There are over one million individuals in the US with a disability appeal pending at the Social Security Administration. There are over 10,000 attorney and non-attorney advocates representing these claimants. Even a quick analysis of the numbers is enough to prove some facts about the Social Security disability program.
Fact 1. Over 1 million claimants were denied by Social Security, which is why there are so many claims waiting for a hearing.
Fact 2. Many of these claims will be approved in the appeal process. Otherwise, attorneys and advocates could not afford to labor for months or years on these appeals because they would not get paid for doing so.
Fact 3. If you put Fact 1 and Fact 2 together, the obvious conclusion is that hundreds of thousands of disability claims were recently denied that should have been approved in the first place. Otherwise, an appeal process would be a waste of time.
Conclusion: Social Security disability claims are seldom approved at the first step. Getting an approval requires skill and knowledge of the appeal process. The claimant should be represented by a professional who understands evidence, regulatory processes, burden of proof and how to present a legally sound case that can be paid by an administrative law judge.
If a case is not paid at the hearing level, the representative should have laid a foundation for further appeals that may give the claimant a chance of recovering benefits from the Appeals Council or, in some cases, in a Federal District Court.
So, in one sense, it's quite a shame that a disabled person needs a legal representative to help him or her get disability benefits. In the practical sense, however, that is the system we are dealing with. The reality is that you will probably need an experienced legal representative to help you collect the benefits to which you are entitled. There are just too many errors you can make if you try to "go it alone." You don't know what you don't know--and walking blindly through the Social Security disability process is like walking through a mine field blindfolded. You might win but the odds are highly unfavorable.
"Good Representation Isn't Expensive. It's Priceless."
The Disability Determination Service (DDS) is located in Birmingham, AL. This is a state run agency contracted by Social Security to examine disability claims and make the initial decision as to whether a claimant meets the rules for disability benefits. Here are some of the things DDS typically does with a new claim:
- Order records from doctors and other medical providers
- Analyze medical records to determine what conditions/impairments you have
- Schedule any medical exams that they feel you need
- Obtain your past work history and classify your past relevant jobs
- Determine what your Residual Functional Capacity (RFC) is
- Decide whether you are eligible for benefits under Social Security rules
- Deny a majority of claims that they review (About two-thirds of all claims)
WHY THE DDS IS LIKELY TO DENY YOUR DISABILITY CLAIM:
- Their track record is a denial rate of over two-thirds. It speaks for itself.
- DDS will likely decide that you can perform some "other work," even if you are not able to perform past relevant jobs (A Step 5 Denial).
- DDS will nearly always establish a "Residual Functional Capacity" that is unrealistic for you and which permits you to still perform some type of work.
A key idea that we try to communicate here at the Forsythe Firm is: A denial by the DDS is not the end of the claims process, it is just the beginning. We hope for the best but prepare for the worst, realizing that DDS is a denial machine, churning out denials to even well qualified claimants in wholesale numbers. That's what we're here for. Contact us as soon as you are denied and we will begin an immediate appeal to the next level, helping to preserve your rights, obtain an approval of your claim and collect the back pay you deserve.
There is no fee for any service we provide unless you win your claim and collect back payments dating back to the date you first became disabled (your alleged onset date or amended onset date). We are LOCAL Social Security disability advocates, located across from the Bridge Street Town Centre in Huntsville. Call us locally at (256) 799-0297 or visit www.ForsytheFirm.com
Definition of Disability: One or more severe and medically determinable impairments which has lasted, or can reasonably be expected to last at least 12 consecutive months or end in death-- and which prevents you from performing full-time work activity. You cannot receive any disability benefit if you are currently working at substantial gainful activity, no matter how severe your impairment is.
When Should You Apply for Disability? You should apply as soon as you are diagnosed with a disabling condition which can reasonably be expected to last for a minimum of 12 consecutive months. Note that Social Security does not provide a disability benefit for conditions lasting less than 12 months.
How Do You Apply? If you are filing a regular SSDI claim, you may file online at www.socialsecurity.gov. Or you may contact a local Social Security office for assistance. If you feel you need a representative, advocate or attorney to help you, you may contact someone to help you file your claim.
How Long Will a Decision Take? The initial decision will typically take 3 to 4 months, sometimes longer. Records have to be obtained from your treating doctors and other providers and this can take some time.
What if You Are Denied? It is not uncommon to be denied. In fact, over two-thirds of all applications that are filed in Alabama will be denied. You have 60 days to file and appeal, which amounts to requesting a hearing before an administrative law judge. An appeal is not the same as filing a new claim. If you have questions about an appeal or how to present evidence for your appeal, you may wish to consider obtaining representation.
