Monday, December 30, 2013

Social Security Disability Calculators: How to Find Out Your SSI/SSDI Benefit Amount

As a Social Security Disability Lawyer my job is to prove that my clients are found "disabled" under the Social Security Disability rules.  This process involves a great deal of work dealing mostly with medical and vocational issues.  I rarely get to calculate the specific amounts that my clients will receive.  For the most part, mathematical calculations are beyond the scope of what I do.  However, very often clients ask me how they can find out what amount their disability benefit will be if their cases are granted.  In response to this frequent question, I will like to post some links to some very useful calculators, available online, that can help disability claimant's estimate their benefits.     
The first link is an SSI/SSDI Calculator App available at Google's Play Store.  You can download this App into your phone totally free of charge:
I find that this App is particularly useful when you are trying to determine how much money will be taken from your SSI payments if you receive earnings from part time work.  By using this App, you can make an analysis of how you will end up financially if you decide to take apart time job.  Download the App, use it, play with it, and let me know how it works for you.
In addition to this phone App, the Social Security Administration has several calculators in its webpage that can help claimants determine their benefit amounts:

Note that the SSA has more than one calculator available.  There are different calculators for different types of Social Security benefits.  This variety of calculators is particularly useful for older claimants who are planning their disability benefits in conjunction with their retirement.  This way they can calculate disability benefits and retirement benefits for their spouses.
Hopefully my readers will find these electronic gadgets useful.  Please let me know how well these calculators work for you.  

Monday, December 23, 2013

Holiday Wish List from The Connecticut Social Security Disability Lawyer Blog

I would like to extend my warm holiday wishes to all the faithful readers of the Connecticut Social Security Disability Lawyer Blog. 

First and foremost, let me point out that I have not missed a single blog this year!  This blog has been updated every Monday --with the exception of one week when it was updated on Tuesday because I was on vacation in Portland, Oregon. 

As I reflect on this past year, I realize that my practice has grown and that there are many changes coming to my office in 2014.  Here is a modest wish list of some of the things that I would like Santa to bring me, in my capacity as a Connecticut SSDI Lawyer.

Next year Santa will be bringing me a brand new office space in Hartford!  I expect to move to a place just two buildings down from where I am now.  I am really excited about this new development.  The new space will be bigger and much more comfortable. 

Santa is also bringing us lots of new gadgets.  We are in the process of acquiring a mega scanner.  This will help us continue with our shift to an office that is almost entirely electronic.  I love the fact that my office is paperless and that I can work and connect with clients from practically any location.  All this state of the art technology enables us to represent clients in practically any corner of Connecticut or Massachusetts.     
I would also like to install video conference equipment in our new conference room.  This way we can conduct meetings via Skype and, also develop educational materials in video format that we can then distribute to our clients via You Tube. 
And... last but not least, Santa will bring a fancy espresso machine for Jessica: our wonderful para-legal.

Monday, December 16, 2013

The Significance of "Episodes of Decompensation" in Mental Illness Cases

If you or someone you love is applying for Social Security Disability due to a mental health condition, it is likely that you might have heard the term: "episodes of decompensation".  This is an important term that it usually used in determining whether a claimant meets the listing for conditions such as:
  • schizophrenia
  • anxiety
  • bipolar disorder, or
  • depression.
The term episodes of decompensation refers to a point when a person's mental health deteriorates after previously being able to deal or manage the condition.  It is fair to say that an episode of the decompensation occurs when a mental health patient experiences a crisis or a sharp decline in their ability to function.   

It is important to properly document any episodes of decompensation experienced by a person who is seeking disability benefits.  Creating proper documentation of these episodes is perhaps one of the biggest challenges faced by Social Security Disability lawyers.  In many instances, we find that friends or relatives of the claimant tell us of an unusual mental health crisis that they witness but then, we find out that no one took the time and effort to document it.  For this reason, it is always beneficial to obtain mental health treatment whenever a claimant's mental health condition worsens.  Seeking medical treatment is the best way to insure that a proper record is generated, describing the specific nature of episode suffered by the claimant.    
As a general rule, a claimant must suffer an average of three episodes of decompensation in a year in order to meet the mental health listing.  Each one of these episodes should last at least two weeks.  However, the number of episodes required is not a 'black and white" type of rule.  Social Security will look at each case separately depending on the severity and duration of each episode and could grant disability benefits even when the specific requirements are not met. 

