"I have heard that there is no such thing as a partial disability with Social Security. However, I just received a decision that says NOTICE OF DECISION - PARTIALLY FAVORABLE. What does this mean?
You are correct that Social Security does not grant any benefit for a partial disability. A claimant is either disabled or not disabled, nothing between. However, Social Security does issue two types of favorable decisions:
FULLY FAVORABLE - Means that benefits are awarded exactly as applied for in the application with no changes made by decision makers, such as the administrative law judge. This usually involves the date of disability onset, which affects the amount of back pay. For example, you claim that you became disabled on July 10, 2015. Social Security agrees and awards benefits back to that date. Your decision is, therefore, Fully Favorable with no changes.
PARTIALLY FAVORABLE - Means you were found to be disabled, but some fact in the application was changed to make the decision less favorable than the one you wanted. You will get a monthly benefit but some other part of the decision is unfavorable to you. This usually involves a change in the established onset date. For example, you claimed in the application that you became disabled on July 20, 2015 and asked for benefits back to that date. The decision maker found, however, that you did not meet the requirements for disability benefits until January 1, 2017. You get your monthly benefit but your back pay will be reduced because of the later onset date. Therefore, the decision is only partially favorable to you. It gives you part of what you asked for, but not all.
I might emphasize that the claimant in both of these examples is fully disabled. It's not the disability which is partial, it's the decision. In the case of a partially favorable decision, the claimant is fully disabled but the full disability didn't begin on the date that he/she alleged. Because the beginning date (onset) of disability got moved, back pay was reduced. So, it's a full disability but a partially favorable decision. (The monthly benefit is the same in both cases, only the back pay is affected).
SOCIAL SECURITY JUSTICE
HELPING HONEST, HARD WORKING PEOPLE GET THE DISABILITY BENEFITS THEY DESERVE. WE WORK TO GET YOU MAXIMUM BENEFITS AS QUICKLY AS POSSIBLE. Phone (256) 799-0297.
Saturday, January 5, 2019
HOW LONG WILL IT TAKE TO GET A SOCIAL SECURITY DISABIILTY HEARING...?
How long will it take to get a Social Security disability hearing?
Typically, it takes 18 to 24 months from the date you file your appeal/request for hearing. About 25 percent of claims will be approved without an appeal; the other 75 percent must appeal and wait. The wait is due to a huge backlog in the Social Security Administration.
How long will I have to wait for a decision after my hearing has been held?
The wait varies from judge to judge and office to office. 60 to 90 days is common. Fully favorable decisions are the quickest because they are the least complicated to write.
Once I get my favorable decision, how long will I have to wait to get paid?
The time varies. Most people wait 30 to 45 more days to receive their first check. Back pay may take even longer. If a Supplemental Security Income (SSI) claim was also filed, the wait will be longer because the SSI paperwork must be processed first and that requires an interview with the claimant.
Can I receive any emergency benefits while I wait for Social Security to decide my case or to pay me?
No. Unfortunately, Social Security has one speed for almost everyone and it does not include any special advances or funds to cover emergencies.
Can anything speed up my disability case?
There are three things that might get expedited (faster) processing for a Social Security disability claim:
1) Critical case designation. if the claimant has a terminal illness and is expected to live no more than 12 months, the case may be declared a critical case and acted on more quickly.
(2) Dire Need. If the claimant is homeless and has no way to provide food or shelter. If the claimant needs emergency medical treatment which he/she cannot afford or obtain, Social Security may designate a case as "dire need" and speed up the process.
2) Disabled veterans who have a 100 percent permanent, total VA disability rating may get expedited claim processing with Social Security.
Obviously, there are some things that all applicants should do to avoid needless delays in their claims. Try to file a complete, accurate application--and this applies to all the questionnaires and reports that go with the application. Attend all interviews or examinations as directed. If denied, file an immediate appeal--because hearings are assigned in the order in which appeals were filed.
