Quick SSD Reversal

We were retained by a 45 year old Education Director after her Social Security Disability (“SSD”) application was denied.  She had to stop working due to Yao’s Syndrome.

Yao’s syndrome is a relatively new rheumatic condition, which is not well understood.  Having successfully obtained SSD benefits for other claimants afflicted with Yaos, we knew what clinical and opinion evidence to submit to win approval.  Fortunately, we secured the SSD benefits in a few months, without the claimant having to attend a hearing.

If you are thinking about applying for disability benefits, please contact our office for a free phone consultation at (888) 572-0861.  We have offices located on Long Island in both Nassau and Suffolk counties.

QC Reviews

The Social Security Administration (“SSA”) routinely conducts “quality reviews” of decisions from the State agency.  The SSA insists that the reviews are random.  However, since the last Century, every time one of my client’s decisions has been pulled for review, the State agency decision was an approval of Social Security Disability (“SSD”) benefits.  Moreover, every colleague I know has also expressed that their clients have never had a disapproved decision reviewed.

We represent a 54 year old teacher from Port Jefferson Station with diabetes and mental impairments.  The State agency approved SSD benefits three days after we submitted very supportive reports from the claimant’s psychiatrist and therapist.  Nonetheless, it took a month and a half to obtain the approval because the decision had been pulled for quality review. 

 There is zero justification for quality reviews.  The fact that only awards are reviewed reveals that their purpose is not to attempt to improve that quality of the State agency decisions.  Rather, their purpose is to try to find some means to reverse the approval.  Just as the SSA is being called upon to eliminate the reconsideration stage of the hearing process, the SSA should also eliminate so-called quality reviews.

 

Insurance Scam

Insurance companies do whatever they want to make money.  Even if you have been paying into a plan, and then find yourself in need of filing a disability claim, the number one concern of the insurance companies is profit.  They don't care about you, they care about the bottom line.  They've already "denied" you before they even see your claim.  They will act like they're your best friend, and then stab you in the back.

Retaining an attorney for a long term disability claim is vital if you want to have a much better chance of being approved.  We have decades of experience with all of the insurance companies, and know how they operate.  We also have an extremely high rate of success.  Please call our office for a free phone consultation.  We have offices on Long Island in both Nassau and Suffolk Counties.

by Susan Golden

 

 

Winning Hands

 Most unskilled sedentary jobs require good use of both hands and the fingers; i.e., bilateral manual dexterity (“BMD”). Fine movements of small objects require use of the fingers; e.g., to pick or pinch.  Most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions.

For over 40 years, the Social Security Administration (“SSA”) has recognized that BMD is necessary for the performance of substantially all unskilled sedentary occupations.”  In fact, SSR 83-14 provides that a limitation to unskilled sedentary work with an additional loss of BMD  is significant and, thus, warrants a conclusion of disabled.

Vocational experts (“VEs”) routinely testify that claimants who lack bilateral manual dexterity are precluded from performing any sedentary occupations.  However, the fact that a VE had to testify at a hearing means that the State agency denied the claimant Social Security Disability (“SSD”) benefits two times.

We represent a 59 year old nurse from Syosset with many diverse impairments, including carpal tunnel syndrome and a trigger finger.  After we submitted records and a report detailing the claimant’s lack of BMD, the State agency approved SSD benefits, just three months after we filed the application.  No doubt, the approval was based on the claimant’s lack of BMD. Regardless of what impairments claimants may have, they should take care to obtain reports that detail the functional limitations and restrictions they may have in using their hands.

SSA on the Hotseat

The House Ways and Means Committee held a thearing on October 26, 2023, to question the acting assistant deputy commissioner of operations from the Social Security Administration ("SSA") about the decades old systemic problems that affect millions of Social Security Disability ("SSD") applicants.  If you ever applied for SSD benefits, or know someone who has, then you probably already know about these problems.

The SSA is supposed to help people who are eligible for SSD benefits when they become too ill to work.  However, the application process is antiquated, customer service is almost non-existent, the wait time to speak to someone on the phone averages 35 minutes, and the wait time for a decision is ridiculously long.