Monday, December 9, 2013

New Social Security Study Explains the "Explosion" in Disability Benefits

Its time to put all the misinformation regarding the Social Security Disability programs to rest.  Fraud or laziness are not the reasons for the explosion in Social Security Disability claims.  A new study conducted by two economist confirms, once again, that this rise in disability claims has been caused by the changing demographics of the American population.
A copy of this study can be found here.  Economists David Pattison and Hilary Waldron examined 36 years of demographic data and made the following findings:
We find that three factors—(1) population growth, (2) the growth in the proportion of women insured for disability, and (3) the movement of the large baby boom generation into disability-prone ages—explain 90 percent of the growth in new disabled-worker entitlements over the 36-year subperiod (1972–2008). The remaining 10 percent is the part attributable to the disability “incidence rate.” Looking at the two subperiods (1972–1990 and 1990–2008), unadjusted measures appear to show faster growth in the incidence rate in the later period than in the earlier one. This apparent speedup disappears once we account for the changing demographic structure of the insured population. Although the adjusted growth in the incidence rate accounts for 17 percent of the growth in disability entitlements in the earlier subperiod, it accounts for only 6 percent of the growth in the more recent half. Demographic factors explain the remaining 94 percent of growth over the 1990–2008 period.

The "disability incident rate" was lower between 1990 to 2008 than it was between 1972 to 1990

The most significant part of this report is the section where the authors discuss the actual "disability incident rate".  This is the rate at which disability claims increased if one takes the demographic changes out of consideration.  This factor is extremely important because it can shed light as to whether factors other than demographics (i.e. fraud, abuse or lax application of the rules for eligibility) are causing the disability claims to raise.  For this reason, the authors of the study found that it was important "to be able to calculate an incidence rate that shows the changes in disability incidence that are not due to the shifting age composition of insured workers". 
The report found that the "disability incidence" rate has been falling over the past 18 years; not "skyrocketing" or "exploding" as critics of the Social Security Disability programs suggest.   
Pattison's and Waldron's work is specially important at this particular moment, when SSDI is under heavy attacks from uninformed critics like Sen. Tom Coburn from Oklahoma.  The Republican Senator went  on "60 Minutes" and, in a sensationalistic fashion, exclaimed out loud: "where all the disabled people came from?".   Well, Senator, here is the answer!  Read the study!  The Senator's suggestion that the increase in disability claims was a result of fraud or laziness was completely shameful and baseless.

Monday, December 2, 2013

Obtaining Social Security Disability with Interstitial Cystitis

Interstitial Cystitis, which is also called IC or Painful Bladder Syndrome, is a chronic and painful inflammatory condition in the wall of the bladder.  Social Security does not have a specific listing for this condition, however there are different ways that you may be found eligible for Social Security Disability Benefits due to IC.  

Interstitial Cystitis is extremely painful.  Some of its symptoms are:
  • Frequent urination
  • Feelings of pain and pressure in the bladder, the pelvis or the genital areas
  • Pain during sex
  • Men suffer from pain and discomfort in the penis and the scrotum
  • In most women symptoms get worse around the menstrual cycle

The diagnosis of IC is a difficult one.  Doctors usually make the diagnosis of this condition by excluding all other possible illnesses.  This is in part why social security issued a ruling to address the methodology to be followed by the agency when faced with a case involving Interstitial Cystitis.  (See SSR 02-02p) 

Since there isn’t a listing for Interstitial Cystitis, most Social Security Disability cases dealing with this condition will be evaluated at step 4 and step 5 of the Social Security sequential evaluation process.  At step 4, the claimant must be able to prove that the condition prevents him or her from doing the work performed during the past 15 years (past relevant work).  If you are not able to perform past relevant work, then Social Security will consider your limitations, such as how long are you able to sit without pain, which can make a sedentary job impossible. Pain can also make physical work like lifting or carrying difficult. Side effects from medications, including fatigue and dizziness, may also impact your ability to perform physically at work.  Based on your age, your education and your skills Social Security will then determine at step 5 of the sequential evaluation process whether you still have the capacity to do other work.  If you are not able to do any other work do to your limitations, you will be granted Social Security Disability Benefits.

