OTRs

Most times, a request for an on-the-record (“OTR”) decision is not considered until a couple of days before a hearing is scheduled to take place. Nonetheless, an OTR should still be pursued because it avoids the stress a claimant experiences when having to attend the hearing with an ALJ. Also, ALJs appreciate OTRs because they allow ALJs to devote more time to more complicated claims.

We represent a 57 year old security guard from Jamaica, who stopped working due to pain from various musculoskeletal impairments. The State agency medical consultants found the severity of the claimant’s pain to be credible. However, those consultants denied Social Security Disability (“SSD”) benefits twice because the claimant had no doctor providing functional limitations.

Since the claimant had to stop working because of pain, we referred the claimant to a pain management specialist, who supplied the requisite opinion. Based on that opinion, we submitted a brief explaining why the medical and vocational evidence in the file supported finding the claimant disabled under the Social Security rules and regulations. The ALJ agreed.

Retaining a disability attorney who has years of experience handling SSD claims is in your best interest. We have an encyclopedic of knowledge of the ins and outs of the SSA, from the initial application with the local office, to working with the State agency, the ALJ’s, and if necessary, the Appeals Council and Federal Court. If you want to greatly increase your chances of receiving a favorable outcome to your SSD claim, please contact our Melville, Long Island office for a free phone consultation.

 

 

 

 

LTD Surveillance

We represent claimants who are applying for Long Term Disability benefits.  We work with many different insurance companies, none of whom have your best interests at heart, even though they act like they are your best friend.

We always warn our clients to be aware of their surroundings because the insurance companies will most likely hire a surveillance company to spy on them, usually for three days in a row.  For example, if you see a strange vehicle on your block that stays in place for an extended period of time, then call the police.  If you notice a car following you, call the police.  If someone comes to your door when you are not expecting anyone, do not answer the door yourself.  The surveillance companies have many tricks to try and catch you doing something that they can manipulate into looking like you were doing something that proves you can work.  This is just a friendly reminder to be careful.

 

 

The Truth about Immigrants and Social Security

by Susan Golden

It is no secret that getting approved for Social Security Disability ("SSD") benefits is a battle.  To be entitled to SSD benefits, a person must have worked and paid into Social Security long enough to earn at least 40 work credits.  If you don't have enough work credits, you might be eligible for Supplemental Security Income ("SSI").  You must meet the same medical criteria, but you also have to meet the financial criteria.

Before filing a claim, we make certain that our clients have current treating doctors who support their inability to work fulltime due to their medical condition(s).  After their application is filed, it is processed by their local Social Security office and then sent to the State agency ("DDS") for review.  But even when we submit supporting medical evidence to DDS, mostly due to the incompetence of their analysts, our client is denied.  More than half of the time, claimants are denied at the initial application, and at the first level of appeal, reconsideration.  As we've discussed so much over the years, the State agency analysts are civil service workers, not doctors or lawyers, and they deny claimants erroneously all of the time.  Claimants have a much better chance of getting approved at the hearing level simply because there are actual attorneys reviewing the claims and experienced Judges presiding at the hearing, if one is needed.  We've had quite a few of our claimant's cases approved On The Record over the past few months, because we have decades of experience handling SSD claims.

We receive a lot of phone calls from people who have applied on their own and have been denied.  They've realized that this is not an easy process, they cannot do this on their own and they are ready to retain us to take over their claim for them.

It has come to our attention that vice presidential candidate J.D. Vance, has been making false claims stating that, "Social Security and Medicare are facing a “massive fraud problem” because of undocumented immigrants who are collecting benefits, citing what he said were incidents of fraud related to him by some of his constituents and friends."   As we stated above, it is difficult to get approved for Social Security even when you meet the eligibility requirements.  You cannot collect benefits if you do not have a Social Security number.  If an immigrant has a Social Security number, and they have enough work credits and a disabling condition that prevents them from working full-time, they will be eligible to apply for benefits, and are entitled to them, just as any U.S. citizen with the same criteria is.

