DDS Denials Overturned

A few of our recent blogs have focused on favorable On-the-Record (OTR) decisions, which has become a recurring theme for many of our cases. While we are always pleased when our clients receive the benefits they deserve, the increasing number of OTR approvals raises an important question; why are so many deserving claimants being denied earlier in the process when the evidence supporting disability is already present in the file?

Recently, our office represented a 43-year-old former retail store associate from Brooklyn, NY, who suffers from a combination of significant physical and mental health impairments. Her medical conditions include chronic physical limitations, severe migraines, bipolar disorder, and anxiety. As her conditions progressed, she became increasingly unable to perform even basic daily activities without assistance. She required a home health aide for approximately 35 hours per week to assist with daily routines and personal care. She had been issued a handicap parking permit due to her mobility limitations, and her treating providers consistently documented the impact her conditions had on her ability to function.

Despite the strength of the evidence, her claim was not approved at the initial application or reconsideration levels of the disability process. After the case was appealed to the hearing office, the evidence was reviewed more closely, and an OTR decision was issued, resulting in a fully favorable outcome without the need for a hearing before an Administrative Law Judge.

While every case is unique, we continue to see a pattern in many of these OTR approvals. In case after case, substantial medical evidence supporting disability is already contained in the file, yet the claim is denied at the Disability Determination Services level. By the time the case reaches the hearing office, the same evidence often leads to a favorable decision without any testimony being required.

This trend suggests that strong medical evidence is too often being overlooked or improperly evaluated during the initial stages of the disability process. For claimants, these unnecessary denials can mean months or even years of additional waiting, financial hardship, and stress before receiving benefits.

Cases like this serve as an important reminder that a denial is not always the end of the road. When the medical evidence supports disability, pursuing the appeals process can make all the difference.

If you are considering filing for SSD, call our office (888) 572-0861 for a free consultation.

 

 

Rare OTR

We recently helped a 31-year-old office assistant from East Meadow obtain Social Security Disability benefits after a serious motor vehicle accident left her unable to work. She sustained injuries to her wrist and hips, along with significant nerve damage, resulting in ongoing pain and functional limitations that prevented her from returning to full-time employment.

Despite extensive treatment, including multiple surgical procedures, her symptoms persisted. Her medical records documented ongoing pain, reduced mobility, difficulty using her hands, and limitations with standing, walking, and sitting for prolonged periods.

One factor that strengthened this case was the quality and consistency of the medical evidence. The claimant's treating physicians maintained detailed treatment records, and the operative reports from her surgeries provided objective evidence of the severity of her condition. The medical documentation clearly demonstrated that her impairments prevented her from sustaining full-time competitive employment.

Equally important was the claimant's diligence throughout the disability process. She consistently kept our office informed of every medical appointment, treatment update, and procedure. By promptly providing records and visit information, we were able to ensure that the Social Security Disability analyst had the most current evidence available throughout the evaluation of her claim.

Although a hearing had already been scheduled before an Administrative Law Judge ("ALJ") we continued to submit updated medical evidence as it became available. After reviewing the extensive record, the judge determined that the evidence overwhelmingly supported a finding of disability. Approximately two months before the scheduled hearing date, the judge issued a fully favorable On-The-Record ("OTR") decision, eliminating the need for the claimant to appear at a hearing.

An OTR decision is relatively uncommon and generally occurs when the medical and vocational evidence leaves little doubt that a claimant meets Social Security's definition of disability. Additionally, it is very rare for an ALJ to issue an OTR for a claimant that is under 50.  In this case, the combination of serious injuries, multiple surgeries, objective medical findings, and consistent treatment created a compelling record that supported approval without the need for testimony.

This case serves as a reminder that strong medical evidence and active participation in the disability process can make a significant difference. By keeping her treatment current and ensuring that all relevant records were submitted, this claimant helped build the type of record that allowed the judge to issue a favorable decision before the hearing even took place. 

Compassionate Allowance

A former client referred her husband to us to file a Social Security Disability claim after he was diagnosed with Stage 4 pancreatic cancer, a condition that qualifies for a Compassionate Allowance claim under Social Security guidelines. We were glad to assist with filing his claim on his behalf, even though we knew there would be no attorney fees.

Her husband, a 61-year-old mail handler from Laurinburg, North Carolina, was approved in less than two weeks. When we submitted the claim, we notified Social Security that it qualified for Compassionate Allowance treatment. Once the case reached the state agency for review, we promptly provided his pathology report, and the claim was approved

Hearing Loss Approval

Many people assume that hearing loss alone is not enough to qualify for Social Security Disability benefits. However, when hearing impairments are severe and accompanied by significant balance problems, they can have a profound impact on a person's ability to perform competitive work. Recently, our office successfully obtained disability benefits for a 56-year-old former union field representative from Deer Park, NY, whose long career was cut short by progressive hearing and balance disorders.

Our client developed profound bilateral otosclerosis, resulting in significant hearing loss in both ears. In addition to his hearing impairment, he experienced ongoing balance issues that affected his ability to safely navigate work environments and travel for his job duties. These symptoms made it increasingly difficult for him to perform the tasks that had been routine throughout his career.

The key to this case was strong medical evidence. His treatment records thoroughly documented the severity of his hearing loss, the progression of his condition, and the impact it was having on his daily functioning. Just as importantly, we worked with his treating physician to obtain a detailed Medical Findings Summary. The physician clearly explained how our client's hearing and balance limitations would interfere with his ability to sustain full-time employment on a regular and continuing basis and Social Security approved his claim for disability benefits.

When hearing impairments are severe, well-documented, and accompanied by symptoms such as balance disturbances, they can significantly limit a person's ability to work. Obtaining comprehensive medical records and detailed opinions from treating providers can make a substantial difference in the outcome of a disability claim.