Monday, November 25, 2013

Sen. Elizabeth Warren's Corageous Speech in Support of Social Security

As a Social Security Disability lawyer who represents claimants in Massachusetts, I am honored to count on a U.S. Senator who is not afraid to support Social Security.  At a time when Social Security is coming under attack, Senator Elizabeth Warren has taken the courageous step of pushing for an expansion of benefits.   
"Social Security works -no one runs out of benefits and the payments don't rise and fall with the stock market,"  Warren said in a speech at the Senate floor.  Warren was particularly brave in that she not only criticised conservative voices such as the Washington Post, but she was also critical of President Obama's plan to change the way that Social Security benefits are calculated by tying them to a different gauge of inflation known as the chained CPI.  The Senator said that using this type of measurement would not keep pace at which the beneficiaries' cost of living.
This defense of Social Security by Senator Warren is much needed at a time when many conservatives voices in Washington are pushing to cut Social Security programs, including Social Security Disability.  Senator Warren is not alone in her fight: Senator Harkin from Iowa, Senator Begich from Alaska and Senator Sanders from Vermont have been working to introduce legislation that would expand this vital program. 
Thank you Senator Warren for fighting to expand Social Security!

Monday, November 18, 2013

The Transferability of Skills Issue at Step 5 (SSR 82-41)

When a claimant is unable to do the work that he or she has performed in the past 15 years, Social Security must then determine whether the claimant will be able to transfer his or her skills to another occupation.  Social Security must review the issue of transferability of skills in light of a claimant's vocational abilities as well as age and education.  In order to provide a more uniform and fair adjudication of the question of transferability of skills, Social Security issued SSR 82-41.  This ruling sets forth some very detailed guidelines that must be used in order to determine whether a claimant, who can no longer perform past relevant work, can perform other jobs in the national economy. 
In this blog, I will to summarize some of the most important aspects of SSR 82-41.  In addition, I would like to point out some of the most important concepts that Social Security Disability Lawyers and their clients must keep in mind whenever the issue of transferability of skills comes up in a case.   
1.  Clearly explain the nature and the skills of all the jobs performed by the claimant in the past 15 years.  Go in depth and explain what the claimant was doing in each job and state what skills were used in the performance of this work.  Note that SSR 82-41 states: "job titles, in themselves, are not determinative of skill level."  Therefore, don't allow the vocational expert to make assumptions on skill level based on broad or imprecise job descriptions.
2. Skills can only be transferred to other jobs at the same skill level or a lesser skill level.  When a vocational expert testifies at the hearing, it is important to take down the DOT code numbers of any jobs identified as possible jobs that the claimant can perform.  Watch out, in some instances, the jobs identified by the VE are at a higher level of skill that the ones previously performed by the claimant.
3.  Skills can only be transferred to other occupations that use "similar tools and machines".  Therefore, it is a good idea to spend sometime asking the claimant about the type of equipment used at his former workplace.  Some very creative arguments can probably come out of such a line of questioning.
4.  Skills are generally transferable to jobs using "the same or similar raw materials, products, processes or services are involved."  However, SSR 82-41 states that an exact similarity of all these factors is not required. 
5.  Don't forget the medical factors. If factors such as cognitive problems and visual disturbances affect a persons ability to transfer to something new, make sure to point it out.  SSR 82-41 specifically states that these factors must be considered in making a determination of transferability.
6.  Age matters greatly.   For example, a 60 year old machinist (medium strength work) who no longer can perform his occupation will likely be found disabled even if he can still perform light strength work.  "For a finding of transferability of skills to light work for persons of advanced age who are closely approaching retirement age (age 60 or older), there must be very little, if any, vocational adjustment required in terms of tools, work processes, work settings, or the industry."  SSR 82-41

Monday, November 11, 2013

Veteran's Need Us to Protect Social Security Disability Benefits

Today is Veteran's Day.  Lets honor veterans by strengthening our Social Security disability system for current and future generations. 
American veterans need action not empty rhetoric.  Veteran's need us to protect Social Security Disability programs in the midst of all the recent attacks against a safety net that has been vital to them and their families.  Any cuts in Social Security will make life harder than it already has been for the 22 million veterans in the U.S.
Did you know that 1 in 5 adult Social Security beneficiaries is a veteran?  Vets and their families make up more than a third of the Social Security beneficiary population. 
Currently, there are 3.2 million disabled veterans.  As a Social Security Disability Lawyer, I have seen how difficult it is for veterans to obtain disability benefits.  I have also seen how severely American Servicemen and women have by affected by the wars in Iraq and Afghanistan. 
According to a news story published today "The numbers are staggering- more than 1,600 Afghanistan and Iraq war veterans have lost limbs. Over 156 are blind.  More than 177,000 have suffered hearing loss and upwards of 200 need face transplants.
Also, this doesn’t cover the number of silent troops- the ones who experienced horrific things and haven’t spoken up."
Click here to read an article about the importance of Social Security for Veteran's.

