The Social Security Disability (“SSD”) application process is usually a lengthy one. However, if you have a critical condition that requires an immediate decision you may be eligible to request a Compassionate Allowance, which is designed to reduce the time between applying and receiving benefits. Compassionate Allowances are an expedited way for the Social Security Administration (“SSA”) to identify medical conditions that invariably qualify for SSD benefits based on minimal objective medical information.
I represent a 58 year old plumber diagnosed with live cancer, which is one of the diseases included on the Compassionate Allowance list. Others on the list include cancers, lymphomas, mesothelioma, Creutzfeldt-Jakob Disease, Lesch-Nyhan Syndrome, spinal or brain injuries, early onset Alzheimer's Disease and some types of dementia. To avoid any potential delay, the application and report regarding liver cancer were faxed, mailed, and followed up almost on a daily basis to ensure that everything was received and being immediately processed as a Compassionate Allowance. The claimant’s SSD benefits, as well as his children’s benefits, were approved today, three weeks after the application was filed.
The SSA can deny a request for a Compassionate Allowance just like any other SSD claim. Similarly, the SSA can lose evidence submitted on a Compassionate Allowance claim, or have it fall through the bureaucratic cracks like thousands of other SSD claims. While an attorney should not be required to obtain SSD benefits ultimately for a condition on the Compassionate Allowance list, if time is a concern, then an attorney can help ensure that the SSD application, along with any Child’s Benefits application, will be expeditiously and properly processed as a Compassionate Allowance.
Friday, October 29, 2010
Thursday, October 28, 2010
Unum Approves Fibromyalgia Claim
Several years ago I was able to get Unum to approve long term disability (“LTD”) benefits for a woman who worked for Keyspan when her claim was reviewed under the Reassessment Settlement Agreement. Towards the end of last year, Unum started to re-evaluate her claim, which included a field visit interview, even though the identical questions had already been answered in response to questionnaires Unum sent, and new medical records, even though her treating doctor said that the claimant’s condition had not improved.
The claimant was disabled by fibromyalgia, which was being treated by a rheumatologist. Courts recognize that a rheumatologist is the appropriate specialist to treat fibromyalgia. I provided reports from the rheumatologist that showed the claimant’s condition had not changed since Unum had approved LTD benefits. Nonetheless, Unum insisted on receiving reports from the claimant’s internist and chiropractor, who were not treating fibromyalgia.
I sent Unum letters stating that records from doctors other than the rheumatologist showed that Unum was either failing to understand the nature of the claimant’s disability or that it was not proceeding in good faith. However, because Unum stopped paying LTD benefits during its re-evaluation, to expedite a decision, I allowed Unum to receive reports from the claimant’s other doctors, but not before ensuring that they understood the type of responses that Unum would seize upon to terminate benefits. Although records from her other doctors were irrelevant because they were not treating fibromyalgia, Unum restored the LTD benefits only after receiving their reports.
Fortunately, because the claimant had discussed the situation with her other doctors, even though their reports were not actually relevant, they did not contradict the information provided by the rheumatologist. I have no doubt that if a report from one of the other doctors was inconsistent with the rheumatologist’s report, then Unum would have terminated the claimant’s LTD benefits. Unfortunately, when dealing with disability insurance companies, you have to be very careful, even with evidence that is not actually relevant.
The claimant was disabled by fibromyalgia, which was being treated by a rheumatologist. Courts recognize that a rheumatologist is the appropriate specialist to treat fibromyalgia. I provided reports from the rheumatologist that showed the claimant’s condition had not changed since Unum had approved LTD benefits. Nonetheless, Unum insisted on receiving reports from the claimant’s internist and chiropractor, who were not treating fibromyalgia.
I sent Unum letters stating that records from doctors other than the rheumatologist showed that Unum was either failing to understand the nature of the claimant’s disability or that it was not proceeding in good faith. However, because Unum stopped paying LTD benefits during its re-evaluation, to expedite a decision, I allowed Unum to receive reports from the claimant’s other doctors, but not before ensuring that they understood the type of responses that Unum would seize upon to terminate benefits. Although records from her other doctors were irrelevant because they were not treating fibromyalgia, Unum restored the LTD benefits only after receiving their reports.
Fortunately, because the claimant had discussed the situation with her other doctors, even though their reports were not actually relevant, they did not contradict the information provided by the rheumatologist. I have no doubt that if a report from one of the other doctors was inconsistent with the rheumatologist’s report, then Unum would have terminated the claimant’s LTD benefits. Unfortunately, when dealing with disability insurance companies, you have to be very careful, even with evidence that is not actually relevant.
Monday, October 18, 2010
Comorbid Conditions
When applying for long term disability (“LTD”) benefits no single medical condition necessarily needs to be disabling. I represent a 41 year old former Insurance Company Vice President whose LTD benefits Lincoln Financial Group approved on appeal today after supplying evidence of a second medical condition.