If you are unable to work due to hearing loss, balance disorders, or another serious medical condition, please call our office at (888) 572-0861to schedule a complimentary call.

 

 

 

 

OTRs

One of the most frustrating aspects of representing Social Security Disability claimants is seeing strong cases denied despite substantial medical evidence supporting their claims. While the disability determination process is designed to identify individuals who qualify for benefits, there are too many times when critical facts and medical records are overlooked during the initial review stages.

Recently, our office represented two younger claimants whose cases were ultimately approved with On-the-Record (“OTR”) decisions by Administrative Law Judges (“ALJs”).  In both cases, the ALJs found the evidence compelling enough to issue favorable decisions without requiring a hearing. Unfortunately, both claimants endured lengthy delays and multiple denials before receiving the benefits they deserved.

The first claimant was a former draftsman from Syosset, NY, who suffered from significant mental health impairments that affected nearly every aspect of his daily functioning. His medical records documented ongoing treatment, consistent symptoms, and substantial limitations in his ability to work. Yet despite this evidence, the claim was denied at the Disability Determination Services (“DDS”) level.

As the appeals process continued, the claimant's circumstances became increasingly dire. He was evicted from his apartment, and he was living in his car.  We alerted Social Security to this and asked for his case to be expedited, but he still had to wait almost seven months for a decision on his disability claim. Even this level of instability and hardship failed to move the needle during the earlier stages of review.

When the case reached the hearing level, the ALJ reviewed the complete record and issued a favorable OTR decision. The ALJ recognized what had been evident in the medical documentation for quite some time: the claimant's mental health conditions were limiting and that prevented him from sustaining full-time employment.

The second claimant from East Meadow, NY has been disabled since childhood and applied for benefits under a parent's Social Security retirement record. Disabled Adult Child (“DAC”) claims require proving that the disabling condition began before age 22 and continued thereafter. In this case, the evidence supporting that standard was substantial.

The claimant's records documented longstanding impairments dating back to childhood. Medical providers supplied supportive documentation outlining the severity of his condition and its impact on functioning over time. Educational and treatment records further reinforced the continuity of his disability. Nevertheless, the claim encountered resistance during the DDS review process.

After a lengthy wait and additional appeals, the case reached an ALJ. Following a review of the evidence, the ALJ issued a favorable OTR decision, finding that the claimant met the requirements for benefits based on disability that began in childhood.

No disability claim is guaranteed approval, and every case is unique. However, these two cases serve as important reminders that an initial denial does not necessarily mean a claim lacks merit. When strong evidence exists, continuing the appeal process may make all the difference. 

If you or someone you know is considering filing for SSD or DAC benefits, please reach out to our office at (888) 572-0861 for a free consultation.

 

PSA: Overpayments

We have recently experienced a significant increase in phone inquiries from individuals receiving Social Security Disability ("SSD") benefits who have received an “overpayment” notice from Social Security. In essence, Social Security is indicating that they have paid more money than the claimants were entitled to receive.

Many SSD recipients find it challenging to subsist on the limited monthly benefit provided. If one’s health permits, it is possible to engage in limited part-time employment while receiving SSD benefits; however, it is essential to understand the earning limits stipulated by Social Security to avoid an overpayment.

Any form of compensated work constitutes employment, regardless of the nature or perceived difficulty of the job. The critical factor is the gross monthly income earned, not the type of work performed.

Recently, we consulted with a former client who is unable to meet her financial needs solely through SSD benefits. She supplements her income by babysitting, which involves collecting children from school and supervising them until their parents return home. Although she believed this activity would not impact her SSD benefits due to its simplicity, we advised her that Social Security considers only the total monthly earnings, irrespective of job complexity.

Social Security regulations are unequivocal. If your gross income exceeds the Substantial Gainful Activity ("SGA") threshold for more than a nine months trial work period within a 60-month period (regardless of whether these months are consecutive), you must notify Social Security to suspend your benefits temporarily. Should you become unable to continue working within five years, you may file for "expedited reinstatement" of your disability benefits without having to file a new application.  Failure to report excess earnings can result in substantial repayment obligations once Social Security identifies the discrepancy. It is crucial to familiarize yourself with these regulations to prevent such situations from occurring.

Lifelong Disability Approved

Our client is a 30-year-old woman born with Cerebral Palsy, a lifelong condition affecting her mobility, muscle control, and overall functional capacity. Despite significant limitations, she had attempted to navigate the disability process twice on her own but was denied both times. By the time she retained our office, she was understandably frustrated.

We elected to file a new application and developed the case thoroughly from the outset. Updated medical records were obtained, and we worked to ensure the evidence clearly documented not only her diagnosis, but also her limitations in standing, walking, balance, coordination, and endurance over the course of a workday. Unfortunately, the State agency denied the application at the initial and reconsideration levels. While disappointing, these denials, are not uncommon, even in cases involving longstanding impairments.

We requested a hearing before an Administrative Law Judge ("ALJ"). Prior to the hearing date, the attorney at the hearing office assigned to review the file explored the possibility of resolving the matter without a formal appearance before the ALJ. Although those discussions were constructive, the case ultimately proceeded to a hearing. As part of our pre-hearing preparation, we amended the alleged disability onset to a much earlier date. At the hearing, the ALJ observed our client directly and heard her testimony regarding her daily functioning and work-related limitations. Following the hearing, the ALJ issued a fully favorable decision.

Every disability case is unique, but this one reinforces why careful case development, strategic advocacy, and preparation for hearing can change the outcome entirely. If you are considering filing for SSD, please reach out to our office for a free consultation.