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QC Reviews

The Social Security Administration (“SSA”) routinely conducts “quality reviews” of decisions from the State agency. The SSA insists that the reviews are random. However, since the last Century, every time one of my client’s decisions has been pulled for review, the State agency decision was an approval of Social Security Disability (“SSD”) benefits. Moreover, every colleague I know has also expressed that their clients have never had a disapproved decision reviewed.

We represent a 54 year old teacher from Port Jefferson Station with diabetes and mental impairments. The State agency approved SSD benefits three days after we submitted very supportive reports from the claimant’s psychiatrist and therapist. Nonetheless, it took a month and a half to obtain the approval because the decision had been pulled for quality review.

There is zero justification for quality reviews. The fact that only awards are reviewed reveals that their purpose is not to attempt to improve that quality of the State agency decisions. Rather, their purpose is to try to find some means to reverse the approval. Just as the SSA is being called upon to eliminate the reconsideration stage of the hearing process, the SSA should also eliminate so-called quality reviews.

Insurance Scams

Winning Hands

Most unskilled sedentary jobs require good use of both hands and the fingers; i.e., bilateral manual dexterity (“BMD”). Fine movements of small objects require use of the fingers; e.g., to pick or pinch.  Most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions.

For over 40 years, the Social Security Administration (“SSA”) has recognized that BMD is necessary for the performance of substantially all unskilled sedentary occupations.”  In fact, SSR 83-14 provides that a limitation to unskilled sedentary work with an additional loss of BMD  is significant and, thus, warrants a conclusion of disabled.

Vocational experts (“VEs”) routinely testify that claimants who lack bilateral manual dexterity are precluded from performing any sedentary occupations.  However, the fact that a VE had to testify at a hearing means that the State agency denied the claimant Social Security Disability (“SSD”) benefits two times.

We represent a 59 year old nurse from Syosset with many diverse impairments, including carpal tunnel syndrome and a trigger finger.  After we submitted records and a report detailing the claimant’s lack of BMD, the State agency approved SSD benefits, just three months after we filed the application.  No doubt, the approval was based on the claimant’s lack of BMD. Regardless of what impairments claimants may have, they should take care to obtain reports that detail the functional limitations and restrictions they may have in using their hands.

SSA on the Hotseat

The House Ways and Means Committee held a hearing on October 26, 2023, to question the acting assistant deputy commissioner of operations from the Social Security Administration (“SSA”) about the decades old systemic problems that affect millions of Social Security Disability (“SSD”) applicants.   If you ever applied for SSD benefits, or know someone who has, then you probably already know about these problems.

The SSA is supposed to help people who are eligible for SSD benefits when they become too ill to work.  However, the application process is antiquated, customer service is almost non-existent, the wait time to speak to someone on the phone averages 35 minutes, and the wait time for a decision is ridiculously long.

Some of our clients retain us after they have applied on their own, and they realize that trying to navigate the SSA’s system is extremely stressful and difficult.  We take that burden off of them and make certain that the SSA has no direct contact with them.  Our clients would rather be working than applying for SSD, but due to any number of medical conditions, cannot work on a full-time basis.  But trying to stay afloat while the SSA makes a decision is almost impossible for many of our clients.  We have had clients pass away while waiting for a decision, and the SSA just does not seem to care.  The SSA simply blames the delays on backlogs and lack of staff.

David Camp, interim chief executive of the National Organization of Social Security Claimants’ Representatives, also testified at the hearing.  He explained how changing some of the SSA’s rules and regulations, which are ineffective and old, could reduce the wait time for a decision, and free up the State agencies’ analysts to work more efficiently.  These common sense changes could make a huge difference in many people’s lives.  Of course, the members of the Ways and Means Committee would have to agree to continue to fund the SSA, because any cuts to their budget would be detrimental for anyone that is trying to obtain SSD benefits.

Medical Investigating

Attorneys representing claimants seeking Social Security Disability (“SSD”) benefits frequently will attack an administrative law judge (“ALJ”) for failing to credit the claimant’s subjective complaints.  Attorneys need to listen their clients as well.

