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.

 

 

Vocational Evidence

Obtaining Social Security Disability (“SSD”) benefits requires proving the inability to perform any full-time job for at least twelve months.  The process requires submitting substantial medical support from treating providers. Many claimants are unaware that there is also a vocational component involved in the evaluation process.

In addition to submitting medical evidence, claimants must provide detailed information about their work history for the past five years. Social Security not only reviews medical documentation but also employs Vocational Experts ("VEs") to examine claimants' work histories. A VE considers the claimant’s job experience, age, and any restrictions or limitations when determining what work, if any, is possible. A VE may also assess whether the claimant possesses transferable skills that would allow them to work full-time in another occupation.

VEs frequently rely on the Dictionary of Occupational Titles ("DOT") an outdated resource.  Each occupation listed in the DOT is classified into categories such as sedentary, light, medium, heavy or heavy work.

We represent a 52-year-old Peace Officer from Baldwin, New York, who recently received a Fully Favorable Decision regarding their SSD application. Several months prior to the scheduled hearing, we requested an On the Record (“OTR”) decision; the administrative law judge ("ALJ"), however, declined to grant it at that time.

Shortly before the hearing, we submitted an in-depth description of the claimant’s past occupation as a Peace Officer from his employer, New York City, including the requirements necessary for the position. Upon reviewing this information, the ALJ recognized that the claimant did not possess transferable skills applicable to other occupations. As a result, the ALJ approved the OTR the day before the hearing was scheduled.

  

QR Increases on Approvals

It is no coincidence that all of our cases approved by the State agency at the initial and reconsideration levers are being reviewed by the Federal government's Quality Review ("QR") unit. The QR process process is supposed to select State agency decisions at random.  However, the QR unit only pulls approved cases to evaluate.  In most instances, the approvals are confirmed. 

For decades, only one or two of our cases annually would be selected for QR, and rarely overturned. We spoke to a State agency analyst who verified that almost every approved claim is currently being pulled for further examination. This new policy is counterproductive to efforts to reduce costs and spending.  Overturning approvals makes it harder for disabled people, who cannot work due to medical conditions, to receive Social Security Disability benefits. This alarming treatment of individuals with disabilities is deeply concerning.