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DDS Laziness

We represent a 49 year old financial advisor from Plainview with residual problems from a stroke, whose Social Security Disability (“SSD”) benefits were approved today without a hearing, but with little help from the State agency.

Since the claimant was under 50 years of age, there was little need for vocational information, because transferable skills were not an issue.  Nonetheless, the State agency repeatedly held the claim up by requesting more details about the claimant’s work duties than they do in other cases.

To compound matters further, we submitted thousands of pages of medical and hospital records detailing the stroke sequelae.  The records documented hemiparalysis, balance issues, fatigue, foot drop, among other things.  Nonetheless, the State agency kept sending requests for the claimant’s brain scans – which we confirmed each time had already been submitted.  Then it became obvious to us what the problem was.

We went through the records that were in the State agency’s electronic folder for the claimant.  We pulled out the brain scans, and resubmitted a second time.  SSD benefits were approved shortly thereafter.  In other words, the State Agency representative refused to review the medical records because they were so voluminous, so we had to do their job for them.

It is vital to have an experienced disability attorney represent you if you plan on applying for SSD benefits.  From the moment we file our client’s application, we stay on top of the representative(s) handling your claim.  For example, when we submit medical evidence directly into our client’s efile, we receive a confirmatory receipt. However, we consistently find that when we check the efile a few days later, the evidence we submitted is not there.  The State agency analysts’ stock answer is that it’s the “system’s” fault.  It’s a constant game of submitting evidence, checking to make sure it shows up in our claimant’s file, and then calling the State agency when we don’t find the evidence in the file.

The bottom line is that most of the analysts at the State agency do not do their jobs.  It could be that they are lazy, stupid or they just don’t care.  If you want to maximize your chances of being approved for SSD benefits, then you need to retain an experienced disability attorney.  We have been handling disability claims since the last Century.  Please call our office for a free phone consultation if you plan on applying for SSD benefits.  We have offices located in both Nassau and Suffolk counties on Long Island.

DDS Sham

In New York, Disability Determination Services (“DDS”), a State agency, initially decides if you get Social Security Disability (“SSD”) benefits.  Experience reveals that most of the people working at DDS are lazy.

We constantly have cases sitting at DDS for months without any review activity.  Then, after we submit medical records and reports, DDS asks for the same things again, as if simply churning the file shows they have done something.  Because they wait too long to review files, DDS regularly claims that the medical records are stale.  If DDS had bothered to review the records in a reasonably prompt manner, then the records would not have become stale.

Many DDS medical consultants (“MCs”) are amongst the laziest DDS employees.   We always provide MCs with more than ample medical evidence to find claimants disabled.  However, MCs refuse to review the medical records and opinions reports that we submit.  Instead, the MCs claim that there is insufficient evidence if a claimant does not attend a consultative examination (“CE”).  In other words, the only evidence the MCs care about reviewing is the CE report.  We had a case with thousands of pages of medical records and reports detailing claimants’ limitations, yet the MCs still said there was insufficient evidence.

We received an OTR  today that illustrates the DDS laziness.  We represent a 60 year old medical receptionist from Lindenhurst, who had to stop working after suffering a stroke.  The file contained over 500 pages of medical records, including detailed functional limitational form the claimant’s neurologist, yet Robert Dickerson, the DDS MC, denied SSD benefits on the grounds that there was insufficient evidence.  We appealed by requesting a hearing, which transferred the case from the State agency to the Social Security Administration (“SSA”).  It was so obvious to an attorney from the SSA that our client was disabled, that the case was approved OTR, without any additional medical evidence having been submitted.

The DDS laziness wasted the claimant’s time, and the SSA’s resources as well.  It is sad that an agency who is supposed to be helping people actually do the opposite.  We want to help you.  If you are applying for SSD, you need an experienced, competent attorney.  Please contact our office for a free phone consultation.  We have offices located on Long Island in both Nassau and Suffolk counties.