We represent a 55 year old claims adjuster from Franklin Square, who asked us to seek SSD benefits due to mental impairments.  When preparing the claimant for his hearing, he complained about neck and hand pain.  We immediately advised him to see a neurologist, who performed EMG testing, which yielded abnormal results.

The ALJ disregarded the claimant’s physical impairments when denying the case.  Shortly thereafter, in light of the abnormal EMG, the neurologist sent the claimant for an MRI of his cervical spine.  The MRI revealed shockingly severe findings.

When appealing the ALJ’s decision, we submitted the MRI.  The Appeals Council remanded the case to the ALJ in near record time.  The same ALJ approved the claimant’s SSD application today based primarily on the physical impairments.

Our client, who suffers from extreme anxiety, was so grateful to us for being successful in getting his claim approved.  We are glad we were able to relieve one burden from his shoulders.  Please call our office if you are looking for an experienced disability attorney to help you apply for Social Security Disability benefits.  We have offices located on Long Island in Nassau and Suffolk counties, and offer a free phone consultation.

COLA Increase

More ALJs Needed

We represent a 58 year old from Fair Lawn, NJ, with mental and physical impairments, who requested a hearing with an administrative law judge (“ALJ”) on September 7, 2022.  The good news is that ALJ Dina Loewy from the Jersey City hearing office approved Social Security Disability (“SSD”) benefits today OTR.  Unfortunately, it took 13 months to obtain the OTR.

The average wait time for a hearing at the Jersey City office is 13 months, which is better than most hearing offices.  For example, the average wait time for a hearing at the Long Island hearing office is 16 months.  Consequently, the Long Island hearing office has been transferring SSD appeals to other offices, like Albany and Hartford, which have average hearing waits of 14 and 13 months respectively.

It is not a secret that ALJs are under pressure to increase the number of cases they adjudicate in order to reduce the hearing wait times.  An internal memo from last year from the Deputy Communications Commissioner for Social Security, said that years of inadequate funding resulted in the agency  being unable to ” keep up with the demand for service and our annual fixed cost increases.”  According to the memo, Disability Determination Services (“DDS”), which assesses disability claims, experienced “historically high attrition as workloads become less reasonable with fewer staff.”

It would seem to be in everyone’s best interest if the number of ALJs and State agency representatives could be increased.  The SSD safety net was designed to help workers at the most vulnerable point  of their careers.  Workers paid into the system for the explicit purpose of receiving some limited financial assistance just in case they become disabled.  Workers should not have to wait a year for the DDS to render a decision, and if denied, then wait over another year for a hearing with an ALJ.

If you are thinking about applying for SSD, you should retain an experienced disability attorney to represent you.  The process of applying is not a simple one and can cause a claimant a lot of undue stress.  Our offices are located in Nassau and Suffolk counties on Long Island.  We offer a free phone consultation.

DDS Laziness

We represent hundreds of clients applying for Social Security Disability (“SSD”) at any given time.  It is our job to make certain that we are getting all the relevant medical evidence from our client’s treating sources, so the State agency, which processes the claims, has the requisite  information to make a timely decision.  Thus, it is very frustrating when, not only do we have to do our job, but we also have to do the State agency’s job for them because/when they are to lazy to do it themselves.

We represent a 61 year old teacher from Atlantic Beach, NY, who was approved for SSD benefits today, but only after we repeatedly called the State agency to ask them to look at the medical evidence that we had submitted.  The analyst handling the application repeatedly insisted that she did not have the claimant’s records, even though we had the electronic filing receipts that proved the State agency had received the records.  To make matters even worse, we have access to the claimant’s file, and could see the records were in there.  My office had to tell the analyst where to look in the file to find the documents that the analyst claimed were not there.

