Category Archives: Medicare & Medicaid

Your Disability Case is Just a Money Grab Bag for some Disability Firms! SSD in a Nutshell Series Blog #5

canstockphoto32474085-1Most people seeking help with filing a disability claim turn to the internet for information.  A quick Google search will offer up loads of links for “Disability Advocates” that will provide a “Free” review of a person’s case to see winning benefits is possible. The prospective disabled client enters his or her contact information into the site contact form and answers a few questions. The information is forwarded to disability advocates and lawyers who pay for this information. There is nothing wrong with this practice and it puts many people in contact with excellent advocates that can win cases. As a matter of fact many other legal services professionals utilize this type of promotional tool to obtain clients

A problem arises when this information is improperly distributed and when firms purchase more contacts than they have staff to properly process.

Leads Companies:

Companies that publish these websites and gather information usually agree to give information (leads) to only one attorney or advocate at a time.  In other words, if you enter your information into a site, your information should only be sent to one of the website company’s clients. It is important a person does not enter his contact information into more than one site to avoid causing his own tidal wave of advocate firms calling him.Yet, some of these website companies provide information to several of their clients. This results in a barrage of calls, emails, texts, and mail from several advocate companies being sent to one person in an attempt to obtain his or her case. It is very overwhelming on the prospective disability client to receive all this information and try to sort out which firm to hire. A person entering her information into one of these sites can see 15 text messages and calls from advocacy firms in one day that want to take her case. It is important to read the fine print on these websites to see who is collecting the information and why.  The website should indicate that it is gathering contact information to provide a law or advocacy firm and by providing information the prospective client is agreeing to be contacted by a representative of that firm.

It is important to understand SSA will not text anyone regarding an application for disability and demand the person call the number in the text to “complete” the application. (SSA may send text messages but only if specific steps are taking by the individual to receive texts specifically from SSA). Some of the firms that go overboard in contacting prospective clients purposely imply they are the SSA.

The advocate firm representatives that contact the prospective client by phone should not sound like they are reading from a script or be calling from outside the US. They should clearly state they are NOT the Social Security Administration and that they wish to represent the prospective disabled client in his her or claim and will charge a fee for doing so.  These companies should also immediately honor any request to stop communications.

Disability firms that abuse leads information:

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It is very hard for disability advocates to make money in this practice.  Fees are relatively low compared to the average legal fee that lawyers receive for services. Disability advocate firms can struggle with making a profit and maintaining ethical standards of serving clients. Despite this fact there are many disability firms that succeed in this balance and help many disabled people get their disability benefits. There are too many firms however, that skip the ethics for fast and large profits. These firms operate with the perception that in order to profit they must gather mass amounts of cases and invest the least in staff and processing of these cases.  These firms employ a limited number of qualified staff and the lion’s share of the work and case processing is left to entry level workers.  These workers receive limited training in filing forms and gathering information from the clients and are buried under hundreds of cases. Without the constant guidance of an experienced advocate these workers can quickly get overwhelmed and quality of case management suffers. Progress with client cases gets delayed and the risk of a denied claim is actually increased.

When someone files for disability he is usually in dire need of the benefits and deserves to see his case approved as quickly as possible. Hiring a bad firm could mean that it could take several weeks from the firm receiving the documentation from the client to actually getting the case filed with SSA.  If a case gets denied these firms are often behind in filing appeals meaning cases will sit until the 60 day deadline is near.  This can easily add  an unnecessary 4-6 months to the already long disability process.  Further adding to these delays is failure to respond to SSA and follow up on case processes to ensure proper processing of the case.  There are unique and often complicated details that arise in each case that if not addressed can mean the difference of winning or losing the case. A disabled person is better off without an advocate than hiring a firm that operates like this.

Websites, advertisements, and familiar names are not guarantees of great advocacy for a disability case. A good place to start is to search online for complaints.  One must keep in mind that even the best company will have had disgruntled clients from time to time. However, long lists of complaints with a common thread should be seen a red flag that the firm does not put its clients, first. These can be:

  1. Clients complain of their case being assigned and re-assigned to several case managers at the firm in a short amount of time.
  2. Clients cannot get someone on the phone, are put on hold for long periods, or do not receive returned calls.
  3. Clients complain that despite having submitted needed documents the firm takes a long time to get cases filed and information submitted to SSA.
  4. Complaints of poor customer service such as a lack of compassion from case managers or not getting help when its asked for.

If a disabled person is not well serviced by her advocate she can dismiss the advocate and hire someone, new. The previous advocate cannot charge a fee for the work they have done without specific approval from SSA.  The previous advocate must show that a very significant amount of work was performed properly on the case to be allowed to charge a fee. In many  of these cases, the previous advocate will not be able to show SSA they deserve a fee for work prior to the client firing them.  An advocate cannot prevent a client from dismissing them.

There are both attorneys and non-attorneys that do an excellent job advocating for the disabled and winning cases.  In this work, being an attorney does not necessarily make the advocate better than someone who is not an attorney. Organizations such as NADR and NOSSCR can put disabled persons in direct contact with a qualified representative in good standing via their referral services  These services can also assist in finding a local advocate which is sometimes preferred over an advocate far away.

