evaluation. (256) 799-0297 or (256) 431-1599.
ATHENS, AL: PROCESS FOR SOCIAL SECURITY DISABIITY
What is the process for applying for Social Security disability benefits in Athens, AL?
1. File a complete application. You may do this by contacting the Social Security office at 717 McGlathery Lane, Dectur, AL 35601. (There is no Social Security office in Athens). Phone 1-888-289-9185. You may also file online at www.socialsecurity.gov. Or, you may choose to have an advocate or attorney help you file the application. You cannot be charged a fee just for filing an application.
After you file, it will take 3 to 4 months to get an initial decision. Unfortunately, 7 out of 10 claims are denied at this level, many times erroneously. If you are denied, you must appeal by asking for a hearing before an administrative law judge within 60 days of the denial letter. This is a strict, unforgiving deadline. Miss it and your appeal is dead.
If you must appeal, you will normally wait 16 to 18 months to get before a judge. Once you are there, however, your odds of winning jump to about 48 percent, based on state averages. Your odds may be better or worse, depending on the facts of your individual case and depending on other factors, such as which judge hears your case.
If you win your appeal, you will probably receive back pay covering the months you have been waiting for Social Security to process the appeal. Some of my clients have received lump sum back pay settlements of over $70,000 in addition to their monthly checks which are continuing.
Social Security, for most people, is the only financial lifeline when disability strikes. Be sure you understand the peculiar requirements of Social Security, what evidence you must submit, and how the process works. It will require a careful, well devised plan to get benefits. It won't just happen.
It can be a long process and can be overwhelming. You are more likely to lose than to win. I think having a professional advocate or representative to help you is a good idea. You won't have to pay your representative unless you win. And the fee comes only out of back pay. So, if you win but don't recover back pay, no fee is due.
The Forsythe Firm has been helping hundreds of Social Security claimants in North Alabama for years. You will receive committed, personal attention. You won't be just a number in our system. Free consultations and case evaluations. Contact us at (256) 799-0297 or (256) 431-1599. Visit Us on the Web to tell us about your case.
1. File a complete application. You may do this by contacting the Social Security office at 717 McGlathery Lane, Dectur, AL 35601. (There is no Social Security office in Athens). Phone 1-888-289-9185. You may also file online at www.socialsecurity.gov. Or, you may choose to have an advocate or attorney help you file the application. You cannot be charged a fee just for filing an application.
After you file, it will take 3 to 4 months to get an initial decision. Unfortunately, 7 out of 10 claims are denied at this level, many times erroneously. If you are denied, you must appeal by asking for a hearing before an administrative law judge within 60 days of the denial letter. This is a strict, unforgiving deadline. Miss it and your appeal is dead.
If you must appeal, you will normally wait 16 to 18 months to get before a judge. Once you are there, however, your odds of winning jump to about 48 percent, based on state averages. Your odds may be better or worse, depending on the facts of your individual case and depending on other factors, such as which judge hears your case.
If you win your appeal, you will probably receive back pay covering the months you have been waiting for Social Security to process the appeal. Some of my clients have received lump sum back pay settlements of over $70,000 in addition to their monthly checks which are continuing.
Social Security, for most people, is the only financial lifeline when disability strikes. Be sure you understand the peculiar requirements of Social Security, what evidence you must submit, and how the process works. It will require a careful, well devised plan to get benefits. It won't just happen.
It can be a long process and can be overwhelming. You are more likely to lose than to win. I think having a professional advocate or representative to help you is a good idea. You won't have to pay your representative unless you win. And the fee comes only out of back pay. So, if you win but don't recover back pay, no fee is due.
The Forsythe Firm has been helping hundreds of Social Security claimants in North Alabama for years. You will receive committed, personal attention. You won't be just a number in our system. Free consultations and case evaluations. Contact us at (256) 799-0297 or (256) 431-1599. Visit Us on the Web to tell us about your case.
Saturday, March 18, 2017
BASIC DISABILITY INFORMATION: FINANCIAL SURVIVAL DURING DISABILITY
I've taken time to answer many of the most basic questions about Social Security disability, so you can save time, have answers and plan your financial survival. If your question isn't answered here, please contact me at (256) 799-0297 or (256) 431-1599 and I will speak to you at no cost or obligation. Please note that my practice is limited solely to Social Security disability, so I can address only this issue.
Who can apply for Social Security disability (SSDI) benefits? Anyone who has worked enough to be covered under the Social Security program. Coverage is obtained by earning wages and paying FICA tax to Social Security. Also, you need to be under full retirement age to get disability benefits. For most folks, that's around age 66 or 67.
What are the basic medical requirements to get benefits? You must have at least one severe impairment which has lasted, or is expected to last for at least 12 consecutive months (or to end in death). Your impairment must pose a significant restriction on your ability to work. You will need medical proof with recent medical treatment.