Some of our clients retain us after they have applied on their own, and they realize that trying to navigate the SSA's system is extremely stressful and difficult.  We take that burden off of them and make certain that the SSA has no direct contact with them.  Our clients would rather be working than applying for SSD, but due to any number of medical conditions, cannot work on a full-time basis.  But trying to stay afloat while the SSA makes a decision is almost impossible for many of our clients.  We have had clients pass away while waiting for a decision, and the SSA just does not seem to care.  The SSA simply blames the delays on backlogs and lack of staff.

David Camp, interim chief executive of the National Organization of Social Security Claimants’ Representatives, also testified at the hearing.  He explained how changing some of the SSA's rules and regulations, which are ineffective and old, could reduce the wait time for a decision, and free up the State agencies' analysts to work more efficiently.  These common sense changes could make a huge difference in many people's lives.  Of course, the members of the Ways and Means Committee would have to agree to continue to fund the SSA, because any cuts to their budget would be detrimental for anyone that is trying to obtain SSD benefits.

 

Medical Investigating

Attorneys representing claimants seeking Social Security Disability (“SSD”) benefits frequently will attack an administrative law judge (“ALJ”) for failing to credit the claimant’s subjective complaints.  Attorneys need to listen their clients as well.

We represent a 55 year old claims adjuster from Franklin Square, who asked us to seek SSD benefits due to mental impairments.  When preparing the claimant for his hearing, he complained about neck and hand pain.  We immediately advised him to see a neurologist, who performed EMG testing, which yielded abnormal results.

The ALJ disregarded the claimant’s physical impairments when denying the case.  Shortly thereafter, in light of the abnormal EMG, the neurologist sent the claimant for an MRI of his cervical spine.  The MRI revealed shockingly severe findings.

When appealing the ALJ’s decision, we submitted the MRI.  The Appeals Council remanded the case to the ALJ in near record time.  The same ALJ approved the claimant’s SSD application today based primarily on the physical impairments.

Our client, who suffers from extreme anxiety, was so grateful to us for being successful in getting his claim approved.  We are glad we were able to relieve one burden from his shoulders.  Please call our office if you are looking for an experienced disability attorney to help you apply for Social Security Disability benefits.  We have offices located on Long Island in Nassau and Suffolk counties, and offer a free phone consultation.

 

COLA Increase

It's the time of the year again when Social Security announces the COLA ("Cost of Living Adjustment").  This year the COLA is 3.2%.  The SSA has estimated that anyone receiving benefits can expect an increase of about $50 beginning in 2024.

More ALJs Needed

We represent a 58 year old from Fair Lawn, NJ, with mental and physical impairments, who requested a hearing with an administrative law judge (“ALJ”) on September 7, 2022.  The good news is that ALJ Dina Loewy from the Jersey City hearing office approved Social Security Disability (“SSD”) benefits today OTR.  Unfortunately, it took 13 months to obtain the OTR.

The average wait time for a hearing at the Jersey City office is 13 months, which is better than most hearing offices.  For example, the average wait time for a hearing at the Long Island hearing office is 16 months.  Consequently, the Long Island hearing office has been transferring SSD appeals to other offices, like Albany and Hartford, which have average hearing waits of 14 and 13 months respectively.

It is not a secret that ALJs are under pressure to increase the number of cases they adjudicate in order to reduce the hearing wait times.  An internal memo from last year from the Deputy Communications Commissioner for Social Security, said that years of inadequate funding resulted in the agency  being unable to " keep up with the demand for service and our annual fixed cost increases."  According to the memo, Disability Determination Services (“DDS”), which assesses disability claims, experienced "historically high attrition as workloads become less reasonable with fewer staff."

It would seem to be in everyone’s best interest if the number of ALJs and State agency representatives could be increased.  The SSD safety net was designed to help workers at the most vulnerable point  of their careers.  Workers paid into the system for the explicit purpose of receiving some limited financial assistance just in case they become disabled.  Workers should not have to wait a year for the DDS to render a decision, and if denied, then wait over another year for a hearing with an ALJ.

If you are thinking about applying for SSD, you should retain an experienced disability attorney to represent you.  The process of applying is not a simple one and can cause a claimant a lot of undue stress.  Our offices are located in Nassau and Suffolk counties on Long Island.  We offer a free phone consultation.

  

CE Reversal Again

Sometimes we get cases after a claimant has tried, unsuccessfully, to obtain Social Security Disability (“SSD”) benefits. Most of the time, that claimant has gone to one or more Consultative Examinations ("CEs"), which is not usually in the claimant’s best interest. This is exactly what happened to a 38 year old client who asked us to represent her after being denied when she applied on her own.