We want to make it perfectly clear that you will not be eligible for SSD benefits if you do not have a Social Security number and if you do not have enough work credits.  If someone tells you that immigrants are taking away your Social Security benefits, they  are dangerously misinformed and do not know what they are talking about.

 

 

"Let's Get Loud" Series - Mental Health Records

by Susan Golden

Claimant 6 – Veteran Rating 100% Disabled and SSA Rules on Mental Health Records

The State Agency denied Mr. C’s case without considering more than half the evidence we submitted.  The denial letter only referred to Mr. C's therapist, and the State Agency’s inability to obtain records from the therapist.  The truth is that we submitted a Medical Findings Summary from the therapist, along with a narrative report from her in lieu of sending her records, per Social Security's own website.  We also had submitted a Medical Findings Summary from the claimant's psychiatrist along with her records.  Furthermore, we submitted a letter from the VA rating Mr. C's disability at 100%.  There was no mention of any of these documents in the denial letter at all.  The continuous denial of claims based on falsehoods at DDS has reached an intolerable point of intentional laziness, disrespect and uncaring.  

 

OTR Efficiency

An on-the-record (“OTR”) decision saves a claimant time by receiving an approval before a hearing with an Administrative Law Judge (“ALJ”) takes place.  An OTR can also save a claimant money.  Since attorney fees grow each month before a claim is approved, by receiving an OTR well in advance of the hearing, there are fewer fees to pay. Unfortunately, most ALJs will not look at a brief requesting an OTR until a couple of days before the scheduled hearing.

An OTR also avoids the stress a claimant experiences when having to attend a hearing with an ALJ.  Hearings can last for a couple of hours if there are experts, and hearings usually do not start on time.  If the case is strong, ALJs like OTRs because they free up time and resources for more complicated claims.

We represent a 55 year old claimant from Franklin Square with physical and mental impairments, who worked as a teacher’s aide and an administrative clerk.  Those occupations are considered light, i.e., more strenuous than sedentary work.  I submitted a brief showing how Vocational Experts had testified that both occupations provide no skills that transfer to sedentary work.

FI showed that five treating doctors explained why the claimant could not even perform sedentary work.  The State agency medical consultant, whose credentials could not be determined because the State refused to disclose the full name, was the only doctor who believed the claimant could work.  The State consultant never saw the claimant, and failed to review most of the medical records.

Given the above facts, I maintained that the claimant should be found disabled under the Grid rules, even if she were capable of full time sedentary work.  Consequently, I asked the ALJ to issue an OTR.  The ALJ agreed that an OTR would be appropriate, which eliminated the need for the claimant to attend the hearing.

This is a perfect example of why retaining an experienced, knowledgable disability attorney is in your best interest if you intent on applying for SSD benefits.  Please call my Long Island office for a free phone consultation.

 

 

 

"Let's Get Loud" Series - DDS's Laziness

by Susan Golden

Claimant 4 – Consultative Exams ordered by the State agency

Ms. G  applied for SSD benefits on June 26, 2024.  Ms. G was an elementary school teacher for 33 years.  She suffers from severe migraines, vertigo, severe back problems and anorexia, to name a few of her impairments.  On August 5, 2024, we submitted supporting medical reports from Ms. G’s treating doctors, which included an EMG and a pharmacy printout.

On August 22, 2024, my assistant, Samantha Diamond, received a phone call from Mr. Begelman, the analyst at the State agency assigned to Ms. G’s case.  He was calling to advise us that he was scheduling Ms. G. for a Consultative Exam (“CE”) with the IMA, the company that SS contracts with to perform CE’s.  According to the regulations, CE’s are supposed to be scheduled only after making best efforts to obtain the necessary information from the treating sources, which are the preferred source.  When Ms. Diamond asked Mr. Begelmann= if he had reviewed Ms. G’s file and seen what we submitted, he admitted that he hadn’t even looked at the file yet.  So without even knowing what was or was not needed, and without doing the bare minimum required by the regulations, Mr. Begelman scheduled Ms. G for a CE with IMA.

