I represent a former Senior Director of Program Management whose microvascular ischemia forced him to stop working when he was 62 years old. I was retained after CIGNA terminated the long term (“LTD”) disability benefits, despite the fact that its own medical peer reviewer agreed with the claimant’s cardiologist that it would be dangerous for the claimant to continue working.
CIGNA terminated the LTD benefits on the grounds that the claimant had the functional capacity to work. CIGNA completely disregarded the fact that it had previously reversed its original decision to deny LTD benefits after conceding that the claimant had to stop working to avoid the effect that work stress had on his microvascular ischemia. Without any written explanation, I received a check today, indicating that CIGNA had admitted that, once again, it was irrelevant whether the claimant could physically perform the work.
CIGNA and other disability insurers have shown an increasing tendency to deny and terminate claims when claimants are over 62 years of age. Apparently, insurers are increasingly taking the position that since relatively few benefits remain, they hope many claimants will not fight the termination, or that there will not be enough at stake for an attorney to accept the case. CIGNA may be right.
I agreed to represent this claimant because I had handled his claim in the past. I knew in advanced that my fee would not be worth the effort. Had I not previously represented the claimant, I may not have agreed to take his case. The problem is that without an attorney, I suspect that CIGNA would not have reversed its decision, and reinstated LTD benefits.
Tuesday, January 20, 2015
Thursday, January 15, 2015
Disability Hearing Witnesses
The ostensible purpose for an Administrative Law Judge (“ALJ”) holding a hearing is to assess the credibility of the claimant who is seeking Social Security Disability (“SSD”) benefits. One way to bolster a claimant’s credibility is by developing work history evidence. Another way is by having a witness corroborate the claimant’s testimony.
The Social Security rules require that evidence be considered from non-medical sources, such as: spouses, parents, caregivers, siblings, other relatives, friends, neighbors, and clergy. When an ALJ fails to discuss hearing testimony from these witnesses in a decision denying SSD benefits, the decision must be reversed.
I represent a 28 year old corrections officer whose unfavorable ALJ decision was rejected today by the Appeals Council. The order from the Appeals Council noted that the ALJ claimed he gave appropriate weight to the testimony of the claimant’s girlfriend, but in fact, failed to indicate the specific weight accorded it.
I advise every claimant to bring a witness to testify at their hearing. Besides bolstering the claimant’s testimony, because ALJ’s routinely ignore lay witness testimony, it provides an additional solid ground for appeal.
The Social Security rules require that evidence be considered from non-medical sources, such as: spouses, parents, caregivers, siblings, other relatives, friends, neighbors, and clergy. When an ALJ fails to discuss hearing testimony from these witnesses in a decision denying SSD benefits, the decision must be reversed.
I represent a 28 year old corrections officer whose unfavorable ALJ decision was rejected today by the Appeals Council. The order from the Appeals Council noted that the ALJ claimed he gave appropriate weight to the testimony of the claimant’s girlfriend, but in fact, failed to indicate the specific weight accorded it.
I advise every claimant to bring a witness to testify at their hearing. Besides bolstering the claimant’s testimony, because ALJ’s routinely ignore lay witness testimony, it provides an additional solid ground for appeal.
Wednesday, January 14, 2015
The State Agency Concedes
In New York, an agency known as the Office of Temporary and Disability Assistance (“OTDA”) decides if the medical evidence supports an application for Social Security Disability (“SSD”) benefits. For the most part, the OTDA’s decision is based upon the opinion of doctors from IMA Disability Services. IMA is the company that provides the doctors to examine disability claimants, even though the exam should be performed by a treating doctor.
I represent a 48 year old highway worker with elbow, CTS, and back problems. The OTDA scheduled the claimant four different times for a consultative examination (“CE”). The OTDA sent my client a letter saying that his SSD application would be denied if he refused to attend the CE.
We had previously notified the OTDA in writing, that the claimant had already appeared not once, not twice, but three times, for a CE. However, IMA failed to cooperate by refusing to examine him because he wanted to record the CE.
We advised that if the claimant’s application were denied for "failure to cooperate," then we would ask the Attorney General’s office to investigate that assertion. The claimant’s SSD application was approved without a CE by IMA.
I represent a 48 year old highway worker with elbow, CTS, and back problems. The OTDA scheduled the claimant four different times for a consultative examination (“CE”). The OTDA sent my client a letter saying that his SSD application would be denied if he refused to attend the CE.
We had previously notified the OTDA in writing, that the claimant had already appeared not once, not twice, but three times, for a CE. However, IMA failed to cooperate by refusing to examine him because he wanted to record the CE.