More will come on this issue as I am very passionate about fair and competent representation of disabled persons. Please feel free to comment below or ask me questions!

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Filed under Basics of Social Security Disability, Disability Advocates, Medicare & Medicaid, Social Security Fraud, SSDI, SSI, Uncategorized

Having Appropriate Treatment for Your Medical Conditions is Crucial for Your Case! SSD in a Nutshell Series Blog 4

Seems like an obvious statement, right?  Well surprisingly there are many Social Security Disability claimants who are not receiving sufficient treatment for their conditions.  Not only does a person benefit by having sufficient health treatment for his medical conditions but his disability case will also benefit.

Until very canstockphoto0076124recently, it was nearly impossible for someone without medical coverage to get appropriate medical treatment. If health insurance was not offered through a person’s employer it was very likely he could not afford to purchase private medical insurance.  The new system is still very far from perfect, but it is somewhat easier these days to receive affordable medical treatment.  I still see about 30% of clients that are still without coverage and adequate treatment.  This is too often out of the control of the client.

Social Security (SSA) is not supposed to deny someone disability benefits for lack of medical treatment.  SSA can send the claimant for examinations.  A good disability advocate that is will assist his client in finding medical care to address the medical conditions the client suffers. The advocate can help the client work with her insurance provider to find a physician or to locate community healthcare for little or no cost. One does not want to rely solely on SSA to schedule an examination to determine disability if it can be helped.

SSA examinations are often a one-time event where where the disabled person is very quickly examined by a physician who knows little or nothing about the medical history of the person.  Some of these physicians do not specialize in the particular condition the person suffers. As mentioned in previous blogs, many of these physicians perform at the highest of medical and professional standards.  Not all of them do. Some do not submit accurate reports of the claimant’s conditions, unfortunately. Perhaps these physicians believe they will no longer get business from SSA if the confirm a person’s disabling conditions. Some of these physicians lack the ability to properly examine the claimant or simply do not thoroughly examine the claimant. Sadly, these bad exam reports can be used against the claimant..  Sometimes the reports are supportive of approving a case and somehow a a wrongly creative SSA decision maker finds a way to disregard the supporting information. It is always best to have the disabled claimant’s own physicians opinions on the record.

Consideration must be given to the opinions of the claimant’s own physician. Sometimes SSA will still require an additional exam from one of its physicians.  Yet, having one’s own physician providing records of treatment, diagnoses, prognosis, tests, etc., is always a benefit to a claim.

who is contemplating or actively pursuing disability should make she she communicates ALL her conditions and impairments to her doctors. A common issue I have come across is a person who has significant pain or other issues that clearly contribute to her disabilities and she does not inform her doctor. A person should always make sure her physicians are noting her health concerns and whenever possible assisting the person with consulting with specialists when needed.  Keeping record of medication side effects, seizures, headaches, days where one cannot get around well due to pain, etc., are a great way to keep the physician informed. The doctor is likely to note these things and this will be reflected on the disability case record. Always ask for a written prescription for canes and other assistive devices. If the doctor tells a person she needs a cane of course she should obtain and use one.  For all sorts of reasons the person should request a written prescription.  One would be in getting assistance from the insurance company paying for these items.  The other is prove to SSA that a cane or other device is needed.  A case can turn on something seemingly as simple as a doctor documenting his patient requires a cane.

If a person is having difficulty getting healthcare treatment and he has no insurance effort must be made to get him established for care with his own physician. Some resources and information can be found at:

Medicaid Website

Healthcare.gov

It may also be helpful to search the web for low-cost medical treatment in the area the claimant resides. There is often lag time before Medicaid or insurance coverage will begin, and sometimes coverage under either is unavailable for the claimant. Seeking treatment at a free clinic may be a great way to establish care.

 

Feel free to comment or ask questions!

©2016 April L. Roberts and Aaria Consulting, LLC. All Rights Reserved.

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Filed under Basics of Social Security Disability, Disability Advocates, Medicare & Medicaid, Obamacare, SSDI, SSI, Uncategorized

Social Security Disability in a Nutshell Series Blog 1

canstockphoto10669314What is Social Security Disability? I can tell you that it is not a welfare program  and is certainly NOT handed out to just anyone.  If this were true I would be driving a Rolls and not a Jeep Patriot.

My name is April Roberts and I am a professional disability advocate. I represent individuals that are applying for Social Security Disability and Medicare benefits. I have had the privilege of representing claimants around the country. I have traveled to over 50  SSA (Social Security Administration) hearing offices in 16 states to argue hearings in front of Administrative Law Judges.  I have learned that many Americans do not understand the Social Security Programs and how they work.  This lack of understanding is used by the media and other special interests to play on public fears.

In truth it is not easy to get approved for Social Security Disability and there are inconsistencies in how the rules are applied by the administration, itself. In fact over 70% of all applications are denied upon initial review. This is not because SSA ‘has’ to deny claimants the first time. There are many reasons for this unfortunate percentage which I will address in future blogs.

