Social Security Benefit Increase

The Social Security Administration made it official that benefits, including disability benefits, will increase 1.5% next year. The annual Cost Of Living Adjustment (“COLA”) is supposed to enable fixed income benefit recipients to keep up with the cost of inflation. However, as medical cost increases exceed many other costs, the COLA is usually inadequate for the disabled, who normally have greater need for medical care.

Wegener's Granulomatosis

According to the Mayo Clinic, Wegener's Granulomatosis, also known as granulomatosis with polyangiitis (“GPA”), is a rare disorder that causes inflammation of your blood vessels. This inflammation restricts blood flow to various organs. 

There is no known cause for GPA, which is commonly treated with immunosuppressive therapy, in which case the patient is advised to avoid large groups of people. According to the American College of Rheumatology, GPA causes shortness of breath, joint pain, numbness and loss of movement in the extremities, among other things. 

I represent a 58 year old bookkeeper with GPA whose Social Security Disability application was approved today, five months after it was filed. The claimant was sent letters on four separate occasions demanding that she attend a consultative examination (“CE”) by IMA Disability Services that stated she needed to attend the CE in order to have her SSD application approved. 

The claimant declined each CE. The claimant’s rheumatologist and neurologist each submitted reports explaining that the GPA precluded her from being able to work. I advised the State agency that a CE was not needed because any medical information could be provided by the claimant’s specialists. I am confident that had the claimant attended the CE, which experience has shown is often cursory and even fraudulent, then the State agency would have relied on the CE to deny the application despite what the treating doctors said.

Reopening Prior Application

Why reopen a prior application? The answer is that it can result in being awarded additional benefits. There is a full 5 month waiting period to receive Social Security Disability (“SSD”) benefits. Thus, if you became disabled on October 25, 2013, the alleged onset date (“AOD”), then you would first become eligible to receive SSD benefits in April 2014, the date of eligibility (“DOE”). 

An application can provide retroactive SSD benefits up to 12 months before the month in which the application is filed. Therefore, a claimant will not lose any benefits as long as the application is filed within 17 months of the AOD, by combining the 12 month retroactive benefit and 5 month waiting periods. 

Reopening a prior application is only automatic if it is done within 12 months after the initial determination on an SSD application. The regulations provide that an application can be reopened within 4 years for good cause, which includes new and material evidence. 

I represent the widow of a claimant, whose SSD application was approved today. By providing new and material evidence, I persuaded the Administrative Law Judge to reopen a prior application. As a result, nearly 2 additional years of benefits will be awarded.

SSA “Quality” Review By QRB

For many years, the Social Security Administration (“SSA”) has reviewed about 1% of the decisions made on Social Security Disability (“SSD”) applications. That percentage significantly increased about two years ago when the SSA enacted new procedures for Appeals Council “own motion review” cases by the Appeals Council’s Quality Review Branch (“QRB”). During the past two years, I have seen a five fold increase in the number of cases subjected to “quality” review. 

The QRB only reviews favorable and partially favorable decisions by Administrative Law Judges (“ALJs”). There is no explanation why the QRB is not concerned about the quality of unfavorable decisions, which shows that the intent of the new rules is simply to increase the number of denied claims. It is unclear if the QRB is randomly sampling decisions, or targeting ALJ's who have higher rates for approving SSD decisions. 

On December 14, 2012, the QRB sent me a letter stating that if I failed to provide additional evidence to support an ALJ’s October 18, 2012 fully favorable decision, then the QRB would reverse it. On December 17, 2012, I sent a detailed letter explaining that I refused on the grounds that the decision was amply supported by objective evidence. On June 6, 2013, because a half year later the QRB still had failed to act, I asked the QRB to stop wasting everyone’s time, and either to confirm the ALJ’s decision so the claimant could get paid, or reverse the ALJ’s decision so I could appeal to federal court. 

On July 29, 2013, instead of reversing the ALJ’s fully favorable decision, the QRB remanded it. Today, without a hearing, the ALJ issued a fully favorable decision. The QRB procedure was a colossal waste of time and money.

Dire Need

The Social Security Disability (“SSD”) application process is a slow one. When people lose their income because of a disability, especially those with little or no savings, they wind up having severe financial troubles. Social Security has a priority plan and procedures to expedite the processing of SSD applications for the most serious claims first.

Dire Need is one basis for expediting. The inability to pay for food, medical needs, or housing can constitute dire need. Providing documentation of creditor threats, late payment, foreclosure papers with a letter explaining why you cannot pay for medications, obtain needed clinical or hospital treatment, or pay for critical expenses, such as utilities, rent, car lease, will help substantiate the dire need.

I represent a 49 year old former administrative services for an insurance company who had to stop working primarily due to spinal cord lesions. Despite a protracted work history, the claimant became destitute. After bringing the claimant’s situation to the attention of the hearing office, buttressed by 40 page letter and documentation detailing her dire need, her case was expedited, and approved in 6 weeks.

Just because a claim is expedited does not guarantee that it will be approved. However, if the claim is going to be denied at a hearing, then it is still better to get the denial expedited to hasten review by the Appeals Council.

Padro Settlement Approved

District Court Judge Carol Bagley Amon gave final approval today to the proposed settlement in the Padro Class Action, despite the objections of ALJ Hazel Strauss. It needs to be seen if the Queens Five will revert to their biased tactics after the time period covered by the settlement expires.

Social Security Increase

It is expected that Social Security recipients will receive a 1.5% increase in their monthly benefits next year.  That includes people who receive retirement and disability benefits.  

Since 1975, the annual automatic cost of living adjustment ("COLA") has averaged 4.1%.  The purpose of the COLA is to help people on fixed incomes keep up with inflationary prices increases. 

Government Shutdown

Due to the shutdown of the Federal Government, there will be a reduction in services provided by the Social Security Administration. Your local field office will remain open, but with limited services, and it needs to be remembered that its hours have already been reduced as a result of sequestration.  Those services include helping you apply for benefits or request an appeal for benefits.  The hearings offices will remain open for Administrative Law Judges to conduct hearings, but it appears that the effectuation of disability benefits for new claimants will be delayed. Social Security Disability and Supplemental Security Income benefit payments will continue with no change in payment dates.