DISABILITY BENEFIT RECOVERY

Social Security uses a 5-step sequential process to determine whether an individual is disabled under their rules.  The burden of proof at steps 1 - 4 rests with the claimant.  However, at step 5 the burden of proof shifts to the Social Security Administration. The claimant bears the burden of proving that he is not engaged in substantial gainful activity; that he has a serious medically determinable impairment; that he meets a disability listing or has a functional capacity that prevents work; and that he cannot perform any of his past relevant work. Then, the burden of proof shifts, at least substantially, from the claimant to the Commissioner of Social Security.  At the 5th and final step, Social Security must prove that the claimant is not able to perform any other work which exists in the local, regional or national economy.  It is not sufficient for Social Security merely to make this argument.  They must demonstrate that a significant number of jobs ...

Posted by:  The Forsythe Firm, Social Security Disability Advocates A question we often get is, "Will alcoholism qualify me for Social Security disability benefits?" Or, "Will alcoholism disqualify me for Social Security disability benefits?" The answer to both questions is, No. A person may not qualify for Social Security disability merely on the basis of alcoholism or other substance abuse.  On the other hand, a person should not be disqualified merely on the basis of alcoholism or substance abuse. The definitive legal ruling on that is found in 20 CFR §404.1535:  "The key factor we will examine in determining whether drug addiction or alcoholism is a contributing factor material to the determination of disability is whether we would still find you disabled if you stopped using drugs or alcohol." So an individual cannot qualify for benefits on the basis of substance abuse, neither can he be denied benefits for substance abuse that does not ma...

Posted by the Forsythe Firm (256) 799-0297 Social Security Disability Representatives in Huntsville, AL The purpose of a Social Security disability appeal is to restore and recover all of your disability benefits, including back pay.  When Social Security sends you a letter stating that "you are not disabled under our rules," your appeal should address the issue of back pay.  You should prove that you were disabled at the time you filed the original application - or even further in the past if that is the case. Too many times we see claimants win current benefits but forfeit all their back pay, which could be thousands of dollars.  An appeal should have a goal of protecting and collecting back benefits as well as future benefits. Back pay hinges on the date of alleged onset.  This is the date the claimant states that he or she first became unable to work.  Under Social Security rules an applicant may go back up to one year prior to the date of applicati...

It seems everyone is loading up to take aim at the integrity of the Social Security disability program.  Senate investigations into Social Security are nothing new but usually they are held by the Senate Finance Committee.  NOSSCR's Social Security Forum reports in their September 2012 edition that on September 13 2012, the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs held a 3 hour hearing on the quality of favorable disability decisions handed down by Administrative Law Judges.  Here is what disturbs me about this "investigation": The Senate subcommittee "investigated" only favorable decisions.  This reinforces the idea that Social Security's main focus is not making sure that everyone who deserves Social Security disability gets it; the main focus is making sure that nobody gets Social Security disability that isn't supposed to. Rarely, if ever, does a government committ...

Grid Rules is a term referring to the Medical-Vocational Rules found in CFR 20 404, Subpart P, Appendix II.  They guide a finding of either "disabled" or "not disabled" based on the claimant's exertional capacity* and vocational factors such as age, education and transferable skills. The "Grids" divide age into categories as follows: Advanced age (55 and over) Closely Approaching Advanced Age (50-54) Younger Individual (45 - 49) Younger Individual (18-44) As a Social Security disability case is being prepared, it is very important to refer to the Grid Rules. The judge who decides your case will likely use them as a guide if your medical condition does not meet a specific listing or your exertional capacity is sedentary or greater. Grid Rules do not apply to impairments caused by strictly mental disorders. *Exertional capacities are the classifications of work based on such factors as lifting, carrying, pushing, pulling, etc.  The clas...

Social Security has a 5 step sequential process to determine disability.  In preparing your claim we look at all 5 steps and develop a factually based approach to meet each step.   Advocates are trained to try to have 3 reasons why the claimant cannot work at any past work or other work.  Of course, medical evidence must support those reasons. Since we know what evidence Social Security will look for, it makes it easier to build the case.  We simply have to be sure that each of the 5 steps are covered with good reasons why the claimant cannot perform work related functions.   A "fully favorable" claim is one that awards the claimant all of his/her benefits, including all of the back pay entitled.