ALJ Carlton Reversed Again

Administrative Law Judge (“ALJ”) John Carlton  denies most cases Social Security Disability (“SSD”) cases because he bases his decisions on his interpretation of the medical data, instead of the interpretation of physicians, as the law requires.

We represent a 56 year old claimant from Bay Shore with hip problems, who worked for over 30 years as a truck driver,  warehouseman, and police officer.  ALJ Carlton, who was not qualified to interpret an x-ray, decided that the claimant only became disabled on the date the claimant’s hip x-ray demonstrated arthritis and degenerative changes.  You do not have to be a physician to realize that degenerative changes cannot possibly occur overnight.  Notably, we represented another claimant in Vellone v. Saul, 2021 WL 2801138 (S.D.N.Y. 07/06/2021) where the court reversed ALJ Carlton’s decision because, once again, he decided to play doctor, and relied on his interpretation of the medical evidence to reject the treating doctor’s opinion that the plaintiff’s hip and back pain precluded working.

In the present instance, ALJ Carlton never explained how the claimant’s hip problems suddenly went from not even being severe, to limiting the claimant to light work, on April 13, 2019.  Upon appealing the case to federal court, we sent a short letter to counsel for the Social Security Administration (“SSA”).  Based upon that letter, the SSA agreed that ALJ Carlton’s decision was indefensible, and voluntarily remanded the claim.

On remand, the case was reassigned to ALJ Alan Berkowitz.  Today, ALJ Berkowitz issued a fully favorable decision, and awarded the claimant SSD benefits, without even holding a hearing.

Hartford Breached Its Fiduciary Duty

Hartford Life, as claims administrator of a long term disability (“LTD”) plan, relies on claim procedures, which the Second Circuit found violated ERISA’s regulations.  Hartford argued that its procedures, which it called “protocols,” entitled Hartford to take more than 45 days to decide if a claimant is entitled to receive benefits.  Hartford admitted that it routinely applies the protocols.  One protocol is Hartford’s appeals department remanding administrative appeals to Hartford’s claims department.  Another protocol is arguing that COVID entitles Hartford to an extension of time.

Since Hartford admitted that it regularly employs the protocols as a general matter, we asserted a cause of action for breach of fiduciary duty, and as relief, asked that Hartford be removed as the Plan’s claim administrator.  Hartford asked the Court to dismiss the breach of fiduciary duty claims.  On January 13, 2023, Magistrate Judge (“MJ”) Arlene Lindsay rejected Hartford’s request.  However, MJ Lindsay indicated that since the breach of fiduciary claims may subject Hartford to a class action, within 30 days, she wanted to be notified of the steps the plaintiff will take towards serving as an adequate representative.

In compliance with MJ Lindsay’s order, we served interrogatories on Hartford that seek the identities of past and present participants of the LTD Plan, since each of those individuals is a potential plaintiff.  The interrogatories also seek the identities of past and present participants of other disability plans where Hartford has or may apply its protocols because each of those individuals also has a potential breach of fiduciary duty claim against Hartford.

Feel free to contact us if Hartford is your LTD claim administrator, and you have questions about the way your claim has been handled. We can be reached at (888) 572-0861.

Excuses Excuses

By Susan Golden

The number one question we get everyday is, “How long will it take to get a decision on my claim?”  The answer is, “Be prepared for the long haul.”  Why is that?  As soon as we file a social security disability (“SSD”) claim with our client’s local Social Security Administration (“SSA”) office, the excuses and delays begin.  Popular excuses from the local offices include: “We don’t have all the paperwork;” “The file must be sitting on someone’s desk;” “We’re backlogged;” “The person handling the case is out;” and “We don’t know why it hasn’t been processed yet, everything we need is here!”

After your local SSA office processes the claim, they send it to the State agency, where the claim is reviewed.  Everything is done electronically, so the file should be transferred quickly to the State agency, and include everything submitted to the Local SSA office, such as your application and our letters of representation.  However, depending on the local office, it can take weeks, sometimes months, to get the file transferred, and even then, the State agency claims documents are  missing.