To compound matters even further, the analyst’s supervisor had asked us for a more detailed job description.  We immediately provided the description on a Friday afternoon.  We called the supervisor the following Monday to confirm she received it.  The supervisor advised my assistant that she was no longer the supervisor for that analyst, and required us to call the new supervisor.   We waited until Wednesday to call the new supervisor, Mr.  Senser, to give him a chance to acclimate himself with the claimant’s file.  Mr. Senser said he did not see the job description that we had submitted.  Once again, we had to tell him where to look in the file, at which point he miraculously found it.

Apparently, because Mr. Senser was humiliated, he told us that the claimant needed to go to a Consultative Exam (“CE”), despite the fact that the last supervisor agreed to accept a neurological exam from the claimant’s treating doctor in lieu of a CE.  In fact, the prior supervisor had also stated that she did not need any additional medical information.  However, Mr. Senser professed that somewhere in the medical notes he saw that one of our client’s doctors said she had improved.

We sent a letter to Mr.  Senser asking him to identify the  notes which supposedly stated that the our client had improved.  We also pointed out that even if someone shows some improvement, that does not mean they can work.  A coma patient who improves by waking up, but is paralyzed, cannot work.

We called Mr. Senser back a few days later to confirm that he had read our letter.  Of course, he was unable to find the letter, until we told him exactly where it was located in the file, that he was responsible for maintaining.  Once again, Mr. Senser miraculously found the letter that he had insisted was not in the file.  Since he could not even find the letter, he obviously had failed to read it.  Curiously, Mr. Senser then represented that he could not remember his statement about the claimant’s notes showing improvement.  Instead, Mr. Senser advised us that the claimant had been approved the previous Friday, which was the very same day when he told us that the claimant needed to go to a CE.

One can only wonder how the State agency gets anything done.  While there are some good analysts, most are either incompetent, or just don’t care about their work.  Consequently, if we do not stay on top of them, and spend our time doing their job, then our clients would still be waiting for their decisions, or even worse, have their claim erroneously denied.

There is no better example of why it is so important to have an experienced disability represent you if you apply for Social Security Disability benefits.  Our office offers free phone consultations with offices located in both Nassau and Suffolk counties.

CE Reversal Again

Sometimes we get cases after a claimant has tried, unsuccessfully, to obtain Social Security Disability (“SSD”) benefits. Most of the time, that claimant has gone to one or more Consultative Examinations (“CEs”), which is not usually in the claimant’s best interest. This is exactly what happened to a 38 year old client who asked us to represent her after being denied when she applied on her own.

Our client suffered from multiple medical conditions, including PTSD, anxiety, depression, anemia and photophobia. We were able to get supportive documentation from her treating doctors, which Social Security’s own rules specify is the preferred source. Our client was ultimately approved for SSD, and she could not be happier with the outcome of her claim.

It is always a wise decision to retain an attorney who specializes in disability if you find yourself in a position where you need to apply for disability. Please feel free to call our office for a free phone consultation. Our offices are located on Long Island in both Nassau and Suffolk counties.

ALJ Haaversen Rejected Again

I rarely take on a new claimant after an administrative law judge (“ALJ”) has already denied their application for Social Security Disability or Supplemental Security Income (“SSI”) benefits.  However, when I read the decision by ALJ Haaversen, I knew I had to make an exception.  Haaversen’s decision was so indefensible, that after I filed motion papers in the federal district court, the U.S. Attorney’s Office and the Office of the General Counsel for the Social Security Administration obviously asked the court to reverse the decision.

On remand, the case was reassigned to ALJ Andrew Weiss.  The medical evidence supporting the claimant’s application was so strong that ALJ Weiss found two different listings were met.  The good news is that the claimant was finally approved for SSI benefits.  The bad news is that the claimant applied for SSI benefits on August 15, 2018, more than five years ago.  How many people can survive, disabled or otherwise, without any income for that period of time?

No doubt, without our help and expertise, our client would almost certainly  have  been denied again.  Our claimant is happy that she made the choice to contact us for help with her claim and obviously overjoyed with the decision.  If you plan on applying for Social Security Disability benefits, it is always in your best interest to retain an experience disability attorney, who knows what information is needed to support a disability claim.  My office offers a free phone consultation with offices located in both Nassau and Suffolk counties.