The claimant came to me after Lincoln had rejected her LTD application, which was based upon her neck impairments. On appeal, besides revealing the flaws with the way Lincoln reviewed the claimant’s cervical problems, I also notified Lincoln that the claimant was being treated for Chronic Fatigue Syndrome (“CFS”). The report from the rheumatologist treating the CFS indicated that the claimant could not work full time due solely to the CFS, just as the claimant’s orthopedist and pain management specialist both concluded that the claimant could not work full time due to her neck problems.
It should have been obvious that if the claimant’s neck impairments and CFS independently rendered the claimant incapable of working, that the combination of the two certainly did. Lincoln’s approval letter did not specify the reason why it reversed its decision and decided to approve LTD benefits. The major difference between what the claimant submitted when applying, and what I supplied when appealing, was the evidence regarding the CFS. Therefore, it would seem most likely that it was the claimant’s comorbid condition that resulted in the approval.
The claimant came to me after Lincoln had rejected her LTD application, which was based upon her neck impairments. On appeal, besides revealing the flaws with the way Lincoln reviewed the claimant’s cervical problems, I also notified Lincoln that the claimant was being treated for Chronic Fatigue Syndrome (“CFS”). The report from the rheumatologist treating the CFS indicated that the claimant could not work full time due solely to the CFS, just as the claimant’s orthopedist and pain management specialist both concluded that the claimant could not work full time due to her neck problems.
It should have been obvious that if the claimant’s neck impairments and CFS independently rendered the claimant incapable of working, that the combination of the two certainly did. Lincoln’s approval letter did not specify the reason why it reversed its decision and decided to approve LTD benefits. The major difference between what the claimant submitted when applying, and what I supplied when appealing, was the evidence regarding the CFS. Therefore, it would seem most likely that it was the claimant’s comorbid condition that resulted in the approval.
Wednesday, October 6, 2010
“Partially Favorable” Decisions
The Social Security Administration (“SSA”) sometimes approves Social Security Disability (“SSD”) benefits with an onset date after the one in the claimant’s application. The belated approval is called a partially favorable decision. A claimant can appeal the partially favorable decision, and receive monthly SSD benefits in the interim.
I represent a former interior designer who became disabled in November 2008, and who just received a partially favorable decision from Administrative Law Judge (“ALJ”) David Nisnewitz that approved SSD benefits as of April 2009. As usual, because all of the treating physicians supported the claimant’s application, Nisnewitz had half a dozen medical and vocational experts testify in order to create evidence to deny the application. However, the last expert to testify was a psychologist named Sharon Grand who stated the claimant met a listing for depression, which prevented the ALJ from denying the case.
As is his custom, ALJ Nisnewitz ignored the overwhelming objective and subjective evidence that supported the claimant’s disability from November 2008 through April 2009. Instead, again as is his practice and pattern, Nisnewitz simply accepted the opinions of medical experts who never examined the claimant over those of the treating physicians, despite the fact that courts have repeatedly told the ALJ that it is improper for him to do so.
Since claimants can receive SSD benefits pending an appeal of a partially favorable decision, there is no reason to waive the additional benefits that they might be entitled to receive. Claimants should promptly appeal such a decision, which could provide additional benefits, such as child’s benefits too.
I represent a former interior designer who became disabled in November 2008, and who just received a partially favorable decision from Administrative Law Judge (“ALJ”) David Nisnewitz that approved SSD benefits as of April 2009. As usual, because all of the treating physicians supported the claimant’s application, Nisnewitz had half a dozen medical and vocational experts testify in order to create evidence to deny the application. However, the last expert to testify was a psychologist named Sharon Grand who stated the claimant met a listing for depression, which prevented the ALJ from denying the case.
As is his custom, ALJ Nisnewitz ignored the overwhelming objective and subjective evidence that supported the claimant’s disability from November 2008 through April 2009. Instead, again as is his practice and pattern, Nisnewitz simply accepted the opinions of medical experts who never examined the claimant over those of the treating physicians, despite the fact that courts have repeatedly told the ALJ that it is improper for him to do so.
Since claimants can receive SSD benefits pending an appeal of a partially favorable decision, there is no reason to waive the additional benefits that they might be entitled to receive. Claimants should promptly appeal such a decision, which could provide additional benefits, such as child’s benefits too.
Thursday, September 30, 2010
Income Doesn't Bar Disability Benefits
Receiving an income does not automatically preclude receiving Social Security Disability (“SSD”) benefits. The test is whether you are engaging in work that involves significant physical or mental activity for pay or hopefully for profit, which excludes any type of passive investment income.
