Social Security Disability

What’s one of the toughest things about Social Security disability appeals? When the administrative law judges (ALJs) deciding the cases don’t follow their own rules before deciding against you. In fact, some of the most frustrating cases I’ve had as a Social Security disability attorney involve ALJs ignoring the opinions of my clients’ doctors.

It makes sense that ALJs are given this power, because no one wants doctors faking evidence and helping people to steal from the government. Unfortunately, some ALJs demand proof from doctors that goes above and beyond what the law requires or they ignore their diagnosis. This shouldn’t be allowed, but it is.

If you’re starting a Social Security disability appeal, you probably have lots of Social Security questions. You might wonder what the process entails and what you need to do. If you’ve reached the point where you need to have a hearing, you will need to know where to go. For an overview, check out my free Social Security disability eBook

Unfortunately, your appeal probably became more difficult last year when Congress passed a budget for the SSA that was more than $1 billion less than they needed. Because of this budget shortfall, the SSA couldn’t hire more people to handle the disability backlog, new hearing offices had to be delayed, and money that was supposed to be put into IT projects to increase productivity was diverted. But the worst news for people making appeals is that around 160 remote temporary sites were closed.

Some of the most common Social Security questions I receive involve how claimants can cover pre-existing conditions while they are waiting for their claim to go through. This is an incredibly important question because the claims process can take a ridiculously long time. Some people will be waiting for Texas Social Security disability benefits for a year or more, and for people awarded cash benefits, Medicare has a 24-month waiting period.

Two years is a long time to wait to get the help you need, and it isn’t unheard of for the health of many people to deteriorate during this time—some have even passed away! This won’t be as much of an issue in 2014 and beyond, when healthcare providers are finally prevented from denying people based on pre-existing conditions, but that’s cold comfort for people who need help today. Luckily, there is another option.

As a Texas Social Security disability attorney, I always thought that the role of government was to look out for and protect those citizens who need it the most. Last year something happened that changed my mind.

The Wall Street Journal ran a story on an administrative law judge (ALJ) in West Virginia who approves people for benefits the vast majority of the time. Almost immediately, both Democrats and Republicans were calling for “reviews” and “related monitoring” of ALJs to make sure that everyone was following the proper procedures.

As a Social Security disability attorney with Marc Whitehead & Associates, I’ve helped many clients who’d all but given up on getting Social Security disability benefits since they’d missed their deadline to appeal.

They thought they were out of options because the regular rules effectively close the door on claimants for missing deadlines. But what most people don’t know is that there’s a little-used rule that may be able to help them: SSR 91-5p. This policy allows adjudicators to extend the time for the claimant to file an appeal if they feel that there’s a good cause for missing the deadline. How long can the extension be? In some cases, lawyers have used this policy to argue for an extension years or even decades later.

On July 16, 2012, the Congressional Budget Office (CBO) issued a report, “Policy Options for the Social Security Disability Insurance Program.” The full report is available at https://www.cbo.gov/publication/43421. The report examines the “rapid” growth in the SSDI program; approaches to addressing the fiscal imbalance in the program; options to provide great support to SSDI beneficiaries; and possible approaches to making fundamental changes in the SSDI program. A more detailed summary of the article will appear in the July 2012 NOSSCR Forum. The report was made at the request of Senator Jeff Sessions (R-AL), the Ranking Member of the Senate Budget Committee. The CBO’s charge is to produce nonpartisan analysis of economic and budgetary issues to support the Congressional budget process. Below is a report summary.

The Social Security Disability System uses a Five Step Sequential Evaluation Process to determine disability. Disabled is defined as an inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

Under the five-step sequential disability evaluation process the following must be proved by a claimant in order to be found disabled:

The Social Security Disability system is vital to disabled workers as it is frequently the only financial resource that keeps them from living in abject poverty. The benefits of winning a SSD claim include not only monthly benefits but also eventually eligibility for Medicare.
Disability and the Sequential Evaluation

The Social Security Act provides that certain individuals who are under a disability shall receive disability benefits. The statutory concept of disability is comprised both of a medical and a vocational element. The Social Security Act defines the term disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. This is the medical component of the statutory definition of disability.

The Social Security Disability system online file access is improved for attorney representatives. One of the unique aspects of social security disability law is that representatives don’t have to be attorneys, however all representatives are held to certain standards. The National Organization of Social Security Claims Representatives (NOSSCR) reports that the Social Security Administration and its disability system have improved online access to disabled claimant’s SSD files if their attorney has registered with SSA:

The Social Security Disability system changes the rules of conduct for representatives. One of the unique aspects of social security disability law is that representatives don’t have to be attorneys, however all representatives are help to certain standards. The National Organization of Social Security Claims Representatives (NOSSCR) reports that the Social Security Administration and its disability system have issued new rules that representatives must follow: