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Category Archives for Appeal issues

Denied at Hearing? Why You Shouldn’t Give Up!

Appeals Council judge reviewing ALJ denialOne of the most common misunderstandings I hear from clients and visitors to my Wednesday evening livestreams has to do with the role of the Appeals Council. As you may know, if the hearing judge (called the Administrative Law Judge or ALJ) denies your disability claim, the next level of appeal is called the Appeals Council.

Many people assume the Appeals Council is simply a next step in the process—a second chance to tell their story and hope for a different result.

That is understandable, but it is not quite right.

The Appeals Council does not act like a second ALJ. It does not rehear the case, and it does not decide disability from scratch. Its job is much narrower and more technical. In most cases, it is not looking for a better answer. It is looking for a legal mistake.

Understanding that difference can mean the difference between a strong appeal and one that is almost certain to fail.

What the ALJ Does

To understand the Appeals Council, it helps to first understand the role of the Administrative Law Judge.

At the hearing level, the ALJ is the main decision-maker. The ALJ represents the Commissioner of the Social Security Adminstration and serves as both the representative of SSA and the finder of facts in your case.  This is where the case is developed, reviewed, and decided. The ALJ listens to testimony, reviews medical records, weighs medical opinions, and decides what the claimant can still do despite their impairments. Continue reading →

The Disability Judge Ruled that One of Your Medical Impairments is “Non-Severe.” What Does this Mean and Why is it Important?

Recently I have noticed a trend at many of cases I am trying on behalf of applicants for Social Security disability. After listening to testimony, but before posting questions to the Vocational Expert, the judge will say something like this: “counselor, I am going to find that the [allegations of depression; breathing problems and COPD; knee damage and reduced range of motion in the left lower extremity; etc.] are non-severe impairments and thus will not be included in questions I ask to the vocational expert. Do you have any objections to this?”

What does this mean to you if you are the claimant appearing at a hearing like this?

The term “non-severe impairment” is a term of art in the Social Security world. When judges evaluate claims, or, more accurately, elements of claims, they are required by law to analyze your case using something called the “five step sequential evaluation process.” Continue reading →

Military Vet Approved for VA Disability, But Denied Social Security Disability

WXIA TV in Atlanta recently ran a story about a 53 year old U.S. Navy veteran who was approved for VA benefits but denied for Social Security.  Retired Navy vet Daniel Norfleat from Covington, Georgia was deemed 90% disabled and unemployable by the VA for PTSD, a heart attack, a stroke and knee surgeries.  Mr. Norfleat applied for Social Security disability and was approved, but SSA changed his onset date.

Norfleat appealed and his case went before a Social Security administrative law judge.  The ALJ not only refused to change the onset date but she reversed the finding of disability entirely and ruled that Mr. Norfleat has the capacity to work at a full time  job.  This despite opinions to the contrary from 15 different doctors and prescriptions for 24 pills a day for pain, depression and insomnia.

Under new rules released by Social Security, their judge no longer has to explain why she disagrees with the VA’s decision.  These new rules also provide that Social Security no longer has to give controlling weight to opinions about employability issued by treating physicians.  See my video here about these new evidentiary rules. Continue reading →

Social Security Disability Intends to Cut You Off: What Should You Do?

What should you do if you receive a notice from Social Security that they have reviewed your case and determined that your medical condition has improved such that you are no longer disabled, and that your benefits will be cut off as of a certain date?

This type of termination is being processed under something called a continuing disability review (CDR) and we are seeing more and more of these CDR termination notices.

First of all, do not panic. Under Social Security’s rules you will have an opportunity to contest SSA’s termination decision. You can also choose to continue receiving your benefits while the CDR evaluation process drags on – this can take a year or longer. Continue reading →

Social Security Eliminates “Treating Source” Rule – What does this Mean for You?

Effective March 27, 2017, Social Security has changed its long-standing policy about how it treats medical records and opinion evidence form your treating physician. Prior to March 27, 2017, evidence from your treating physicians would be given “controlling weight” by a Social Security adjudicator or judge.

Now, records and opinions from your long time treating doctors will be given no special weight. Instead, medical opinions from your treating doctor, consultative doctors and even non-examining medical consultants will be evaluated equally based on “persuasiveness.”

What does this change mean to you?

At first glance, this rule change seems to make no sense at all. Clearly a physician who has treated you for 10 years would have a more educated opinion about your capacity for work than a consultative doctor who met you once 2 years ago for 45 minutes, or a Social Security in house doctor who only knows you through his review of your medical records.

And, yes, there is a danger that a judge who has made up his mind not to approve your case will now have an easier time justifying a denial of your case. Continue reading →

No Jail if You Refuse to Use SSDI Money to Pay Court Ordered Obligations

contempt of courtThe Michigan Court of Appeals recently issued an interesting decision in a case called In re Robby Lampart about the right of a state agency to go after a claimant’s Social Security disability to enforce a criminal restitution order.  In a tightly written opinion which you can read here, the Michigan appellate judges held that a trial court could not use its power of contempt (i.e., putting a defendant in jail) to coerce that defendant to use Social Security funds to pay his obligations.

Usually, of course, the payment dispute involves child support rather than criminal restitution. My sense is that if other courts adopt the Lampart court’s reasoning in child support cases, custodial parents would not be able to use contempt actions to incarcerate disabled non-custodial parents although they could use contempt actions to find out what other assets that non-custodial parent might have.

