Apparently, the Social Security Administration (“SSA”) automatically sends notices to Social Security Disability (“SSD”) claimants that they have been scheduled for a “consultative examination” (“CE”) regardless of what the medical evidence indicates.
I represent a 58 year old delivery driver whose SSD application was approved today without ever being denied at any level. What is baffling is that the claimant was sent letters on two different occasions for a CE, each of which stated that “It will be necessary for you to be examined by the Specialist named below.” The so-called specialist was “IMA Disability Services.” The letters also stated that “You must keep this appointment at the time and date indicated below.”
I had objected to the CE because, among other things, the claimant had submitted medical evidence from his treating doctors that clearly supported his inability to work in any capacity. The SSA obviously agreed because it approved SSD benefits without a CE. The question is, why are letters being sent to SSD claimants stating that it is “necessary” for them to be examined by IMA, and that they “must” attend the CE, when it obviously is not true?
The Free Dictionary defines harassment as the systematic actions of a group, including threats and demands, whose purpose may be merely to gain sadistic pleasure from making someone fearful or anxious. That definition applies to the manner in which IMA Disability Services treats Social Security Disability (“SSD”) claimants.
For many years, my clients have advised me that the consultative examinations performed by IMA contain findings that could not have been made. Consequently, because of IMA’s dishonest conduct, I have advised claimants to videotape their CE. There is no rule prohibiting an SSD claimant from videotaping their CE, and there is a a rule permitting workers compensation (“WC”) claimants to videotape examinations
I represent an SSD claimant who appeared at IMA for a CE. IMA told him that WC claimants can videotape exams, but not SSD claimants. When my client showed IMA that the letter scheduling the CE did not prohibit videotaping the CE, IMA said that their policy is to prohibit the taping, and therefore, IMA refused to perform the CE.
IMA refused to explain why the same person could tape the exam if he were seeking disability benefits from WC, but not SSD. There is absolutely no rational[NO e] or legitimate reason to treat the same person differently just because the source of IMA’s funding is different. Therefore, logic dictates that the purpose of IMA’s systematic inconsistent and arbitrary actions is to gain sadistic pleasure from making SSD claimants fearful or anxious.
The Padro class action provides certain disability claimants who had hearings with Queens ALJs new hearings. I represent a 40 year old pharmaceutical territory manager whose Social Security Disability (“SSD”) was denied by ALJ Fier, despite evidence from several treating doctors that her physical and mental impairments rendered her totally disabled. The claimant alleged that she became disabled in 2008, and her date last insured (“DLI”) was 12/31/13.
The claimant was given a new hearing under the 2014 Padro settlement agreement. The new ALJ had medical and vocational experts testify at the hearing. I supplied new medical reports, which post-dated the DLI. The new ALJ found the claimant was disabled because she met a listing based on one of the new reports I obtained. With that exception, the ALJ approved the claimant’s SSD benefits essentially based upon the same evidence that that had been presented to ALJ Fier.
According to the Centers for Disease Control and Prevention, cancer is the No. 2 cause of death in Americans, second only to heart disease. Even when diagnosed early and attacked with the latest treatments, cancer still has the power to kill. Unfortunately, many survivors are unable to recover fully from the disease, and have difficulty completing the very tasks that they so ably performed before being afflicted with the disease.
I represent a 59 year old property manager, which is a job that requires standing and walking most of the day, and lifting up to 20 pounds. The claimant has breast cancer; a MUGA scan revealed malignant neoplasm. Her application for Social Security Disability (“SSD”) benefits was approved by an administrative law judge (“ALJ”) on-the-record. Consequently, the claimant did not need to appear for a hearing.
The claimant submitted a report from her internist that provided a less than sedentary residual functional capacity (“RFC”). Even if the claimant had a sedentary RFC, the medical-vocational rules would require finding the claimant disabled. Nonetheless, the ALJ approved the claimant’s OTR on the grounds that her cancer qualified as a compassionate allowance.
The MUGA scan was significant because the courts have held that the opinion of a treating physician is entitled to controlling weight where that opinion is based upon electrodiagnostic testing. In addition to the MUGA scan, an ultrasound revealed suspicious abnormalities, and then a biopsy revealed infiltrating ductal carcinoma.
After the Social Security Administration (“SSA”) determines that an individual is disabled, it is required to perform a review periodically to see if that person remains disabled. That review is called a continuing disability review (“CDR”). The purpose of the CDR is to determine if a person’s medical problems have improved.
