Our firm’s s ability to obtain your disability benefits at the earliest point in time is unsurpassed because we aggressively take all measures as soon as possible to strengthen your claim. These efforts not only help force the insurance company, union, plan trustees or the Social Security Administration to reverse its decision to deny or terminate disability benefits, but also strengthen your case if a court has to review the records in litigation. We know what medical and vocational information will help present your claim in the best possible light, making it as difficult as possible for disability benefits to be denied or terminated.
Group and Individual Disability Appeals
If your potential disability benefits come from a group disability or pension plan at work, then it is probably gove rned by ERISA, which is an acronym for the Employee Retirement Income Security Act. The courts and Congress have recognized that ERISA is a very complicated law, and there are strict time limits for acting. Insurance companies take advantage of ERISA’s complexities to deny and terminate disability benefits. For example, insurance companies do not help claimants perfect their appeals, and if the claim needs to be litigated, the claimant may be precluded from submitting important information to the court. Moreover, the insurance companies frequently do not have to prove that it made the correct decision, only that it made a reasonable one.
If your disability coverage is through an individual insurance policy or a group plan that is not governed by ERISA, then we can handle your voluntary appeal with the insurance company, union or plan administrator, or we can proceed directly to litigation. The sooner you get us involved, the more likely we can prevent your benefit denial or termination from being rubber stamped on appeal. We will explain to you the pros and cons concerning a voluntary appeal and litigation, and let you chose how you want to proceed.
Social Security Disability Appeals
If you have worked for several years, you probably are covered under the Social Security Disability program. The government initially denies most disability claims, so it is critical to provide it with the necessary evidence on appeal. Your entitlement to Social Security Disability benefits varies depending upon many factors, including your age and work experience in addition to your medical impairments.
If your application is denied, or if your benefits are terminated after a continuing disability review, then you will need additional medical and vocational evidence to succeed on appeal. After your initial denial, you only have about two months to request an appeal. Therefore, it is important to consult with an attorney promptly. While requesting a timely appeal will expedite the appeal process, you should not give up simply because you missed the deadline. Under many circumstances you can file a new application that may reopen your prior denied application, which may avoid the loss of entitlement to any disability benefits.
The process of appealing can take more than one route. The typical route is a hearing where an Administrative Law Judge (“ALJ”) will hear your case. The ALJ may bring in a medical and/or vocational expert, and it is important to know how to cross examine those experts during the hearing. It is also important for your lawyer to know what questions to ask you and your witnesses during the hearing so that evidence which is helpful to your case will be preserved on the record if the ALJ denies your claim for disability benefits.
Sometimes a hearing can be avoided by submitting a request for a fully favorable decision on the existing record. This request is a written submission that generally summarizes the legal, medical and vocational arguments that support awarding disability benefits. If the request is granted, then there is no need to proceed to a hearing. If the request is denied, then you can still have an ALJ hear your case.
If the ALJ denies your disability claim after a hearing, then you may ask the Social Security Appeals Council to review the ALJ’s decision. The Appeals Council can grant your application which is rare, or may remand your case to the ALJ for another hearing. Common reasons for a sending the case back to the ALJ are that the ALJ overlooked, failed to obtain or improperly assessed evidence. Upon remand, you or your attorney need to address the basis for the remand at the new hearing before the ALJ. The Appeals Council can also agree with the ALJ’s decision not to grant disability benefits, in which case, your final recourse is Federal Court.
You cannot go to Federal Court until you have exhausted all of your administrative remedies. Once in court, your case is normally decided on the administrative record that the Social Security has compiled. The court decides the case by reviewing each side’s legal briefs. Generally, the Social Security’s decision to deny or terminate disability benefits will be overturned only if it is unsupported by substantial evidence. Therefore, it is best to get an attorney involved much earlier in the process. If the court denies your claim, then there is no further appeal. The court may reverse Social Security’s decision and award disability benefits or remand the case to the Social Security Administration for further administrative review. The entire process up to this point can take years, which is why it is advisable to contact us earlier in the process so we can improve your chances of succeeding prior to litigation.