Your file has been transferred to the State agency!  Great, now things will start moving.  Hold on, let’s not get ahead of ourselves.  The State agency is full of their own excuses and delay tactics.  In fact, they are masters at it.  They constantly complain that they don’t have enough information from the claimant’s treating doctors, even though we have submitted exactly what they are asking for!  They mislabel documents in the file, and are too lazy to look through them, because if they did, then they would realize that the file does indeed have exactly what they are asking for.   They don’t look at a file for months, and then all of a sudden they complain the records we have submitted are “stale,” when we had submitted them in a timely manner.  Luckily, we know how to play their game, and call them out on their delay tactics.

I could go on and on, but don’t have enough space or time, but you get the picture.  If you need to apply for SSD, you should make certain that you retain an experienced disability attorney.  We have over three decades of experience, and know the SSA system inside and out.  Please feel free to call our office for a free phone consultation.  We have offices in Nassau and Suffolk counties on Long Island.

SSD Embarrassment

Most people applying for Social Security Disability (“SSD”) benefits or Supplemental Security Income benefits (“SSI”) understand that their doctors need to support the disability claims.  What most people don’t know is that their doctors must support the inability to work at any full time job.  The Social Security Administration (“SSA”) evaluates if there are any occupations in the economy that exist “in significant numbers” that a claimant could perform.   The SSA doesn’t care if the occupations they find are still in existence, or performed in the same manner, or what the purported jobs pay.  The SSA only cares about denying as many cases as possible, even if their methods are questionable and inaccurate.

The SSA relies on testimony from a “Vocational Expert” (“VE”) at hearing.  The VE uses an antiquated publication called the Dictionary of Occupational Titles (“DOT”) to come up with jobs that a claimant could do when the claimant can’t perform their own occupation.  The DOT was updated in 1977.  It doesn’t take a rocket scientist to understand that a lot has changed in the last 45 years, especially in the ways jobs are performed.  A lot of the jobs in the DOT don’t even exist anymore.  Claimants are continuously denied SSD/SSI benefits when a VE finds jobs in the DOT that claimants supposedly can do, and then the VE uses unreliable methods to estimate how many of these jobs are available nationwide.  The SSA wastes billions of dollars, and can never seem to make the necessary updates and changes to their system to be able to make more accurate assessments and decisions.  It’s embarrassing!

It is vitally important that you retain an experienced attorney who specializes in disability and knows how the system works.  We have over three decades of experience working with the SSA and its Administrative Law Judges (“ALJs”), cross examining the medical experts and VEs, which requires a thorough understanding of the DOT and ONET.  Unlike many other disability attorneys, if an ALJ denies your claim, we can appeal your case to Federal Court, where we can succeed in obtaining a new hearing, or an approval of benefits.  While we cannot guarantee the outcome, we can guarantee that we will fight for you to make certain you get a fair hearing.

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

Approved In Under Two Months

As the Washington Post just reported, the system for processing applications for Social Security Disability (“SSD”) benefits is more overburdened than ever.  Knowing how to navigate the process is more important than ever.

We represent a 60 year old barber from Fresh Meadows with cancer.  We succeeded in obtaining SSD benefits in less than two months during the time when most claimants are waiting years.  Understanding what was needed, and promptly obtaining and submitting it, enabled us to expedite securing the claimant’s benefits.

ALJ Grossman Reversed Again

Only 14% of cases that the Appeals Council reviews are reversed.  As a statistical matter, the odds of a case being reversed by the Appeals Council twice are an infinitesimal .0196%.  However, those odds increase greatly when a decision of administrative law judge (“ALJ”) Seth Grossman is being reviewed.

ALJ Grossman has a very low approval rate, and a reputation for issuing biased decisions.  As a result, I have filed extensive Complaints and requests for investigations pursuant to Social Security Ruling SSR 13-1 at the request of clients.

Yesterday, the Appeals Council reversed a decision by ALJ Grossman, for the second time.  The Appeals Council determined that Grossman had committed fundamental errors yet again.  Consequently, the Appeals Council ruled that it would be inappropriate for further review by ALJ Grossman, and ordered that the case be reassigned to another ALJ.

