Social Security is infamous for taking "forever" to process and pay disability claims. Using a professional advocate to represent you may get you paid faster by...
- Avoiding mistakes and oversights
- Providing quicker medical documentation
- Asking for the proper actions on the claim
- Knowing the procedures to follow
- Using all the rules that allow expedited claims processing
Make no mistake, Social Security is a large federal bureaucracy laden with plenty of red tape and delays--some unavoidable. But in some cases, delays can be avoided and payments can be made faster.
The Forsythe Firm's advocates will work tirelessly to get you maximum pay in the shortest time possible. "We fight for you" is not just a slogan, it's a principle.
Phone (256) 799-0297 Local. Experienced.
Have you been denied Social Security disability benefits? Are you headed for an appeal or hearing? Here are some of the factors that will influence whether you are approved at the hearing or denied again.
1) The strength of medical evidence: Is there strong objective medical evidence of a severe impairment that has lasted, or is expected to last, at least 12 consecutive months?
"Your representative will purchase and submit medical records for you, saving you potentially hundreds of dollars in upfront costs...."
2) Vocational Evidence: Do you have a medical source statement from one of your doctors describing how your medical condition limits your specific ability to perform work related activities such as sitting, standing, walking, lifting, bending, concentrating, remembering or staying on task during an 8-hour workday? This can help you win.
3) Are You Now Working? If you are currently working and earning at least $1,170 per month before withholding, you are not currently eligible for SSDI benefits. If you are working and earning less than $1,170 per month, you may be eligible for disability benefits; however, the judge could consider that part-time work is de facto evidence of your ability to work and this might hurt your chance of being approved. This is a gray area, very subjective.
4) Job History: If you have a long history of steady employment with good earnings it will help your chances. Judges like to see a claimant who will take a substantial pay cut by getting on disability. They do not like to put unemployed or under-employed individuals on disability.
5) Which judge will hear your case? Judge's award rates vary tremendously. Some judges pay 70 percent of claimants appearing before them, while other judges may make awards in only 15 or 20 percent of cases they decide. A judge with an higher award rate is obviously better. (No, you don't get to choose your judge; neither does your representative).
6) Completeness of your case file: Many claimants who represent themselves walk into a hearing to find that their medical files have not been updated in the last 18 months and important medical records are missing. This is because Social Security stops ordering or updating medical records when the appeal is filed. From that point on, it is up to the claimant to purchase and submit his own medical records. Without a representative to order the latest doctor's records (or hospital reports), nothing gets updated and the record is woefully incomplete. This will usually result in the hearing being postponed--months of additional waiting while the claimant tries to obtain and submit all the more recent medical reports which are vital to a decision. If the claimant is represented, the attorney or representative is responsible for obtaining these records and making sure the file is complete.
ONCE SOCIAL SECURITY HAS MADE AN INITIAL DENIAL OF A CLAIM, IT STOPS ORDERING MEDICAL RECORDS. SOCIAL SECURITY WILL NOT ORDER ANY MEDICAL RECORDS WHILE YOU WAIT ON A HEARING TO BE SCHEDULED. THIS MUST BE DONE BY YOU OR YOUR REPRESENTATIVE. YOU OR YOUR REPRESENTATIVE MUST PAY FOR THESE RECORDS.
One of the vital services provided by your representative is ordering (purchasing) and submitting your medical records, especially records of treatment you have after the appeal. has been filed. Since the average wait time to get a hearing is around 15 months, there is usually quite a lot of medical records to be obtained. Your representative will usually pay for these records, saving you potentially hundreds of dollars in out-of-pocket costs. (The representative may bill you for the actual cost of these records AFTER you start receiving disability benefits--but only if you win your case). If you do not win, the representative will bear all the cost involved in preparing the appeal or claim, including the cost of medical records--another advantage of being represented.
Charles W. Forsythe, Partner
The Forsythe Firm
7027 Old Madison Pike NW, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297
Free Consultations Pay a Fee Only If you Receive Benefits
Visit Our Website - Answers to Your Questions
You applied for Social Security disability. They sent you to a doctor for an examination, then denied your benefits. Should you assume that Social Security made the correct decision? No. You should assume they made a bad decision.
Close to one-half of those denials will be overturned on appeal. In more than 40 percent of denials which are appealed, a judge will review the evidence and overturn the denial to award full benefits to the claimant.
Never assume a denial by Social Security is correct. Assume it is wrong and can be overturned.
What is the biggest mistake you can make after being denied by Social Security? Failing to appeal the denial within 60 days is the single biggest mistake you can make.
