Compassion v. Calculation

We recently handled a difficult, yet unfortunately common, case that perfectly illustrates a critical flaw in the Social Security Disability ("SSD") Insurance system.  Our client, a 57-year-old golf cart technician from Port St. Lucie, Florida, was recently diagnosed with Stage 4 Pancreatic Cancer. This devastating diagnosis immediately met the criteria for a Compassionate Allowance.  The good news is that the Compassionate Allowance designation worked as intended: his claim was approved in just three weeks. In a time of unimaginable stress, this rapid decision was a small victory, lifting the burden of uncertainty from his family.  However, this victory was overshadowed by a hard reality: the mandatory five-month waiting period for SSD benefits.

By law, an applicant cannot receive their first SSD benefit payment until up to six months after their established onset date when they became unable to work.  Our client stopped working last month.  This means that despite his terminal diagnosis and rapid SSD approval, his first payment will not be due for about six months from the onset date.  The cruel irony is undeniable. Our client, with a terminal illness recognized by Social Security as immediately disabling, may not survive long enough to ever receive the benefits he and his family desperately need and deserve.  Common sense would suggest that when a disability is recognized as terminal, this five to six month waiting period should be inapplicable. Unfortunately, the delay from the waiting rules runs counter contrary to the issuance of a a Compassionate Allowance.

As experienced disability advocates, we knew going into this case that a quick approval meant we would not receive a fee.  We were happy to help our client and his wife navigate the complexities of the SSD application process during this excruciating time.  Our priority was to shoulder the stress of the paperwork and give them back precious time to focus on what truly matters.

This case is a stark reminder that while the Compassionate Allowances program speeds up the approval process, a necessary reform is still needed to bring true compassion to the payment schedule for those with terminal conditions.

 

Quality Review Increases

The Social Security Administration pulls disability claims for review that have been decided by the Stage agency at the initial application.  Social Security Disability claims selected for Federal Quality Review are said to be chosen at random, including both approved and denied cases. However, in my three decades as a disability attorney, only approved claims have been reviewed. Each time we check with the local office, only approved claims have been pulled, which shows the process is not random.  Since the beginning of this year, every one of our cases that have been approved at the initial application were pulled by Quality Review.

Meeting A Listing

When representing a claimant seeking Social Security Disability ("SSD") benefits, we obtain medical records from each of their treating physicians. We also ask these doctors to complete a Medical Findings Summary, which is a questionnaire designed to assess a patient’s restrictions and limitations (“R&Ls”).  The Social Security Administration relies on these R&Ls when making its determination. If the R&Ls from a claimant’s medical impairment is severe, they may satisfy the requirements of one of Social Security’s “Listings.”

We represented a 41-year-old dental assistant from Melville, NY, who suffers from a significant vision impairment. We requested that her doctor to review Social Security’s Listing criteria for Visual Disorders. The physician supported our case by providing medical evidence showing our client met the Listing.  Along with a vision test requested by the State agency, we submitted this information, and our client was promptly approved during the initial application stage.

Retaining an experienced disability attorney is in your best interest if you are planning on applying for SSD benefits.  Our office, located in Melville, NY in Suffolk county, offers a free phone consultation.

Meeting SS Grid Rules

When applying for Social Security Disability (“SSD”) benefits, your likelihood of approval at the initial application stage increases significantly if you meet the criteria outlined under the “Grid Rules.”  These rules are designed to assess disability claims based on three main factors: your age, your highest level of education completed, and your past employment history.  Satisfying the Grid Rules can be crucial in securing benefits, as the Social Security Administration uses these benchmarks to determine whether a claimant can adjust to other work given their impairments.

I represent a 54 year old laborer from Port Washington, NY.   My claimant’s highest completed education was the 5th grade, and he began working as a laborer during his teenage years.  He remained in this occupation until health issues, specifically cardiovascular problems and musculoskeletal ailments, prevented him from continuing.  Social Security classifies the laborer role as an unskilled occupation, meaning it does not provide transferrable skills that could be applied to other types of work.

In this case, the client’s doctors provided substantial support by completing questionnaires that clearly detailed the patient’s restrictions and limitations.  These medical opinions, combined with the client’s age, limited education, and unskilled work history, created a compelling record that led to his approval at the initial application stage.  Although the State agency attempted to delay the decision by requesting a Consultative Exam (“CE”), the evidence provided from the client’s treating physicians was so strong and conclusive that the CE was ultimately canceled. The approval was granted based solely on the evidence already in the file.

Obtaining a favorable decision from the Disability Determination Services (“DDS”) has become increasingly difficult. Rather than thoroughly reviewing claimants’ files, DDS analysts often overlook submitted evidence.  In many cases, it falls upon us to identify and direct the analyst to the relevant documentation within the file.  Effectively, this means doing both our job and part of the analyst’s job to ensure the claim is properly considered.

This case underscores the importance of retaining an experienced disability attorney when applying for SSD benefits.  An attorney can ensure that all necessary evidence is submitted and highlighted for review, increasing the chances of a favorable and expeditious decision.  For those considering an application, my office, located in Melville, NY in Suffolk County, offers a free phone consultation to assist with the process and answer any questions.