Is SSD Permanent? No.

The Social Security Administration (“SSA”) will periodically conduct
a continuing disability review (“CDR”) to determine if you remain
disabled. The regulations state that a CDR should be done at least once
every three years, unless you have a medical condition that is not
expected to improve, in which case the CDR should take place every five
to seven years. If the SSA determines that your medical condition has
improved, then your Social Security Disability (“SSD”) benefits
will be terminated.

We represent a 34 year old financial services manager who the SSA found
disabled in 2018 due to IBS. However, the SSA terminated his benefits on
the grounds that his health had improved, and he retained us again.
On reconsideration, we were able to obtain reports from the claimant’s
doctors that explained how the objective medical evidence supported his
persistent functional deficits. As a result, the SSA reversed its decision, and
reinstated SSD benefits.

The SSA has been increasingly seeking ways to reduce the number of
claimants collecting SSD benefits. You cannot assume that you will continue
to receive SSD benefits until you reach retirement age.  That is why it is vital that you continue to see your doctors on a regular basis even after you are approved for SSD benefits.  It is equally as important to retain an experienced Social Security Disability attorney if the SSA erroneously terminates your benefits.  Our office offers free phone consultations and we have offices located on Long Island in both Nassau and Suffolk counties.

SSA – Is Anyone Listening?

By Susan Golden

The Social Security Administration (“SSA”) has problems.  Serious problems.  Years and years of backlogged claims, analysts who don’t give a damn, inexperienced employees, and Judges who don’t follow the rules.  Unfortunately, we have had claimants pass away, while waiting for a decision on their Social Security Disability claim.  And there are thousands of people across the country who are dying before their claims have been decided. 

We have a client who passed away almost four years ago.  He left behind a wife and two children.  He filed for Social Security Disability benefits on December 5, 2017.  His case, which was supposed to be expedited, went before Judge Carlton at the Bronx Hearing Office on April 12 2019, who erroneously denied the claim, and who took months to make the decision; September 26, 2019 to be exact.  We appealed his case to Federal Court.  On January 29, 2021, a Federal Court Judge made the decision to remand the case back to Judge Carlton for a new hearing.  We immediately sent a letter to Judge Carlton, reminding him the that the claimant had passed away, and that the case was supposed to be expedited, and asked that the hearing be scheduled right away.  The remanded hearing wasn’t held until June 9, 2022.   At the hearing, we reminded Judge Carlton that there were no new records to submit because the claimant had passed away.

It’s been well over four months since the hearing, and not only has the Judge not made a decision on the claim, he has not even LOOKED at the case since the hearing.  We have spoken to supervisors at the Bronx Hearing Office, mailed and faxed letters to the Chief Administrative Law Judge of the Bronx Hearing Office, and have had the claimant’s wife call her local congressman’s office.  There has been NO movement at all.  How is this even possible?  The answer is, there are no consequences or repercussions for Judge Carlton, the Bronx Hearing Office, or the SSA.  The way this case has been handled is a disgrace and a travesty.  And it’s not the first one and it won’t be the last.  No one deserves to be treated like this.  Is anyone listening??

Fraudulent CE’s

Cost of Living Increase

It is almost that time of the year again when Social Security announces the cost of living adjustment (“COLA”) to Social Security checks for 2023.  This year, due to inflation, those receiving Social Security benefits could see as much as an 8.7% increase to their Social Security checks.  Experts’ predictions on the amount of the COLA have been fluctuating over the past several months, but one thing they all seem to agree on is that it will be one of the largest increases in more than 40 years.  It would also be the highest increase anyone currently receiving benefits has ever received.

Unconscionable Delays by ALJ

by Susan Golden

It is a well known fact that the process of applying for Social Security Disability (“SSD”) benefits and waiting for a decision, can take months, or even years.  You cannot continue to work if you want to apply for SSD, yet, you’re expected to live without income and wait, while the system slowly churns.