________
The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
"Across From Bridge Street"
CALL (256) 799-0297
Free consultations - We never ask you for money.
SOCIAL SECURITY JUSTICE - WEBSITE
Typically, it takes 18 to 24 months from the date you file your appeal/request for hearing. About 25 percent of claims will be approved without an appeal; the other 75 percent must appeal and wait. The wait is due to a huge backlog in the Social Security Administration.
How long will I have to wait for a decision after my hearing has been held?
The wait varies from judge to judge and office to office. 60 to 90 days is common. Fully favorable decisions are the quickest because they are the least complicated to write.
Once I get my favorable decision, how long will I have to wait to get paid?
The time varies. Most people wait 30 to 45 more days to receive their first check. Back pay may take even longer. If a Supplemental Security Income (SSI) claim was also filed, the wait will be longer because the SSI paperwork must be processed first and that requires an interview with the claimant.
Can I receive any emergency benefits while I wait for Social Security to decide my case or to pay me?
No. Unfortunately, Social Security has one speed for almost everyone and it does not include any special advances or funds to cover emergencies.
Can anything speed up my disability case?
There are three things that might get expedited (faster) processing for a Social Security disability claim:
1) Critical case designation. if the claimant has a terminal illness and is expected to live no more than 12 months, the case may be declared a critical case and acted on more quickly.
(2) Dire Need. If the claimant is homeless and has no way to provide food or shelter. If the claimant needs emergency medical treatment which he/she cannot afford or obtain, Social Security may designate a case as "dire need" and speed up the process.
2) Disabled veterans who have a 100 percent permanent, total VA disability rating may get expedited claim processing with Social Security.
Obviously, there are some things that all applicants should do to avoid needless delays in their claims. Try to file a complete, accurate application--and this applies to all the questionnaires and reports that go with the application. Attend all interviews or examinations as directed. If denied, file an immediate appeal--because hearings are assigned in the order in which appeals were filed.
________
The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
"Across From Bridge Street"
CALL (256) 799-0297
Free consultations - We never ask you for money.
SOCIAL SECURITY JUSTICE - WEBSITE
Friday, January 4, 2019
WHAT'S IMPORTANT IN YOUR DISABILITY HEARING (SOCIAL SECURITY)?
There are several important "ingredients" in your Social Security disability hearing--things that will influence your decision (approval/denial). Here is my list of things, the most important being on top:
1. Medical Evidence - The law requires objective medical evidence from doctors, hospitals or other treatment providers. Medical evidence must prove the existence of one or more severe and medically determinable impairments which have lasted at least 12 straight months or are expected to last at least that long OR to end in death. Without medical evidence, there is no hope of getting Social Security disability benefits.
2. Your Age. Persons below age 50 are considered younger individuals. This is the most difficult age for Social Security because younger individuals do not meet any medical-vocational guidelines or 'grid rules' that help get a favorable decision. The standard burden for these individuals is to prove that they are not physically and or mentally able to sustain any full-time job which exists in the national economy. This is the highest burden of all. It gets a little easier at ages 50-54, and easier yet at age 55.
3. Past Relevant Work. Social Security looks at all the full-time jobs you have held in the past 15 years. The crucial question is: "Are you able to perform any of your past relevant jobs?" If the answer is yes, you will be denied. For example, you are 48 years old and you held a full-time job in 2007 as an office manager, which is sedentary work with not much lifting, standing, walking, bending, etc. If Social Security finds that you can still perform this work, your claim is denied.
4. Your education. Education plays a role in whether or not you can meet a medical-vocational guideline or grid rule. Having a high school diploma or GED can sometimes prevent you from meeting a grid rule and therefore cause you to be denied. Also, persons with a lot of education, such as college or a certificate in a skilled trade may have transferable skills to other work which can hurt a disability claim.
There are a great many "cut-and-dried" facts to be considered. As a friend of mine says, "It is what it is." You are a certain age, you held certain jobs, you have a certain amount of education...etc. It can't be changed.
