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Support Letters

When the Social Security Administration (“SSA”) decodified the treating physician rule, the new regulations called for greatest emphasis for supportability and consistency.  The more a medical opinion is consistent with other evidence, the more persuasive it will be found.

Evidence includes statements from anyone who has observed a claimant.  We represent a 53 year old clerk from Ronkonkoma with neck and head injuries from a motor vehicle accident.  We supplied disability opinions and a great deal of objective diagnostic evidence of musculoskeletal injuries.  Nonetheless, it was not until we submitted support letters from friends and relatives that the SSA approved disability benefits.

Support letters are evidence from non-medical sources that the SSA must consider.  They corroborate the opinions of the treating medical sources.  Consequently, the support letters make the opinions of the treating medical sources more consistent with the evidence compared to the opinions of the non-treating medical sources.

Our client was ecstatic to learn that she had been approved, and said she was so impressed with our handling of her claim and our knowledge of what was needed to get her a favorable decision.  She said she would highly recommend our services to anyone she knows, who might need to apply for disability.

Please feel free to call our office for a free phone consultation if you are considering applying for disability .  We have offices on Long Island conveniently located in both Nassau and Suffolk counties.

State Agency Doctors

During the first two levels of review for a Social Security Disability (“SSD”) application, the State agency basically has its doctors deciding the claim.  The State agency doctors frequently lack the credentials or qualifications to evaluate a claimant’s impairments.  Therefore, Social Security attempts to insulate the opinions of State agency doctors by refusing to disclose their full names.

Although federal courts rarely accept the opinions of the State agency medical consultants, administrative law judges (“ALJs”) frequently rely on those opinions to deny SSD benefits.  Fortunately, ALJ Crawley is not one of them.

We represent a 54 year old financial analyst from North Babylon with severe back and knee impairments.  His SSD application was at the first two levels of review based upon the opinions of the State agency doctors, who asserted the claimant could perform light work.  ALJ Crawley rejected those opinions in favor of the claimant’s physiatrist for two reasons.  First, the opinions of State agency doctors were unpersuasive because they were based on a review of the record, and not a direct examination of the claimant.  Second, those opinions were obtained before significant evidence was available for review, which rendered them less relevant in assessing the claimant’s functioning.

If you are considering applying for disability benefits, it is in your best interest to retain an attorney who specializes in disability.  You can call our office for a free phone consultation.  Our offices are conveniently located on Long Island in both Nassau and Suffolk counties.

Lung Cancer Approval

We represent a service manager from Shirley, who unfortunately has Stage 4 lung cancer.  By promptly alerting the right representatives at Social Security, and submitting the medical information to qualify for expedited processing, we succeeded in getting benefits approved in 2.5 months.

Delays in processing Social Security applications are well documented.  Knowing how, and being willing, to navigate the Social Security application process from inception is important to ensuring that late stage cancer claims get expedited.

DDS Inconsistency

The State agency makes the initial decision on Social Security Disability (“SSD”) applications.  When we advised the State agency that our 24 year old claimant from Uniondale with back problems would not attend a consultative examination (“CE”) due to the COVID-19 pandemic, the State agency agreed that the treating spine specialist could do the CE.  The specialist provided the very information that the State agency requested, yet it denied the claimant’s SSD application anyway.

The administrative law judge (“ALJ”) found the evidence regarding the claimant’s spine impairments compelling, and promptly approved SSD benefits.  The State agency received the exact information that it had requested, and it all supported the claimant’s SSD application. One can only surmise that the State agency gave no regard to the medical evidence because it had predetermined to reject the claim of a 24 year old.

If you are thinking about applying for SSD benefits, it’s in your best interest to retain an attorney who specializes in disability.  For more information, please call my office for a free phone consultation.  We have offices conveniently located on Long Island in Nassau and Suffolk counties.

ALJ Schriver Reversed

We received a federal court decision today that reversed the denial of Social Security disability (“SSD”) benefits by administrative law judge (“ALJ”) Robert Schriver.

We represent a 50 year old title reader from Bellerose Manor with fibromyalgia.  The ALJ rejected the opinion of the treating rheumatologist that the claimant lacked a sedentary residual functional capacity (“RFC”) because of the fibromyalgia.  We argued that the ALJ impermissibly relied upon his own lay judgment in lieu of medical opinions when concluding the claimant had the RFC for full time work.  The federal district court agreed.

The judge ruled that because the ALJ is a layperson, not a doctor, he is not permitted to interpret raw medical information into an RFC without the assistance of a medical professional’s insight.  The court added that, “Because an RFC determination is a medical determination, an ALJ who makes an RFC determination in the absence of supporting expert medical opinion has improperly substituted his own opinion for that of a physician, and has committed legal error.”

