Health Insurance For Children

For many disabled parents, the loss of working income makes it difficulty to afford health insurance for children. After a year long court battle to recover child’s benefits in connection with a Social Security Disability case, I received a Notice of Award for child’s benefits that included a note about insurance for children through the Children’s Health Insurance Program (“CHIP”).

Each State’s CHIP provides health insurance to uninsured, low-income children 18 years of age or younger, including those who are homeless. You can call 1-877-KIDS-NOW (1-877-543-7669) to find out how to apply, or go to http://cms.hhs.gov/schip for more information.

Avoiding An Improper Consultative Exam

In the vast majority of cases, the Social Security Administration (“SSA”) insists that disability claimants attend a consultative examination (“CE”), which is performed by a doctor selected by the SSA. However, the SSA rules and regulations require that the claimant’s treating doctor perform a CE subject to a few exceptions. The exception that the SSA usually relies upon as grounds for a CE is that the treating doctor’s opinion or report contains conflicts, gaps or inconsistencies. Before the SSA or an Administrative Law Judge (“ALJ”) can ask a claimant to attend a CE by a non-treating doctor on the grounds that the treating doctor’s opinion or report contains conflicts, gaps or inconsistencies, the ALJ must first recontact the treating doctor to explain the perceived conflict, gap or inconsistency.

I represent a former police officer whose arthritis specialist and orthopedist provided reports describing why their patient’s condition prevented him from working in any capacity. ALJ Weiss insisted that the officer attend a CE by an “independent” orthopedist because of alleged conflicts and inconsistencies in the medical reports, but I insisted that the ALJ first recontact the treating doctors in accordance with the regulations. ALJ Weiss then denied the officer’s application on the grounds that the officer lacked good cause for refusing to attend the CE.

After filing a complaint in federal court, the SSA admitted that the officer had good cause for refusing to attend the “independent” CE, and that it was improper to penalize the officer for refusing to attend it. The SSA asked the officer to remand the case, and would require the ALJ to recontact the treating doctors to clarify or provide additional information to resolve the perceived conflicts and inconsistencies in their reports. The SSA also agreed that the Appeals Council remand order will direct the ALJ to issue a decision on the merits of the case even if the officer refuses to attend an independent CE without good cause.

The SSA’s remand offer confirms that a treating source is the preferred source for performing a CE. The SSA’s remand offer also confirms that it cannot ask an “independent” doctor to perform a CE unless the treating source is given the chance to explain any alleged conflict, gap or inconsistency. Finally, the SSA’s remand offer shows that a claimant has good cause, and cannot be penalized, for refusing to attend a CE that fails to comply with the SSA’s rules and regulations.

Multiple Sclerosis

The best type of evidence for a Social Security Disability (“SSD”) claim is evidence that shows the claimant meets a “listed impairment.” If the criteria of a “listing” are met the applicant is presumed to be disabled, and no further medical or vocational development is required to approve SSD benefits.

Multiple Sclerosis (“MS”) is typically treated by a neurologist. Therefore, when applying for SSD benefits based upon MS, the best type of evidence would be an opinion from a neurologist that the claimant meets the criteria under the 11.09 listing for MS.

I represent a 53 year old former secretary and bookkeeper for her husband’s business whose SSD application was approved yesterday, just one month after I submitted a narrative report from her neurologist explaining why the 11.09 criteria were met. The claimant was not even asked to be examined by a Social Security doctor.

The rapid approval was undoubtedly due to the listing opinion from the neurologist. The first thing I always do when analyzing a claim is to determine whether the claimant’s condition can meet or equal a listing, and then securing the necessary records and reports from the treating doctor. If a hearing has already been scheduled, showing that a claimant meets a listing is important because it makes it significantly more difficult for an Administrative Law Judge to deny the claim, or for the denial to be sustained on appeal.

Protective Filing Dates

When filing a Social Security Disability (“SSD”) application, it is possible to be awarded up to twelve months of retroactive benefits. Since there is a full five month waiting period for SSD benefits, a claimant will not lose potential SSD benefits as long as the application is filed seventeen months after the onset of the disability.

For a variety of reasons many people do not file SSD applications immediately after their disability onset. If there is a possibility of filing an application and the 17 month mark is approaching, the safe thing to do is to seek a protective filing date.