Second Opinions

When seeking Social Security Disability (“SSD”) benefits, Medical source statements (“MSS”) are critical to establishing disability.  However, sometimes a claimant’s medical providers do not complete the MSS because they believe it would be more appropriate for another one of the claimant’s doctors to do so.  That is incorrect.

The Social Security Administration (“SSA”) wants “a medical opinion from all of the claimant’s medical sources.”  It does not matter if another medical provider may be more directly involved in your treatment, or seem to have a more relevant specialty.  The SSA is statutorily obligated to seek and consider all evidence.

We represent a 53 year old truck driver from Farmingdale with knee, neck and back problems.  In May, we obtained and submitted a report from the doctor treating the claimant’s neck and back.  The opinion was supported by treatment records citing objective clinical findings and MRI testing revealing herniated discs compressing nerve roots. However, the SSA was not satisfied, and insisted that the claimant attend a consultative examination (“CE”).

Rather than having the claimant submit to the CE, we secured and filed a report from a second medical source.  Shortly thereafter, the SSA approved SSD benefits.

It is important to retain an experienced disability attorney, if you plan on applying for SSD, who knows what medical information should or should not be submitted for your claim to be successful, and who is knowledgeable about all of the SSA’s rules and regulations.  We offer a free phone consultation, and have offices located on Long Island, in Nassau and Suffolk counties.

LTD Surveillance Games

We constantly warn our clients, who are applying for Long Term Disability benefits, or are receiving them, of the certainty of being surveilled.  Usually, the surveillance occurs over a 3 day period, but obviously you have no knowledge of when the surveillance will occur.  We advise our clients if they see a strange car by their house, or one following them, to call the police.  However, the LTD companies will stop at nothing to try and “catch” you doing something they believe proves that you are not disabled and use that information to deny or terminate your claim, even  for something as simple as walking your dog, or answering your front door.  They will pose as UPS workers, or sales people, nothing is too low for them.  So when we say be careful, we mean be careful.

SSA Strikes Again

Last week, we received a phone call from a former client, who received a disturbing and erroneous letter from Social Security’s payment center in Baltimore.  The letter said they were terminating her Social Security Disability benefits (“SSD”) benefits, and would be asking her for money back, because of her “significant earnings” over substantial gainful activity (“SGA”).  The client’s application was approved in January 2022.  Before securing her SSD benefits, we had to submit evidence showing the client was not working, and that her income was from a pension.

Even though our representation ends when a client’s application is approved, we still called the local office in Mineola, as well as the payment center who sent her the letter, on her behalf.  As usual, neither Mineola nor the payment center would take any responsibility for the error.  The Mineola office said the client would have to have her former employer complete a form, and the payment center said they would “send a note to a benefits authorizer to look into it.”  The representative we spoke with at the payment center claimed she had no idea what to do.  Worst of all, there was no urgency or remorse for our client’s situation from either the Mineola office or the payment center.  Just imagine their urgency if their income were being terminated.

Today, we received a phone call from another former client who received a similar letter from Social Security.  The letter stated that Social Security was terminating her benefits due to the fact that she was “working,” and said that she immediately had to repay $60,000.  Again, when our client was approved, Social Security knew that she was receiving pay for unlimited sick days.

The client called her local district office in Jamaica, and was told that she would have to appeal the decision.  Therefore, not only are her SSD benefits being terminated, but Social Security also wants her to pay them $60,000, and to file an appeal, even though she has not worked since she was approved.  To make things even worse, the problem is wholly due to Social Security’s own error.

Lightning doesn’t strike twice.  These letters indicate that Social Security has embarked on a program that terminates SSD benefits without due process.  The program shakes down claimants who are lawfully receiving SSD benefits after administrative law judges already accepted the claimants’ receipt of passive income.  No one at Social Security ever contacted either one of our clients to ask them if they were working.  If they had, then they would have known that the clients were not working, and that they were receiving passive income, which does not affect their entitlement to SSD benefits.

