LTD Approvals

We just received approvals from MetLife, New York Life, and Lincoln Life on three long term disability (“LTD”) applications.  While the approvals involved different insurers and impairments, the applications were similar in their preparation.  Our approach has been called gilding the lily, but our results speak for themselves.

LTD applications almost invariably consist of three parts:  forms for the claimant, the employer, and the treating doctor.  If only those three forms are returned, then the insurer is almost guaranteed to insist on receiving more information before approving.  When we submit an LTD application it is usually is accompanied by objective diagnostic testing and clinical records, witness statements, medical treatise data, functional assessments, and vocational reports.

Most employers establish LTD plans by buying an insurance policy.  Because that insurance company is liable for paying any claims, that is a conflict of interest  results in denials of valid claims.  To be profitable, the insurer must have a liability acceptance rate (“LAR”) where it takes in more premiums than it pays out in claims.  When the LAR is too high, insurers deny more claims, regardless of the merits.

By providing more evidence compared to other applicants, insurers take the path of least resistance, and target other claimants for denial or termination.   Don't let the insurance company fool you by pretending to care, and to be your friend.   All they care about is making money.

Please feel free to call our office for a free phone consultation.  We have helped thousands of individuals obtain long term disability benefits under individual and group policies from many insurance companies, including Unum, Prudential, Reliance, The Standard, Guardian, and Metropolitan Life, to name a few.

 

RCPD

Retrograde cricopharyngeal dysfunction (“RCPD”) is  lifelong condition, where a dysfunctional cricopharyngeus muscle causes an inability to burp, causing in excess gas and discomfort in the chest or throat.  The symptoms include stomach, chest or throat pain, loud gurgling noises, bloating, nausea, and excessive gas.

RCPD is an objectively demonstrable physical impairment.  However, according to the Yale School of Medicine, RCPD symptoms can make social interactions embarrassing, resulting in people experiencing social anxiety.

We represent a 54 year old credit card clerk with RCPD from Massapequa, whose Social Security Disability (“SSD”) benefit application was approved today by an Administrative Law Judge (“ALJ”).  Because the claimant’s mental health providers would not provide their records, or a summary report, we arranged for a psychologist who frequently works for Social Security to evaluate the claimant.  While the ALJ believed the RCPD probably precluded sedentary work, the ALJ determined that the claimant was even more impaired mentally.

Simply submitting medical records is not enough to get an approval for SSD benefits, which is why it is highly recommended to retain an experienced disability attorney to represent you.  Please call our Melville, Long Island office for a free phone consultation.

Disabled Adult Child Benefits

Most people are unaware that there are special situations where a "child" over the age of 21, who is disabled, can apply for Social Security Disability ("SSD") benefits under one of their parents' social security record ("SSR").  One of the parents must be receiving SSD benefits, Social Security Retirement benefits, or have passed away.   Thus, a person over 22 years of age, who did not have enough work history to apply on their own SSR, can apply on a parent's SSR.

We represent a 22 year old client from Bethpage, New York with mental impairments, who lacked sufficient work credits to apply on his own SSR for SSD benefits.  He would have had to apply for Supplemental Security Income ("SSI"), and his monthly benefit would have been much lower.  Moreover, since he lived with his mother he may not have even qualified for SSI benefits.

When he first contacted us, we asked him if either of his parents received SSD benefits.  Because he advised us that his mother was receiving SSD benefits, we were able to apply for his SSD benefits under his mother's SSR.

We received a fully favorable decision from ALJ Tirrell, after supplying medical records that he requested in addition to the medical evidence we had already submitted.

This is another example of why you should retain an experienced disability attorney if you plan on applying for SSD.  Our office, located in Melville, Long Island, offers a free phone consultation.

Multiple Sclerosis

Multiple Sclerosis (“MS”) is a disabling disease because of its symptoms.  Merely having objective evidence for the diagnosis is insufficient to secure disability benefits.

We represent a 32 year old with MS from Bethpage who worked as a teacher.  The MS diagnosis was never challenged, but the State agency denied Social Security Disability (“SSD”) benefits.  We obtained reports from the claimant’s neurologist, internist, pain management specialist, and chiropractor explaining why the claimant’s symptoms interfered with her ability to work consistently.  Based on those reports, the administrative law judge (“ALJ”) agreed that the claimant would be off task at least 21% of the time.  Then, based on the testimony of the vocational expert, the ALJ determined the claimant was disabled.