The SSA has implemented many policies recently in an attempt to try to decrease the number of people receiving disability benefits. Increasing funding to do CDRs is one of the SSA’s new tactics. In other words, the SSA hopes that CDRs will determine that disability claimants have improved so their Social Security Disability (“SSD”) benefits can be terminated. Not surprisingly, the SSA is over employing the CDR process.
I represent a 52 year old fire department dispatcher with back problems, multiple sclerosis (“MS”), and fibromyalgia, whose SSD benefits were approved today. The back impairments and MS were so severe that the SSA’s medical expert concluded each medical condition met a listing. Nonetheless, even though the claimant’s herniated discs and other back problems, and brain lesions are permanent conditions, the decision approving SSD benefits recommends CDR in 12 months because improvement is expected.
The claimant’s orthopedic and neurologic back problems are progressive in nature. While they may not get worse within 12 months, they are permanent will not improve. There is no medical evidence anywhere that MS is curable. It appears that the SSA is simply taking steps to increase the number of CDRs regardless of the facts.
I represent a former Senior Director of Program Management whose microvascular ischemia forced him to stop working when he was 62 years old. I was retained after CIGNA terminated the long term (“LTD”) disability benefits, despite the fact that its own medical peer reviewer agreed with the claimant’s cardiologist that it would be dangerous for the claimant to continue working.
CIGNA terminated the LTD benefits on the grounds that the claimant had the functional capacity to work. CIGNA completely disregarded the fact that it had previously reversed its original decision to deny LTD benefits after conceding that the claimant had to stop working to avoid the effect that work stress had on his microvascular ischemia. Without any written explanation, I received a check today, indicating that CIGNA had admitted that, once again, it was irrelevant whether the claimant could physically perform the work.
CIGNA and other disability insurers have shown an increasing tendency to deny and terminate claims when claimants are over 62 years of age. Apparently, insurers are increasingly taking the position that since relatively few benefits remain, they hope many claimants will not fight the termination, or that there will not be enough at stake for an attorney to accept the case. CIGNA may be right.
I agreed to represent this claimant because I had handled his claim in the past. I knew in advanced that my fee would not be worth the effort. Had I not previously represented the claimant, I may not have agreed to take his case. The problem is that without an attorney, I suspect that CIGNA would not have reversed its decision, and reinstated LTD benefits.
The ostensible purpose for an Administrative Law Judge (“ALJ”) holding a hearing is to assess the credibility of the claimant who is seeking Social Security Disability (“SSD”) benefits. One way to bolster a claimant’s credibility is by developing work history evidence evidence. Another way is by having a witness corroborate the claimant’s testimony.
The Social Security rules require that evidence be considered from non-medical sources, such as: spouses, parents, caregivers, siblings, other relatives, friends, neighbors, and clergy. When an ALJ fails to discuss hearing testimony from these witnesses in a decision denying SSD benefits, the decision must be reversed.
I represent a 28 year old corrections officer whose unfavorable ALJ decision was rejected today by the Appeals Council. The order from the Appeals Council noted that the ALJ claimed he gave appropriate weight to the testimony of the claimant’s girlfriend, but in fact, failed to indicate the specific weight accorded it.
I advise every claimant to bring a witness to testify at their hearing. Besides bolstering the claimant’s testimony, because ALJ’s routinely ignore lay witness testimony, it provides an additional solid ground for appeal.
In New York, an agency known as the Office of Temporary and Disability Assistance (“OTDA”) decides if the medical evidence supports an application for Social Security Disability (“SSD”) benefits. For the most part, the OTDA’s decision is based upon the opinion of doctors from IMA Disability Services. IMA is the company that provides the doctors to examine disability claimants, even though the exam should be performed by a treating doctor.
I represent a 48 year old highway worker with elbow, CTS, and back problems. The OTDA scheduled the claimant four different times for a consultative examination (“CE”). The OTDA sent my client a letter saying that his SSD application would be denied if he refused to attend the CE.
We had previously notified the OTDA in writing, that the claimant had already appeared not once, not twice, but three times, for a CE. However, IMA failed to cooperate by refusing to examine him because he wanted to record the CE.
We advised that if the claimant’s application were denied for “failure to cooperate,” then we would ask the Attorney General’s office to investigate that assertion. The claimant’s SSD application was approved without a CE by IMA.
by Susan Golden
It seems as if we are always hearing stories about people who are defrauding the Social Security Disability (“SSD”) system. We read about it in the newspapers, and we watch it on the news. Even 60 Minutes and 20/20 have devoted entire segments to those stories. While there may be a small minority of people who improperly receive SSD benefits, most people who apply are honest and hard working individuals, who would much rather continue to work if they could. However, what the media is not reporting is how the Social Security Administration (“SSA”) is defrauding us.