We advised both clients to do two things.  First, to contact their local offices again.  Second, to contact their congressional representatives, and the media, about Social Security’s actions, how they were being treated, and that Social Security is taking absolutely no responsibility for their errors, and does not even care.

If you receive a letter like this, you should immediately contact your local Social Security office, as well as your congressperson or senator, and the media.

Neurogenic Claudication

Neurogenic claudication is the most common symptom of lumbar spinal stenosis.  It refers to intermittent leg pain from impingement of the nerves emanating from the spinal cord.  The symptoms of neurogenic claudication include pain, tingling, or cramping in the lower back and one or both legs, hips, and buttocks, as well as weakness or heaviness in the legs.

We represent a 59 year old from Babylon with neurogenic claudication, who worked as a nurse.  The State agency was holding up her Social Security Disability (“SSD”) application because she did not want to attend a consultative examination.

The SSD application was supported by MRI testing.  However, shortly after we submitted a copy of her lumbar laminectomy operative report, whose postoperative diagnosis was lumbar stenosis with neurogenic claudication, her benefits were approved.  While an operative report is not a diagnostic laboratory test, it is just as persuasive as objective testing.

It is important to retain an experienced disability attorney who knows what medical records and reports support a claimant’s disability.  Our offices, located on Long Island in Nassau and Suffolk counties, offer a free phone consultation for anyone who is thinking of applying for SSD or has already applied and looking for legal represenation.

EMG

Back pain has been the leading claim for Social Security Disability (“SSD”) benefits.  The question frequently arises, why do some claims based on back pain get approved, and vice versa.  When it comes to lumbar spine impairments, the answer is usually depends on what diagnostic evidence is provided.

We represent a 45 year old with back pain from Selden, who worked as a heavy equipment operator.  The State agency approved the SSD benefits relatively early in the application process.  What made this case different?

The claimant’s neurologist submitted an EMG, which the doctor described as extensive evidence of neuropathy.  The State agency and the Social Security Administration frequently disregard the opinions of claimants’ doctors, especially since the treating physician rule has been eliminated.  However, when the opinion of a claimant’s physician is accompanied by significant diagnostic testing, then that opinion is much more likely to be accepted.

Chronic Pain Fog

Pain adversely effects cognition.  Research shows that the more widespread the pain, the bigger the memory deficits. As WebMD points out, pain interferes with concentration and staying on task, and executive functioning.

Social Security constantly posits that if a disability applicant has a cognitive issue, such as concentration or staying on task, then it must be because they have a mental impairment.  Consequently, the State agency automatically directs such claimants to attend consultative examination (“CE”) for a “mental problem” in addition to a CE for the physical impairment.

If you do not have a mental problem, then there is no need to attend a CE for a mental problem because the cognitive problem is not due to a psychological disorder.  The irrelevant CE is a waste of time, usually delays processing the application, and can become the focus for denying benefits, regardless of the limitations resulting from the physical impairment.

We represent a 61 year old from Pennsylvania with multiple physical conditions that prevented him from continuing to work as a manager.  The State agency wanted him to go to a psychological CE because of his concentration problems.  We insisted that his concentration issues were due solely to his chronic pain, and he was not alleging a mental impairment.  The claimant was approved for Social Security Disability benefits the following week.

If you are thinking about applying for SSD benefits, it is in your best interest to retain an attorney who specializes in disability.  Our offices are located in Nassau and Suffolk counties on Long Island.  Please call us for a free phone consultation.

Disability Synergy

The Social Security Administration is required to consider the combined effect of all your medical impairments when determining if you are disabled.  Thus, even if none of your impairment renders you disabled, you can still be found disabled by the combined impact of all them.  We represent a 56 year old financial planner from Manhasset with cervical radiculopathy and Crohn’s disease that illustrates the aforementioned synergistic principle.