Since entitlement to SSD benefits does not include a financial need requirement, receiving loans or gifts of money from friends or relative is not an issue. There may be circumstances where a claimant receives money through a family run business while alleging that he or she was not working at the business. In these situations the Social Security Administration presumes that the claimant is working rather than receiving a gift.
On numerous occasions I have represented a claimant who continued to receive money through a family run business after the time when the claimant alleged that he or she stopped working there. The question is how do you prove that the money the claimant received from the family business was not for engaging in work that involved significant physical or mental activity.
I represent a 39 year old woman who worked at her father’s company as a secretary because she was unable to work elsewhere due to her reflex sympathetic dystrophy (“RSD”). Her RSD eventually became so severe that she was unable even to work with all of the accommodations at her father’s business. However, in order to maintain her health insurance, the claimant’s father continued to keep her on the payroll.
I submitted third party evidence to substantiate the fact that the claimant had not been working. Today, I received a fully favorable decision from Administrative Law Judge Ronald Waldman who concluded that the claimant’s 2008 and 2009 income was not substantial because she had not actually worked.
Celiac Disease
Bloomberg News just reported that environmental influences have apparently caused a fivefold rise in Celiac disease during the last 30 years. People with Celiac disease have a problem digesting gluten, which is a protein in staple foods like bread, crackers, and pasta. Fatigue is a common symptom of Celiac disease.
The fatigue from Celiac disease can become severe enough to prevent you from working a complete day. If so, you could be eligible for disability benefits the same way that being afflicted with Chronic Fatigue Syndrome or any other disease resulting in fatigue could render you eligible.
Celiac disease is frequently associated with other autoimmune disorders that also contribute to one’s inability to work. Therefore, even subsisting on a gluten-free diet may not improve one’s functionality sufficient to work a complete day at work. One of my clients was approved for disability benefits due to fatigue and weakness from Celiac disease and myasthenia gravis.
The fatigue from Celiac disease can become severe enough to prevent you from working a complete day. If so, you could be eligible for disability benefits the same way that being afflicted with Chronic Fatigue Syndrome or any other disease resulting in fatigue could render you eligible.
Celiac disease is frequently associated with other autoimmune disorders that also contribute to one’s inability to work. Therefore, even subsisting on a gluten-free diet may not improve one’s functionality sufficient to work a complete day at work. One of my clients was approved for disability benefits due to fatigue and weakness from Celiac disease and myasthenia gravis.
Friday, September 10, 2010
Proving Disabling Pain
Disability adjudicators accept that applicants can become disabled if their pain is bad enough to reduce their ability to perform the physical demands of working. The problem for claimants is usually how to prove that their condition is severe enough that they can no longer work. The claimant’s task basically is trying to provide objective proof to support the subjective claim of pain.
I represent a 57 year old former airline passenger service agent whose radiating neck pain forced him to stop working. His disability benefits were approved today four months after his application was filed without requiring any type of appeal or hearing.
Among other things, the claimant had a cervical MRI that showed discs contacting the spinal cord. His pharmacy list of pain medications and patches, and operative reports of pain injections, were lengthy. As the default position of disability adjudicators is that a claimant’s pain is overstated, simply providing a supportive MRI would be deemed insufficient because while it confirms a diagnosis it fails to establish severe pain. Similarly, just providing pharmacy records would be deemed insufficient because it could be evidence of an addiction or overreaction to a condition. However, supplying both types of medical records provided objective evidence not only that the claimant had a medical condition that was capable of causing severe pain, but also that the condition was being treated as causing severe pain. That objective evidence rendered the pain management physician’s opinion, that the claimant’s condition prevented him from being able to work due to his pain, readily credible.
Some of my colleagues believe that I “gild the lily” by securing and submitting as much evidence as I do, which does make for extra work. However, the end result speaks for itself.
I represent a 57 year old former airline passenger service agent whose radiating neck pain forced him to stop working. His disability benefits were approved today four months after his application was filed without requiring any type of appeal or hearing.
Among other things, the claimant had a cervical MRI that showed discs contacting the spinal cord. His pharmacy list of pain medications and patches, and operative reports of pain injections, were lengthy. As the default position of disability adjudicators is that a claimant’s pain is overstated, simply providing a supportive MRI would be deemed insufficient because while it confirms a diagnosis it fails to establish severe pain. Similarly, just providing pharmacy records would be deemed insufficient because it could be evidence of an addiction or overreaction to a condition. However, supplying both types of medical records provided objective evidence not only that the claimant had a medical condition that was capable of causing severe pain, but also that the condition was being treated as causing severe pain. That objective evidence rendered the pain management physician’s opinion, that the claimant’s condition prevented him from being able to work due to his pain, readily credible.
Some of my colleagues believe that I “gild the lily” by securing and submitting as much evidence as I do, which does make for extra work. However, the end result speaks for itself.
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