Our client suffered from multiple medical conditions, including PTSD, anxiety, depression, anemia and photophobia. We were able to get supportive documentation from her treating doctors, which Social Security's own rules specify is the preferred source. Our client was ultimately approved for SSD, and she could not be happier with the outcome of her claim.

It is always a wise decision to retain an attorney who specializes in disability if you find yourself in a position where you need to apply for disability. Please feel free to call our office for a free phone

ALJ Haaversen Rejected Again

I rarely take on a new claimant after an administrative law judge (“ALJ”) has already denied their application for Social Security Disability or Supplemental Security Income (“SSI”) benefits.  However, when I read the decision by ALJ Haaversen, I knew I had to make an exception.  Haaversen’s decision was so indefensible, that after I filed motion papers in the federal district court, the U.S. Attorney’s Office and the Office of the General Counsel for the Social Security Administration obviously asked the court to reverse the decision.

On remand, the case was reassigned to ALJ Andrew Weiss.  The medical evidence supporting the claimant’s application was so strong that ALJ Weiss found two different listings were met.  The good news is that the claimant was finally approved for SSI benefits.  The bad news is that the claimant applied for SSI benefits on August 15, 2018, more than five years ago.  How many people can survive, disabled or otherwise, without any income for that period of time?

No doubt, without our help and expertise, our client would almost certainly  have  been denied again.  Our claimant is happy that she made the choice to contact us for help with her claim and obviously overjoyed with the decision.  If you plan on applying for Social Security Disability benefits, it is always in your best interest to retain an experience disability attorney, who knows what information is needed to support a disability claim.  My office offers a free phone consultation with offices located in both Nassau and Suffolk counties.

 

Second Opinions

When seeking Social Security Disability (“SSD”) benefits, Medical source statements (“MSS”) are critical to establishing disability.  However, sometimes a claimant’s medical providers do not complete the MSS because they believe it would be more appropriate for another one of the claimant’s doctors to do so.  That is incorrect.

The Social Security Administration (“SSA”) wants “a medical opinion from all of the claimant's medical sources.”  It does not matter if another medical provider may be more directly involved in your treatment, or seem to have a more relevant specialty.  The SSA is statutorily obligated to seek and consider all evidence.

We represent a 53 year old truck driver from Farmingdale with knee, neck and back problems.  In May, we obtained and submitted a report from the doctor treating the claimant’s neck and back.  The opinion was supported by treatment records citing objective clinical findings and MRI testing revealing herniated discs compressing nerve roots. However, the SSA was not satisfied, and insisted that the claimant attend a consultative examination (“CE”).

Rather than having the claimant submit to the CE, we secured and filed a report from a second medical source.  Shortly thereafter, the SSA approved SSD benefits.

It is important to retain an experienced disability attorney, if you plan on applying for SSD, who knows what medical information should or should not be submitted for your claim to be successful, and who is knowledgeable about all of the SSA’s rules and regulations.  We offer a free phone consultation, and have offices located on Long Island, in Nassau and Suffolk counties.

LTD Surveillance Games

We constantly warn our clients, who are applying for Long Term Disability benefits, or are receiving them, of the certainty of being surveilled.  Usually, the surveillance occurs over a 3 day period, but obviously you have no knowledge of when the surveillance will occur.  We advise our clients if they see a strange car by their house, or one following them, to call the police.  However, the LTD companies will stop at nothing to try and "catch" you doing something they believe proves that you are not disabled and use that information to deny or terminate your claim, even  for something as simple as walking your dog, or answering your front door.  They will pose as UPS workers, or sales people, nothing is too low for them.  So when we say be careful, we mean be careful.

SSA Strikes Again

Last week, we received a phone call from a former client, who received a disturbing and erroneous letter from Social Security's payment center in Baltimore.  The letter said they were terminating her Social Security Disability benefits ("SSD") benefits, and would be asking her for money back, because of her "significant earnings" over substantial gainful activity ("SGA").  The client's application was approved in January 2022.  Before securing her SSD benefits, we had to submit evidence showing the client was not working, and that her income was from a pension.

