Most group long term disability (“LTD”) policies reduce your benefit if you receive money from other sources of disability income, such as workers compensation and Social Security Disability (“SSD”). If you are paying for group LTD disability coverage, then you should have it reviewed by an attorney to ensure it is worthwhile.
Most group LTD policies provide for a benefit equal to 50-67% of your salary. If your salary is $80,000 a year, a 60% LTD benefit would be $48,000 or $4,000 a month. If you have a child, the maximum SSD benefit could equal about $4,000 a month. Therefore, it is possible that your LTD benefit would be totally offset by your SSD benefit, and it makes no sense to pay for LTD coverage. In other words, group disability policies really misrepresent the disability benefit they provide due to offsets. Your annual Social Security earnings statement estimates your potential SSD and family benefits.
I represent a claimant with two group LTD policies. One is through her employer, and the other is through a professional associational, AICPA. The employer’s group disability policy offsets any benefit from any other group insurance coverage. This requires considering whether it makes sense to pay for both policies. For example, it could make sense if there is the belief that the AICPA is more likely to pay a benefit, or if there is a likelihood or going to work for another employer, whose LTD policy may not have such an offset. If the claimant were already disabled, then the issue would be whether an application should be filed under each policy, which might depend on whether they offer the same benefit.
It also makes sense to ask an attorney to review your group disability policy if you are leaving your current employer. Many group LTD plans allow employees to convert their LTD coverage to an individual LTD policy, and you can negotiate to exclude offsets, such as SSD, from the converted policy.
Monday, March 7, 2011
Thursday, March 3, 2011
Partially Favorable Decisions
A federal court remanded the decision of Administrative Law Judge (“ALJ”) Andrew Weiss for failing to apply Social Security Ruling (“SSR”) 83-20 properly. The ALJ found that the claimant became disabled due to his mental disorders in March 2007 because that is when he started seeing a psychologist. However, I argued that there was no evidence showing that the claimant’s condition became worse in March 2007, and there was evidence showing the claimant was disabled by January 2005.
On remand, without a hearing, ALJ Frederick Timm found the claimant became disabled as of January 31, 2005. By refusing to accept a partially favorable decision and prosecuting the case in federal court the claimant wound up receiving many additional months of Social Security Disability (“SSD”) benefits that amounted to a large five figure sum.
I received another partially favorable decision today, from ALJ Arthur Schneider. The ALJ selected a disability onset date that was based upon a report by a treating internist, even though the ALJ admitted that the internist concluded the claimant became disabled earlier at her alleged onset date. There were several other medical specialists who concluded that the claimant became disabled at her alleged onset date, including a neurologist who explained that the claimant’s condition was so severe that she met a listing 1.04 as of the alleged onset date. This claimant is also prepared to litigate in federal court in order to receive the additional SSD benefits to which she is entitled.
On remand, without a hearing, ALJ Frederick Timm found the claimant became disabled as of January 31, 2005. By refusing to accept a partially favorable decision and prosecuting the case in federal court the claimant wound up receiving many additional months of Social Security Disability (“SSD”) benefits that amounted to a large five figure sum.
I received another partially favorable decision today, from ALJ Arthur Schneider. The ALJ selected a disability onset date that was based upon a report by a treating internist, even though the ALJ admitted that the internist concluded the claimant became disabled earlier at her alleged onset date. There were several other medical specialists who concluded that the claimant became disabled at her alleged onset date, including a neurologist who explained that the claimant’s condition was so severe that she met a listing 1.04 as of the alleged onset date. This claimant is also prepared to litigate in federal court in order to receive the additional SSD benefits to which she is entitled.
Tuesday, March 1, 2011
SSD While Working
Many claimants are unaware that there are circumstances where a person has the right to collect Social Security Disability (“SSD”) benefits while working. I received a decision today that illustrates this point.
I represent a 41 year old with cerebral palsy, who applied for SSD benefits at his local Social Security office on September 25, 2009. Social Security assigned the claimant a disability onset date of August 27, 2009, which is when he stopped working.
The claimant retained me when his case was scheduled for a hearing. Although he had worked for many years, his cerebral palsy had progressed, which resulted in his working only part time starting in December 2007. At the hearing, I asked Administrative Law Judge (“ALJ”) Joseph Faraguna to consider amending the claimant’s onset date to December 2007 because he had been earning less than $700 a month, which I contended was not substantial gainful activity (“SGA”). As of January 2010, SGA requires earning more than $1,000 per month, which generally precludes being found disabled.