How Long Does the Appeal Take? Getting a hearing can take 12 to 18 months. For most claimants there is no way to get a quick appeal hearing. Exceptions are made for certain disabled veterans and individuals with dire need. The rules for dire need, however, are very restrictive.
Does Drug Addicton or Alcoholism Count as a Severe Impairment? No, the Congress has made drug addiction and alcoholism ineligible for Social Security disability if they are the only impairments. If a person has an unrelated (immaterial) impairment, he or she may still get disability in spite of drug addiction or alcoholism, as long as those conditions are not material to the other impairment(s). For example, an individual who has brain cancer could be found disabled even if he is an alcoholic because alcoholism did not cause or contribute to the brain cancer.
What Does it Cost to Get a Representative or Attorney? Representatives do not charge you a fee unless you win your claim and it results in the recovery of back pay or past due benefits. In that event, a fee that you have already agreed to will be deducted from your back pay. If you don't win, or don't receive any back pay, there is no fee due.
Is the Forsythe Firm Affiliated with Social Security or the US Government? No. The Forsythe Firm is a privately owned professional firm that represents claimants and works for claimants. We are not affiliated with the Social Security Administration.
Social Security disability benefits are paid for severe impairments that prevent the ability to work. Work has both physical and mental demands. A severe restriction in the ability to perform the mental demands of work, as defined by SSR 96-9(p) or SSR 85-15, may result in disability payments.
Not only must the claimant prove that he/she has a severe impairment that significantly restricts the ability to work, other considerations include:
1) Are you insured under the Social Security Act? In brief, have you worked long enough, and recently enough, to have accumulated the minimum quarters of coverage to be insured? If not, you are not covered by the Act and cannot get Title 2 benefits.
2) Are you currently engaged in Substantial Gainful Activity (SGA)? SGA is defined in 2015 as gross earnings of at least $1,090 per month from employment or self employment. If you are now working at SGA level, you cannot receive disability benefits from Social Security, no matter what your age or how severe your medical impairments are. SGA does not include investment income, such as stocks, bonds or rental property.
3) Do you meet the Duration Requirement? Social Security requires that you be unable to work for at least 12 consecutive months. If you are expected to be able to return to work within 12 months, you will not qualify for disability from Social Security.
4) Are you able to perform some other type of work, not necessary just the job you have recently been doing? If you still able to perform other kinds of work (perhaps easier or simpler work), you would not be found disabled under Social Security rules.
Evaluation of a potential Social Security disability case is complex. Our firm is happy to provide a free analysis of your claim and decide whether we are able to assist you in getting disability benefits. There is no cost or obligation for a consultation with us.
(256) 799-0297.
I have had two recent hearings where approval was based on properly classifying the claimant's past relevant work. Past relevant work (PRW) is defined as all work performed at a full time or substantial gainful activity level during the 15 years prior to the application.
Here is why PRW may be critical: At Step 4 of the decision process, the administrative law judge must determine if the claimant is able to perform any of his/her past relevant work. If the answer is yes, the law requires the judge to find that the claimant is not disabled. An exception would be made for persons in certain older age categories who meet medical-vocational guidelines.
In both of my cases, the claimants were persons of advanced age (over age 55), had only high school educations and had held unskilled jobs. Medical-vocational guidelines would direct a finding of disabled unless they were able to return to past relevant work. So, it was critical to show that they were not capable to performing any of the work they had performed during the past 15 year period.
Here is where PRW must be carefully described so it is classified correctly by the vocational expert who will be providing testimony. The claimant's representative must carefully determine how much standing, walking and lifting were required in each of the past jobs. Past job duties must be described in detail so that only only the exertion level is properly classified but the skill level is also properly classified. In other words, if the past relevant work gets classified as semi-skilled but it was really unskilled work, it can affect the outcome of the case.
I find that claimants often breeze through the disability application forms--often not giving any real effort or thought to proper completion. They may not take time to fill in the Work History Report. This can lead to an improper classification of their past relevant work, which in turn can cause a denial.
My advice is to always complete all the forms completely and carefully. There is a reason for each form (and there are many forms). The Work History Report can become a nightmare if it is completed improperly or incompletely. If it has been improperly completed, that must be straightened out during the hearing.
Disabled veterans may qualify for both VA disability and Social Security disability. (SSDI). These two benefits do not offset each other, meaning, a veteran may collect full VA benefits and full SSDI benefits at the same time.
The applications, procedures and requirements for each program is different, however. Just because you qualify for VA disability does not automatically mean that you qualify for SSDI benefits. Social Security must go through a separate process and find that you are disabled under their own rules.
Social Security can be a significant source of additional income for disabled veterans. The maximum disability benefit for a non-blind individual is $2,633 per month.
Some key points to consider:
- Persons of any age (before full retirement age) can receive SSDI benefits.
- Benefits are not restricted by your income or financial resources.