Even though our representation ends when a client's application is approved, we still called the local office in Mineola, as well as the payment center who sent her the letter, on her behalf.  As usual, neither Mineola nor the payment center would take any responsibility for the error.  The Mineola office said the client would have to have her former employer complete a form, and the payment center said they would "send a note to a benefits authorizer to look into it."  The representative we spoke with at the payment center claimed she had no idea what to do.  Worst of all, there was no urgency or remorse for our client's situation from either the Mineola office or the payment center.  Just imagine their urgency if their income were being terminated.

Today, we received a phone call from another former client who received a similar letter from Social Security.  The letter stated that Social Security was terminating her benefits due to the fact that she was "working," and said that she immediately had to repay $60,000.  Again, when our client was approved, Social Security knew that she was receiving pay for unlimited sick days.

The client called her local district office in Jamaica, and was told that she would have to appeal the decision.  Therefore, not only are her SSD benefits being terminated, but Social Security also wants her to pay them $60,000, and to file an appeal, even though she has not worked since she was approved.  To make things even worse, the problem is wholly due to Social Security's own error.

Lightning doesn't strike twice.  These letters indicate that Social Security has embarked on a program that terminates SSD benefits without due process.  The program shakes down claimants who are lawfully receiving SSD benefits after administrative law judges already accepted the claimants' receipt of passive income.  No one at Social Security ever contacted either one of our clients to ask them if they were working.  If they had, then they would have known that the clients were not working, and that they were receiving passive income, which does not affect their entitlement to SSD benefits.

We advised both clients to do two things.  First, to contact their local offices again.  Second, to contact their congressional representatives, and the media, about Social Security's actions, how they were being treated, and that Social Security is taking absolutely no responsibility for their errors, and does not even care.

If you receive a letter like this, you should immediately contact your local Social Security office, as well as your congressperson or senator, and the media.

Neurogenic Claudication

Neurogenic claudication is the most common symptom of lumbar spinal stenosis.  It refers to intermittent leg pain from impingement of the nerves emanating from the spinal cord.  The symptoms of neurogenic claudication include pain, tingling, or cramping in the lower back and one or both legs, hips, and buttocks, as well as weakness or heaviness in the legs.

We represent a 59 year old from Babylon with neurogenic claudication, who worked as a nurse.  The State agency was holding up her Social Security Disability (“SSD”) application because she did not want to attend a consultative examination.

The SSD application was supported by MRI testing.  However, shortly after we submitted a copy of her lumbar laminectomy operative report, whose postoperative diagnosis was lumbar stenosis with neurogenic claudication, her benefits were approved.  While an operative report is not a diagnostic laboratory test, it is just as persuasive as objective testing.

It is important to retain an experienced disability attorney who knows what medical records and reports support a claimant's disability.  Our offices, located on Long Island in Nassau and Suffolk counties, offer a free phone consultation for anyone who is thinking of applying for SSD or has already applied and looking for legal representation.

EMG

Back pain has been the leading claim for Social Security Disability (“SSD”) benefits.  The question frequently arises, why do some claims based on back pain get approved, and vice versa.  When it comes to lumbar spine impairments, the answer is usually depends on what diagnostic evidence is provided.

We represent a 45 year old with back pain from Selden, who worked as a heavy equipment operator.  The State agency approved the SSD benefits relatively early in the application process.  What made this case different?

The claimant’s neurologist submitted an EMG, which the doctor described as extensive evidence of neuropathy.  The State agency and the Social Security Administration frequently disregard the opinions of claimants’ doctors, especially since the treating physician rule has been eliminated.  However, when the opinion of a claimant’s physician is accompanied by significant diagnostic testing, then that opinion is much more likely to be accepted.

Chronic Pain Fog

Pain adversely effects cognition.  Research shows that the more widespread the pain, the bigger the memory deficits. As WebMD points out, pain interferes with concentration and staying on task, and executive functioning.

Social Security constantly posits that if a disability applicant has a cognitive issue, such as concentration or staying on task, then it must be because they have a mental impairment.  Consequently, the State agency automatically directs such claimants to attend consultative examination (“CE”) for a “mental problem” in addition to a CE for the physical impairment.

If you do not have a mental problem, then there is no need to attend a CE for a mental problem because the cognitive problem is not due to a psychological disorder.  The irrelevant CE is a waste of time, usually delays processing the application, and can become the focus for denying benefits, regardless of the limitations resulting from the physical impairment.

