Witnesses

Many people seeking Social Security Disability (“SSD”) benefits do not include third party support statements when applying, or have third parties testify at hearings.  Having witness attestations should not be overlooked.

We represent a 57 year old Financial Vice President from Queens Village with spine impairments.   The claimant had two SSD applications that were denied before we were retained.   The good news is that we succeeded in getting the claimant’s third application approved on-the-record without a hearing.  The bad news is that the ALJ would not reopen the prior applications, which resulted is a substantial loss of benefits.

One difference in the third application was a report from the claimant’s friend, which the ALJ specifically considered in accordance with Social Security Ruling (SSR) 16-3p.  Specifically, he considered the personal observations in terms of how consistent those observations are with the claimant's statements about their symptoms as well as with all of the objective medical evidence in the file. Third party statements are not evaluated using the same criteria as medical source statements; however, they were considered to complete the narrative of the claimant's subjective complaints in accordance with accordance with and 20 CFR 404.1520b(c) and 416.920b(c).

The claimant made the right decision when he realized that he needed to retain an experienced disability attorney after filing on his own, and being denied twice.  We cannot emphasize enough the importance of  his decision.  Please feel free to call our office for a free phone consultation if you are considering applying for SSD benefits.  We are located on Long Island with offices located in both Nassau and Suffolk counties.

 

 

 

Dire Need

According to Social Security, a dire need situation exists when a claimant alleges any of the following circumstances:

• The claimant is without food and is unable to obtain it.
• The claimant lacks medicine or medical care and is unable to obtain it, or access to necessary medical care is restricted because of a lack of resources.
• The claimant lacks shelter (e.g., without utilities such that their home is uninhabitable, homelessness, expiration of a shelter stay, or imminent eviction or foreclosure with no means to remedy the situation or obtain shelter).

Absent evidence to the contrary, accept a person's allegation that the person does not have enough income or resources to meet an immediate threat to their health or safety.  HO employees will err on the side of designating the case critical.

Despite the above, many requests to have a claim classified as a dire need case are ignored by the assigned analyst.

We represent a 58 year old with multiple foot, spine and wrist problems from Valley Stream who worked as an electrician.  We were able to obtain strong evidence from the claimant’s pain management specialist.  The claimant qualified as a dire need case because his utilities were being shut off.  However, the case was languishing because the analyst was holding dire need status hostage.

The analyst refused to tag the case as a dire need because he wanted to the claimant to attend a consultative examination (“CE”) with IMA. We had to escalate the matter above the analyst’s head, who claimed there was nothing he could do.  We succeeded in getting the supervisor to expedite the case, which was approved in about 10 days, without the need for a CE.

The claimant is so happy that he retained us, and that we had the experience and knowledge to do what was needed to get his claim expedited.   This is just another of many reasons why you should retain an experienced disability attorney to represent you if you plan on filing for Social Security Disability benefits.   If we hadn't known what to do, our claimant's case would still be sitting there.

If you are planning on applying for Social Security Disability benefits, please call our office for a free phone consultation at (888) 572-0861.  Our offices are conveniently located in Nassau and Suffolk counties on Long Island.

 

DDS Laziness

We represent a 49 year old financial advisor from Plainview with residual problems from a stroke, whose Social Security Disability (“SSD”) benefits were approved today without a hearing, but with little help from the State agency. 

Since the claimant was under 50 years of age, there was little need for vocational information, because transferable skills were not an issue. Nonetheless, the State agency repeatedly held the claim up by requesting more details about the claimant’s work duties than they do in other cases. 

To compound matters further, we submitted thousands of pages of medical and hospital records detailing the stroke sequelae. The records documented hemiparalysis, balance issues, fatigue, foot drop, among other things. Nonetheless, the State agency kept sending requests for the claimant’s brain scans – which we confirmed each time had already been submitted. Then it became obvious to us what the problem was. 