- A 100% permanent VA disability rating will expedite your Social Security claim.
- You do not necessarily have to be on VA disability to get Social Security and vice versa.
- A representative, attorney or advocate will not charge a fee unless you win benefits.
- Legitimate claims are often denied and must be appealed to receive benefits.
For a free consultation and review of your claim, please contact an advocate with the Forsythe Firm, located in Research Park, at 7027 Old Madison Pike, Suite 108 (by appointment). Or phone us at (256) 799-0297.
"Without evidence of a limited Residual Function Capacity (RFC), you don't have a disability case."
Unfortunately, Social Security disability law is filled with technical terms that people don't understand, yet they are critical in the successful outcome of a disability claim.
One of those terms is Residual Function Capacity (RFC).
I hate to belabor this but let me try to explain what the RFC is and why it can make or break your Social Security disability claim. This is critical to understand if you plan to handle your own case.
What is residual function capacity? Simply put, it is the maximum you are able to do with regard to work-related activities, such as standing, walking, lifting and carrying, pushing and pulling, bending, stooping, remembering, concentrating, making decisions, etc. Those are all job functions. Capacity is the measurement of where your limits are.
Where does the RFC come from? The residual function capacity (RFC) comes out of the medical records. While a decision maker can take your testimony or statements into account, your statements must be supported by objective medical evidence. What is most helpful is when your doctor will complete a form that defines your RFC. This is why I ask my client's doctors to complete a form that states, Mr. X can lift so many pounds, stand or walk for so many minutes, etc. If your doctor does not complete an RFC form, the judge or other decision maker at Social Security will develop their own RFC. That can cause problems.
What are the terms Social Security will use to put limits on my functional capacity? Social Security will use terms such as:
- Constant - There are no limitations on this ability.
- Frequent - This function can be performed up to two-thirds of an 8-hour workday.
- Occasional - This function can be performed from very little up to one-third of a workday.
- Never - This function can never be performed and must be avoided.
One of the best things a claimant can do before a disability hearing is to scour the medical records to develop a proper set of qualifying limitations of his/her functional abilities. For example:
- I would be limited to lifting and carrying no more than ___ pounds based on records from Dr. A.
- I would be unable to sit more than 1 hour at a time or 3 hours in an 8-hour workday, based on records from Dr. B.
- I can only occasionally stoop, kneel, crouch and crawl, based on my medical impairments treated by Dr. C.
- I would never be able to climb, operate machinery, or be exposed to unprotected heights, based on conditions treated by Dr. D.
- Dr. D and Dr. E both say that I would be absent more than 2 days per month because of ----------------.
Frankly, this is the type of thing I do all day, nearly everyday. I scour medical records to justify functional limitations that prove my client is not able to perform past relevant work, or any other work. When I get paid a fee, it is not because I went to a 45-minute hearing with my client. Rather, it is because I spent hour upon hour reading the medical files to find objective medical evidence that proves that my client has a limited residual function capacity (RFC). Without that limited RFC, you do not have a disability case.
When Social Security denies a disability claim you must request a hearing before a US administrative law judge (ALJ). Here are a few critical things you must know about the hearing process if you are to win your disability benefits.
The ALJ will deal only in facts. If it is not in your medical record, it did not happen.
The ALJ will need specifics. Generalities will not suffice. Avoid terms like "not very often, not very much, every now and then, or a whole lot." You will need to provide answers in terms of minutes, hours, yards, feet, pounds, etc.
Winning requires a limited residual functional capacity. A residual functional capacity (RFC) is the most you are able to do in terms of work-like activities, such as sitting, standing, walking, lifting, bending, concentrating, staying on task, etc. The RFC must come from the medical records. You need to provide evidence that will help the judge develop a properly limited RFC, or else you may lose your case. (This is so important that I plan to write a separate post just on the RFC itself).
The burden of proof is on you until you reach Step 5. In parts 1-4 of the sequential evaluation process, Social Security does not have to prove anything. They assume you are NOT disabled unless you can prove otherwise. They do not have to prove that you are not working now. They do not have to prove that you do not have a severe impairment. They do not have to prove that you don't meet a Listing. They don't have to prove that you can perform some of your past relevant work. The burden of proof with all these facts rests with you, the claimant. Failing to establish proof will lose the case.
The Burden of proof shifts at Step 5. At the last part of the hearing, "Step 5," the burden of proof shifts, at least partially, from the claimant to Social Security. In this final consideration, Social Security must prove that there exists a significant number of jobs in the US economy that you could perform, considering your age, education, residual functional capacity and previous relevant work experience. They will attempt to prove this using testimony from a vocational expert. Unless you can challenge the testimony of the vocational expert there is a high probability that you will lose your case.