Notably, most of the time the “specialists” at IMA are from the wrong medical board, if they are certified at all, let alone trained in the specialty that is relevant to the claimant’s impairments.  Additionally, IMA doctors claim they do not have any records or information from the State agency about claimants, which begs the question, how do they know what exam to perform?  IMA also has signs all over their offices which state that Social Security claimants are not allowed to record their exams, yet in small print on the same sign it states that Workers’ Comp claimants are allowed.  That disparate treatment is ridiculous, and if our claimant tries to record an exam, the IMA employees cry that their HIPAA rights are being violated.  HIPAA only applies to a person’s medical information - it provides no rights, and has no relevance, to IMA staff.  Since IMA admits to allowing Workers Comp claimants to record exams in the very same offices where the SS claimants are being examined, by the very same staff, and the very same doctors, then IMA must be confessing to countless HIPPA violations.

"Let's Get Loud" Series - ALJ's

by Susan Golden

Claimant 3:  Administrative Law Judges

Mr. V applied for benefits in 2017.  He retained our service after he had applied on his own.  Mr. V. worked as a jeweler his entire professional life, well over 30 years.  He had 2 children, and was separated from his wife, but they remained friendly.  His only concern was being able to take care of his children.  He suffered from severe lower back pain and needed surgery.

On January 10, 2018, I submitted proof of dire need to the State agency.  Mr. V’s case was initially denied and a hearing was scheduled for April 12, 2019.  On January 30, 2019, three months before the scheduled hearing, I received a phone call from Mr. V’s mother that he had passed away.  She actually found him dead on the floor of their apartment.

ALJ John Carlton, at the Bronx hearing office, denied Mr. V’s claim on September 26, 2019.  It took the ALJ FIVE months to issue a decision.  We appealed the case to the Appeals Council (“AC”).  Prior to 2016, the AC remanded and even approved quite a lot of cases.  After 2016, approvals disappeared, remands are rare, and most cases are denied.  Mr. V’s claim was denied by the AC on December 9, 2019.

We appealed the case to Federal Court.  The Honorable Judge Ronnie Abrams ordered a remand for a new hearing on July 6, 2021.  The case was supposed to go back to ALJ Carlton for another hearing, but first it had to be sent back to the AC for processing from Judge Abrams.  The AC did not send it back to ALJ Carlton until January 2022.

On January 9, 2022, we received a letter from the Bronx hearing office, on behalf of the ALJ, requesting updated medical information, despite knowing that the claimant had been deceased at this point for three years.  On March 9, 2022, two months later, we received another letter from Hearing Office Director Michael E. Higgins, requesting a “current Authorization to Release Information” form.  Again, the claimant was deceased.  What is going on at this office?  The hearing was scheduled for June 8, 2022, six months after the Bronx OHO received the case, almost a year after the case was remanded by Judge Abrams, three years after the claimant passed away, and five years after he had originally applied for SSD benefits.

On September 27, 2022, almost four months after the last hearing, we sent a letter to Chief Judge Selwyn S. Walters at the Bronx OHO because ALJ Carlton had still not issued a decision.  We did not receive a response.  On December 21, 2022, SIX months after the last hearing, ALJ Carlton denied the claim again, seventeen months after Judge Abrams remand order.

After filing another appeal in Federal Court, on December 13, 2023, United States Magistrate Judge Stewart D. Aaron remanded Mr. V’s case for a new hearing.  The case was assigned to a different judge, ALJ Joani Sedaca at the New York City OHO, because ALJ Carlton had already heard the case twice.  Notably, our initial request for a hearing was May 9, 2018.  Mr. V’s third hearing has been scheduled for December 2, 2024, six and half years after the initial request, and six years since Mr. V passed away.