To a certain extent, the medical evidence "is what it is," also. Yet, there is some interpretation involved in medical evidence. Primarily, what limitations are imposed by the medical impairments? For example, if a claimant has asthma, what are the severe symptoms? Shortness of breath on exertion, fatigue, weakness...? What restrictions are caused by the asthma? Inability to stand or walk for prolonged periods? Inability to left, bend or stoop? Need to take frequent rest breaks? Need to use inhalers, nebulizers or other medical intervention frequently? How would a workday be disrupted by the asthma? These questions may not be "cut-and-dried" in the doctor's records, so an interpretation is called for.
In short, does the claimant's documented medical conditions impose such severe functional restrictions that he/she cannot work 8 hours a day, 5 days per week on a regular and consistent basis? If the answer is Yes, Social Security probably will award benefits.
A final question: Does Social Security consider non-exertional limitations, such as depression, anxiety, fatigue, pain, etc.? The answer is, yes. All documented medical impairments are considered.
Exertional activities include such things as sitting, standing, walking, pushing, pulling, and lifting.
Postural activities include such things as stooping, reaching, kneeling, crouching and crawling.
Mental requirements of work include such things as concentration, remembering and understanding simple directions, carrying out directions and completing tasks, interacting appropriately with co-workers, supervisor or the general public.
All of these should be considered by Social Security decision makers. However, there must be medical evidence to support the probability of functional limitations. You can't just claim that you have difficulty remembering or concentrating. You need a doctor, preferably, a licensed psychologist or psychiatrist, to say that.
Here's the take-away: A Social Security claim is a terribly complex legal maneuver. Certain facts have to be proven with objective evidence. Then, certain conclusions must be drawn based on that evidence. The claimant must prove that he/she meets the federal regulations that allow a disability benefit. Telling the judge a good story (even if true) simply won't be enough. "Where's the beef?" is better translated, "Where's the evidence?"
______________
The Forsythe Firm
Social Security Disability Specialists
7027 Old Madison Pike NW - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
Free Consultations - Never a Fee Unless You Win!
SOCIAL SECURITY JUSTICE
1. Medical Evidence - The law requires objective medical evidence from doctors, hospitals or other treatment providers. Medical evidence must prove the existence of one or more severe and medically determinable impairments which have lasted at least 12 straight months or are expected to last at least that long OR to end in death. Without medical evidence, there is no hope of getting Social Security disability benefits.
2. Your Age. Persons below age 50 are considered younger individuals. This is the most difficult age for Social Security because younger individuals do not meet any medical-vocational guidelines or 'grid rules' that help get a favorable decision. The standard burden for these individuals is to prove that they are not physically and or mentally able to sustain any full-time job which exists in the national economy. This is the highest burden of all. It gets a little easier at ages 50-54, and easier yet at age 55.
3. Past Relevant Work. Social Security looks at all the full-time jobs you have held in the past 15 years. The crucial question is: "Are you able to perform any of your past relevant jobs?" If the answer is yes, you will be denied. For example, you are 48 years old and you held a full-time job in 2007 as an office manager, which is sedentary work with not much lifting, standing, walking, bending, etc. If Social Security finds that you can still perform this work, your claim is denied.
4. Your education. Education plays a role in whether or not you can meet a medical-vocational guideline or grid rule. Having a high school diploma or GED can sometimes prevent you from meeting a grid rule and therefore cause you to be denied. Also, persons with a lot of education, such as college or a certificate in a skilled trade may have transferable skills to other work which can hurt a disability claim.
There are a great many "cut-and-dried" facts to be considered. As a friend of mine says, "It is what it is." You are a certain age, you held certain jobs, you have a certain amount of education...etc. It can't be changed.