The SSA disability process is getting more corrupt by the day. The SSA does whatever it wants, without any repercussions, without any real checks and balances. When someone files an application for SSD benefits, his or her local office processes it. The local offices constantly lose important paperwork, which holds up the applications, or even deny applications based upon the local office’s own errors and incompetence. When they do eventually process the SSD application, the local office sends it out to the New York State Office of Temporary and Disability Assistance, to review the medical evidence. Much of the time, the local office does not forward all the paperwork, including medical records that the claimant has submitted, creating more problems for the claimant. The biggest joke of all is the “reviewing” of the claim by the “analyst” at the NYS office. They don’t follow their own rules and regulations, important medical evidence is misplaced, or worse yet, purged from the record, in order to provide them with a specious basis for denial. The State agency also fabricates communications with treating doctors.
Perhaps the greatest injustice of all is the State agency’s practice of scheduling claimants to attend Consultative Exams (“CE’s”), which are frequently performed by unqualified doctors, who usually misrepresent their findings. As a result of the fictitious CE findings, claimants are typically denied SSD benefits. Importantly, the SSA’s own rules state that a treating doctor should perform any CE, although the State agency rarely, if ever, complies with those rules.
To avoid being denied SSD benefits for supposedly “failing to cooperate,” which is the SSA’s practice if the claimant does not attend the CE, we have advised our clients to video tape their CE’s. There is no Social Security rule or regulation that prohibits recording of a CE, which has become necessary since the doctors blatantly lie about what occurs during the exam. Notably, the New York State agency overseeing workers compensations (“WC”) benefits has a rule explicitly stating that a claimant can video tape an independent medical exam (“IME”), which is equivalent to the SSA CE, precisely to guard against fictitious exam findings. It defies logic for a claimant with both an SSD and WC claim to be allowed to tape an IME but not a CE.
One of our clients went to his CE today, and recorded the visit. However, the person at the CE receptionist desk from Industrial Medicine Associates (“IMA”) told our client that they would not allow him to record the CE, and asked him to leave their office. It was the IMA doctor contracted by the SSA, not the claimant, who refused to proceed with the CE. The claimant recorded the IMA receptionist saying they would claim that the claimant failed to show up for his CE, which is an unmitigated lie. In fact, it seems that IMA’s claiming that a claimant failed to appear for his CE is an act of fraud that must be investigated by the SSA Office of the Inspector General (“OIG”).
The sad fact is there apparently is not a damn thing that can be done about these fraudulent practices. Over the years, we have shown how CE reports are replete with medical findings that could not possibly have been made, and have requested that the matter be referred to the OIG, but to no avail. Therefore, claimants will most likely continue to be wrongly denied SSD benefits for purportedly not attending the CE, or attending one that culminates in a report containing fraudulent findings.
The SSA should help the disabled, especially the homeless, which increasingly includes many veterans. Instead, the SSA only hurts and demeans the people who need help the most; those who can no longer work and have no money to survive. It is a travesty and disgrace. When will the media do a story about this?
Although it’s no secret, for example, see House rule sets up election-year battle over Social Security, that the new Congress is trying to prevent people from receiving disability benefits. New York Republican Tom Reed sponsored a rule that will cut benefits to the disabled and their families by 19%. All Democrats opposed the new rule, while almost every Republican voted in favor of it.
For more information, see Michael Hiltzik, LA Times Do Republicans misunderstand Social Security, or just feign ignorance?
This is an update to the recent post regarding the Binder & Binder bankruptcy. According to at least once source, Binder & Binder has in fact “pulled the plug” on it’s ubiquitous television campaign. Besides firing approximately 2/3 of it’s workforce, 27 of 34 offices will be shut down.
We agree that the logistics of Binder & Binder’s shutting down 27 offices, firing 600+ employees, transferring cases and personnel to offices in different states, attending hearings with the bankruptcy court and negotiating with creditors, will probably distract the effective handling of their 58,000 clients’ cases.
Was it an end of the year quota or a Christmas present? Unfortunately, probably neither.
I represent a 54 year old nursing assistant who suffered a stroke also known as a vascular accident. One common symptom of stroke is difficulty speaking. The claimant’s stroke was so severe that she suffered a complete loss of the ability to speak, amongst other symptoms.
There is a listing that provides a person is disabled if they have “ineffective speech.” If simply having ineffective speech means a person is disabled, then having no speech at all is an disability determination.