Can I apply for SSDI while I am still working? No. If you are earning wages or self-employment income that amounts to "substantial gainful activity" or SGA, you may not get disability benefits. SGA for 2017 is defined as wages, tips, salary or self-employment income of at least $1,170 per month before deductions. (Other types of non-earned income do not count).
When should I apply? Apply as soon as you have a medical condition that is expected to keep you from working for at least 12 consecutive months? You don't need to wait 12 months to file an application.
How long will it take to get a decision? Social Security usually takes 90 to 120 days to reach a decision on a disability application.
I've heard that most applications are denied. Is that true? Yes, unfortunately, about two-thirds of applications are denied and require an appeal.
Are my odds of approval better at the appeal level? Yes, considerably better. Especially if you have competent legal representation to help you at your hearing.
How much will my monthly benefit be? Monthly benefit will vary, based on your age, earnings, how long you have worked and paid into Social Security. The national average for SSDI checks is about $1,160 per month. Your amount may be higher or lower.
How does legal representation work? A representative will work on your case and prepare the application, or prepare for the appeal hearing, whichever is required. You will never be charged a fee unless you win benefits, including recovery of back pay or past due benefits. If your representative has qualified for direct payment of fees, Social Security will withhold the approved fee from your back pay and pay the representative directly.* If you are not approved, or if you don't receive any back payments, no fee is due and you owe nothing.
When do I need to get a representative involved? That really depends on you. Some claimants like a representative involved from the very beginning to help file a proper application and oversee the gathering of medical evidence. Others wait to see if they are denied, then get a representative to help with the appeal and hearing. If you are really good at completing complex forms, and can get it done accurately and on time, you may not need a representative until you are denied. Many people, however, feel that a representative may help prevent mistakes on the application and get a quicker decision or a better outcome. The choice is yours to make.
We've answered a lot of common questions here. Chances are you have more questions that we didn't post. If so, call us anytime in Huntsville at (256) 799-0297 or in Athens at (256) 431-1599.
*Our advocate, Charles Forsythe, is qualified for Direct Fee Payment from the Social Security Administration.
The Forsythe Firm is NOT affiliated with the US Social Security Administration. We are a privately owned professional firm and we work for our clients.
Who can apply for Social Security disability (SSDI) benefits? Anyone who has worked enough to be covered under the Social Security program. Coverage is obtained by earning wages and paying FICA tax to Social Security. Also, you need to be under full retirement age to get disability benefits. For most folks, that's around age 66 or 67.
What are the basic medical requirements to get benefits? You must have at least one severe impairment which has lasted, or is expected to last for at least 12 consecutive months (or to end in death). Your impairment must pose a significant restriction on your ability to work. You will need medical proof with recent medical treatment.
Can I apply for SSDI while I am still working? No. If you are earning wages or self-employment income that amounts to "substantial gainful activity" or SGA, you may not get disability benefits. SGA for 2017 is defined as wages, tips, salary or self-employment income of at least $1,170 per month before deductions. (Other types of non-earned income do not count).
When should I apply? Apply as soon as you have a medical condition that is expected to keep you from working for at least 12 consecutive months? You don't need to wait 12 months to file an application.
How long will it take to get a decision? Social Security usually takes 90 to 120 days to reach a decision on a disability application.
I've heard that most applications are denied. Is that true? Yes, unfortunately, about two-thirds of applications are denied and require an appeal.
Are my odds of approval better at the appeal level? Yes, considerably better. Especially if you have competent legal representation to help you at your hearing.
How much will my monthly benefit be? Monthly benefit will vary, based on your age, earnings, how long you have worked and paid into Social Security. The national average for SSDI checks is about $1,160 per month. Your amount may be higher or lower.
How does legal representation work? A representative will work on your case and prepare the application, or prepare for the appeal hearing, whichever is required. You will never be charged a fee unless you win benefits, including recovery of back pay or past due benefits. If your representative has qualified for direct payment of fees, Social Security will withhold the approved fee from your back pay and pay the representative directly.* If you are not approved, or if you don't receive any back payments, no fee is due and you owe nothing.
When do I need to get a representative involved? That really depends on you. Some claimants like a representative involved from the very beginning to help file a proper application and oversee the gathering of medical evidence. Others wait to see if they are denied, then get a representative to help with the appeal and hearing. If you are really good at completing complex forms, and can get it done accurately and on time, you may not need a representative until you are denied. Many people, however, feel that a representative may help prevent mistakes on the application and get a quicker decision or a better outcome. The choice is yours to make.
We've answered a lot of common questions here. Chances are you have more questions that we didn't post. If so, call us anytime in Huntsville at (256) 799-0297 or in Athens at (256) 431-1599.
*Our advocate, Charles Forsythe, is qualified for Direct Fee Payment from the Social Security Administration.
The Forsythe Firm is NOT affiliated with the US Social Security Administration. We are a privately owned professional firm and we work for our clients.
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