A protective filing date is the date a claimant first contacts the Social Security about filing for SSD benefits. The protective filing date can be used to establish an earlier application date than the date when Social Security actually receives the signed application. A protective filing date can be established by calling the Social Security Administration’s toll free number - 800-772-1213, which eventually leads to a live operator who will take the application. The SSA usually follows up with a letter confirming an appointment. Even if the appointment is cancelled, the letters serves as proof for a protective filing date.

It is important to retain the SSA letter. I received a fully favorable on the record decision today that did not provide the protective filing date. I had reminded the claimant of the importance of the letter, but he misplaced the letter, resulting in a loss of a month’s benefits.

SSD Delays

Delays are commonplace when applying for Social Security Disability (“SSD”) benefits. Those delays frequently create “dire need” situations, such as being unable to afford medications, medical treatment, utilities, rent, or mortgage costs. Fortunately, the Social Security Program Operations Manual System permits expediting a claim when dire need circumstances exist.

I advise my clients to write me a letter explaining why their need exceeds that of other claimants, who may be able to pay for their health and housing. I suggest that they provide copies of eviction papers or past dues notices that substantiate their claims. I then provide the letter to the SSA describing how their delays have exacerbated the claimant’s dire need, and cite the relevant rules pertaining to expediting such claims.

I represent a 52 year old teacher who had to apply for food stamps while awaiting a decision on her SSD application. The SSA local office lost the application and demanded a new one. After showing proof that I had submitted the application, I sent a copy of the claimant’s letter stating that she had been approved for food stamps, and asked that the case be expedited as a dire need situation without having to submit a new application. The claimant was approved today for SSD benefits just one month after the dire need letter was submitted.

Reopening Past SSD Denial

It is common for people to apply for Social Security Disability (“SSD”) benefits more than once. Each new application starts a new date when benefits potentially become payable. What many people don’t realize is that it may be possible to “reopen” a prior application, which can result in the payment of additional benefits.

I represented a 44 year old carpenter who had applied three times, and was proceeding with his third application when he retained me. The oldest application was filed in February 2004, and the latest was filed in July 2007. I requested copies of the prior application files.

After reviewing all of the records, I obtained a report from the claimant’s treating physician that showed the claimant had lacked the ability to work since November 2003. I made a motion to reopen the prior application on the grounds that the report constituted new and material evidence. ALJ Brian Crawley agreed, and issued a fully favorable decision that approved SSD benefits based upon the prior application’s filing date.

The result of the reopening was that the claimant received well over three years of additional SSD benefits. When filing a new application always investigate whether there are grounds for reopening the prior one

ALJ Strauss’ Reliance On ME Cohen’s Testimony Proves She Is Biased

ALJ Hazel Strauss just issued a decision that proves she is biased against disability claimants. The Appeals Council had reassigned the case to ALJ Strauss from ALJ Seymour Fier on remand. The claimant is a 62 year old Italian woman with a third grade education who had worked as an unskilled sewing machine operator.

ALJ Strauss relied on the testimony of a medical expert (“ME”) from a prior hearing named Theodore Cohen. ME Cohen’s testimony was shown to be so utterly biased against claimants that ALJ Fier ruled that it had to be struck from the record; and therefore, he did not refer to ME Cohen’s anywhere in his 2008 decision. However, without any authority or explanation for doing so, ALJ Strauss based her October 2, 2009 decision on ME Cohen’s testimony.

Since ALJ Strauss knew that she could not use ME Cohen’s testimony because it had been struck from the record, how is it possible to explain her relying upon it? What possible excuse did ALJ Strauss have for using ME Cohen’s testimony, when it was clear from the record's hearing transcript and ALJ Fier’s 2008 decision that it had been struck?

ALJ Strauss claimed that she reviewed the entire record, which made it abundantly clear that ME Cohen's testimony had been struck. Therefore, ALJ Strauss cannot cannot claim that it was stupidity or negligence that caused her to rely on ME Cohen’s testimony -- ALJ Strauss knew that she was improperly relying on it. ALJ Strauss purposely relied on ME Cohen’s testimony because her preference for denying disability claims inhibited her impartial judgment, which is the American Heritage Dictionary definition for bias.

ALJ Strauss' will be reversed, although that is little solace to the claimant who now has to wait for the lengthy appeal process.