ALJ Faraguna accepted the amended onset date, and found that the claimant became disabled in December 2007, instead of September 2009. By alerting the ALJ to the disability onset date error made by the Social Security employee, the claimant will receive more than a year and a half in additional SSD benefits.
I represent a 41 year old with cerebral palsy, who applied for SSD benefits at his local Social Security office on September 25, 2009. Social Security assigned the claimant a disability onset date of August 27, 2009, which is when he stopped working.
The claimant retained me when his case was scheduled for a hearing. Although he had worked for many years, his cerebral palsy had progressed, which resulted in his working only part time starting in December 2007. At the hearing, I asked Administrative Law Judge (“ALJ”) Joseph Faraguna to consider amending the claimant’s onset date to December 2007 because he had been earning less than $700 a month, which I contended was not substantial gainful activity (“SGA”). As of January 2010, SGA requires earning more than $1,000 per month, which generally precludes being found disabled.
ALJ Faraguna accepted the amended onset date, and found that the claimant became disabled in December 2007, instead of September 2009. By alerting the ALJ to the disability onset date error made by the Social Security employee, the claimant will receive more than a year and a half in additional SSD benefits.
Monday, February 28, 2011
Date Last Insured
In order to qualify for Social Security Disability (“SSD”) benefits a claimant must have acquired enough work credits, which are earned by paying taxes into the Social Security systems. Work credits expire after a period of time. The Date Last Insured (“DLI”) is the day when the work credits expire. A claimant must establish that he became disabled before the DLI.
Some claimants are under the misperception that they are precluded from obtaining SSD benefits if they fail to apply before the DLI. A claimant can apply well after the DLI, and still be approved for SSD. I filed an SSD application last April for a 55 year old former salesperson whose DLI expired at the end of 1999. I received her SSD approval today.
When the claimant contacted me she had been led to believe that she was not eligible for SSD benefits because her DLI had expired in 1999. The claimant will now start receiving her monthly SSD as well as SSD benefits back to April 2009.
Some claimants are under the misperception that they are precluded from obtaining SSD benefits if they fail to apply before the DLI. A claimant can apply well after the DLI, and still be approved for SSD. I filed an SSD application last April for a 55 year old former salesperson whose DLI expired at the end of 1999. I received her SSD approval today.
When the claimant contacted me she had been led to believe that she was not eligible for SSD benefits because her DLI had expired in 1999. The claimant will now start receiving her monthly SSD as well as SSD benefits back to April 2009.
Multiple sclerosis
Multiple sclerosis (“MS”) is a chronic, often disabling disease that attacks the brain, spinal cord, and optic nerves. When applying for Social Security Disability (“SSD”) benefits, the best strategy is to provide evidence that shows the claimant meets the MS “listing.” If the criteria of the MS “listing” are met then the applicant is presumed to be disabled, and no further medical or vocational development is required. Since MS is usually treated by a neurologist it would be best to obtain an opinion from a neurologist that the claimant meets the criteria under the 11.09 listing for MS.
I represent a 54 year old former attorney whose SSD application was approved in less than three months, and shortly after I submitted medical evidence from the claimant’s neurologist showing that the 11.09 criteria were met. The claimant was not even asked to be examined by a Social Security 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. Moreover, it is also likely that an attorney advisor would approve an on-the-record request for a fully favorable decision if shown that the medical evidence meets a listing.
I represent a 54 year old former attorney whose SSD application was approved in less than three months, and shortly after I submitted medical evidence from the claimant’s neurologist showing that the 11.09 criteria were met. The claimant was not even asked to be examined by a Social Security 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. Moreover, it is also likely that an attorney advisor would approve an on-the-record request for a fully favorable decision if shown that the medical evidence meets a listing.
Expediting Disability Benefits
The attorney-advisors who work in the Social Security hearing offices can help you avoid the long wait for a hearing on your Social Security Disability (“SSD”) appeal if they approve your on-the-record (“OTR”) request for a fully favorable decision. I just returned from being out of the country for a week, and found that attorney advisors from Jericho, New York and Topeka, Kansas had approved two OTRs.
