"RECONSIDERATION" RAVAGES DISABILITY CLAIMANTS

Prior to March 2020, 10 states allowed denied Social Security disability claims to go directly to an Administrative Law Judge (ALJ) for a hearing.  The other 40 states required a process called "Reconsideration" first, where the denied claim goes back to the same office that denied it for a second "review" or "reconsideration."  Starting October 1, 2019, Alabama became one of states that requires "Reconsideration" before an appeal to a judge.  By March 2020, all 50 states and Puerto Rico require the "Reconsideration process."

The US Government performed an audit of the "Reconsideration" process to see how it effects Social Security claimants.  Here is that audit:

In 2015, 616,917 claims were denied. at Reconsideration.  Of that number, 86,400 (14 percent) gave up and did not take any further action, receiving no benefit.  530,500 (86 percent) appealed and went to a hearing before a judge.  Of these 530,500 claimants who went to a judge 290,000 (55 percent) were awarded benefits.

Note that the government saved money on the 86,400 claimants who gave up after "Reconsideration" and filed no further appeal.

How much does "Reconsideration" delay getting benefits?  In 2018, it took 79 days longer for a claimant to receive an award (approval) in states that used "Reconsideration."  In total, it took an average of 924 days to get an award in states using "Reconsideration.

So, this process makes the claimant wait an additional 79 days.  "Reconsideration" issues the wrong decision 55 percent of the time.

Why has the government required all 50 states to use this process?

The audit answers the question:  It saves the government money.  It will save $3.9 billion over a 10-year period (2019 - 2028),

A majority of that savings will result from the 14 percent of claimants who drop out or die after being denied at "Reconsideration" and file no further appeal.  So, it's all about saving money.

Based on this audit, the government fully knows that "Reconsideration" takes longer and results in incorrect decisions 55 percent of the time; yet, it has actively required the 10 states that did not use the stinking process to adopt it.  It saves money.

If you or I had a business operation that we knew made serious mistakes 55 percent of the time, on operations essential to our mission, and added 79 days to getting our job done, what would we do?  We would either change quickly or go out of business.  However, Social Security saves billions of dollars by with their ineptitude, according to the government audit.

It's difficult not to believe that the Social Security Administration is saving $3.9 billion because they know 14 percent of individuals making claims against them will die or quit after they are denied at "Reconsideration," although there is a 55 percent chance they could get benefits if they stuck to it and went to a judge. 

It is difficult for me not to see "Reconsideration" as a delaying process that eliminates a large portion (14%) of the claimant pool before getting to the place where an award can be made.

Instead of requiring the 10 states that did not use "Reconsideration" to start using it, Social Security should have required the 40 states that did use it to stop.  Again, if I owned 50 businesses and 10 of them were 55 percent less efficient than the other 10, what would I do?  I would try to make the 40 conform to the 10, not the other way around.

  "Reconsideration" should be eliminated.

I practiced in Alabama for years when we did not have "Reconsideration."  I can tell you that in every way, it has resulted in nothing but an unnecessary burden on disabled claimants, who are already burdened enough.  They wait 79 days longer for a decision than they should, and in 55 cases out of 100, the decisions they finally get are incorrect--denying benefits when they should have paid them.

WHY SOCIAL SECURITY MAY NOT SAVE YOU

WHY SOCIAL SECURITY MAY NOT SAVE YOU

 1 out of 4 Americans will become disabled before retirement age.  Most of us assume that if it happens, Social Security disability will save us.

That may not be true.

Social Security may not save your home.  You may lose your car.  You could become homeless unless you have family or friends to count on.  Here's why.

1.  Social Security does not pay the first 5 full months of disability (SSDI).  5 months is the mandatory exclusion or "waiting period."  You're on your own.

2.  It can take months or years to get a Social Security disability claim approved.  Very few are approved without an appeal.  In fact, very few are approved without at least 2 appeals.  I've seen claims drag on for 2 or 3 years with no payment.  If you've ever dealt with the government, you understand.

3.  You may never get approved for a Social Security disability check.  Just because you are not able to work does not necessarily mean that Social Security will pay you.

4.  If your disability claim goes well (I mean perfectly), you won't get paid for 6 months.  There's the 5-month waiting period that isn't covered.  Plus, Social Security plays one month in the arrears.  So add another month to get the first check.  6 months minimum.

