Presentation Transcript

1. Social Security Disability

   Protecting Your Client’s Financial Rights Now & Prospectively The Social Security Disability Law Office of Stephanie O. Joy
2. Overview Why you need to recognize when Your Clienthas a valid Right to Claim How to recognize a Social Security-defined Disabled Client Prevalent Myths Debunked The Two Federal Programs and How They Differ The 5-Step Sequential Evaluation Process The Stages of a Properly Represented SSD/SSI Claim Hotspots The Social Security Disability Law Office of Stephanie O. Joy
3. I. Whyyou need to recognize when Your Client has a valid Right to Claim RIB Repercussions of not claiming when able – despite WC benefit or PI award Earlier is often better than later Term Insurance Remote DLI and evidence development problems SSI possible but… Back benefits limits Securing a Protective filing date Possible added evidence for a PI or WC case Earlier Medicare coverage or Medicaid coverage The Social Security Disability Law Office of Stephanie O. Joy
4. II. Howto recognize a Social Security defined “Disabled” Client The CFR: “The law defines disability as the inability to do 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.” http://www.ssa.gov/OP_Home/cfr20/404/404-1505.htm The Social Security Disability Law Office of Stephanie O. Joy
5. How, continued Inability to engage in substantialgainful activity (CFR § 404.1572) Catch 22: Doing it = Not disabled & SGA Medically determinablephysical or mental impairment Know your acceptable medical sources - http://www.ssa.gov/OP_Home/cfr20/404/404-1513.htm#a Expected to result in deathor… of not less than 12 months.” The Social Security Disability Law Office of Stephanie O. Joy
6. How, continued Practical Tips Has your client been out of work due to medical reasons (WC related or other)? - If Yes,Consider SSD. Knowing his medical file, can you reasonably expect him to be able to work 35+ hours a week in his old job now, or in the very near future, on a sustained basis? - If No, Consider SSD. If back to work or going back to work, was he out of work for over a year? - If Yes, Consider SSD (Closed case). Have you considered all of his medical problems, not just the ones involved in your case? If he has not yet left work, has he indicated that working the full day or full week is getting very, very difficult, due to pain, fatigue, or other symptoms? – If Yes, Consider SSD The Social Security Disability Law Office of Stephanie O. Joy
7. III. Prevalent Myths Debunked Permanency - Inability to work SGA need not be permanent. Durational requirement - The 12 month durational requirement need not have passed already, to file, so long as it is expected to last 12 months. Part time work - that is not SGA is not inconsistent, per se, with being disabled. Unemployment Insurance claim - is not per se inconsistent with a Social Security claim. Illegal aliens - are not permitted SSD benefits. SSD is not welfare. Alcohol or drug abuse is not an absolute bar to disability. The Social Security Disability Law Office of Stephanie O. Joy
8. IV. Two Federal Programs Social Security Disability Insurance Benefits Supplemental Security Income Title 2 (SSD, SSDIB, DIB) Medicare Insured status requirement and recent test Must be disabled as defined in the Act Income and resources are not factors Benefit amount is based on individual lifetime SS earnings up to maximum. Dependent benefits Can work and earn minimally without benefits loss. Waiting period Title 16 (SSI) Medicaid No Insured status nor work record requirement Must be disabled as defined in the Act Household income and resources limitations apply Benefit amount is capped at Federal benefit/unrelated to earnings No dependent benefits Near all working will reduce SSI benefit No waiting period The Social Security Disability Law Office of Stephanie O. Joy
9. V. 5-Step Sequential Evaluation Process Is client working SGA? (If Yes, not disabled) Is his medical condition “severe”? (If No, not disabled) Does his condition meet a Blue Book Listing? (If Yes, Disabled; if No, what is his RFC?) Can he do his prior work? (If Yes, not disabled) Can he do any other kind of work? (If Yes, not disabled; if No, claimant is disabled) http://www.ssa.gov/OP_Home/cfr20/404/404-1520.htm The Social Security Disability Law Office of Stephanie O. Joy
10. VI. The Stages of Paperwork of a Properly Represented SSD/SSI ClaimA. The Initial Application Initial Representation Documents – at a minimum: SSA-1696, Legal Fee Agreement (R) (sent by mail) Title 2 (SSD) claim – online for Title II orpaperSSA-16-BK (R) Title 16 (SSI) – in person or phone interview or SSA-8001-BK (R) If paper claim, add Disability Report – Adult (SSA-3368) and Work History Report (SSA-3369) (R) SSA Medical Authorization - (SSA-827) (R) Your firm’s HIPAA compliant release continued The Social Security Disability Law Office of Stephanie O. Joy