We represent a 61 year old from Pennsylvania with multiple physical conditions that prevented him from continuing to work as a manager.  The State agency wanted him to go to a psychological CE because of his concentration problems.  We insisted that his concentration issues were due solely to his chronic pain, and he was not alleging a mental impairment.  The claimant was approved for Social Security Disability benefits the following week.

If you are thinking about applying for SSD benefits, it is in your best interest to retain an attorney who specializes in disability.  Our offices are located in Nassau and Suffolk counties on Long Island.  Please call us for a free phone consultation.

Disability Synergy

The Social Security Administration is required to consider the combined effect of all your medical impairments when determining if you are disabled.  Thus, even if none of your impairment renders you disabled, you can still be found disabled by the combined impact of all them.  We represent a 56 year old financial planner from Manhasset with cervical radiculopathy and Crohn’s disease that illustrates the aforementioned synergistic principle.

The claimant’s application for Social Security Disability (“SSD”) benefits was denied by the State agency.  When the case proceeded to a hearing, the administrative law judge (“ALJ”) sounded surprised when the medical expert testified that the claimant’s severe Crohn’s disease would pose no limitation on her ability to stay on task and avoid sick days.

The ALJ issued a fully favorable decision today.  Among other things, the ALJ accepted the treating physician's opinions  that the claimant would be absent from work more than three times per month, and would be off task greater than 20% of the workday, which would preclude all work.  He accepted these opinions without asking the Vocational Expert, assigned to the hearing, to testify, after my intense cross examination of their Medical Expert.

Only an experienced disability attorney would know how to navigate the hearing in order to obtain the approval of the claim.  Please call my office for a free phone consultation if you are considering applying for disability benefits.  Our offices are located on Long Island, in Nassau and Suffolk counties.

Too Long

We represent a 55 year old construction worker from St. James with hip and spine impairments, whose Social Security Disability (“SSD”) benefits were approved today, six months after we filed his application.  While we are glad that we were able to obtain SSD benefits without the need for a hearing, six months was still too long a time for the approval.

Based on the claimant’s work history, age and education, he was entitled to SSD benefits under the medical-vocational rules even if he were physically able to perform “light work.”  Light work is more strenuous than sedentary, desk work.

The claim file contained close to 1,500 pages of medical records.  There were plenty of objective diagnostic test results that showed the claimant would be unable to stand and walk for the requisite 6 hours a day to perform light work.

Social Security has many excuses when we challenge their delay tactics.  The undeniable fact is that if we do not constantly call the local office, and the Stage agency analyst handling our clients’ claims, the delays would be much longer.  Do not accept their perpetual cycle of delays.  Call our office for a free phone consultation, whether you are considering applying for SSD, or if you applied on your own and realize that you need an experienced disability attorney to navigate the administrative process.  Our offices are located on Long Island in Nassau and Suffolk counties.

 

LTD Benefits Reinstated

We represent a claimant whose long term disability (“LTD”) benefits were denied by Lincoln Life.  After we filed suit Fredrich v. Lincoln Life and Annuity Co. of N.Y., 2022 WL 1537162 (E.D.N.Y. 05/13/2022)  Lincoln approved LTD benefits on June 22, 2022, and paid past due benefits.  However, last month, Lincoln terminated the LTD benefits.  We requested the claim file, and began gathering medical and vocational evidence for the appeal.

When I reviewed the claim file, I found notes dated February 28, 2023, from the Lincoln claim handler who terminated the LTD benefits.  Her notes stated that a peer review dated February 27, 2023, supported the claimant being disabled from August 1, 2020 to present and ongoing, and that the claim would be re-evaluated in three months.  Therefore, I sent a letter to the Lincoln claim handler on March 9, 2023, asking why she terminated benefits if the file was not even due to be reviewed for another three months.  Perhaps more importantly, I asked what medical tests, exam findings, and symptoms, did Lincoln contend changed after June 22, 2022, which Lincoln believes shows the claimant was no longer disabled.

I received a call today from Lincoln’s LTD Manager.  After reading the March 9, 2023, the LTD Manager agreed that the claimant remained disabled, and advised me that Lincoln was reinstating LTD benefits.  While the claimant had already incurred some costs in obtaining updated reports, he was happy to receive an expeditious reversal of the termination.