5.  Social Security may not pay you enough to make ends meet.  The average Social Security disability benefit is about $1,250 per month.  For some families, that doesn't even cover the mortgage.

These are depressing facts--but worth thinking about.

So, what can you do to protect yourself and your family?  Here are 3 important things.

1.  Buy short-term and long-term disability insurance through your employer if it is offered.  These plans usually pay while you wait on Social Security and they pay even if Social Security denies your claim.  Many of my clients are surviving financially because they have disability insurance through their former employers.  It is absolutely life-saving.  And it's usually not expensive.  But get it now, while you can.

2.  Try to save enough for at least 6 months without income.  Figure out what your family budget requires for 6 months, and start saving.  Do it a little at a time if necessary.  Start a savings plan at your bank or credit union and contribute regularly.  Yes, it will hurt at first.  But not as much as a sudden loss of all income through disability.  Instead of buying a big screen TV or something with your tax refund, think about saving it. Same thing with your stimulus check!

3.  If you must file for Social Security disability, get an advocate or attorney professionally involved before your claim gets irrevocably messed up.  There comes a point when no attorney can help you.  Don't reach that point before you call someone.  If you're not ready to hire professional help, at least call someone for some free advice to get pointed in the right direction.

A little planning and effort before-hand can make all the difference when a sudden disability strikes.

IT'S THE THINGS WE DON'T PLAN FOR THAT ARE DISASTROUS.

 

YOUR SSDI CAN EXPIRE UNLESS YOU FILE YOUR CLAIM IN TIME

You stopped working a few years ago.  At the time, you didn't think about disability.  You just didn't feel up to the wear and tear a job was putting you through.

Years later, your condition worsens and you feel it's time to file a new Social Security disability claim.

Social Security tells you that your insured status for disability has expired.  Your Date Last Insured or DLI has already past.  What does this mean?

In simple terms, it may mean that you may have waited too long to file a claim.  You are no longer insured for disability by the Social Security Administration (SSA).

Social Security disability insurance (SSDI) is only for workers.  It does not insure the general public, but only workers who pay FICA through payroll deduction.  You must pay into Social Security to be covered by it, just like you must pay your car insurance or homeowners insurance to remain covered.

SSDI generally expires about 5 years after an individual stops working and stops paying FICA.  Like any other insurance policy that isn't paid, it expires.  The expiration date is called the "Date Last Insured," or DLI.  This applies to new claims.

Here is the general rule on coverage.  You must have worked at least 5 out of the past 10 years to be covered.

Let's say your DLI has passed.  You are no longer an insured person.  Can you still file a claim?

Yes, it may be possible.  Persons who are no longer insured by SSDI get one chance to file a new claim.  They are permitted to file one, and only one, new claim after their date last insured.  There is a catch, however.  They must prove that their disability began before their date last insured.

For example, if your DLI was 12/31/18, you must prove that your disability began prior to that date.  The further in the past your DLI was, the harder it will be to prove disability.

Think of it in the same terms as your automobile insurance.  If your car policy expired on 12/31/18, accidents occurring before that date are covered.  Those occurring after that date are not covered.  The accident must occur before the insurance expired.

SSDI insures against a worker's disability.  It stands to reason that disability must occur before the disability insurance expires.

How do you find out what your date last insured (DLI) is?  It's simple.  Call your local Social Security office and ask.  It's in their computer under your account and can be accessed in 1 minute or less.

Here's the point to take away from this discussion:  If you have stopped working and feel you are disabled, file an SSDI claim right away.  (You cannot file while you are still working at "substantial gainful activity").

TOUGHEST QUESTIONS AT A DISABILITY HEARING

Social Security hearings are held so a judge can look at the claim and decide whether disability benefits can be paid under the law.

A lot of the questions are routine:  your age, past work, when you stopped working, your highest level of education?

Some of the questions are....well....tough. Such as:

"If you had a job where you could rotate from standing to sitting as often as you want, had to lift nothing heavier than 10 pounds, and only had to make simple decisions--why couldn't you do that job?"

(This describes a sedentary unskilled job, which is usually what determines the decision for claimants under age 50).

Example of this type job would be:  ticket taker, hand packager, or parking garage attendant.