To a certain extent, the medical evidence "is what it is," also. Yet, there is some interpretation involved in medical evidence. Primarily, what limitations are imposed by the medical impairments? For example, if a claimant has asthma, what are the severe symptoms? Shortness of breath on exertion, fatigue, weakness...? What restrictions are caused by the asthma? Inability to stand or walk for prolonged periods? Inability to left, bend or stoop? Need to take frequent rest breaks? Need to use inhalers, nebulizers or other medical intervention frequently? How would a workday be disrupted by the asthma? These questions may not be "cut-and-dried" in the doctor's records, so an interpretation is called for.
In short, does the claimant's documented medical conditions impose such severe functional restrictions that he/she cannot work 8 hours a day, 5 days per week on a regular and consistent basis? If the answer is Yes, Social Security probably will award benefits.
A final question: Does Social Security consider non-exertional limitations, such as depression, anxiety, fatigue, pain, etc.? The answer is, yes. All documented medical impairments are considered.
Exertional activities include such things as sitting, standing, walking, pushing, pulling, and lifting.
Postural activities include such things as stooping, reaching, kneeling, crouching and crawling.
Mental requirements of work include such things as concentration, remembering and understanding simple directions, carrying out directions and completing tasks, interacting appropriately with co-workers, supervisor or the general public.
All of these should be considered by Social Security decision makers. However, there must be medical evidence to support the probability of functional limitations. You can't just claim that you have difficulty remembering or concentrating. You need a doctor, preferably, a licensed psychologist or psychiatrist, to say that.
Here's the take-away: A Social Security claim is a terribly complex legal maneuver. Certain facts have to be proven with objective evidence. Then, certain conclusions must be drawn based on that evidence. The claimant must prove that he/she meets the federal regulations that allow a disability benefit. Telling the judge a good story (even if true) simply won't be enough. "Where's the beef?" is better translated, "Where's the evidence?"
______________
The Forsythe Firm
Social Security Disability Specialists
7027 Old Madison Pike NW - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
Free Consultations - Never a Fee Unless You Win!
SOCIAL SECURITY JUSTICE
Monday, December 31, 2018
DISABILITY BENEFITS FOR SEIZURES
We frequently represent individuals with Epilepsy or seizures in the attempt to get Social Security disability benefits.
While a seizure disorder may certainly be disabling under Social Security's rules, this isn't always the case. Social Security will evaluate the disorder based on it's nature (type of seizures), frequency and medical treatment.
Here is what you will need to be approved and paid:
Besides medical care, the one thing that will help your case the most is a diary or written record of your seizure activity, kept by a third party who can document the type of seizures, what activity accompanies a seizure and how often they occur. You can't just depend on doctors or emergency room records because by the time you get to the ER or doctor's office, the seizure has already long passed. Also, many people don't go to the doctor or ER every time they have a seizure.
The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
Free evaluations and consultations
While a seizure disorder may certainly be disabling under Social Security's rules, this isn't always the case. Social Security will evaluate the disorder based on it's nature (type of seizures), frequency and medical treatment.
Here is what you will need to be approved and paid:
- a diagnosis of epilepsy or other seizure disorder
- a detailed description of your typical seizure, including all pre- and post-seizure symptoms
- a statement from your doctor corroborating your account of the nature and frequency of your seizures
- a description of your seizures from a third-party witness
- a record indicating the frequency of your past seizures
- results of an EEG, and
- a detailed treatment history, including medications and other treatments that you’ve tried and your response to them.
Besides medical care, the one thing that will help your case the most is a diary or written record of your seizure activity, kept by a third party who can document the type of seizures, what activity accompanies a seizure and how often they occur. You can't just depend on doctors or emergency room records because by the time you get to the ER or doctor's office, the seizure has already long passed. Also, many people don't go to the doctor or ER every time they have a seizure.
The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
CALL (256) 799-0297
Free evaluations and consultations
Tuesday, November 27, 2018
HOW TO PREPARE FOR A SUCCESSFUL SOCIAL SECURITY DISABILITY HEARING
Social Security disability hearings only happen if you were denied and then filed an appeal. The hearing is the government's response to your appeal. They will appoint a federal administrative law judge (ALJ) to listen to your evidence and render a new decision.