11. Stages, A., continued Your own specific RFC form – to obtain 1 or more MSSs Function Report (SSA-3373) Third Party Function Report (SSA-3380) Possible SSA ordered CE SSA orders medical records from sources noted on Disability Report (online or paper) plus after-provided medical providers The Social Security Disability Law Office of Stephanie O. Joy
12. B. Denial on InitialRequest for Reconsideration Stages, B., continued NJ enjoys a Reconsideration stage (PA/NY do not) Represented claimants: Attorney must file Appeal online (R) Unrepresented claimants: paper SSA-561 (Notice/Request for Reconsideration) & SSA-3441 (Disability Report – Appeal) New SSA-827 (R) Deadline: 60 days + 5 May be another request for SSA-3373 or CE SSA orders updated medical records Order CD of claimant’s SSA file from local FO The Social Security Disability Law Office of Stephanie O. Joy
13. C. Denial on ReconsiderationRequest ALJ Hearing Stages, C., continued For Attorneys: Same as if denied on Initial, must file appeal online for Appeal/Request for Hearing Before ALJ Pro Se Claimants: May use paper forms: HA-501 (Notice of Appeal/Request for Hearing before ALJ), SSA-3441 & new SSA-827 Order updated medical records: SSA does not order medical records; ODAR?... If no ERE/ARS access, request CD from ODAR The Social Security Disability Law Office of Stephanie O. Joy
14. Stages, C., continued Attorney orders medical records updates, not the SSA Can charge client for the expenses/charges Prepare a pre-hearing brief Analyze option of a requesting OTR Prepare client/witnesses for the hearing Request that hearing remain open for ____ Wait for written decision If denial after hearing, advise client on option of AC appeal v. option of new application The Social Security Disability Law Office of Stephanie O. Joy
15. VII. Hot Spotsto be aware of…. Work related injury? - May be an offset to SS benefit http://www.socialsecurity.gov/pubs/10018.html Workers Compensation settlement? - Medicare derived from Social Security beneficiary status may not cover WC related medical costs later – look into “set aside” requirements http://www.cms.gov/Medicare/Coordination-of-Benefits/Workers-Compensation-Medicare-Set-Aside-Arrangements/WCMSAP-Overview.html Veteran’s Pension? – May be reduced or eliminated upon receipt of Social Security Disability http://benefits.va.gov/PENSIONANDFIDUCIARY/pension/vetpen.asp Taxation? – Some portion of Social Security Disability may be subject to income tax http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/493/~/paying-income-tax-on-social-security-benefits Unemployment Insurance benefits? – Not an automatic bar to SSD or SSI, but be prepared for… The Social Security Disability Law Office of Stephanie O. Joy
16. VII. Hotspots continued SSD case involving a Workers Compensation case can result in No Attorney Legal Fee SSD case involving state welfare benefits, can result in No Attorney Legal Fee The Social Security Disability Law Office of Stephanie O. Joy
17. Official Resources BlueBook of Listings http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm Program Operating Manual System (POMS) https://secure.ssa.gov/apps10/ Social Security and Acquiescence Rulings (SSRs) http://www.ssa.gov/OP_Home/rulings/ Code of Federal Regulations (sections 404 & 416) http://www.ssa.gov/OP_Home/cfr20/ Hearings, Appeals & Litigation Law Manual (HALLEX) http://www.ssa.gov/OP_Home/hallex/ The Social Security Disability Law Office of Stephanie O. Joy
18. Stephanie O. Joy, Esq. The Stephanie O. Joy Social Security Disability Law Office East Stroudsburg, PA 18301 www.MySsiCase.com Ph: 201-317-0610 Fax: 888-550-7517 stephaniejoy@myssicase.com Stephanie Joy is a 1989 Economics graduate of Rutgers University and 1994 graduate of Seton Hall Law School. In her initial years of practice in New Jersey, Stephanie was a litigation associate in two New Jersey law firms, practicing insurance defense, personal injury and family law. She started her Morris County New Jersey general practice in 2000 and by 2005, after moving to Pennsylvania, made the decision to focus her practice exclusively on Social Security Disability matters. She represents clients in most of the 50 states, with a focus on those in the mid-Atlantic-to-northeast area. In addition to her practice, she provides Social Security consulting services for 3 firms and a large internet-based corporation. She is a volunteer E-mentor to Pennsylvania high school students, and in June 2013, participated in the American Cancer Society’s Relay for Life of Stroudsburg, as well as the ALS Association’s Somerset NJ Walk to defeat Lou Gehrig’s Disease, in Honor of her close friend, Morristown Sgt. Detective Elaine Stewart Tyrrell, who is currently contending bravely with an ALS diagnosis. She resides in Stroudsburg, Pennsylvania with her husband and two children. The Social Security Disability Law Office of Stephanie O. Joy