Preparing an OTR requires summarizing the medical and vocational evidence, and explaining why the Social Security rules and regulations show that a hearing is not needed to approve disability benefits. The Kansas OTR involved a 48 year old woman who had worked with the mentally disabled, who has cervical radiculopathy. The Jericho OTR concerned a 51 year old former jewelry sales representative with neck and back impairments as well as carpal tunnel syndrome. I have found that since Social Security has started using templates to write their decisions that an OTR request does not need to be long; it just has to focus on the most salient pieces of evidence in the record.
A claimant should want their attorney to submit an OTR whenever possible because it could result in receiving benefits many months, even years, before a hearing would take place. The expedited awarding of disability benefits not only improves the claimant’s cash flow sooner and avoids the stress of a hearing, but may also result in a reduced attorney fee. The SSA regulation authorizing attorney advisor decisions is set to expire August 10, 2011.
Preparing an OTR requires summarizing the medical and vocational evidence, and explaining why the Social Security rules and regulations show that a hearing is not needed to approve disability benefits. The Kansas OTR involved a 48 year old woman who had worked with the mentally disabled, who has cervical radiculopathy. The Jericho OTR concerned a 51 year old former jewelry sales representative with neck and back impairments as well as carpal tunnel syndrome. I have found that since Social Security has started using templates to write their decisions that an OTR request does not need to be long; it just has to focus on the most salient pieces of evidence in the record.
A claimant should want their attorney to submit an OTR whenever possible because it could result in receiving benefits many months, even years, before a hearing would take place. The expedited awarding of disability benefits not only improves the claimant’s cash flow sooner and avoids the stress of a hearing, but may also result in a reduced attorney fee. The SSA regulation authorizing attorney advisor decisions is set to expire August 10, 2011.
Saturday, February 19, 2011
Radiculopathy
Radiculopathy or radiculitis is any disease of the spinal nerve roots or cord, whose typical symptoms include pain, numbness, tingling, and weakness. When the evidence shows that a spinal condition is causing radicular symptoms a disability claim is usually approved.
When applying for Social Security Disability (“SSD”) benefits, if a claimant’s spine condition compromises the nerve roots or spinal cord, resulting in pain, range of motion and motor strength loss, and either reflex or sensory loss, then a claimant should be found presumptively disabled under listing 1.04, making the claimant’s functionality irrelevant. Usually, a treating doctor’s opinion that a claimant meets listing 1.04 is needed to have an SSD application approved at first instance. However, there are exceptions when the evidence is crystal clear.
I represent a 56 year old former appliance repairman whose SSD application was approved shortly after I submitted the claimant’s neck and back MRI reports. I had made sure to submit treatment records that had described various spinal impairments and radicular symptoms that met listing 1.04, yet the claim sat for several months. Then, just a couple of weeks after I submitted the MRI reports, which undeniably revealed spinal conditions that impinged and flattened the nerve roots and spinal cord, the SSD application was approved.
Even though a treating doctor’s listing 1.04 opinion was not submitted, medical records were submitted that clearly evinced all of the criteria of the listing. The claimant was not asked to be examined by a Social Security doctor, which is how Social Security normally assesses a claimant’s functionality. Therefore, it appears that listing 1.04 was found to apply. By understanding what information regarding the claimant’s spine conditions should be submitted it greatly expedited the claimant's receipt of SSD benefits.
When applying for Social Security Disability (“SSD”) benefits, if a claimant’s spine condition compromises the nerve roots or spinal cord, resulting in pain, range of motion and motor strength loss, and either reflex or sensory loss, then a claimant should be found presumptively disabled under listing 1.04, making the claimant’s functionality irrelevant. Usually, a treating doctor’s opinion that a claimant meets listing 1.04 is needed to have an SSD application approved at first instance. However, there are exceptions when the evidence is crystal clear.
I represent a 56 year old former appliance repairman whose SSD application was approved shortly after I submitted the claimant’s neck and back MRI reports. I had made sure to submit treatment records that had described various spinal impairments and radicular symptoms that met listing 1.04, yet the claim sat for several months. Then, just a couple of weeks after I submitted the MRI reports, which undeniably revealed spinal conditions that impinged and flattened the nerve roots and spinal cord, the SSD application was approved.
Even though a treating doctor’s listing 1.04 opinion was not submitted, medical records were submitted that clearly evinced all of the criteria of the listing. The claimant was not asked to be examined by a Social Security doctor, which is how Social Security normally assesses a claimant’s functionality. Therefore, it appears that listing 1.04 was found to apply. By understanding what information regarding the claimant’s spine conditions should be submitted it greatly expedited the claimant's receipt of SSD benefits.
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