The hearing will last less than one hour on average but it may be the most important hour of your life, financially speaking. How do you get ready for it?
1. Be certain that all of your medical records have been ordered and placed in your Social Security file. Most cases these days have electronic files. If you are unrepresented, Social Security is supposed to order your medical records, but they will only order the records you tell them about. It is imperative that you review your file about 3 months prior to your hearing and see if the records from each treating medical provider are included in your file. If not, you will need to obtain these records and submit them. If you have an attorney, he or she is responsible for obtaining all these records. Incomplete records will either result in a postponement of your hearing or possibly a denial.
2. Figure out the exact date you last worked, even if it was for just one day. Step 1 of the hearing will be to determine when you last worked. You will be asked this question and you should know the answer. Judges determine this first because the law doesn't allow a disability benefit to be paid for months in which you worked at "substantial gainful activity," no matter how sick they were.
3. Medical records are essential but they alone often aren't enough to get an award. Try for opinion evidence from your doctor. Specifically, try to get a form called a "Medical Source Statement" completed by your doctor that details the limitations in your work-related functions: sitting, standing, walking, bending, lifting, etc.
4. Be able to explain why you can't hold a full-time job--from a health or disability point of view. Be able to articulate your functional limitations that prevent you from working. Speak in specific terms: "I can't sit longer than ___ minutes. I can only stand for about ____ minutes, etc."
5. Research the technical issues involved in your case. These include:
7. Read your medical records. Make a note of where to find each of your major illnesses or impairments in the record. For example, "My bulging lumbar disc is medically documented by an MRI report in Exhibit 4F, page 16." Or, "My severe depression is noted by Doctor Feelgood in Ex. 9F, pgs. 3, 9 and 15; and in 11F, 6, 11 and 17).
8. If Social Security sent you to one of their doctors for a consultative examination (CE), read and study that report, which will be in your file. Note what that doctor said concerning your physical and/or mental limitations and how those limitations restrict your ability to do work-like functions. Sometimes, these reports actually help you win.
9. Prepare yourself to speak Social Security lingo. If the judge uses terms you don't understand, ask him or her to explain what they mean.
10. Here are common sense tips I give to all my clients before they set foot in a hearing room:
Do You Need Help?
Many people will benefit from hiring an attorney or experienced disability advocate to prepare the hearing and attend with them. In the first place, it will save you enormous time and hard work. In the second place, it increases the odds that you will be awarded benefits. Finally, it may save you untold frustration and anxiety--just having someone who knows what it's all about sitting beside you, and having prepared for all the angles.
___________________
Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
"Across From Bridge Street"
CALL (256) 799-0297
SOCIAL SECURITY JUSTICE - WEBSITE
Free Consultations - Never a Fee Unless You Win
The hearing will last less than one hour on average but it may be the most important hour of your life, financially speaking. How do you get ready for it?
1. Be certain that all of your medical records have been ordered and placed in your Social Security file. Most cases these days have electronic files. If you are unrepresented, Social Security is supposed to order your medical records, but they will only order the records you tell them about. It is imperative that you review your file about 3 months prior to your hearing and see if the records from each treating medical provider are included in your file. If not, you will need to obtain these records and submit them. If you have an attorney, he or she is responsible for obtaining all these records. Incomplete records will either result in a postponement of your hearing or possibly a denial.
2. Figure out the exact date you last worked, even if it was for just one day. Step 1 of the hearing will be to determine when you last worked. You will be asked this question and you should know the answer. Judges determine this first because the law doesn't allow a disability benefit to be paid for months in which you worked at "substantial gainful activity," no matter how sick they were.
3. Medical records are essential but they alone often aren't enough to get an award. Try for opinion evidence from your doctor. Specifically, try to get a form called a "Medical Source Statement" completed by your doctor that details the limitations in your work-related functions: sitting, standing, walking, bending, lifting, etc.