The claimant’s application for Social Security Disability (“SSD”) benefits was denied by the State agency.  When the case proceeded to a hearing, the administrative law judge (“ALJ”) sounded surprised when the medical expert testified that the claimant’s severe Crohn’s disease would pose no limitation on her ability to stay on task and avoid sick days.

The ALJ issued a fully favorable decision today.  Among other things, the ALJ accepted the treating physician’s opinions  that the claimant would be absent from work more than three times per month, and would be off task greater than 20% of the workday, which would preclude all work.  He accepted these opinions without asking the Vocational Expert, assigned to the hearing, to testify, after my intense cross examination of their Medical Expert.

Only an experienced disability attorney would know how to navigate the hearing in order to obtain the approval of the claim.  Please call my office for a free phone consultation if you are considering applying for disability benefits.  Our offices are located on Long Island, in Nassau and Suffolk counties.

Too Long

We represent a 55 year old construction worker from St. James with hip and spine impairments, whose Social Security Disability (“SSD”) benefits were approved today, six months after we filed his application.  While we are glad that we were able to obtain SSD benefits without the need for a hearing, six months was still too long a time for the approval.

Based on the claimant’s work history, age and education, he was entitled to SSD benefits under the medical-vocational rules even if he were physically able to perform “light work.”  Light work is more strenuous than sedentary, desk work.

The claim file contained close to 1,500 pages of medical records.  There were plenty of objective diagnostic test results that showed the claimant would be unable to stand and walk for the requisite 6 hours a day to perform light work.

Social Security has many excuses when we challenge their delay tactics.  The undeniable fact is that if we do not constantly call the local office, and the Stage agency analyst handling our clients’ claims, the delays would be much longer.  Do not accept their perpetual cycle of delays.  Call our office for a free phone consultation, whether you are considering applying for SSD, or if you applied on your own and realize that you need an experienced disability attorney to navigate the administrative process.  Our offices are located on Long Island in Nassau and Suffolk counties.

LTD Benefits Reinstated

We represent a claimant whose long term disability (“LTD”) benefits were denied by Lincoln Life.  After we filed suit Fredrich v. Lincoln Life and Annuity Co. of N.Y., 2022 WL 1537162 (E.D.N.Y. 05/13/2022)  Lincoln approved LTD benefits on June 22, 2022, and paid past due benefits.  However, last month, Lincoln terminated the LTD benefits.  We requested the claim file, and began gathering medical and vocational evidence for the appeal.

When I reviewed the claim file, I found notes dated February 28, 2023, from the Lincoln claim handler who terminated the LTD benefits.  Her notes stated that a peer review dated February 27, 2023, supported the claimant being disabled from August 1, 2020 to present and ongoing, and that the claim would be re-evaluated in three months.  Therefore, I sent a letter to the Lincoln claim handler on March 9, 2023, asking why she terminated benefits if the file was not even due to be reviewed for another three months.  Perhaps more importantly, I asked what medical tests, exam findings, and symptoms, did Lincoln contend changed after June 22, 2022, which Lincoln believes shows the claimant was no longer disabled.

I received a call today from Lincoln’s LTD Manager.  After reading the March 9, 2023, the LTD Manager agreed that the claimant remained disabled, and advised me that Lincoln was reinstating LTD benefits.  While the claimant had already incurred some costs in obtaining updated reports, he was happy to receive an expeditious reversal of the termination.

Hartford Settles

Nearly three years after commencing an action against Hartford to recover long term disability (“LTD”) benefits, and a few months after getting Hartford to start paying monthly LTD benefits, we have an agreement in principle to settle the remaining cause action in connection with a buy-out of the claimant’s future benefits.

Disability insurance companies, like Hartford, are notorious for deciding to deny LTD claims before they have even started reviewing a claim, and for terminating benefits without a medical reason, they just want to avoid paying the claim anymore.  The disability insurance companies only care about their profitability.  They do not care about claimants, which is why you need an experienced disability attorney to represent you for your LTD claim.   Our office offers a free phone consultation with offices located on Long Island in Nassau and Suffolk counties.