The most noteworthy part of the decision was that the judge highlighted the importance of the treating physician’s opinion even after the repeal of the treating physician rule.

It’s important to note, that when you hire an attorney to represent you with a Social Security Disability claim,  you should confirm that he/she has the credentials to take your case to Federal Court, if the need should arise.  Please contact our office for a free phone consultation if you are considering filing for disability.  Our offices are conveniently located on Long Island in both Nassau and Suffolk counties.

The Wait is Over

We filed a Social Security Disability (“SSD”) for a claimant from Brooklyn with depression over 5.5 years ago.  After administrative denials, we appealed in federal court, and succeeded in obtaining a reversal.  On remand, the administrative law judge (“ALJ”) asked a medical expert (“ME”) and a vocational expert (“VE”) to testify.

At the hearing, after the ME testified that the claimant met a listing, the ALJ ended the hearing without any testimony from the VE, which means SSD benefits will be approved.  Today we received the Fully Favorable Decision; however, the notice of award (“NOA”) that details the benefits that are due and the lump sum past due benefits can take many months to get, especially when the claim involves a federal court remand.

Our claimant is ecstatic that he was approved, and grateful that we fought so hard for him.  If you are thinking about applying for disability, please call my office for a free phone consultation.  Our offices are conveniently located on Long Island in Nassau and Suffolk counties.

LTD Buy Outs

A long term disability (“LTD”) benefit “buyout” is where the insurance company pays a lump sum instead of continuing to make monthly payments in the future.  Should you accept a buy out?  A buy out will always be less than the possible total amount of future benefits remaining, for which there are valid reasons.

The insurer will continue to reassess the claim.  The insurer may believe that it is possible for your condition to improve, at which point your benefits will be terminated.  That is why insurers do surveillance, and pay “IME” doctors thousands of dollars to opine that the claimant has improved.  The insurer will also want a discount to reflect the chance that you might die from some unrelated cause.

I typically advise my clients that their only concern should be if the buy out makes financial sense – could they invest the lump sum to earn approximately what the monthly payouts would equal. To determine if a buy out makes sense, you should always discuss it with your financial advisor, who can evaluate the present value formula that the insurer is using.  To oversimplify, if you win a lottery, you can choose a lump sum or annual installment payments.  The former is always smaller than the total amount of the jackpot.

The key to analyzing the present value is the “discount rate,” which is an interest rate.  A lottery uses a discount rate to reflect the annual rate of growth of the invested lump sum for a typical individual, which is what the present value of a lump sum is supposed to do.  Disability insurers knowingly misuse the term present value.  Instead of using an interest rate that reflects the expected rate of investment growth, the disability insurer uses the corporate bond rate because that supposedly reflects the cost to them of borrowing to pay for the lump sum.  However, that has nothing to do with the present value of a lump sum to you; only the cost of the lump sum to them.

Most of the time, we advise claimants that buy outs are offering far too little relative to the overall claim.  We negotiated a buy out for a Unum client today.  The claimant understood that there was a significant discount for Unum.  However, the claimant already had to relocate from Queens to Upstate New York where the cost of living is lower.  After discussing the buy out with financial advisors, despite the discount, the claimant felt she had to accept the buy out due to financial stress.

Covid Long Haulers

As if it wasn’t hard enough to get approved for Social Security Disability (“SSD”), Covid has complicated the matter even more.  Some people who have had Covid have become “long haulers.”  They have experienced lingering medical issues, and new medical issues, which have left them unable to return to work.  While they can apply for SSD, the Social Security Administration (“SSA”) is not prepared for how to treat these cases, and will most likely deny them,erroneously.

How many more of our fellow citizens are going to be subjected to the uneducated decisions of the “analysts” at the State agency who review their claims?  These “analysts” are civil service workers, not doctors or lawyers, who most of the time are ill prepared for what they are doing, and are not really interested in trying.  Under the new acting Commissioner of the SSA, we can only hope that the SSA trains their employees about how to handle long haulers’ claims, and that they do not automatically deny them or make them wait years for a decision.

Remand for Benefits

There are three possible outcomes when appealing a Social Security Disability (“SSD”) case in Federal court:  the appeal can be denied, remanded for further proceedings, or approved and remanded for a calculation of benefits.  The third possibility is the best for a claimant, but is also the rarest, occurring only 2% of the time.

Unfortunately, more claimants are having to litigate in order to receive SSD benefits.  Social Security has precipitously reduced the percentage of cases that it approves and remands at the Appeals Council since 2016.  It seems that Social Security made the cynical decision that it is a win-win for it to reject more cases at the Appeals Council.

