"Let's Get Loud " Series - Payment Center Delays

by Susan Golden

About a week ago, after receiving yet another egregious denial on one of our client's cases, I decided that I needed to do something more to help our clients.  After much thought, I wrote a letter to Martin O'Malley, the Commissioner of Social Security and sent copies of the letter to Senators Gillibrand and Schumer.  I also sent a copy of the letter to the media.  I chose to give a synopsis of some of our clients' cases, each case representing a different, serious problem  within the Social Security Administration.  I wanted to make some "noise".  While our hands are tied, and we have to follow the SSA's procedures regarding appealing claims, I want to get these stories out there, and hope that someone in the government or media will hear my plea and really try to make changes within the SSA that benefits our hard working, deserving citizens.

I want to share these cases with you, while respecting the privacy of our clients.  Today I will begin with the first case in the series, Let's Get Loud.  Our client was approved for SSD benefits, 11 years after applying.  Her case highlights the problems at the payment centers, where an approved claimant's retroactive benefits are calculated and then released to the claimant.

Claimant Number 1:  Delayed Retroactive Benefits

Ms. Y was forced to stop working on December 12, 2012, due to a Protein S deficiency that causes her blood to clot, resulting in deep vein thromboses and pulmonary emboli.  Her post thrombotic syndrome produces painful leg edema, which requires her to elevate her legs as much as possible.  Ms. Y applied for benefits on October 23, 2013.  Her date last insured was December 3, 3017.  She had her first hearing on October 16, 2015.  On March 23, 2023, after Ms. Y’s case was twice reversed by federal district court and reassigned to ALJ Patrick Kilgannon, he issued a partially favorable approval of benefits as of September 12, 2017.  We appealed to Federal Court again, and received a remand solely for a calculation of benefits on December 18, 2023, for the time period from February 15, 2013 to September 12, 2017.

On May 15, 2023, I sent information to Ms. Y’s field office in Freeport, New York, advising them that Ms. Y was in a dire need situation.  She had no medical insurance, and no money, and without medical treatment, she could die.  I asked that her retroactive benefits be expedited.  It has been eleven years since Ms. Y applied for benefits, seventeen months since her first approval, and Ms. Yearby has not received a dime of her retroactive benefits.  I have been emailing the Special Appeals Federal Court Remand processing center since May 2023.  The processing centers are responsible for calculating claimants’ retroactive benefits who have had their claims approved in Federal Court or after a Federal Court remand.  Most of my emails go unanswered.  On the rare occasion I get a response after begging for one, it is the same robotic response each time, “currently our processing times are longer than normal.”

Ms. Yearby had no choice but to return to work at a substantial risk of stroke or death during 2021-2022 because she needed medical insurance.  Her doctor repeatedly confirmed that she risked her life by working.  It does NOT take seventeen months to figure out what a claimant is owed.  In fact, a year after they had the claim, the processing center asked us for Ms. Y’s pay stubs for the time period that she worked.  It took them a year to ask for that information, and then several months later they asked Ms. Y to submit Form SSA-821, Work Activity Report.  As you can see, the mishandling of this claim is horrific.  I even went to the media and contacted Kristen Thorne of ABC news.  Her attempts to contact the processing center have been futile because they did not even respond to her.

Another Seven Year Saga

A 35 year old claimant from Brooklyn with mental impairments retained us in March 2017, to apply for Social Security Disability (“SSD”) benefits.  We successfully went to federal court twice to get the administrative law judge (“ALJ”) reversed.  The second reversal ordered that the case be reassigned to a new ALJ.

On remand, the new ALJ accepted the opinions of the treating psychiatrists, and found the claimant was entitled to SSD benefits since 2016.  It took five administrative hearings, two protracted federal court appeals, and over seven years, but the claimant finally obtained the outcome she desired.

This case was not a difficult case to approve as evidenced by the final decision.  The decision was based on the same medical evidence that had been submitted five years ago.  If the SSA wasn't fraught with analysts and adjudicators who are lazy and incompetent, and if so many of the SSA's rules and regulations weren't so outdated and nonsensical, then this case would have been approved seven years ago.

We don't give up on our clients if they have a medical problem with doctors who support their case and are willing to help.  We truly care about our clients, and in many cases, such as this one, form a special bond with them.  If you want an experienced disability attorney who is going to fight for you, please call our Melville, Long Island office for a free phone consultation.

 

 

Non-Medical Evidence

We represent a 61 year old from Mount Vernon with physical impairments.  The administrative law judge (“ALJ”) held a hearing today, which made it clear that Social Security Disability (“SSD”) benefits would be approved. The approval was expected given the impact of a new regulation.

The claimant’s past relevant work (“PRW”) had consisted of three occupations during the previous 15 years: Customer Care Representative (“CCR”), which was sedentary work, Medical Clerk and Ward Clerk, which were light occupations.  However, under the revised regulation, PRW is now limited to the past five years, which made CCR no longer relevant.  The State agency found Ms. Thomas not disabled because she could perform her past sedentary work as a CCR.

Under the Grid rules, the claimant had to be found disabled if she had no acquired skills from her PRW as a Medical Clerk or Ward Clerk that could transfer to sedentary occupations.  Before the hearing, I supplied the ALJ with various federal court decisions where vocational experts (“VEs”) testified the Medical Clerk and Ward Clerk occupations did not provide any transferable skills.  Thus, even accepting the State agency doctor’s opinion that the claimant could do sedentary work, a finding of disabled was required.

The hearing was relatively short.  ALJ posed a hypothetical to the VE, who concluded the claimant was unable to perform her PRW.  And because the ALJ accepted the treating opinions that the claimant could not even perform sedentary work, transferability was not even an issue.  Consequently, the claimant had to be found disabled.

Every claimant's case is different.  There are many factors that Social Security takes into consideration when deciding whether or not a person is unable to work a fulltime job, which is Social Security's definition of being disabled.  The person's age, past work history, and medical problems are just to name a few.  So while it may seem obvious to someone that they are disabled and cannot work,  it is not so clear cut to Social Security.  In this case, it was non-medical evidence based on the claimant's PRW and Grid rules that we focused on, which is the evidence the ALJ based his approval upon.  Our client put her trust in us, and together, we obtained the information necessary to get her SSD benefits approved.  Please call our office, if you are thinking of applying for SSD, for a free phone consultation.  Our office is conveniently located on the border of Nassau and Suffolk counties on Long Island.

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.