We went through the records that were in the State agency’s electronic folder for the claimant. We pulled out the brain scans, and resubmitted a second time. SSD benefits were approved shortly thereafter. In other words, the State Agency representative refused to review the medical records because they were so voluminous, so we had to do their job for them. 

It is vital to have an experienced disability attorney represent you if you plan on applying for SSD benefits. From the moment we file our client’s application, we stay on top of the representative(s) handling your claim. For example, when we submit medical evidence directly into our client’s efile, we receive a confirmatory receipt. However, we consistently find that when we check the efile a few days later, the evidence we submitted is not there. The State agency analysts' stock answer is that it’s the “system’s” fault. It’s a constant game of submitting evidence, checking to make sure it shows up in our claimant’s file, and then calling the State agency when we don’t find the evidence in the file. 

The bottom line is that most of the analysts at the State agency do not do their jobs. It could be that they are lazy, stupid or they just don’t care. If you want to maximize your chances of being approved for SSD benefits, then you need to retain an experienced disability attorney. We have been handling disability claims since the last Century. Please call our office for a free phone consultation if you plan on applying for SSD benefits. We have offices located in both Nassau and Suffolk counties on Long Island.

DDS Sham

In New York, Disability Determination Services (“DDS”), a State agency, initially decides if you get Social Security Disability (“SSD”) benefits.  Experience reveals that most of the people working at DDS are lazy.

We constantly have cases sitting at DDS for months without any review activity.  Then, after we submit medical records and reports, DDS asks for the same things again, as if simply churning the file shows they have done something.  Because they wait too long to review files, DDS regularly claims that the medical records are stale.  If DDS had bothered to review the records in a reasonably prompt manner, then the records would not have become stale.

Many DDS medical consultants (“MCs”) are amongst the laziest DDS employees.   We always provide MCs with more than ample medical evidence to find claimants disabled.  However, MCs refuse to review the medical records and opinions reports that we submit.  Instead, the MCs claim that there is insufficient evidence if a claimant does not attend a consultative examination (“CE”).  In other words, the only evidence the MCs care about reviewing is the CE report.  We had a case with thousands of pages of medical records and reports detailing claimants’ limitations, yet the MCs still said there was insufficient evidence.

We received an OTR  today that illustrates the DDS laziness.  We represent a 60 year old medical receptionist from Lindenhurst, who had to stop working after suffering a stroke.  The file contained over 500 pages of medical records, including detailed functional limitational form the claimant’s neurologist, yet Robert Dickerson, the DDS MC, denied SSD benefits on the grounds that there was insufficient evidence.  We appealed by requesting a hearing, which transferred the case from the State agency to the Social Security Administration (“SSA”).  It was so obvious to an attorney from the SSA that our client was disabled, that the case was approved OTR, without any additional medical evidence having been submitted.

The DDS laziness wasted the claimant’s time, and the SSA’s resources as well.  It is sad that an agency who is supposed to be helping people actually do the opposite.  We want to help you.  If you are applying for SSD, you need an experienced, competent attorney.  Please contact our office for a free phone consultation.  We have offices located on Long Island in both Nassau and Suffolk counties.

ALJ Carlton Reversed Again

Administrative Law Judge (“ALJ”) John Carlton  denies most cases Social Security Disability (“SSD”) cases because he bases his decisions on his interpretation of the medical data, instead of the interpretation of physicians, as the law requires.

We represent a 56 year old claimant from Bay Shore with hip problems, who worked for over 30 years as a truck driver,  warehouseman, and police officer.  ALJ Carlton, who was not qualified to interpret an x-ray, decided that the claimant only became disabled on the date the claimant’s hip x-ray demonstrated arthritis and degenerative changes.  You do not have to be a physician to realize that degenerative changes cannot possibly occur overnight.  Notably, we represented another claimant in Vellone v. Saul, 2021 WL 2801138 (S.D.N.Y. 07/06/2021) where the court reversed ALJ Carlton’s decision because, once again, he decided to play doctor, and relied on his interpretation of the medical evidence to reject the treating doctor’s opinion that the plaintiff’s hip and back pain precluded working.