What are the risks if I appeal and lose? There is no risk. In an appeal, you have everything to win and nothing to lose. If you do not win the appeal, your legal representation is free. You cannot be charged a representative's fee unless you win. And any attorney's fee must come out of past due benefits that you win during the appeal. No past due benefits, no fee. So it is win-win for you.
"Always assume that a denial of benefits is wrong and can be overturned on appeal."
For help with a Social Security disability denial (or to file a new application), contact the Forsythe Firm in Huntsville at (256) 799-0297. We cover all costs of appeal until you win. (256) 799-0297.
When an individuals file for disability, Social Security will often send them to be examined by one of their own doctors who work under contract. In most instances, the Social Security doctor will not find any disabling impairment and the benefit will be denied. This happens more often than not. But are these "consultative examinations" fair, thorough and adequate? Chances are, the answer is No to each of these questions.
Here's what you should know about consultative visits to Social Security doctors:
1) The visits are brief, superficial and often inadequate to find any serious disease or disabling impairment, even if one is present.
2) Social Security is usually required by law to give more weight to the opinion of your own doctor than to the consulting doctor they send you to. In failing to do this, Social Security may have set themselves up to lose an appeal if you push the denial to the appeal level (which you certainly should).
3) The Social Security doctor who examined you is probably not a specialist. Even if he or she is a specialist, probably not a specialist in your disabling condition. For example, if you are disabled by arthritis and the doctor who examines you is a dermatologist, he is certainly not a specialist in your disease. Therefore, his or her opinion may not be worth very much in court. If you have been examined and treated by a rheumatologist (who is a specialist in Fibromyalgia), that doctor's opinion may overrule the opinion of the dermatologist from Social Security.
These factors will never come out except at the appeal. If you don't appeal, you may be stuck with an unfair denial that could easily have been overturned in court (at a hearing). This happens more often than not. Cases that could easily have been won at appeal are allowed to be denied simply because the claimant did not appeal, or did not appeal within the 60 day deadline allowed.
If you have recently been denied Social Security disability benefits (with or without a doctor's examination), we urge you to appeal now. You do not need to understand the system or the law. Simply appoint a representative who does. You will not pay any fees or costs unless you win your case and receive the back pay that was wrongly denied. There is no risk.
For help making sure Social Security has treated you fairly and given you every benefit you are entitled to, contact the Forsythe Firm in Huntsville. Phone (256) 799-0297.
PHONE (256) 799-0297 WEBSITE: www.ForsytheFirm.com
7027 Old Madison Pike NW, Suite 108
Huntsville, AL 35806
(256) 799-0297
CLICK HERE TO SEE OUR "HUNTSVILLE DISABILITY GUIDE"
Social Security disability benefits may be available for persons who have worked recently enough to be covered, have a long-term severe medical impairment that will last at least 12 consecutive months, and who have adequate medical records.
Why is a work history required? Individuals gain insured status by working and paying FICA tax through payroll withholding. Most workers require 22 quarters of work to be covered. The rule of thumb is--you have worked at least 5 our of the most recent 10 year period.
What is a severe medical impairment? An impairment which prevents you from performing one or more of the functions required of full-time work is severe. Impairments may be physical, mental or a combination of both. The severity of impairments and how they limit the ability to perform full-time remunerative work is the key to a Social Security disability claim.
What if little or no medical evidence is available? The regulations provide disability benefits only for "medically determinable impairments." Subjective complaints, such as pain, headaches, depression, etc. are not enough. Social Security will want doctor's records and they especially favor objective evidence such as X-ray, MRI, CT scans, etc.
About 70 percent of disability applications are denied. Your odds may be better at an appeal hearing. Hearings are technical legal proceedings and we recommend professional representation. A representative will not charge a fee unless you win and recover past due benefits as a result of the hearing.
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Free disability consultations are available in Huntsville at the Forsythe Firm, (256) 799-0297.
In about 20 percent of Social Security disability cases, the agency will send claimants to one of their contracted doctors for a consultative examination (CE). Social Security contracts with doctors in private practice to perform these exams. Here is generally what to expect at a consultative exam (CE):
- It will be brief. The doctor may spend as little as 15 minutes with you. Usually there are no tests.
- The doctor has been provided with a checklist of things to look for. He/She will focus only on what is on the list.
- CEs are often not helpful for the claimant.
As a result of the examination by this doctor, Social Security will probably deny your benefits. This happens more often than not. If it does, you should appeal the denial because it is probably based on a bad physical exam and a bad set of facts.
Here is what you should know about these questionable Social Security doctor's exams:
1) The exams are superficial and often inadequate to find any disabling impairment, even if there is one (or more).