This is the second time in a week where an insurance company reversed its adverse disability decision, and we obtained a favorable outcome for our clients' LTD claims.  You need an attorney representing you when navigating the LTD claim and appeal process.  Lincoln would not have reversed itself if the claimant had been unrepresented.  Call our office for a free phone consultation.  We are located on Long Island, with offices in both Nassau and Suffolk counties.

 

Hartford Settles

Nearly three years after commencing an action against Hartford to recover long term disability (“LTD”) benefits, and a few months after getting Hartford to start paying monthly LTD benefits, we have an agreement in principle to settle the remaining cause action in connection with a buy-out of the claimant’s future benefits.

Disability insurance companies, like Hartford, are notorious for deciding to deny LTD claims before they have even started reviewing a claim, and for terminating benefits without a medical reason, they just want to avoid paying the claim anymore.  The disability insurance companies only care about their profitability.  They do not care about claimants, which is why you need an experienced disability attorney to represent you for your LTD claim.   Our office offers a free phone consultation with offices located on Long Island in Nassau and Suffolk counties.

Witnesses

Many people seeking Social Security Disability (“SSD”) benefits do not include third party support statements when applying, or have third parties testify at hearings.  Having witness attestations should not be overlooked.

We represent a 57 year old Financial Vice President from Queens Village with spine impairments.   The claimant had two SSD applications that were denied before we were retained.   The good news is that we succeeded in getting the claimant’s third application approved on-the-record without a hearing.  The bad news is that the ALJ would not reopen the prior applications, which resulted is a substantial loss of benefits.

One difference in the third application was a report from the claimant’s friend, which the ALJ specifically considered in accordance with Social Security Ruling (SSR) 16-3p.  Specifically, he considered the personal observations in terms of how consistent those observations are with the claimant's statements about their symptoms as well as with all of the objective medical evidence in the file. Third party statements are not evaluated using the same criteria as medical source statements; however, they were considered to complete the narrative of the claimant's subjective complaints in accordance with accordance with and 20 CFR 404.1520b(c) and 416.920b(c).

The claimant made the right decision when he realized that he needed to retain an experienced disability attorney after filing on his own, and being denied twice.  We cannot emphasize enough the importance of  his decision.  Please feel free to call our office for a free phone consultation if you are considering applying for SSD benefits.  We are located on Long Island with offices located in both Nassau and Suffolk counties.

 

 

 

Dire Need

According to Social Security, a dire need situation exists when a claimant alleges any of the following circumstances:

• The claimant is without food and is unable to obtain it.
• The claimant lacks medicine or medical care and is unable to obtain it, or access to necessary medical care is restricted because of a lack of resources.
• The claimant lacks shelter (e.g., without utilities such that their home is uninhabitable, homelessness, expiration of a shelter stay, or imminent eviction or foreclosure with no means to remedy the situation or obtain shelter).

Absent evidence to the contrary, accept a person's allegation that the person does not have enough income or resources to meet an immediate threat to their health or safety.  HO employees will err on the side of designating the case critical.

Despite the above, many requests to have a claim classified as a dire need case are ignored by the assigned analyst.

We represent a 58 year old with multiple foot, spine and wrist problems from Valley Stream who worked as an electrician.  We were able to obtain strong evidence from the claimant’s pain management specialist.  The claimant qualified as a dire need case because his utilities were being shut off.  However, the case was languishing because the analyst was holding dire need status hostage.

The analyst refused to tag the case as a dire need because he wanted to the claimant to attend a consultative examination (“CE”) with IMA. We had to escalate the matter above the analyst’s head, who claimed there was nothing he could do.  We succeeded in getting the supervisor to expedite the case, which was approved in about 10 days, without the need for a CE.

The claimant is so happy that he retained us, and that we had the experience and knowledge to do what was needed to get his claim expedited.   This is just another of many reasons why you should retain an experienced disability attorney to represent you if you plan on filing for Social Security Disability benefits.   If we hadn't known what to do, our claimant's case would still be sitting there.

If you are planning on applying for Social Security Disability benefits, please call our office for a free phone consultation at (888) 572-0861.  Our offices are conveniently located in Nassau and Suffolk counties on Long Island.

 

DDS Laziness

We represent a 49 year old financial advisor from Plainview with residual problems from a stroke, whose Social Security Disability (“SSD”) benefits were approved today without a hearing, but with little help from the State agency. 