Social Security Hearings are Technical and Complex. They are legal proceedings. The claimant is the only participant in the hearing who is not a trained professional. You will be dealing with alleged onset date, significant gainful activity, residual functional capacity, listings from Appendix I, medical-vocational guidelines from Appendix II and many other technical issues from the Social Security rules and regulations. Most claimants will need help to protect their own best interests during these hearings.
Don't be misled by the statement that these hearings are "informal" or "semi-formal." All this means is that Social Security will not have an attorney arguing against you. However, the administrative law judge has a law degree. The vocational witness usually has a masters or doctorate degree. If there is a medical expert present, he or she will have an MD degree and a license to practice medicine. Why would you not want an advocate who argues your side of things?
When you file a Social Security disability claim or file an appeal on a denied claim, it is vital that you focus on the key issue. The key issue is "Why I am disabled."
The Social Security Act does not concern itself with the question "Why I Can't Get a Job." One is a disability issue; the other is an employment issue.
A disability claim must focus on severe functional limitations that can be proven with medical evidence. By "functional limitations," I mean the inability to perform one or more work-related activities. Functional limitations may be divided into two broad categories, and I have given a few examples for illustration:
Exertional Limitations
- I cannot lift and carry more than 10 pounds.
- I cannot walk more than 25 yards without resting.
- I can't use my upper extremities to push/pull.
Non-exertional Limitations
- I have a severe hearing disorder.
- I am unable to remember, understand or carry out simple instructions.
- I am not able to focus or concentrate long enough to do work activities.
Too often, disability claimants get side tracked into non-productive areas like, "No one will hire me because...." This line of thought will never prove successful in Social Security disability applications or appeals. The correct approach would be, "I am not able to work because..." Those may sound like very subtle differences but to Social Security decision makers, they are huge differences.
The Forsythe Firm is one of Huntsville's most active and involved Social Security disability advocates. Our mission is to help the truly disabled in the long, difficult process to obtain Social Security disability benefits. We work with veterans and non-veterans from all walks of life.
The firm is full-service, meaning that we may help with filing the initial application for disability benefits, developing the case and representing clients during hearings or appeals. You do not have to wait to be denied before we will help you.
The Forsythe Firm will never charge you a fee for any service or representation until (a) you win your disability claim AND (b) recover past due or retroactive benefits, usually paid in a lump sum settlement. If you do not recover past due benefits there will be no fee for any service we have rendered, no matter how much we worked on your case.
The Forsythe Firm is local to North Alabama, headquartered at 7027 Old Madison Pike, Suite 108, Huntsville, AL 35806--directly in front of the Bridge Street Town Centre.
We serve all the communities in northern Alabama, including the counties of Madison, Limestone, Lauderdale, Morgan, Lawrence, Cullman, Jackson, DeKalb, etc.
The Forsythe Firm may appear before federal administrative law judges in all 50 states. We actively practice regularly in Alabama, Tennessee and Mississippi.
More information about the Forsythe Firm or about Social Security disability in general may be obtained from our website (here), or by calling us at (256) 799-0297.
MEMBER:
NATIONAL ORGANIZATION OF SOCIAL SECURITY CLAIMANTS REPRESENTATIVES
Social Security offices in North Alabama are no longer using telephone numbers with 256 Area Codes. They have switched to toll free telephone numbers that start with 866, 855 or 888, etc.
Finding a telephone number for a local Social Security office can be difficult. Here are some of the numbers we get requests for:
Huntsville Social Security office 866-593-0665
Decatur Social Security office 888-289-9185
Florence Social Security office 855-884-3407
Social Security Office Hours
Weekdays (except Wednesdays) 9:00 AM to 3:00 PM
Wednesdays 9:00 AM to 12:00 Noon
*Offices are closed on weekends and all federal holidays.
To discuss your claim with an experienced disability advocate who specializes in Social Security claims, call the Forsythe Firm in Huntsville at (256) 799-0297. Forsythe Firm Web Page
The Forsythe Firm is not affiliated with the US Social Security Administration. This posting is not sponsored or endorsed by Social Security.
If
you are age 50 or over, you may qualify for Social Security benefits for
any physical or mental condition which prevents you from full-time
work.
Yes,
younger individuals may also qualify. However, Social Security uses
Medical-Vocational Guidelines which relax the requirements somewhat for
persons age 50 and over.
In
addition to your age, other factors include your past work experience
and education. But being age 50 or more is the greatest single
advantage a claimant has in being approved for Social Security benefits.
The
Forsythe Firm will provide you with a free case evaluation and local
consultation. If we represent you, you will never pay a fee until you
get benefits with back payments. If you do not win benefits you will
never pay us a fee for any service we perform.
Contact us at (256) 799-0297. We're located across from Bridge Street.