Social Security calculated that many claimants will not go to court, and if they do, then the court will decide if a remand is needed.  Basically, Social Security has foisted its obligation to determine if a remand is needed onto the courts.  Social Security anticipates that the courts will respond to the increased SSD caseload by denying more cases in order to discourage appeals.  At worst, a remand significantly delays the time when Social Security has to pay benefits, and Social Security does not pay interest on past due benefits.

We represent a 36 year old catering manager from Mineola with multiple impairments, including pseudotumor cerebri, which causes headaches.  Administrative Law Judge (“ALJ”) Roxanne Fuller denied the case, which the Appeals Council rubber stamped.  U.S. District Court Judge Brian Cogan reversed and remanded the case today for a calculation of benefits.

Judge Cogan rejected the ALJ’s argument that because the claimant’s headaches were not disabling because she did not experience them during all her examinations.  Since the record was sufficiently developed, and no medical opinion contradicted the opinions of the treating physicians who concluded the claimant cannot work on a regular basis, Judge Cogan held that a calculation of benefits was the proper remedy.

Our client cannot express her gratitude enough, for our handling and outcome of her claim.   She had originally applied on her own and realized that filing for SSD was an arduous and complex matter.   She was referred to us by an old client of ours, who highly recommended calling us, based on their own positive experience, knowing that we specialize in disability claims, and are able to litigate claims in Federal court when necessary.  Our office offers free phone consultations and have offices conveniently located on Long Island in Nassau and Suffolk counties.

Prostate Cancer

We represent a claimant with complications from prostate surgery who was approved today for Social Security Disability (“SSD”) benefits without even having to attend a hearing with an administrative law judge (“ALJ”).  The ALJ not only found that urinary impairments and fatigue prevented the claimant from performing his past work, but also any other work as well.

Transferability means applying work skills that the person has demonstrated in vocationally relevant past jobs to meet the requirements of other skilled or semi-skilled jobs.  The ALJ concluded that any skills the claimant acquired from his past work were not transferable to any other jobs; that any other occupation would require too much vocational adjustment in terms of tools, work processes, work settings or the industry in order for any acquired skills to be transferable.

Vocational considerations take on added significance when the impairments at issue are non-exertional.  Therefore, we retained and worked with a vocational expert (“VE”) on this matter.  Without the VE, it is unlikely that the claimant’s SSD application would have been approved without a hearing.

More Good News?

SS Commissioner Fired

COVID Long-Haulers

COVID has affected the lives of millions of people. While some people who have had COVID recover after two weeks, and return to their normal life, there are many people who are left with long lasting, even permanent, medical conditions that they did not have before contracting COVID. These people are referred to as “long-haulers”. One of the many problems these people face is their inability to return to work, for an unknown period of time, or permanently. They face the difficult challenge of applying for disability, whether through Social Security, or from a group or private insurance policy, neither of which is prepared for “long-hauler” claims. But they need to prepare quickly, because there are going to be a lot of people left disabled from this virus, and they will need disability payments to survive.

SDNY Affirms SSD Win

Judge Ronnie Abrams rejected the decision of Administrative Law Judge (“ALJ”) John Carlton that our client from the Bronx with spinal impairments was not disabled. The decision is of significant importance because Judge Abrams clarified that “the law that an ALJ may not substitute his own medical opinion for that of a physician” even after the treating physician rule was decodified. Thus, an ALJ cannot base a residual functional capacity (“RFC”) assessment on his own interpretation of the medical evidence. In order for an RFC to be supported by substantial evidence it must be based on a physician’s opinion.

It is vital to make sure that the disability attorney who will represent you when applying for Social Security Disability will also fight for you in Federal Court if necessary. Not many disability attorneys are qualified and willing to litigate their clients’ claims if they have to go to Federal Court, and they will refer you to a litigation attorney. We can and do litigate our clients claims. 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.

Prudential Approval

We represent a nurse from Manhassett with Lupus and back problems. We originally persuaded Prudential to reverse its decision that the claimant was able to work as a nurse after we filed an action in federal court. However, relatively soon thereafter, Prudential challenged whether the claimant was unable to perform any other occupation.

At the time of the lawsuit, even though the claimant only needed to establish that she was incapable of working as a nurse, we went out of our way to demonstrate how the medical and vocational evidence submitted supported her being incapable of performing any full time occupation. We provided Prudential with information from the claimant’s doctors showing that there had been no change in her medical tests, clinical examination findings, or symptoms.

Prudential notified the claimant today that it determined she is unable to be gainfully employed. If we had not exceeded the evidentiary requirements initially, it is unlikely that Prudential would have concluded that the claimant was disabled from any occupation.

Please take note of how important it is to retain an attorney who specializes in disability claims, if you intend on filing for disability. Our office offers free phone consultations. We have offices located on Long Island, in both Nassau and Suffolk counties.