I've been an advocate for Social Security disability claimants for years.  I try to use all of the rules and regulations to help my clients, whom I feel are truly disabled, to get their disability benefits.  If you read the blog post I wrote earlier about "Why Your Claim Was Diened," you will see a number of things that an advocate can do to increase your odds of winning a Social Security disability claim.  Using those proven techniques helps to reduce the odds of getting denied.  Without an experienced attorney or advocate working with you on a claim, Lady Luck plays a much larger role in how your case gets decided. At the initial application level, it depends a great deal on which disability specialist examines your claim down at the determination service.  Testimony before the US Ways and Means Committee on May 20, 2012 argues that up to 60 percent of all denied Social Security disability claims could have been awarded--if they had been reviewed by a differ...

Being denied for Social Security disability is the rule, not the exception.  The latest Alabama statistics show that 74.9 percent of all initial applications will be rejected at the first level.  The reason is that the review of a disability application on the first level is rather mechanical.  A disability specialist, who is not a doctor, compares your medical file with the "disability handbook."  And very few applications will meet a listing for disability.  All kinds of things can go wrong in this approach: The medical evidence may not be complete.  All it takes sometimes is for one doctor to fail to send in your file. The medical evidence may not be legible.  I get medical records all the time that neither I or anyone on my staff can read. The medical records usually do not give the vocational implications of your condition:  they will not say that you are limited to lifting 10 pounds, sitting for 1 hour at a time, or standing for only 10 ...

Nicole Maestas, a RAND Corp. analyst, told the House Ways and Means Committee on May 20th that 60 percent of denied Social Security applications could have been awarded if they had been reviewed by a different examiner.   In other words, whether your disability application got denied or approved depends on which examiner you happened to get. As an experienced disability advocate, I believe there is a lot of truth to this statement.  At the initial application level, a state examiner may be handling 80 to 100 claims at any given time.  There's a limit on how much time they can invest on any one claim.  And some examiners are better than others. Qualifying for Social Security disability is not enough.  You have to convince an adjudicator that you qualify.  Social Security applications and hearings are governed by laws and rules.  But the average applicant doesn't understand them.  That's why an experienced disability advocate is so important, e...

Earlier this year, the US Social Security Administration told US administrative law judges (ALJs) that they cannot use the internet to investigate disability claimants.  Senator Thomas Coburn (R-OK) responded by saying this ban removes a valuable tool to investigate fraudulent applications for disability benefits. Sen. Coburn used this example, which I have paraphrased.  Suppose an ALJ looks up an applicant on Facebook.  There he finds pictures and discussion of the applicant playing sports or participating in his bowling league.  If the applicant has claimed severe back problems on his application, his credibility is suddenly called into question. I caution my clients to stay off of Facebook and the social media and I believe that is still very good advice.  It remains probably the first place investigators look when trying to deny benefits (even disability claims with private insurance companies). Use common sense but don't become paranoid.  For exa...

If there's a Social Security disability hearing in your future, here is what you must prove to obtain your benefits. You are not working and have not worked at substantial gainful activity* since your alleged onset date--the date you say you became disabled. You have a severe impairment that has lasted or is expected last for 12 consecutive months or more. If you do not meet one of the Social Security listings, then your residual function capacity (RFC) must be determined. It is best if you bring documentation from your own doctor concerning functional limitations. You are not able to perform any of your past relevant work because of your condition(s).  This includes all work you performed at substantial gainful activity levels during the past 15 years. You are also not able to perform any other work based on your residual functional capacity, age, education, etc. The "easiest" work classification is sedentary work - which is work that can be performed mostly ...

Our firm frequently handles Social Security disability claims for individuals with a mental or emotional impairment.  I think there are 2 challenges to winning these type of claims for our clients. First, we should direct the claimant to good medical treatment.  Too often people will ignore psychological problems - sometimes because they are self-conscious, or perhaps because they think they can't afford treatment.  The lack of medical treatment not only hurts the ability to win a Social Security disability claim, it also results in the patient not getting better.  Our office will gladly provide you with non-profit clinics or mental health providers that may help at a fee you can afford to pay. The second challenge is, we have to show the results of the impairment in vocational terms.  How does this condition prevent the individual from working?  What mental functions are impaired?  Is it concentration, mood, memory, the ability to follow instructio...