There are great people who work at SSA and most are just like anyone else trying to do a job.Like any organization there are problems and mistakes are made. There are times when a claimant does not need a representative or attorney to help them. Most of the time claimants can benefit from having someone advocate for them.  Some representatives and attorneys are great.  Some representatives and attorneys are not.

With that said, my intentions are to educate people on these things and hopefully publish a simple book to help people better understand the disability process and rights to those benefits. Since I have never written a book I am hoping all of you can help me.  By that I mean commenting on each blog I publish with your thoughts and questions. Hopefully your input can help me direct my writing to cover all the areas where people have questions . So, with no further adieu…

What is Social Security Disability?

Simply put, Social Security Disability (otherwise known as SSDI) is a disability insurance program. Most working Americans pay into this insurance program via income tax withholding. Once a person has achieved a required minimum of earnings and time worked, she will become eligible for disability income should she become disabled. There is much more to this and I will address it in a later blog. But here are some basics.

The ONLY ways someone is eligible to receive benefits through the SSDI program are:

  1. Be disabled per Social Security’s rules and meet the minimum work and earnings requirements or;
  2. Be the dependant of a person who is receiving SSDI benefits or;
  3. Be the Substitution of Party (ie surviving family member or appointed person) of a deceased person to whom SSA still owes benefits to

Since this is a program you have to pay into to become eligible, this program is NOT a welfare program.  SSDI can be compared to the Social Security Retirement benefits in that a person has to work and pay into the program. SSDI is too often mistaken for SSI or Supplemental Security Income which IS a welfare  or “needs based” program.

What is SSI?

SSI is a needs based disability program through Social Security. SSI rules for medical eligibility are the same as SSI. SSI recipients must be very low income and have limited assets. He may not have the requisite earnings and time worked to have earned any SSDI benefits. A person who is eligible for an SSDI benefit that is below a certian threshhold may qualify for SSI in addition to his SSDI benefit. A disabled child whose parents’ income and assets fall below a certain threshold may be eligible for SSI. The thing to remember with SSI is that the medical rules are the same as SSDI but is based on the needs of the indigent claimant.

SSA keeps tabs on recipients of SSI to make sure that at no time does a claimant rise above the minimum income or assets to continue recieving SSI. If a person does rise above the threshold, SSA can stop the benefits and sometimes even demand return of any over-payments that may have been received by the claimant.

Who is eligible to receive Disability Benefits?

This is where things begin to get more complicated but I promise to keep it simple and break these issues down over the course of time.

Once a person becomes unable to perform “SGA” or Substantial Gainful Activity due to health problems she becomes medically eligible to receive disability through Social Security. I will focus on adult disability for now.

SSA has a five step sequential process in how it must determine if an adult claimant meets the medical requirements for eligibility. There are many thing that affects these steps but the basic breakdown is as follows.

1. Is the person working at “SGA” levels since he alleged his disability began? For 2016 a person earning more than $1130/mo is working at SGA levels and will likely be found not disabled right off the bat. SGA also refers also to how much a claimant works and working alot of hours may cause a person to be found not disabled. There are many variables that can be considered regarding these factors but for the most part if someone is working less than 30 hours and earning less than $1130/month due to an inability to work any more than this, he may still be found disabled despite the fact he is working. If a person has worked since his disability started and the work is under the monthly SGA amount or he has not worked at all, then SSA proceeds to step 2. (Yikes I can work while getting disability? Yes! I am saving that for another blog)

2. Does the claimant suffer from  a severe impairment? The claimant must suffer from a mental and/or physical condition that is so severe that it will be expected to prevent her from working at SGA  levels for twelve months; or result in death. Of course these conditions must be diagnosed by a medical doctor. If SSA finds there is a severe medical condition at this step the process moves to step 3.

3. Do the claimant’s  impairments meet or equal the criteria under certain medical conditions set forth by SSA? These lists of criteria are referred to as listings or body systems. In other words if your diagnoses, symptoms, and prognosis fit under certain specific disease listings then SSA may have to find you disabled. If SSA does not find that the claimant’s conditions fit into one or more of these listings then process moves to step 4.

4. Can the claimant return to his past relevant work? Past Relevant Work is work that a claimant has performed in the past for a period long enough to have learned each job. If SSA finds the person cannot perform any work he has done before then the process moves to step 5.

5. Can the claimant perform other work? What SSA means by ‘other’ work is any other type of work that is performed in the general national economy that the claimant might be able to perform.  SSA considers the claimant’s age, level of education completed, residual functional capacity (ie what can the claimant do now), and transfer-ability of job skills from past  work that could be used in other jobs.

If the claimant cannot perform any of his past work and any other work he may be approved for SSDI and/or SSI.

This I hope gives a clear basic picture of the Social Security Disability process. Please leave comments and questions here on the blog site, Facebook, or Twitter for me. I am open to your input and happy to answer questions.

Next up, “Why do so many people who should not get disability get approved for it?”

©2016 April L. Roberts and Aaria Consulting, LLC. All Rights Reserved.

 

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Filed under Basics of Social Security Disability, Disability Advocates, Medicare & Medicaid, Spouse's Benefits, SSDI, SSI, Uncategorized