Since the claimant was under 50 years of age, there was little need for vocational information, because transferable skills were not an issue. Nonetheless, the State agency repeatedly held the claim up by requesting more details about the claimant’s work duties than they do in other cases. 

To compound matters further, we submitted thousands of pages of medical and hospital records detailing the stroke sequelae. The records documented hemiparalysis, balance issues, fatigue, foot drop, among other things. Nonetheless, the State agency kept sending requests for the claimant’s brain scans – which we confirmed each time had already been submitted. Then it became obvious to us what the problem was. 

We went through the records that were in the State agency’s electronic folder for the claimant. We pulled out the brain scans, and resubmitted a second time. SSD benefits were approved shortly thereafter. In other words, the State Agency representative refused to review the medical records because they were so voluminous, so we had to do their job for them. 

It is vital to have an experienced disability attorney represent you if you plan on applying for SSD benefits. From the moment we file our client’s application, we stay on top of the representative(s) handling your claim. For example, when we submit medical evidence directly into our client’s efile, we receive a confirmatory receipt. However, we consistently find that when we check the efile a few days later, the evidence we submitted is not there. The State agency analysts' stock answer is that it’s the “system’s” fault. It’s a constant game of submitting evidence, checking to make sure it shows up in our claimant’s file, and then calling the State agency when we don’t find the evidence in the file. 

The bottom line is that most of the analysts at the State agency do not do their jobs. It could be that they are lazy, stupid or they just don’t care. If you want to maximize your chances of being approved for SSD benefits, then you need to retain an experienced disability attorney. We have been handling disability claims since the last Century. Please call our office for a free phone consultation if you plan on applying for SSD benefits. We have offices located in both Nassau and Suffolk counties on Long Island.

DDS Sham

In New York, Disability Determination Services (“DDS”), a State agency, initially decides if you get Social Security Disability (“SSD”) benefits.  Experience reveals that most of the people working at DDS are lazy.

We constantly have cases sitting at DDS for months without any review activity.  Then, after we submit medical records and reports, DDS asks for the same things again, as if simply churning the file shows they have done something.  Because they wait too long to review files, DDS regularly claims that the medical records are stale.  If DDS had bothered to review the records in a reasonably prompt manner, then the records would not have become stale.

Many DDS medical consultants (“MCs”) are amongst the laziest DDS employees.   We always provide MCs with more than ample medical evidence to find claimants disabled.  However, MCs refuse to review the medical records and opinions reports that we submit.  Instead, the MCs claim that there is insufficient evidence if a claimant does not attend a consultative examination (“CE”).  In other words, the only evidence the MCs care about reviewing is the CE report.  We had a case with thousands of pages of medical records and reports detailing claimants’ limitations, yet the MCs still said there was insufficient evidence.

We received an OTR  today that illustrates the DDS laziness.  We represent a 60 year old medical receptionist from Lindenhurst, who had to stop working after suffering a stroke.  The file contained over 500 pages of medical records, including detailed functional limitational form the claimant’s neurologist, yet Robert Dickerson, the DDS MC, denied SSD benefits on the grounds that there was insufficient evidence.  We appealed by requesting a hearing, which transferred the case from the State agency to the Social Security Administration (“SSA”).  It was so obvious to an attorney from the SSA that our client was disabled, that the case was approved OTR, without any additional medical evidence having been submitted.

The DDS laziness wasted the claimant’s time, and the SSA’s resources as well.  It is sad that an agency who is supposed to be helping people actually do the opposite.  We want to help you.  If you are applying for SSD, you need an experienced, competent attorney.  Please contact our office for a free phone consultation.  We have offices located on Long Island in both Nassau and Suffolk counties.

ALJ Carlton Reversed Again

Administrative Law Judge (“ALJ”) John Carlton  denies most cases Social Security Disability (“SSD”) cases because he bases his decisions on his interpretation of the medical data, instead of the interpretation of physicians, as the law requires.

We represent a 56 year old claimant from Bay Shore with hip problems, who worked for over 30 years as a truck driver,  warehouseman, and police officer.  ALJ Carlton, who was not qualified to interpret an x-ray, decided that the claimant only became disabled on the date the claimant’s hip x-ray demonstrated arthritis and degenerative changes.  You do not have to be a physician to realize that degenerative changes cannot possibly occur overnight.  Notably, we represented another claimant in Vellone v. Saul, 2021 WL 2801138 (S.D.N.Y. 07/06/2021) where the court reversed ALJ Carlton’s decision because, once again, he decided to play doctor, and relied on his interpretation of the medical evidence to reject the treating doctor’s opinion that the plaintiff’s hip and back pain precluded working.