Social Security’s excuse for their long delays  in processing a claim has always been that they are understaffed and backlogged.  While this in part may be true, the bulk of the delays seem to be due to a simple lack of caring. While there are many concerned and committed workers at the SSA, they seem to be more of a rarity, as a lot of the more experienced employees retire.  So many cases are delayed simply because a file sits on someone’s desk for days, weeks and even months.

We represent a claimant who applied for  SSD benefits on December 5, 2017.  The claimant became unable to work a fulltime job on June 15, 2016, and contacted us in December of 2017, seeking our services. Unfortunately, he passed away 3 months before his initial hearing.  He left behind a wife and two children, who were his world.  Five months after his hearing, his claim was denied by ALJ John Carlton at the Bronx hearing office.  This is an unusually long period of time for a Judge to take to make a decision.

We appealed the claim at the Appeals Council (“AC”) and it was denied three months later, in December of 2019.  We subsequently filed suit in Federal Court, and the case was remanded for another hearing. The order was signed and issued by Federal Court Judge Ronnie Abrams on July 6, 2021, and sent back to the AC to process and send back to the hearing office.

It then took the AC an unusually long six months to send a letter to AlJ Carlton, advising him that our claimant’s case had been remanded for further proceedings.  Two weeks later, we sent a letter to ALJ Carlton, reminding him that the claim was supposed to be expedited, even though the AC didn’t treat it as such, and asked that the hearing be scheduled.

Our client’s remanded hearing was held on June 8, 2022, six months after we requested ALJ Carlton to have the hearing scheduled, and almost a year after Judge Abrams issued her decision for a remand.

Four months have passed since the June 8th hearing, and ALJ Carlton has not made a decision.  In fact, he has not even looked at the case.  We have called the Bronx hearing office on a number of occasions to ask why this is so.  We were simply told the case is with the ALJ, and there is nothing they can do.  In the beginning of August, we sent a letter to ALJ Carlton, on behalf of our claimant’s wife and children, asking him to please make a decision on the case, as there was no new evidence to submit since the claimant has been deceased since prior to the original hearing in April of 2019.

Regrettably, our request has fallen on deaf ears, and has been completely ignored.  Our claimant’s wife is understandably angry and upset at the way her husband’s case has been handled, and feels that their children deserve to be treated with dignity and respect.  The delays in this case have been unconscionable.

This week, we sent a letter to Chief Judge Selwyn S. Walters, at the Bronx hearing office, respectfully asking him to speak with ALJ Carlton, to avoid any further delays, and to ask him to make it a priority to make a decision on this case.

Podiatrists

Do not underestimate the importance of podiatrists.  when applying for Social Security Disability (“SSD”) benefits.  The Social Security regulations specifically state that podiatrists are acceptable medical sources for purposes of establishing impairments of the foot.  Claimants frequently overlook podiatrists with foot problems when they are not the primary impairment.

We represent a 56 year N.Y.P.D. detective from North Carolina who had been found disabled because he needed kidney dialysis.  After recovering from a kidney transplant, the Social Security Administration (“SSA”) conducted a hearing during a continuing disability review (“CDR”).  The SSA reinstated benefits yesterday.  However, the CDR found that the claimant was disabled based on the claimant’s foot problems from diabetes, not any renal impairment.

Regardless of whether a foot problem is your primary impairment, your podiatrist’s records and disability opinion should be sought.

CE Boondoggle Continues

Time to discuss again the needless demands the State agency makes for a Social Security Disability (“SSD”) claimant to attend a consultative examination (“CE”).

Since the last Century, virtually every CE notice I have received has violated the Social Security regulations.  Demanding a CE means the State agency refuses to believe what the treating doctors say.  The CEs have delayed claimants’ receipt of SSD benefits, wasted taxpayer money, and wasted the time of administrative law judges.  To make matters worse, the State agency has insisted on CEs throughout COVID.