We advised that if the claimant’s application were denied for "failure to cooperate," then we would ask the Attorney General’s office to investigate that assertion. The claimant’s SSD application was approved without a CE by IMA.
Tuesday, January 13, 2015
Social Security Fraud
by Susan Golden
It seems as if we are always hearing stories about people who are defrauding the Social Security Disability (“SSD”) system. We read about it in the newspapers, and we watch it on the news. Even 60 Minutes and 20/20 have devoted entire segments to those stories. While there may be a small minority of people who improperly receive SSD benefits, most people who apply are honest and hard working individuals, who would much rather continue to work if they could. However, what the media is not reporting is how the Social Security Administration (“SSA”) is defrauding us.
The SSA disability process is getting more corrupt by the day. The SSA does whatever it wants, without any repercussions, without any real checks and balances. When someone files an application for SSD benefits, his or her local office processes it. The local offices constantly lose important paperwork, which holds up the applications, or even deny applications based upon the local office’s own errors and incompetence. When they do eventually process the SSD application, the local office sends it out to the New York State Office of Temporary and Disability Assistance, to review the medical evidence. Much of the time, the local office does not forward all the paperwork, including medical records that the claimant has submitted, creating more problems for the claimant. The biggest joke of all is the “reviewing” of the claim by the “analyst” at the NYS office. They don’t follow their own rules and regulations, important medical evidence is misplaced, or worse yet, purged from the record, in order to provide them with a specious basis for denial. The State agency also fabricates communications with treating doctors.
Perhaps the greatest injustice of all is the State agency’s practice of scheduling claimants to attend Consultative Exams (“CE’s”), which are frequently performed by unqualified doctors, who usually misrepresent their findings. As a result of the fictitious CE findings, claimants are typically denied SSD benefits. Importantly, the SSA’s own rules state that a treating doctor should perform any CE, although the State agency rarely, if ever, complies with those rules.
To avoid being denied SSD benefits for supposedly “failing to cooperate,” which is the SSA’s practice if the claimant does not attend the CE, we have advised our clients to video tape their CE’s. There is no Social Security rule or regulation that prohibits recording of a CE, which has become necessary since the doctors blatantly lie about what occurs during the exam. Notably, the New York State agency overseeing workers compensations (“WC”) benefits has a rule explicitly stating that a claimant can video tape an independent medical exam (“IME”), which is equivalent to the SSA CE, precisely to guard against fictitious exam findings. It defies logic for a claimant with both an SSD and WC claim to be allowed to tape an IME but not a CE.
One of our clients went to his CE today, and recorded the visit. However, the person at the CE receptionist desk from Industrial Medicine Associates (“IMA”) told our client that they would not allow him to record the CE, and asked him to leave their office. It was the IMA doctor contracted by the SSA, not the claimant, who refused to proceed with the CE. The claimant recorded the IMA receptionist saying they would claim that the claimant failed to show up for his CE, which is an unmitigated lie. In fact, it seems that IMA’s claiming that a claimant failed to appear for his CE is an act of fraud that must be investigated by the SSA Office of the Inspector General (“OIG”).
The sad fact is there apparently is not a damn thing that can be done about these fraudulent practices. Over the years, we have shown how CE reports are replete with medical findings that could not possibly have been made, and have requested that the matter be referred to the OIG, but to no avail. Therefore, claimants will most likely continue to be wrongly denied SSD benefits for purportedly not attending the CE, or attending one that culminates in a report containing fraudulent findings.
The SSA should help the disabled, especially the homeless, which increasingly includes many veterans. Instead, the SSA only hurts and demeans the people who need help the most; those who can no longer work and have no money to survive. It is a travesty and disgrace. When will the media do a story about this?
It seems as if we are always hearing stories about people who are defrauding the Social Security Disability (“SSD”) system. We read about it in the newspapers, and we watch it on the news. Even 60 Minutes and 20/20 have devoted entire segments to those stories. While there may be a small minority of people who improperly receive SSD benefits, most people who apply are honest and hard working individuals, who would much rather continue to work if they could. However, what the media is not reporting is how the Social Security Administration (“SSA”) is defrauding us.
The SSA disability process is getting more corrupt by the day. The SSA does whatever it wants, without any repercussions, without any real checks and balances. When someone files an application for SSD benefits, his or her local office processes it. The local offices constantly lose important paperwork, which holds up the applications, or even deny applications based upon the local office’s own errors and incompetence. When they do eventually process the SSD application, the local office sends it out to the New York State Office of Temporary and Disability Assistance, to review the medical evidence. Much of the time, the local office does not forward all the paperwork, including medical records that the claimant has submitted, creating more problems for the claimant. The biggest joke of all is the “reviewing” of the claim by the “analyst” at the NYS office. They don’t follow their own rules and regulations, important medical evidence is misplaced, or worse yet, purged from the record, in order to provide them with a specious basis for denial. The State agency also fabricates communications with treating doctors.