You cannot assume that you will get approved for disability based on a medical diagnosis.  It’s important to know what information, beyond a diagnosis and medical records, would be needed to have your claim approved.  This is why we always recommend hiring an experienced disability attorney to represent you for your SSD claim.  Our office, located on Long Island, offers a free phone consultation.  Please call us if you want to apply for disability and we will discuss your options with you.

Headaches

Disability adjudicators are skeptical about approving claims for headaches because the pain cannot be seen, and there is no diagnostic test for them.  However, if a cause for the headaches can be objectively established, then the benefits should be approved.

We represent a 55 year old administrative clerk from Wantagh with pseudotumor cerebri.  Pseudotumor cerebri is a somewhat rare condition that causes increased pressure inside the skull.  As the pressure increases, so do a person’s headaches.  In preparation for a hearing with an administrative law judge (“ALJ”), we submitted medical treatise information identifying the symptoms of pseudotumor cerebri, and detailed reports from the treating neurologist, which explained the genesis and severity of the resulting headaches.

The ALJ issued a fully favorable decision, awarding the claimant Social Security Disability ("SSD") benefits.   Our client is overjoyed, and thankful that she retained us.  We highly recommend retaining an experienced disability attorney if you are applying for SSD benefits.  Call our office for a free phone consultations.  We are conveniently located on Long Island in Melville.

Transferable Skills

The number of on-the-record (“OTR”) approvals has decreased over the years, due in large part to the elimination of the treating physician rule allowance rate has correspondingly decreased.  Nonetheless, when the vocational facts align with the medical evidence, an OTR should be sought.

We represent a 58 year old from Port Jefferson Station with sleep apnea, cardiovascular and orthopedic impairments that stopped him from working in law enforcement.  During a hearing with an ALJ from Connecticut, a vocational witness (“VW”) testified that the claimant’s past work was light and had no transferable skills.

The claimant’s pulmonologists confirmed that Mr. Kline met the criteria of listing 3.02 A and B, based on an FVC of 1.68 and an FEV of 1.12.  The claimant’s pulmonary function testing revealed “severe restriction/obstruction.”

After the case was transferred back to the Long Island hearing office, the physicians treating the claimant’s musculoskeletal impairments and obstructive sleep apnea concluded the claimant could not even perform sedentary work.  Moreover, the VW had testified that leg elevation would preclude all work, and the claimant’s orthopedist stressed the importance for the claimant to elevate his legs.

In light of the above, we submitted a request for an OTR.  Even if the claimant did not meet a listing, his less than sedentary work capacity would require finding him disabled.  Furthermore, even if the claimant did not meet a listing, and did not have a less than sedentary work capacity, his need to elevate his legs would require finding him disabled.  Additionally, even if the claimant did not meet a listing, and did not have a less than sedentary work capacity, and did not need to elevate his legs, and had light work capacity, then the medical-vocational rules would require finding him disabled.  The ALJ approved canceled the hearing, and approved the OTR.

 

OTR Approved

The number of on-the-record (“OTR”) approvals has decreased over the years, due in large part to the elimination of the treating physician rule allowance rate has correspondingly decreased.  Nonetheless, when the vocational facts align with the medical evidence, an OTR should be sought.

We represent a 58 year old from Port Jefferson Station with sleep apnea, cardiovascular and orthopedic impairments that stopped him from working in law enforcement.  During a hearing with an ALJ from Connecticut, a vocational witness (“VW”) testified that the claimant’s past work was light and had no transferable skills.

The claimant’s pulmonologists confirmed that the claimant met the criteria of listing 3.02 A and B, based on an FVC of 1.68 and an FEV of 1.12.  The claimant’s pulmonary function testing revealed “severe restriction/obstruction.”

After the case was transferred back to the Long Island hearing office, the physicians treating the claimant’s musculoskeletal impairments and obstructive sleep apnea concluded the claimant could not even perform sedentary work.  Moreover, the VW had testified that leg elevation would preclude all work, and the claimant’s orthopedist stressed the importance for the claimant to elevate his legs.

In light of the above, we submitted a request for an OTR.  Even if the claimant did not meet a listing, his less than sedentary work capacity would require finding him disabled.  Furthermore, even if the claimant did not meet a listing, and did not have a less than sedentary work capacity, his need to elevate his legs would require finding him disabled.  Additionally, even if the claimant did not meet a listing, and did not have a less than sedentary work capacity, and did not need to elevate his legs, and had light work capacity, then the medical-vocational rules would require finding him disabled.  The ALJ approved canceled the hearing, and approved the OTR.