Persistence is Key

When it comes to applying for Social Security Disability (SSD) benefits, many applicants face roadblocks along the way—especially when the evidence is clear,  but still gets overlooked by the Social Security Administration (SSA). This was the case for our client, a 42-year-old ophthalmic technician from Hicksville, who suffered from severe mental health conditions. Despite having strong support from her doctors and submitting their expert opinions, her claim was repeatedly denied. However, after persevering and bringing the case before an administrative law judge (ALJ), we were finally able to get her SSD claim approved.

Our client had a long history of mental health conditions, including severe anxiety and depression. Although her treating doctors were fully supportive of her disability claim, their expert opinions were repeatedly rejected by the SSA during the Disability Determination Services (DDS) review process.

The district courts in New York continue to hold that the opinions of the claimant’s treating doctors should be found more persuasive than SSA doctors, even if they are no longer required to be given controlling weight under the regulations, because the former are the most familiar with the patient's condition and treatment history. However, in this case, the DDS analysts repeatedly disregarded the expert testimony and supporting documentation provided by our client’s doctors. Despite their detailed, professional assessments and consistent backing of her claim, the SSA denied her initial claim as well as the reconsideration.

At this point our client’s case was sent to an ALJ for a hearing.  At the hearing level an ALJ reviews the evidence in person and makes the final decision. The ALJ was presented with a full range of medical records, including detailed opinions from our client’s treating doctors. The ALJ also had the opportunity to hear our client’s testimony about how her mental health conditions had prevented her from being able to work. Without any contradictory opinions or expert analysis from the SSA to challenge the treating doctors’ assessments, the ALJ approved the claim.

For anyone struggling with a denied SSD claim, particularly for mental health conditions, this case shows that persistence is key. Even if the SSA denies your claim or ignores important medical evidence, you have the right to take your case further, and an ALJ might be more likely to understand your situation.

Having a lawyer who knows how to navigate these challenges can significantly increase your chances of success. We’re here to help guide you through the SSD process and fight for the benefits you deserve.  Our office, located in Melville, NY, offers a free phone consultation.

Impairment-Related Work Expenses

Impairment-Related Work Expenses (IRWE), as defined by the Social Security Administration (SSA), are "costs for items or services that you need in order to work because of your disability. Social Security will deduct the costs of an IRWE from your countable income when determining your eligibility for Social Security disability benefits."

We represent a 36-year-old claimant from Brooklyn who suffers from schizoaffective disorder, bipolar disorder, cognitive decline, and hypersomnia. He met the criteria for an IRWE because he was paying out-of-pocket for his medical costs, which enabled him to continue seeking treatment with his longtime psychiatrist, without being reimbursed by an insurance carrier. He could not work at all without receiving his medications and treatment from his doctor. The costs were reasonable, which met other criteria of the IRWE.

The claimant was working with accommodations, provided as a favor to his father, who worked for the same company, enabling our client to work part-time. We had to submit all of our client's earnings to his local SSA office, including pay stubs and tax returns, so that the local field office could calculate how much his medical expenses offset his salary. We also submitted a statement from his employer confirming his accommodations and salary.

The State agency approved the medical portion of our client's disability claim based on the information we submitted from the treating doctor. Ms. Kircher, at the Borough Hall field office in Brooklyn, undertook the complicated project and determined that our client's income fell below SS's Substantial Gainful Activity threshold, approving the non-medical portion of the claim.

Overcoming SSD Denial

Dealing with a disability claim can be a long and often frustrating process. Many applicants face challenges in getting their claims approved, even when their medical conditions are severe. This was the case for one of our clients who had been living with rheumatoid arthritis, lupus, and several orthopedic issues. Despite the gravity of their conditions, their initial Social Security Disability (“SSD”) claim was denied. However, with perseverance and the right approach, we were able to get their claim approved on reconsideration.

It is not uncommon for SSD claims to be rejected, especially when the medical documentation provided doesn’t align perfectly with the Social Security Administration’s (SSA) criteria for proving disability. In many cases, the issue lies not in the severity of the condition, but in how the evidence is presented.

We represent a 54 year old USPC worker from White Plains, NY with rheumatoid arthritis and Lupus.  After she was initially denial, we requested a reconsideration of her claim. The reconsideration process allows applicants another chance to have their case reviewed, by a different analyst. This time the new analyst gave us specific information that was needed by the SSA doctors. These details, which hadn’t been part of the initial claim, were critical in strengthening the case. To meet these specific requirements, we reached out to our client’s doctors to request additional, more detailed documentation.

After we submitted the updated, more comprehensive medical documentation, the SSA reassessed the claim. This time, the application was approved on reconsideration. Our client was granted the SSD benefits they rightfully deserved. This outcome shows how crucial it is to have the right medical evidence to meet the requirements to meet the SSA’s disability criteria.

While the process can be lengthy and complex, persistence and attention to detail are crucial. Having a lawyer who knows how to navigate these challenges can significantly increase your chances of success. We’re here to help guide you through the process and fight for the benefits you deserve. My office, located in Melville, NY, offers a free phone consultation.  Please feel free to reach out if you are applying for SSD benefits.

Rare Decision

In June of 2022, we appealed a decision of ALJ Suarez to the Second Circuit after Magistrate Judge Davidson upheld Suarez’s denial in district court.  Last September, the Second Circuit rejected Suarez’s decision, and remanded it to the district court to send the case for a new hearing with the Social Security Administration (“SSA”).

Last January, the district court sent the case back to the SSA.  Specifically, the case was sent to the Appeals Council, which normally prepares a remand order with instructions for the ALJ.

We learned today that, unbeknownst to us, last February, rather than issuing instructions, the Appeals Council issued a rare ruling that the claimant was disabled and entitled to benefits.  The Appeals Council rejected Suarez’s finding that the claimant did not meet listing 12.04.