2) The doctor who performs these exams is probably not a specialist, and almost certainly is not a specialist in the area of your disabling impairment.
3) There is an excellent chance the exam will not stand up in court. Therefore, appeal, appeal, appeal--and do so within the 60 days allowed.
4) If you have medical records from your own treating doctor, they are usually entitled to more weight than the opinion of the Social Security doctor. This does you no good, however, unless you appeal.
An appeal is designed to fix errors and to correct mistakes or injustices that may have occurred with your denial of benefits. For the system to protect you, you must use it. You must appeal. And you must appeal quickly.
You may not know the law or the system. Don't let this stop you. Get a good representative and let him or her handle the appeal. There is no risk. You cannot be charged a fee unless you win and collect past due benefits when the appeal goes your way. You do not pay any upfront costs to file an appeal.
The Forsythe Firm in Huntsville has been handling appeals for years and has seen hundreds of denials reversed and paid on appeal. Don't take a denial lying down. Fight back and win! Call us at (256) 799-0297.
You have an accident that forces you to quit working for a long time (one year or longer). You have a sudden health event, such as a heart attack or stroke, that takes you off work. You lose all your income. How do you survive financially?
Here is a checklist that you can use now to plan to survive a disability later:
1. Find out what type of group disability insurance policy your employer has purchased, if any. These are common, especially among larger and mid-sized companies.
- How long must you be off work before the policy begins to pay? This is often called a waiting period or elimination period.
- How much is the maximum monthly benefit? (60% of your salary is common, but plans can vary).
- What other sick leave benefit is offered by your employer?
2. How much will your Social Security disability benefit be? This is determined by how long you have worked, your total wages, and your age. You can get an estimate by calling Social Security or going to www.socialsecurity.gov and setting up an individual account. Caution: Social Security has the following limitations for disability:
- It only covers a disability lasting 12 consecutive months or more (No short term benefit is available).
- It pays no benefit during the first 5 months of a disability (There is a 5-month waiting period).
- You must meet the strict definition of a medical disability. Being off work is not enough, even with a doctor's excuse. Social Security has their own guidelines. For persons under age 50, disability usually means that you cannot perform ANY full-time job, not just the job you are used to doing). The medical guidelines are very difficult to meet.
- Aside from all these limitations, it will take an average of 4 months to get a disability application processed (approved or denied). An appeal will take up to 18 months longer. Social Security is not quick. So, plan for another means of financial survival while you wait.
3. Start a savings plan or add to a plan you already have. This is probably the weakest link for most individuals. Little or no savings. If you suddenly become disabled, and you depend on your income to pay the bills, savings will be absolutely essential. There are usually no government benefits to help pay the rent, mortgage, utilities or other living expenses. Savings to provide a few months of household expenses will be very valuable if you become disabled. It can mean the difference between keeping your home or losing it, being able to afford medical care or doing without it, and a dozen other important necessities. Saving a few dollars a month over a long period of time can offer a safety net should a health catastrophe strike.
Disability strikes, as most catastrophes strike, unannounced and unplanned. It can happen very suddenly. When the medical emergency is over, attention turns to the financial catastrophy. How do I survive without my job and with no income?
What are the possible sources of income for a suddenly disabled person?
(1) Social Security. Social Security disability, a type of federal insurance for workers, may be available if the worker
- has earned coverge by working 5 out of the most recent 10 year period. If not, there's no benefit.
- can prove that he/she meets Social Security's strict definition of a medical disability. (Just being off work isn't enough, even with a doctor's excuse).
- will be disabled for at least 12 consecutive months.
- can survive 4 to 24 months while the matter is being decided. Social Security is not quick. Therefore, workers need something else to tide them over while Social Security slowly meanders its way to approving or denying the application, scheduling hearings, doing examinations, etc. (70% of all applications are denied, so it's not a sure thing by any means).
(2) Employer sponsored disability insurance or sick leave. Many employer's offer some form of accumulated sick leave. They may also offer a private insurance policy for short-term and/or long-term disability. You should check to see if your employer offers this insurance, if you are covered, what the "waiting period" is, and how much benefit you may get if you become disabled. These plans usually pay while you are waiting on a decision by Social Security.
(3) Savings. We recommend savings to pay essential living expenses (rent, mortgage, utilities, food, etc.) for at least 6 months.
There are relatively few programs available to help disabled workers financially. Rent, mortgage payments, utilities....they all go on....but Social Security can take months (even years) to approve benefits. We can't stress financial planning enough. While we don't sell or endorse insurance plans, we strongly encourage you to consider protecting yourself and family from disability by an insurance plan other than Social Security--whether through your employer or a private insurer.