Factors that may keep you from being able to perform these type of jobs would include:

• severe, chronic pain
• inability to concentrate or remain on task
• inability to get along with supervisors or the public
• need to lie down a few times each day
• inability to use the hands for repetitive motions
• the need for a break more often than every 2 hrs.
• being absent more than 1 day a month due to illness.

Your attorney or representative will sit down with you prior to the hearing and help you truthfully answer the "tough" questions you may get during your hearing.

DISABILITY JUDGES IN ALABAMA & THEIR PAY RATES

Most Social Security Disability (SSDI) cases wind up before an administrative law judge, who will decide whether or not to approve and pay the claim.

The approval rate of north Alabama judges varies widely from judge to judge, as the following data shows:

ALJ	Approval Rate
Digby, Patrick R.	31.83%
Green, Gloria W.	56.59%
Grimes, James	N/Available
Lewis, Jason A.	52.44%
Richey, Mallette	38.30%
Weaver, Cynthia G.	17.17
Williams, Lori J.	36.43%
Wright, Douglas A.	73.56%

*Data from http://www.ssa.gov/appeals/DataSets/03_ALJ_Disposition_Data.html

The important thing is to be sure your case is prepared well and presented to the judge in the best manner possible.

Being properly represented plays a huge part.  

WHAT WILL A DISABILITY JUDGE CONSIDER?

Most people who apply for Social Security disability will wind up before a judge, who must decide if they qualify for benefits.  What type of things will the judge consider?

In addition to your medical record, there are several factors that a judge will look into:

1.  Your Work Record.  Judges like to see claimants who have a long, steady work history.  This gives the claimant a great deal of credibility.

2.  Are Other Family Members on Disability?  Judges don't like to see a household where multiple members of the family are on disability benefits.

3.  Have You Tried to Keep Working?  Judges will ask how you have tried to stay in the workforce.  They want to know about medical treatment, physical therapy, rehabilitation or looking for an easier job that you may still be able to perform.

4.  What Are Your Hobbies and Recreational Activities?  You say you are not able to work, but how do you spend your time?  Do you go to ballgames, hunt, fish, travel or engage in other hobbies?  Do these recreational activities indicate inconsistency with the idea that you are disabled?

5.  Do You Have Unreported Wages?  Judges want to know if you have worked "under the table."  They usually view this as dishonesty because no FICA or federal tax were paid on these earnings.  Such work may also indicate that a person really isn't disabled, since they have been working.

6.  Do You Have Transferable Skills?  You may have performed a job in the past that you are no longer able to do.  In that job you may have used skills that can be transferred to easier jobs that you can still do.  A vocational expert at your hearing will assess any transferable skills and the judge will decide how those skills affect a disability decision.
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THE FORSYTHE FIRM
7027 Old Madison Pike   Suite 108
Huntsville, AL 35806
CALL (256) 799-0297

Email Us:  forsythefirm@gmail.com

Free phone consultations available     No fees unless you win!

ARDMORE DISABILITY ATORNEYS & ADVOCATES

Ardmore, AL and Ardmore, TN are served by the Forsythe Firm, helping Ardmore residents get the Social Security disability benefits they deserve.

Sure, you could go to an out of town firm and hire someone you will never meet.  But why not hire an expert who lives and works near your home?  

We offer:

1) Local appointments right here in north Alabama.

2)  Free consultations by phone or in person.

3)  Contingency Fee:  You pay us nothing up front, and never pay us a fee until your benefits are paid.

4)  One advocate who will stay with you and your case until it is resolved.

5)  The ability to reach your managing advocate with one phone call.  Yes, we will answer you call.  Yes, we do return calls if you miss us.  We'll be here for you!

Some things Ardmore residents should know about Social Security Disability Insurance (SSDI):

1.  Denials are very common and do not mean that you can't get a benefit.

2.  Most claims are approved in the appeal process, not by filing an application alone.

3.  Most claimants choose to get professional help when trying to get benefits.

4.  You cannot be charged a legal fee if unless you win your claim.  Any fee charged by your attorney/advocate must come out of your back pay.  No back pay, no fee.

5.  If you initial claim is denied, you only have 60 days to appeal.

CONTACT THE FORSYTHE FIRM AT (256) 799-0297.

EMAIL US AT forsythefirm@gmail.com

DISABILITY COUNSELORS AND ADVOCATES FOR ARDMORE