Monday, November 4, 2013

Do I have to be a U.S. Citizen to get Social Security Disability?

I am often asked whether a person needs to have U.S. citizenship in order to be able to receive Social Security Disability benefits.  The answer depends greatly on the type of Social Security Disability program that is being applied for.  In previous blogs, I have explained that there are two Social Security Disability programs: SSDI and SSI: 
The Social Security Disability Insurance (SSDI) program pays benefits to you, if you worked long enough and paid Social Security taxes.  On the other hand, Supplemental Security Income (SSI) is a “welfare type of program” that pays benefits to disabled adults and children who have limited income and resources.
When it comes to citizenship requirements, different rules apply to each program:

Citizenship Rules for SSDI:

A person can receive SSDI as long as he or she is lawfully in the United States.  Therefore, a claimant does not have to be a U.S. Citizen in order to be eligible for benefits.  SSDI is based on contributions made by workers in to the Social Security Trust Fund. SSDI is not public assistance or welfare.  This is a benefit that a worker earns based on their contributions.  Typically, a person must work at least 5 out of the last 10 years to be able to qualify for SSDI.

Citizenship Rules for SSI:

A noncitizen may receive Supplemental Security Income (SSI) if the person meets the requirements of the laws for noncitizens that went into effect on August 22,1996 and all the other requirements for SSI eligibility, such as the limits on income and resources.  Under some circumstances, Cuban and Haitian refugees, as well as other political refugees, might be eligible for SSI.

Monday, October 28, 2013

Social Security Increase Will be Low, Once Again

For a second year in a row Social Security increases will be historically low.  Preliminary figures put the raise at about 1.5 percent.
Next year’s raise will be smaller because consumer prices haven’t gone up much in the past year, according to figures from the government. The exact size of the cost-of-living adjustment (COLA) won’t be known until the Labor Department releases September’s inflation report.
The report was supposed to be published on October 9th, but the news media has stated that the government shutdown delayed it. The COLA announcement is made in October, so that Social Security and other benefit programs have time to adjust their January payments.
While the shutdown has delayed and halted several projects, reports, and payments, social security benefits haven’t been affected. The Social Security Administration hasn’t indicated whether raises will be delayed because of the shutdown either.

Monday, October 21, 2013

4,000 SSDI Cases Will Have to Be Heard "All Over Again" Due to Bias By Judges in Queens

A lawsuit alleging that five administrative judges in Queens, N.Y. were biased against Social Security Claimants has been settled by the federal government.
Under the terms of the settlement approved by Chief Judge Carol Bagely Amon, the five administrative law judges will undergo new training and will be monitored for 30 months. 
The SSA has not provided any figures about exactly how many cases in Queens will get a fresh hearing. But the lawyers who fought the lawsuit on behalf of plaintiffs in Queens estimate that there are at least 4,000 cases that are eligible for a new hearing based on the period of the settlement agreement, which states fresh hearings for all claims denied by the five judges between Jan 2008 and the date of the settlement.
"Thousands of disabled workers suffering from financial hardship and declining health will now receive long overdue consideration of their claims, said Emilia Sicilia, director of the Disability Advocacy Project at the Urban Justice Center.
Plaintiffs’ case was proven based on statistics. The rejection rate for the Queens ALJs was the highest in New York State and the third highest in the nation. The rejection rate for Queens was twice as high as the adjacent borough of Brooklyn. Both boroughs are located on Long Island, NY.
Also, the Queens ALJ approval rates for applicants who were immigrants and had been low-income citizens were very different from those who came from a higher income bracket.

Monday, October 14, 2013

What is the "Onset Date" in a Social Security Disability Case?

Even when you are represented by a lawyer, it is good to be aware of some of legal terminology used by lawyers and judges in Social Security Disability cases.  One of the terms that I have noticed that many of my Social Security Disability clients get confused with is the term "onset date" or "disability onset date".
The "disability onset date" or the "DOD", as some disability examiners call it, is the date when a claimant has enough medical evidence to prove that he or she meets the definition of disability under the Social Security rules.  The definition of disability under Social Security is very strict and is very different from other programs.  No payments are payable under Social Security for partial disability or for short term disability (less than 12 months).  Therefore, it is important to note that the onset date is not necessarily the date when a person was diagnosed with an illness or condition or, when the person began to feel sick or limited by a disease or physical injury.  The onset of disability is the date when the condition finally prevented the claimant from working. 
There is often a gray area as to when a condition prevented a person from working.  This is why Administrative Law Judges (ALJ's) often raise this issue at the hearing.  At this point, I find that it is very helpful if my client is fairly well acquainted with Social Security rules, particularly with the term "onset date".  Judges often may request that a different (usually later) onset date be used in order to allow a favorable decision.  Amending the onset date at the hearing is in some circumstances something positive.  In many instances, an amended onset date results in a favorable decision.  However, the claimant gives up past due benefits owed between the original onset date requested and the amended onset date. 