Perhaps the greatest injustice of all is the State agency’s practice of scheduling claimants to attend Consultative Exams (“CE’s”), which are frequently performed by unqualified doctors, who usually misrepresent their findings. As a result of the fictitious CE findings, claimants are typically denied SSD benefits. Importantly, the SSA’s own rules state that a treating doctor should perform any CE, although the State agency rarely, if ever, complies with those rules.
To avoid being denied SSD benefits for supposedly “failing to cooperate,” which is the SSA’s practice if the claimant does not attend the CE, we have advised our clients to video tape their CE’s. There is no Social Security rule or regulation that prohibits recording of a CE, which has become necessary since the doctors blatantly lie about what occurs during the exam. Notably, the New York State agency overseeing workers compensations (“WC”) benefits has a rule explicitly stating that a claimant can video tape an independent medical exam (“IME”), which is equivalent to the SSA CE, precisely to guard against fictitious exam findings. It defies logic for a claimant with both an SSD and WC claim to be allowed to tape an IME but not a CE.
One of our clients went to his CE today, and recorded the visit. However, the person at the CE receptionist desk from Industrial Medicine Associates (“IMA”) told our client that they would not allow him to record the CE, and asked him to leave their office. It was the IMA doctor contracted by the SSA, not the claimant, who refused to proceed with the CE. The claimant recorded the IMA receptionist saying they would claim that the claimant failed to show up for his CE, which is an unmitigated lie. In fact, it seems that IMA’s claiming that a claimant failed to appear for his CE is an act of fraud that must be investigated by the SSA Office of the Inspector General (“OIG”).
The sad fact is there apparently is not a damn thing that can be done about these fraudulent practices. Over the years, we have shown how CE reports are replete with medical findings that could not possibly have been made, and have requested that the matter be referred to the OIG, but to no avail. Therefore, claimants will most likely continue to be wrongly denied SSD benefits for purportedly not attending the CE, or attending one that culminates in a report containing fraudulent findings.
The SSA should help the disabled, especially the homeless, which increasingly includes many veterans. Instead, the SSA only hurts and demeans the people who need help the most; those who can no longer work and have no money to survive. It is a travesty and disgrace. When will the media do a story about this?
Thursday, January 8, 2015
Congress Killing Disability
Although it’s no secret, for example, see House rule sets up election-year battle over Social Security, that the new Congress is trying to prevent people from receiving disability benefits. New York Republican Tom Reed sponsored a rule that will cut benefits to the disabled and their families by 19%. All Democrats opposed the new rule, while almost every Republican voted in favor of it.
For more information, see Michael Hiltzik, LA Times Do Republicans misunderstand Social Security, or just feign ignorance?
For more information, see Michael Hiltzik, LA Times Do Republicans misunderstand Social Security, or just feign ignorance?
Monday, January 5, 2015
Binder & Binder Bankruptcy
This is an update to the recent post regarding the Binder & Binder bankruptcy. According to at least once source, Binder & Binder has in fact "pulled the plug" on it's ubiquitous television campaign. Besides firing approximately 2/3 of it's workforce, 27 of 34 offices will be shut down.
We agree that the logistics of Binder & Binder’s shutting down 27 offices, firing 600+ employees, transferring cases and personnel to offices in different states, attending hearings with the bankruptcy court and negotiating with creditors, will probably distract the effective handling of their 58,000 clients’ cases.
We agree that the logistics of Binder & Binder’s shutting down 27 offices, firing 600+ employees, transferring cases and personnel to offices in different states, attending hearings with the bankruptcy court and negotiating with creditors, will probably distract the effective handling of their 58,000 clients’ cases.
Friday, January 2, 2015
SSD In Less Than A Month
Was it an end of the year quota or a Christmas present? Unfortunately, probably neither.
I represent a 54 year old nursing assistant who suffered a stroke also known as a vascular accident. One common symptom of stroke is difficulty speaking. The claimant’s stroke was so severe that she suffered a complete loss of the ability to speak, amongst other symptoms.
There is a listing that provides a person is disabled if they have “ineffective speech.” If simply having ineffective speech means a person is disabled, then having no speech at all is an disability determination.
I represent a 54 year old nursing assistant who suffered a stroke also known as a vascular accident. One common symptom of stroke is difficulty speaking. The claimant’s stroke was so severe that she suffered a complete loss of the ability to speak, amongst other symptoms.
There is a listing that provides a person is disabled if they have “ineffective speech.” If simply having ineffective speech means a person is disabled, then having no speech at all is an disability determination.
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