Monday, August 21, 2017
Monday, August 14, 2017
After being notified of a Social Security decision, a claimant has 60 days to file an appeal. If this deadline is missed, the claimant usually has to make an entirely new Social Security claim, but in some cases claimants are allowed to file late appeals.
The SSA will decide if a claimant has a “good cause” for filing a late appeal. “Good” causes include circumstances that prevent a claimant from filing an appeal on time, whether or not the claimant understood what needed to be done, whether or not SSA or CMS misled the claimant, and whether there was a physical, mental, educational, or language limitation that kept the claimant from filing a timely appeal.
Examples of “good causes” for the SSA to accept a late appeal include:
- If you were very sick when the appeal was due and you could not have contacted Social Security yourself or through anyone else. You will need to show that you were seriously ill; otherwise Social Security will find that you could have submitted the appeal paperwork on time or asked someone to do it for you.
- If there was a death or serious illness in your immediate family.
- If records that you needed for the appeal were destroyed by a fire or other accident. You will need to show that the records were destroyed close in time to the appeal deadline and that they were important to your meeting the deadline. For example, if your house burned down the week before your deadline and your denial notice was inside the house, you would have a strong argument that you had good cause for missing the deadline.
- If you were actively looking for evidence to support your claim but failed to ask for an extension of time before the deadline passed.
- If you or your lawyer asked Social Security for more information about its denial before the appeal deadline passed. You would have 60 days after Social Security gave you the additional information to file for reconsideration or for a hearing.
- If Social Security or CMS gave you incorrect or confusing information about appealing your claim.
- If you did not understand that you were required to file an appeal by the deadline or you were not able to appeal because of a physical or mental problem.
- If you did not receive a denial notice. You will need proof that you never got the notice. For example, if Social Security mailed the notice to the wrong address, and you had notified them of the right address, then they might find good cause for your late appeal.
- If you sent your appeal to another government agency within the time limit because you misunderstood that the appeal needed to be sent to Social Security, and the other agency did not forward your request until after the deadline.
- If there were any other unusual or unavoidable circumstances, and you could not reasonably be expected to have met the deadline.
To make a late appeal, you must attach a written document with the reason for the late submission to the appeal form. Social Security is obligated to consider your late appeal request, but has the right to deny the request if they find there is no good cause. Even if the request is denied, Social Security may consider the date you made a late appeal request as a protective filing date for the next time you apply for benefits.
Monday, August 7, 2017
Tuesday, August 1, 2017
Monday, July 24, 2017
Monday, July 17, 2017
Ms. S sought legal representation from a long term disability attorney after Cigna denied the continuation of her long term disability benefits. Ms. S worked at a desk job that required repetitive typing motions.
Fortunately, Ramos Law was able to help her win back her LTD benefits.
Prior to becoming disabled, Ms. S had worked at a large investment services firm until the pain in her hands made it impossible for her to continue with her job.
Ms. S had bilateral carpal tunnel syndrome, trigger finger in multiple fingers as well as other severe issues in her wrists and hands. Ms. S underwent several surgeries and physical therapy sessions for these debilitating conditions. Unfortunately, her hand pain persisted despite aggressive treatment. Ms. S also had several other health issues which caused pain in her back, hips, foot, and ankle. Ms. S complained of pain in her hands, hips, and back both while working and during her long drive to and from the office each day. Ms. S’s doctor also recommended elevating her foot and ankle intermittently throughout the day, which also significantly interfered with her ability to work at the office.
Like many other LTD plans, Cigna’s policy in Ms. S’s case provides disability benefits for a period of 24 months if she is unable to perform the material duties of her regular occupation or “own” occupation. In Ms. S’s case, Cigna denied the continuation of her long term disability benefits, claiming that she was physically able to her own job.
Attorney Ramos thoroughly reviewed Cigna’s denial letter and Ms. S’s entire claim file. He noted that Cigna’s medical and vocational reports contained numerous inconsistencies and did not take into account the progressive nature of Ms. S’s conditions. As part of the administrative appeal that was submitted to Cigna, Ramos Law obtained new medical opinions from Ms. S’s doctors as well as a thorough opinion from a vocational expert.
Hiring our own vocational expert in this particular case was extremely helpful. Through the use of a vocational expert, we were able to prove that Ms. S’s could not perform the material duties of her own job without requiring the use of her hands and fingers at least two thirds of the workday.
Through the use of a more recent medical opinion and a vocational evaluation, Ramos Law was able to prove that Ms. S’s conditions continued to meet the definition of disability under the terms of the policy provided by Cigna. Besides the inability to use her hands on a frequent basis, our appeal also provided substantial evidence which showed that, non-exertional limitations such as chronic back pain did not allow her to maintain the pace and concentration needed to stay on task in an office that deals with challenging financial information.
Once Cigna reviewed the documents that Ramos Law filed in support of Ms. S’s case, Cigna was forced to reinstate her long term disability benefits. Our paralegal Jessica Smith was informed by telephone that Cigna had agreed to grant our appeal and told that a retroactive check had been issued to Ms. S’s for the amount owed in back due benefits.