I represent a 47 year old former clerk from Glen Cove with multiple sclerosis (“MS”), bladder cancer and depression.  Despite supportive reports and records from the claimant’s urologist, neurologist and psychiatrist, the State agency denied SSD benefits because the claimant, with a compromised immune system due to cancer, would not attend a CE.

The case was approved today without a hearing.  As soon as an attorney from the Social Security Administration received the case, it was approved OTR.  The four demands for the claimant to attend a CE obviously were unnecessary.

Does the State agency have an unwritten regulation that requires they insist that every claimant attend a CE?  Doubtful.  More likely, the State agency examiners are too lazy or too busy to read the file.  Therefore, the examiners want to disregard all the medical evidence in the file, and just want to rely on what the CE says.

Yao Syndrome

Yao syndrome (“Yaos”) is an autoinflammatory syndrome involving irregularly occurring episodes that can last for several days, of fever and abnormal inflammation affecting many parts of the body, particularly the skin, joints, and gastrointestinal system.  The joint pain, swelling and inflammation is similar to arthritis, and frequently happens in the legs, ankles and feet.

We represent a 41 year old Director at a Health Care facility from Mineola with Yaos.  Based upon his treatment records, we obtained a report from the claimant’s rheumatologist, Qingping Yao, which explained why he believed the claimant was incapable of working on a full time basis.  Dr. Yao is the Chief of the Division of Rheumatology, Allergy and Immunology, and Director of the Center of Autoinflammatory Diseases at SBUH.  It was Dr. Yao who identified Yaos when he was a senior rheumatologist at the Cleveland Clinic.

Not surprisingly, the claimant was approved for disability benefits without the need for a hearing.   But our client had originally applied for Social Security Disability benefits on her own, and was denied.  She retained our services after she was denied, and she is very happy that she did so.

If you are thinking about applying for disability benefits, please contact our office for a free phone consultation at (888) 572-0861.  We have offices located on Long Island in both Nassau and Suffolk counties.

SSA’s Total Dysfunction

We are constantly asked why a case is denied, when it is so obvious that a claimant is disabled, which as defined by the Social Security Administration (“SSA”) means you are unable to perform any job on a full-time basis.

A perfect example is a case where a claimant fell down an elevator shaft, and sustained numerous severe, life changing, injuries.  He was denied at the initial application, and at the reconsideration stage, and twice by the same ALJ, and twice by the Appeals Council, and his case was remanded three times by the Federal Courts, before it was finally approved 12 years after his accident.

There is nothing that can excuse our government’s laziness, ignorance, or total disinterest in fixing the countless problems with the SSA, so that eligible workers do not have to have their lives ruined, while going through the process of applying for Social Security Disability benefits.

While an attorney cannot fix the problems with the SSA, retaining an attorney who specializes in SSD and disability law greatly improves your chances of being approved, and approved more quickly.  We have been handling disability claims with the SSA since the last Century, and know the system like the back of our hands.  We know what to focus on, and what is needed to obtain an approval.  We offer a free phone consultation during which we explain the entire process of filing for SSD benefits, and guide you with the type of support that is required from your doctors in order to have a successful claim.

Long COVID Approval

According to the CDC, 20% of the people who contract COVID end up with long COVID, and the distribution is notably high for those in the 50-59 age category.  Long COVID is no different from any other medical condition when it comes to eligibility for disability benefits.

We represent a 60 year old medical site manager from Riverhead who became unable to work due to long COVID.  Her symptoms were so severe that she was promptly approved for Social Security Disability after it was determined that she was incapable of resuming her job or any other occupation.  However, the claimant had a more difficult time maintaining long term disability (“LTD”) benefits from Unum.

Despite having many doctors who explained why the claimant’s numerous medical signs, tests and symptoms prevented her from working, Unum terminated the claimant’s LTD benefits shortly after approving them.  After we sued Unum, it immediately urged the court to mediate to avoid further litigation.  The claimant accepted Unum’s offer during mediation, and the case will settle.

SS Benefits Increase for 2023

Lack of Funding