Rheumatoid Arthritis

Rheumatoid Arthritis or “RA” is an incurable form of inflammatory arthritis and an autoimmune disease.  When applying for Social Security Disability (“SSD”) benefits, the most expeditious way to establish entitlement to benefits is to show that the claimant meets the criteria under “listing” 14.09.

We represent a 47 year old Vice President of Human Resources from Glen Cove, who was approved for SSD benefits in five months, without requiring a hearing.  There was no written decision because the claimant was approved at an early stage.  However, we were able to access the internal documents from the Social Security file, and learned that the claimant met listing  14.09 because of the effect that the RA had on her hands.  We had submitted a report that focused on how the claimant’s use of her hands were limited, and treatment records that reflected the nodules on them.

The SSD claim process is a lengthy one, especially during the COVID era.  Explaining why the medical evidence supported the claimant meeting the listing significantly expedited her receipt of SSD benefits.   This is why it is so important to have a disability attorney representing you for SSD benefits.  If you are planning on applying for SSD, or have already applied on your own, please call my office for a free phone consultation.  Our offices are conveniently located on Long Island in both Nassau and Suffolk counties.

We Take Care of Our Own?

Mystery Solved

Sometimes it is unclear why Social Security approves a claimant. We represent a 32 year old educator from Brooklyn with bipolar disorder, whose supplemental security Income (”SSI”) application was just approved. We submitted very strong medical opinions along with their treatment records, but that does not usually result in an approval prior to a hearing with an administrative law judge.

We received a notice of award (“NOA”) for the claimant. However, a NOA explains the benefits to which a claimant is entitled, but does not explain the basis for the decision. Because Social Security conducts continuing disability reviews (“CDR”), it would help a claimant prepare for that eventuality if the NOA was accompanied with some sort of rationale for the approval. As the client’s attorney, I was able to access his electronic file and review the State agency’s notes. This enabled us to ascertain that the claimant was approved because he met the listing for bipolar disorder, which will prove invaluable when his CDR comes up.

Is the claimant had not retained us, or another disability attorney, he would never have known the basis for his approval. This is why it is so important to hire a disability attorney if you are thinking of applying for disability. We have offices conveniently located on Long Island, in both Nassau and Suffolk counties. Please call our office for a free phone consultation.

More State Agency Deceit

We filed a reconsideration appeal on May 3, 2021.  Just three weeks later, the State agency denied the claim without requesting any additional information. The State agency claimed that we refused to allow our client to attend a Consultative Exam (“CE”) because of “a medical condition.”  That claim was deceptive at best.

The State agency concealed that the claimant’s “medical condition” was his cardiovascular heart disease, which resulted in two heart surgeries in February, and two more surgeries in March, when COVID was still raging.  In his condition, the claimant could not risk being exposed to COVID.  To minimize the risk, we offered to have one of his cardiologists perform the CE, who also happen to be the preferred source under the regulations.  His doctors were perfectly willing to perform the CE, but the State agency ignored that offer.

The medical section of our client’s Social Security claim file contains 2,421 pages of records that support his disability from work.  The State agency denied this claim because the claimant did not attend a CE.  We have seen quality control memos rejecting such denials, and reminding the State agency to make a decision on the other evidence in the file.  The State agency failed to do that here.

There were thousands of pages of medical records.  The State agency refused to identify any medical documentation that was purportedly missing.  There was a great deal of documentation regarding our client’s medical conditions, including diagnoses, objective diagnostic test data, operative reports, supportive letters and reports from multiple treating doctors.  There was no need for our client to attend a CE.

Logic dictates that the State agency was too lazy to review the 2,421 pages of medical records. This claim should have been approved.  It is a travesty that it was denied.

We will continue to fight for our client and are confident that the hearing office will give this claim the proper consideration and review.  If you find yourself in need of assistance applying for disability, please contact my office for a free phone consultation.  We have offices conveniently located on Long Island in Nassau and Suffolk counties.

Responsiveness Counts

Social Security Disability (“SSD”) claimants frequently ask, “How long does it take to get a decision?”  That general question cannot really be answered because it depends on countless variables.  However, the process can be hastened if your doctors and other sources supporting your claim respond promptly and fully.

We represent a former salesperson from Lynbrook who suffers from anxiety and PTSD whose SSD application was approved without a hearing.  We were able to obtain reports from the claimant’s psychiatric nurse practitioners, one of whom also provided thorough and complete answers to a questionnaire from Social Security, and psychotherapist.  As everything Social Security requested was expeditiously submitted, a consultative examination was not requested.

The claimant may not have had the same outcome if she had filed on her own.  This is why it is so important to retain an attorney who specializes in disability if you plan on applying for SSD.  If you are thinking about applying for SSD, please call my office for a free phone consultation.   We have offices conveniently located on Long Island in Nassau and Suffolk counties.