4. Be able to explain why you can't hold a full-time job--from a health or disability point of view. Be able to articulate your functional limitations that prevent you from working. Speak in specific terms: "I can't sit longer than ___ minutes. I can only stand for about ____ minutes, etc."
5. Research the technical issues involved in your case. These include:
- Do you meet one of the published Listings?
- Will a grid rule direct a finding of disability at your age?
- Does your application date allow Social Security to pay back to your alleged onset date?
- Did you have substantial earnings after your alleged onset date?
- Do you need to amend your alleged onset date?
- When is (was) your Date Last Insured? Can you prove disability onset prior to that date?
- Classify each job you have held during the 15 year period prior to filing for disability. Be familiar with the the classifications of sedentary, light and medium work.
7. Read your medical records. Make a note of where to find each of your major illnesses or impairments in the record. For example, "My bulging lumbar disc is medically documented by an MRI report in Exhibit 4F, page 16." Or, "My severe depression is noted by Doctor Feelgood in Ex. 9F, pgs. 3, 9 and 15; and in 11F, 6, 11 and 17).
8. If Social Security sent you to one of their doctors for a consultative examination (CE), read and study that report, which will be in your file. Note what that doctor said concerning your physical and/or mental limitations and how those limitations restrict your ability to do work-like functions. Sometimes, these reports actually help you win.
9. Prepare yourself to speak Social Security lingo. If the judge uses terms you don't understand, ask him or her to explain what they mean.
10. Here are common sense tips I give to all my clients before they set foot in a hearing room:
- Always tell the truth.
- Tell the truth, then stop. Don't say too much.
- Never answer a question that you do not understand.
- Avoid generalities such as: sometimes, once in a while, a little bit, not very often, pretty bad, not much.
- Answer questions with defined words, using terms like: days, hours, minutes, feet, yards, etc. Example: "I can sit for about 15 minutes before my legs no numb." Better than, "I can only sit a little while before my legs go numb." ("A little while" is not defined).
Do You Need Help?
Many people will benefit from hiring an attorney or experienced disability advocate to prepare the hearing and attend with them. In the first place, it will save you enormous time and hard work. In the second place, it increases the odds that you will be awarded benefits. Finally, it may save you untold frustration and anxiety--just having someone who knows what it's all about sitting beside you, and having prepared for all the angles.
___________________
Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
"Across From Bridge Street"
CALL (256) 799-0297
SOCIAL SECURITY JUSTICE - WEBSITE
NEED SOCIAL SECURITY DISABIITY MONEY? HERE'S WHAT YOU HAVE TO DO
I assume that you have a legitimate long-term disability that basically meets the rules and regulations for a Social Security check. You are not working now at a job which plays at least $1,180 per month. Your impairment is expected to last at least 12 straight months. Those are the starting points.
What do you have to do?
First, file an application with the Social Security Administration: go online to www.socialsecurity.gov and file, call or visit a Social Security office and file, or find an attorney or disability advocate who is willing to help you file an application. You will wait 4 to 6 months to get a decision, which is often a denial.
Why Most Benefits Are Initially Denied
The denial letter will disguise the reason they denied your claim. However, it usually boils down to one of two reasons:
1. They find that you can perform at least one of your past jobs (called a Step 4 denial) OR
2. They find that if you can't perform any past jobs, there is other work in the national economy that you could perform (called a Step 5 denial).
Neither of these assumptions by Social Security may be true. The truth is, they probably rated your ability to work much higher than it really is. (The technical term for the ability to work is residual functional capacity). So, the denial isn't fact-based, it's error-based.
What Do You Have to Do If Denied?
File an appeal within 60 days of the date on the denial letter. This is the second step and the most important step.
Gather additional medical evidence from your doctors and medical providers that prove how severe your symptoms are and how your impairment makes it impossible for you to work a full-time job. Be prepared to make an impregnable argument before the administrative law judge who will preside at your hearing.
Will You Need an Attorney or Legal Representative?