In the present instance, ALJ Carlton never explained how the claimant’s hip problems suddenly went from not even being severe, to limiting the claimant to light work, on April 13, 2019.  Upon appealing the case to federal court, we sent a short letter to counsel for the Social Security Administration (“SSA”).  Based upon that letter, the SSA agreed that ALJ Carlton’s decision was indefensible, and voluntarily remanded the claim.

On remand, the case was reassigned to ALJ Alan Berkowitz.  Today, ALJ Berkowitz issued a fully favorable decision, and awarded the claimant SSD benefits, without even holding a hearing.

Hartford Breached Its Fiduciary Duty

Hartford Life, as claims administrator of a long term disability (“LTD”) plan, relies on claim procedures, which the Second Circuit found violated ERISA’s regulations.  Hartford argued that its procedures, which it called “protocols,” entitled Hartford to take more than 45 days to decide if a claimant is entitled to receive benefits.  Hartford admitted that it routinely applies the protocols.  One protocol is Hartford’s appeals department remanding administrative appeals to Hartford’s claims department.  Another protocol is arguing that COVID entitles Hartford to an extension of time.

Since Hartford admitted that it regularly employs the protocols as a general matter, we asserted a cause of action for breach of fiduciary duty, and as relief, asked that Hartford be removed as the Plan’s claim administrator.  Hartford asked the Court to dismiss the breach of fiduciary duty claims.  On January 13, 2023, Magistrate Judge (“MJ”) Arlene Lindsay rejected Hartford’s request.  However, MJ Lindsay indicated that since the breach of fiduciary claims may subject Hartford to a class action, within 30 days, she wanted to be notified of the steps the plaintiff will take towards serving as an adequate representative.

In compliance with MJ Lindsay’s order, we served interrogatories on Hartford that seek the identities of past and present participants of the LTD Plan, since each of those individuals is a potential plaintiff.  The interrogatories also seek the identities of past and present participants of other disability plans where Hartford has or may apply its protocols because each of those individuals also has a potential breach of fiduciary duty claim against Hartford.

Feel free to contact us if Hartford is your LTD claim administrator, and you have questions about the way your claim has been handled. We can be reached at (888) 572-0861.

 

 

 

Excuses Excuses

By Susan Golden

The number one question we get everyday is, "How long will it take to get a decision on my claim?"  The answer is, "Be prepared for the long haul."  Why is that?  As soon as we file a social security disability ("SSD") claim with our client's local Social Security Administration ("SSA") office, the excuses and delays begin.  Popular excuses from the local offices include: "We don't have all the paperwork;" "The file must be sitting on someone's desk;" "We're backlogged;" "The person handling the case is out;" and "We don't know why it hasn't been processed yet, everything we need is here!"

After your local SSA office processes the claim, they send it to the State agency, where the claim is reviewed.  Everything is done electronically, so the file should be transferred quickly to the State agency, and include everything submitted to the Local SSA office, such as your application and our letters of representation.  However, depending on the local office, it can take weeks, sometimes months, to get the file transferred, and even then, the State agency claims documents are  missing.

Your file has been transferred to the State agency!  Great, now things will start moving.  Hold on, let's not get ahead of ourselves.  The State agency is full of their own excuses and delay tactics.  In fact, they are masters at it.  They constantly complain that they don't have enough information from the claimant's treating doctors, even though we have submitted exactly what they are asking for!  They mislabel documents in the file, and are too lazy to look through them, because if they did, then they would realize that the file does indeed have exactly what they are asking for.   They don't look at a file for months, and then all of a sudden they complain the records we have submitted are "stale," when we had submitted them in a timely manner.  Luckily, we know how to play their game, and call them out on their delay tactics.

I could go on and on, but don't have enough space or time, but you get the picture.  If you need to apply for SSD, you should make certain that you retain an experienced disability attorney.  We have over three decades of experience, and know the SSA system inside and out.  Please feel free to call our office for a free phone consultation.  We have offices in Nassau and Suffolk counties on Long Island.