The 3 most important keys in winning a Social Security disability claim are
1. Documentation
2. Documentation
3. Documentation
Everything must be documented, and from acceptable medical sources. You may read on the internet (or read in the newspaper or hear on TV ) that all you have to do is claim pain or back problems or depression and you're in the money. Baloney!
Take it from someone who has attended thousands of disability hearings. If your medical complaints are not well documented by objective medical evidence, and from accepted medical sources, your claim is going under--fast.
You need to go one step beyond objective medical evidence. Beyond X-rays, MRIs, CAT scans--you need your doctor's opinion about how your symptoms limit your ability to function. How long can you sit and stand? How far can you walk? How much can you lift on a consistent basis? How many days per month would you likely be absent because of your symptoms? What are your specific limitations on bending, kneeling, crouching, crawling, handling, reaching, using stairs, understanding simple instructions, or responding appropriately to co-workers or supervisors?
An experienced representative will know what documentation you need and how to get it. He or she will analyze each medical document, apply grid rules, determine whether you meet a Listing, etc. One of the representative's jobs is to determine what type of documentation you need and set about to get it. Then, he/she will use that documentation to make an effective argument that you meet specific regulations regarding disability.
Aside from the medical issues, there are vocational issues that must be documented. At the hearing, Social Security will call a vocational expert to give testimony about your past work and also about other work that exists in the US economy. Your representative must be prepared to question this vocational expert and handle any testimony that can hurt your case.
Go to your hearing prepared. That probably means taking an experienced representative or advocate with you--one who understands the requirements and regulations, and one who knows how to document the evidence properly.
Expecting a favorable outcome by luck or chance is like hoping for an unabridged dictionary to come out of an explosion at the printing shop. It rarely happens. A favorable decision has to be planned and documented.
The following 5 items can get you approved for Social Security disability benefits.
1) Admissible objective evidence from acceptable medical sources.
2) Admissible opinion evidence from acceptable medical sources.
3) Elimination of past relevant jobs from your most recent 15 years of employment history.
4) Elimination of other jobs that exist in the national work force.
5) Proper application of Medical-Vocational Guidelines (Grid Rules) under 20 CFR 404, Subpart P, Appendix II.
The Social Security disability process is a complex maze of legal, medical, procedural and vocational issues. Getting the proper professional assistance to navigate these treacherous waters can make a huge difference in the outcome of your case.
After you attend a Social Security disability appeal hearing, the judge may issue one of 3 possible decisions:
1). Fully Favorable - You get everything you asked for, including pay back to the alleged onset date (the date you claim to have first become disabled).
2) Partially Favorable - You get current monthly benefits, but lose some or all of your back pay because the judge finds you to have become disabled later than you allege in your original application.
3) Unfavorable - The judge finds that you were never disabled according to the Social Security Act and you get no benefit at all.
It is the "Partially Favorable" decision that confuses folks the most often. There is no such thing as a "partial disability" under Social Security. You are either fully disabled or not disabled at all--nothing in between.
So a "partially favorable" decision refers to the decision, not to the disability. As explained above, some aspect of the decision was not as favorable to you as it could have been. Usually, this means the date you became disabled is determined to have been later than you claim. This causes you to receive less "back pay" than you would have if you had been determined to have become disabled at an earlier date.
For example, Mr. Alpha alleges that he became disabled on July 1, 2012 and he wants to collect disability payments back to that date. However, the judge finds that Mr. Alpha did not actually become disabled until January 1, 2015. Mr. Alpha is fully disabled, but only back to January 2015, not July of 2012. Therefore, he will be paid back to January of 2015, not back to July of 2012. So his decision is "partially favorable." This does not affect the amount of his monthly disability payment, only the number of months he will be paid retroactive benefits.
Again, there is no partial disability with Social Security.
What's in your
medical file may shock you. And if you are coming up for a Social
Security disability hearing, you should find out. Doctor's files often
contain more than medical information. And just because it's in your
medical file doesn't necessarily mean that it's true.
For example, I once had a client who was confronted about his two week vacation to Vail, Colorado. Turns out, he had told his doctor and the doctor had included a note about the vacation in the medical record.
I
have found citations in medical files about gambling, drinking,
smoking, vacations, domestic abuse, drug use, marital problems,
shoplifting or other criminal activities, and much, much more. And not
all of the information was accurate. Most often, the claimants had no
idea these things were in their files.
Social media seems to be another prime source for revealing, personal information. Does Social Security look at your Facebook page? I assume they do. You should, too.
