Non-Medical Evidence

We represent a 61 year old from Mount Vernon with physical impairments.  The administrative law judge (“ALJ”) held a hearing today, which made it clear that Social Security Disability (“SSD”) benefits would be approved. The approval was expected given the impact of a new regulation.

The claimant’s past relevant work (“PRW”) had consisted of three occupations during the previous 15 years: Customer Care Representative (“CCR”), which was sedentary work, Medical Clerk and Ward Clerk, which were light occupations.  However, under the revised regulation, PRW is now limited to the past five years, which made CCR no longer relevant.  The State agency found Ms. Thomas not disabled because she could perform her past sedentary work as a CCR.

Under the Grid rules, the claimant had to be found disabled if she had no acquired skills from her PRW as a Medical Clerk or Ward Clerk that could transfer to sedentary occupations.  Before the hearing, I supplied the ALJ with various federal court decisions where vocational experts (“VEs”) testified the Medical Clerk and Ward Clerk occupations did not provide any transferable skills.  Thus, even accepting the State agency doctor’s opinion that the claimant could do sedentary work, a finding of disabled was required.

The hearing was relatively short.  ALJ posed a hypothetical to the VE, who concluded the claimant was unable to perform her PRW.  And because the ALJ accepted the treating opinions that the claimant could not even perform sedentary work, transferability was not even an issue.  Consequently, the claimant had to be found disabled.

Every claimant's case is different.  There are many factors that Social Security takes into consideration when deciding whether or not a person is unable to work a fulltime job, which is Social Security's definition of being disabled.  The person's age, past work history, and medical problems are just to name a few.  So while it may seem obvious to someone that they are disabled and cannot work,  it is not so clear cut to Social Security.  In this case, it was non-medical evidence based on the claimant's PRW and Grid rules that we focused on, which is the evidence the ALJ based his approval upon.  Our client put her trust in us, and together, we obtained the information necessary to get her SSD benefits approved.  Please call our office, if you are thinking of applying for SSD, for a free phone consultation.  Our office is conveniently located on the border of Nassau and Suffolk counties on Long Island.

LTD Approvals

We just received approvals from MetLife, New York Life, and Lincoln Life on three long term disability (“LTD”) applications.  While the approvals involved different insurers and impairments, the applications were similar in their preparation.  Our approach has been called gilding the lily, but our results speak for themselves.

LTD applications almost invariably consist of three parts:  forms for the claimant, the employer, and the treating doctor.  If only those three forms are returned, then the insurer is almost guaranteed to insist on receiving more information before approving.  When we submit an LTD application it is usually is accompanied by objective diagnostic testing and clinical records, witness statements, medical treatise data, functional assessments, and vocational reports.

Most employers establish LTD plans by buying an insurance policy.  Because that insurance company is liable for paying any claims, that is a conflict of interest  results in denials of valid claims.  To be profitable, the insurer must have a liability acceptance rate (“LAR”) where it takes in more premiums than it pays out in claims.  When the LAR is too high, insurers deny more claims, regardless of the merits.

By providing more evidence compared to other applicants, insurers take the path of least resistance, and target other claimants for denial or termination.   Don't let the insurance company fool you by pretending to care, and to be your friend.   All they care about is making money.

Please feel free to call our office for a free phone consultation.  We have helped thousands of individuals obtain long term disability benefits under individual and group policies from many insurance companies, including Unum, Prudential, Reliance, The Standard, Guardian, and Metropolitan Life, to name a few.