Here’s what happened in the Lampart case.

Lampart’s mother, Diana Alexandroni, was ordered to pay criminal restitution of $28,210 at rate of $250 per month. The trial judge ordered Ms. Alexandroni to submit to a wage garnishment of $62.50 per week from her job with the funds payable to the State of Michigan. Continue reading →

SSA Overpayment Issues Can be Difficult to Handle

SSA overpayment claimIf you need a lawyer to help you with an overpayment issue, you are going to have a hard time finding help. Overpayment cases arise when Social Security discovers that they have paid you too much – sometimes for years – and now they want their money back.

In most cases, you will receive a letter that says something like this:

We are writing to give you new information about the disability/retirement/survivors benefits which you receive on this Social Security record. We have determined that you were overpaid in the amount of $30,000. Please refund this overpayment within 30 days.

An explanation of the overpayment will be included. And, to show that they have some compassion, they do include an envelope. If you do not send them the full amount due they will withhold your monthly benefit check for as many months as it takes to recover the overpayment.

Obviously if your Social Security money is your only source of income, this can be a huge problem.

An overpayment can happen for several reasons.

  • Perhaps you were found disabled then returned to work under the Ticket to Work or a trial work period program. Social Security may have continued to pay you disability benefits even after you returned to work.
  • You could be an SSI recipient whose income and resources exceeded the stingy limits of that program.
  • You could be a disabled widow who was receiving benefits under a deceased spouse’s earnings record and now you have remarried.
  • The mistake could have been on SSA’s end – they may have advised you that you were eligible for a particular type of benefit but later concluded that you were not so eligible.

Whatever the reason, it is probably a safe bet that you don’t have $10,000, $20,000 or whatever the overpayment number is claimed. What can you do? Continue reading →

Will I Win if the Judge Does Not Use a Vocational Witness or Medical Expert?

what are your chances of winning a case at a hearing when there is no voc rehab guy or medical specialist to assist the alj in a decision.
–Lamont

My response: Lamont, I think that yes you can win if the judge does not use a VE or an ME.   Here is how I would analyze:

First, what is the custom in your hearing office?  In Atlanta, where I practice, all but one or two judges regularly use vocational expert witnesses.  There are a couple of judges who almost never use them.   If a judge who always uses a VE hears a case without VE testimony, it most likely means that the issue is fairly clear cut one way or the other.

In the Atlanta hearing offices, judges rarely use medical experts – in my practice I would estimate that ME’s appear about 15% of the time.  The absence of an ME would be of less concern to me here in Atlanta. Continue reading →

Rheumatoid Arthritis Claimant Gets Denied – What Can She Do Next

I just got unfavorable decision for my SSI Disability and I can hardly walk or use my hands. I have RA and my doctor said I was permanently disabled. So why am I being denied?
– LaTrica

My response: LaTrica, firstly you should understand that there is an appeal you can filed to challenge the unfavorable decision.  In most jurisdictions, the appeal would be to the Appeals Council in Falls Church, Virginia.   In some limited jurisdictions the appeal would be directly to federal district court. Continue reading →

What to do if You are Getting the Run-around from your Lawyer’s Office

I frequently get emails from frustrated disability claimants who are upset at the long delays.  Often the claimant expresses frustration with his lawyer because of the delays.  Earlier this week, for example, I received an email from an individual who is suffering with a fairly significant medical problems and who is about to lose her home – she wanted to fire her lawyer and retain me.  I responded by telling the claimant that the delays were not her lawyer’s fault and to stay the course.  In that case, I happened to know the lawyer and I also told her that she had very capable counsel.

This morning I received a slightly different question about attorneys, which I will reproduce here:

I hired a law firm to help me with my disability appeal. I am at the ALJ stage and needed help filing that appeal, representing me at the hearing. It is going on 3-4 weeks of talking with the lawyers clerk about filing for me. They say they filed one day, then the next say they are going to be filing, this has gone on 4 times now. Although I have not talked to the actual attorney that will be representing me, I don’t mind as long as the person I do talk to knows what they are doing and are truthful about it. What advice can you give me to handle this situation? Should I fire this firm and find another? I appreciate your suggestions, thoughts, advice.

Thanks,
Leighann

My response: Leighann’s question raises a somewhat different issue than delays.  Here, the problem is lack of communication.  Since short (60 day) deadlines are involved, I think that Leighann has the right to be concerened about missing the deadline.

Bear in mind that not missing deadlines is topic #1 in any malpractice or lawyer discipline seminar.  Every law firm should have a solid calendaring system to insure that no deadlines are missed.

Given the run-around that Leighann has been getting, it may be time for becoming a bit more forceful in her communications.  I would advise her to get the name of the paralegal who is assisting her, then write a letter to the paralegal, with a copy to the lawyer who is the actual representative.  The letter should express her concerns (like she did in her email to me) and ask for a copy of the filed appeal paperwork.   Both copies of this letter should be sent by registered mail, return receipt requested.

I don’t know the law firm at issue, but if they handle Social Security cases regularly, I would be surprised if they did not have the appeal deadlines of their cases under control.  However, nothing gets the attention of a lawyer like a registered letter from a client inquring about possible missed deadlines.

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