In the present instance, ALJ Carlton never explained how the claimant’s hip problems suddenly went from not even being severe, to limiting the claimant to light work, on April 13, 2019.  Upon appealing the case to federal court, we sent a short letter to counsel for the Social Security Administration (“SSA”).  Based upon that letter, the SSA agreed that ALJ Carlton’s decision was indefensible, and voluntarily remanded the claim.

On remand, the case was reassigned to ALJ Alan Berkowitz.  Today, ALJ Berkowitz issued a fully favorable decision, and awarded the claimant SSD benefits, without even holding a hearing.

Hartford Breached Its Fiduciary Duty

Hartford Life, as claims administrator of a long term disability (“LTD”) plan, relies on claim procedures, which the Second Circuit found violated ERISA’s regulations.  Hartford argued that its procedures, which it called “protocols,” entitled Hartford to take more than 45 days to decide if a claimant is entitled to receive benefits.  Hartford admitted that it routinely applies the protocols.  One protocol is Hartford’s appeals department remanding administrative appeals to Hartford’s claims department.  Another protocol is arguing that COVID entitles Hartford to an extension of time.

Since Hartford admitted that it regularly employs the protocols as a general matter, we asserted a cause of action for breach of fiduciary duty, and as relief, asked that Hartford be removed as the Plan’s claim administrator.  Hartford asked the Court to dismiss the breach of fiduciary duty claims.  On January 13, 2023, Magistrate Judge (“MJ”) Arlene Lindsay rejected Hartford’s request.  However, MJ Lindsay indicated that since the breach of fiduciary claims may subject Hartford to a class action, within 30 days, she wanted to be notified of the steps the plaintiff will take towards serving as an adequate representative.

In compliance with MJ Lindsay’s order, we served interrogatories on Hartford that seek the identities of past and present participants of the LTD Plan, since each of those individuals is a potential plaintiff.  The interrogatories also seek the identities of past and present participants of other disability plans where Hartford has or may apply its protocols because each of those individuals also has a potential breach of fiduciary duty claim against Hartford.

Feel free to contact us if Hartford is your LTD claim administrator, and you have questions about the way your claim has been handled. We can be reached at (888) 572-0861.

 

 

 

Excuses Excuses

By Susan Golden

The number one question we get everyday is, "How long will it take to get a decision on my claim?"  The answer is, "Be prepared for the long haul."  Why is that?  As soon as we file a social security disability ("SSD") claim with our client's local Social Security Administration ("SSA") office, the excuses and delays begin.  Popular excuses from the local offices include: "We don't have all the paperwork;" "The file must be sitting on someone's desk;" "We're backlogged;" "The person handling the case is out;" and "We don't know why it hasn't been processed yet, everything we need is here!"

After your local SSA office processes the claim, they send it to the State agency, where the claim is reviewed.  Everything is done electronically, so the file should be transferred quickly to the State agency, and include everything submitted to the Local SSA office, such as your application and our letters of representation.  However, depending on the local office, it can take weeks, sometimes months, to get the file transferred, and even then, the State agency claims documents are  missing.

Your file has been transferred to the State agency!  Great, now things will start moving.  Hold on, let's not get ahead of ourselves.  The State agency is full of their own excuses and delay tactics.  In fact, they are masters at it.  They constantly complain that they don't have enough information from the claimant's treating doctors, even though we have submitted exactly what they are asking for!  They mislabel documents in the file, and are too lazy to look through them, because if they did, then they would realize that the file does indeed have exactly what they are asking for.   They don't look at a file for months, and then all of a sudden they complain the records we have submitted are "stale," when we had submitted them in a timely manner.  Luckily, we know how to play their game, and call them out on their delay tactics.

I could go on and on, but don't have enough space or time, but you get the picture.  If you need to apply for SSD, you should make certain that you retain an experienced disability attorney.  We have over three decades of experience, and know the SSA system inside and out.  Please feel free to call our office for a free phone consultation.  We have offices in Nassau and Suffolk counties on Long Island.