Well, you are headed to a judge who will decide your case based on complicated rules and regulations of the federal government, specifically based on 20 Code of Federal Regulations, Part 404. If you aren't familiar with the Code or the burden of proof required to be awarded federal benefits in an appeal case, you may want help.
Also, keep in mind that preparing an appeal is a time consuming affair. Not only must you order and then read all your medical records, you must annotate them with notes that you use at your hearing to tell the judge where the medical records indicate that you are unable to work. Some cases that I work on have 4,000 pages of medical records (or more), which can takes weeks just to read.
Then, there is the problem of the hearing itself. You will be confronted by a vocational expert, or jobs expert, who is likely to testify that there are indeed thousands of jobs available which you could still perform. You will need to refute this idea with pointed questions to the VE if you want to win. And the regulations will let you ask some questions, not others. Some questions are helpful, while others can hurt your case. So, you must prepare to ask the right questions.
Finally, there are the technical issues of the case: alleged onset date, date last insured, listings, medical-vocational rules, acceptable medical sources, etc. Should you amend your alleged onset date if the judge suggests it, or should you hold firm?
All things considered, I think legal representation is a good idea and worth what it costs (which is nothing unless you win).
What do you have to do?
First, file an application with the Social Security Administration: go online to www.socialsecurity.gov and file, call or visit a Social Security office and file, or find an attorney or disability advocate who is willing to help you file an application. You will wait 4 to 6 months to get a decision, which is often a denial.
Why Most Benefits Are Initially Denied
The denial letter will disguise the reason they denied your claim. However, it usually boils down to one of two reasons:
1. They find that you can perform at least one of your past jobs (called a Step 4 denial) OR
2. They find that if you can't perform any past jobs, there is other work in the national economy that you could perform (called a Step 5 denial).
Neither of these assumptions by Social Security may be true. The truth is, they probably rated your ability to work much higher than it really is. (The technical term for the ability to work is residual functional capacity). So, the denial isn't fact-based, it's error-based.
What Do You Have to Do If Denied?
File an appeal within 60 days of the date on the denial letter. This is the second step and the most important step.
Gather additional medical evidence from your doctors and medical providers that prove how severe your symptoms are and how your impairment makes it impossible for you to work a full-time job. Be prepared to make an impregnable argument before the administrative law judge who will preside at your hearing.
Will You Need an Attorney or Legal Representative?
Well, you are headed to a judge who will decide your case based on complicated rules and regulations of the federal government, specifically based on 20 Code of Federal Regulations, Part 404. If you aren't familiar with the Code or the burden of proof required to be awarded federal benefits in an appeal case, you may want help.
Also, keep in mind that preparing an appeal is a time consuming affair. Not only must you order and then read all your medical records, you must annotate them with notes that you use at your hearing to tell the judge where the medical records indicate that you are unable to work. Some cases that I work on have 4,000 pages of medical records (or more), which can takes weeks just to read.
Then, there is the problem of the hearing itself. You will be confronted by a vocational expert, or jobs expert, who is likely to testify that there are indeed thousands of jobs available which you could still perform. You will need to refute this idea with pointed questions to the VE if you want to win. And the regulations will let you ask some questions, not others. Some questions are helpful, while others can hurt your case. So, you must prepare to ask the right questions.
Finally, there are the technical issues of the case: alleged onset date, date last insured, listings, medical-vocational rules, acceptable medical sources, etc. Should you amend your alleged onset date if the judge suggests it, or should you hold firm?
All things considered, I think legal representation is a good idea and worth what it costs (which is nothing unless you win).
Monday, November 26, 2018
MEDICARE DRUG COVERAGE IS CHANGING FOR 2019. ACT BEFORE DEC. 7TH FOR THE BEST PLAN
Many Medicare recipients enroll in a prescription drug plan (called Part D) and just assume that the plan continues to remain the same year after year. But, that isn't at all true. Medicare Part D plans change almost every year. What was the best plan for you in 2018 may be a terrible plan for 2019.
You have until December 7th this year to change your plan. After that, you're stuck with it for another year.
Some changes that drug plans make each year incude:
Here's What You Should Do
Go to Medicare's official website at
https://www.medicare.gov/find-a-plan/results/planresults/plan-compare.aspx
This link takes you to the official government website for Medicare. [CAUTION: www.medicare.com, once operated by Medicare, is no longer a government website].
Once on this site, look for the blue tab in the upper left corner of the screen that says "Sign Up/Change Plans." Click this tab, then on the left side of the screen, click "Find Health and Drug Plans." Then, follow the cues.
You will be able to enter your information and type in each of the prescription drugs that you take regularly. Be sure to enter the correct dosage and number of pills or capsules that you buy each 30-day or 90-day period. (*Mail order drugs will save you up to 50 percent compared to buying at a local pharmacy, and your prescriptions will come from a Medicare-approved mail order pharmacy).
Another caution: There are dozens of websites run by insurance companies that look like Medicare websites. They are not. I had to search for 20 minutes just to find the official government website (in the link above). The insurance companies have agents that want to sell you insurance. So, avoid the sales pitches and go straight to the official Medicare website. Compare premiums, co-pays and deductibles for 2019. This website will actually let you customize your prescription use and tell you which Part D plan has the lowest out-of-pocket cost for you.
By way of disclaimer, I'd like to say that neither I or anyone at the Forsythe Firm are licensed insurance agents and we do not sell or recommend insurance plans to anyone. We do think you need to compare Part D drug plans every year to be sure you're getting the best deal. It takes about 30 minutes on your computer to be sure. And the deadline to change plans this year is December 7th.
________________
The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
(256) 799-0297
*Please do not call us about insurance related questions. However, if you have a Social Security disability question, we welcome your call. We offer free consultations.
SOCIAL SECURITY JUSTICE - WEBSITE
You have until December 7th this year to change your plan. After that, you're stuck with it for another year.
Some changes that drug plans make each year incude:
- Increasing the monthly premium
- Eliminating some of the drugs that they cover (formulary changes)
- Increasing co-pays
- Increasing annual deductibles
- Raising your out-of-pocket annual costs
Here's What You Should Do
Go to Medicare's official website at
https://www.medicare.gov/find-a-plan/results/planresults/plan-compare.aspx
This link takes you to the official government website for Medicare. [CAUTION: www.medicare.com, once operated by Medicare, is no longer a government website].
Once on this site, look for the blue tab in the upper left corner of the screen that says "Sign Up/Change Plans." Click this tab, then on the left side of the screen, click "Find Health and Drug Plans." Then, follow the cues.
You will be able to enter your information and type in each of the prescription drugs that you take regularly. Be sure to enter the correct dosage and number of pills or capsules that you buy each 30-day or 90-day period. (*Mail order drugs will save you up to 50 percent compared to buying at a local pharmacy, and your prescriptions will come from a Medicare-approved mail order pharmacy).
Another caution: There are dozens of websites run by insurance companies that look like Medicare websites. They are not. I had to search for 20 minutes just to find the official government website (in the link above). The insurance companies have agents that want to sell you insurance. So, avoid the sales pitches and go straight to the official Medicare website. Compare premiums, co-pays and deductibles for 2019. This website will actually let you customize your prescription use and tell you which Part D plan has the lowest out-of-pocket cost for you.
By way of disclaimer, I'd like to say that neither I or anyone at the Forsythe Firm are licensed insurance agents and we do not sell or recommend insurance plans to anyone. We do think you need to compare Part D drug plans every year to be sure you're getting the best deal. It takes about 30 minutes on your computer to be sure. And the deadline to change plans this year is December 7th.
________________
The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
(256) 799-0297
*Please do not call us about insurance related questions. However, if you have a Social Security disability question, we welcome your call. We offer free consultations.
SOCIAL SECURITY JUSTICE - WEBSITE
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