Monday, October 7, 2013

60 Minutes Story About Social Security Disability was Inaccurate and Misleading

I was going to spend part of this afternoon writing a Blog rebutting the shameful attacks made in last night’s 60 Minutes story.  The television segment sought to portray Social Security Disability beneficiaries as freeloaders who are gaming a system that is “ravaged by waste and fraud”. 

However, as I was preparing to write, I was “interrupted” by a visit to my office from Carlos, a client who has an SSD hearing coming up this November.  (I have changed my client’s name for obvious confidentiality reasons.)  Before Carlos came to my office, I thought that I was going to write a blog pointing out all the statistical reasons why there has been an increase in Social Security Disability claims.  Among other things, I was going to explain that 60 Minutes misrepresented the number of Social Security Disability beneficiaries and that the reason for the increase in claims stems from demographic changes in our society. 

More importantly, I was also going to explain that it is inappropriate to use mere anecdotal statements to criticize a program as important as SSDI.  As an advocate for the disabled, I maintain that it is incorrect to draw broad conclusions from a few sensational stories of fraud or abuse.  Then, as Carlos’ visit was about to end, it occurred to me that instead of writing about numbers and statistics, I should write a blog that gives Mr. Kroft, Senator Coburn, and the rest of the CBS crew a taste of their own medicine.  Why not write a Blog about Carlos’ ordeal with the Social Security Administration?  Why not blog about a real life anecdote of what an SSD claimant goes through?  This is precisely the most important perspective that the 60 Minute story failed to portray.  It is appalling that they did a piece criticizing Social Security Disability claimants without interviewing a single disabled person.

As I helped Carlos get out of his chair and ushered him carefully to the front door for fear that he might fall, I became and angry and wondered: “Why isn’t Steve Kroft here filming this?  Why doesn’t he come over to Hartford and Springfield and film the dozens of Carlos’s that are desperately waiting to receive benefits?  Why doesn’t Kroft have the courage to stand in front of people like my client --who lives in constant pain and has obvious difficulties walking--, and ask in his FoxNewesque and arrogant tone: “Hey Carlos, isn’t it really easy to get SSDI benefits?”  

The story that Kroft would get from people like Carlos is far more convincing that the campaign of hate waged against the disabled by a few powerful figures like Senator Coburn.  Carlos’ story is the farthest thing from that of a person who is trying to “game” the system.  Before Carlos became injured, he was a driver of eighteen wheeler trucks.  He put in many hours of overtime, driving all over the snowy roads of Western Massachusetts and Worcester County.  (He got badly injured in an accident.  His shoulder is now almost completely frozen.)   He is the proud father of two children.  No one can call him a freeloader.  In fact, after driving trucks, he went to school to learn how to be a diesel mechanic.  He eventually found a higher paying job fixing large trucks.  Unfortunately, he got reinjured shortly after starting the mechanic job and, after thinking it over for a long time, he had no other option but to apply for disability.

As Carlos was leaving, he asked the usual litany of questions that most my clients ask me: why do people like me have to wait two years to get to a hearing?  Do you think we will win the case?  Will I get food stamps? 

I should not have to listen to these questions all by myself.  Is there anyone from the news media willing to join me?  Forget about CBS; they have lost all credibility.  Are there any responsible journalists brave enough to listen to the questions raised by those who have been abused by the Social Security Disability bureaucrats?  Are they willing to talk to thousands of people like Carlos whose voices are not being heard?

Important note: Michael Hiltzik a Pulitzer winning business columnist for the LA Times has written an outstanding article debunking the baseless allegations made by 60 Minutes and Republican Senator Tom Coburn.  Please read: “60Minutes” A Shameful Attack on the Disabled.

Monday, September 30, 2013

How I Win Social Security Disability Benefits for Claimants Over 60

The Social Security Administration acknowledges a basic precept of the human condition: the older we get, the harder it is for us to perform certain types of work and re-adapt to the requirements of a new job. In fact, Social Security Disability law provides special guidelines for persons over 60 who are seeking disability benefits. Here are some of the basic strategies that I use to win Social Security Disability Benefits for claimants over 60.
Social Security Disability rules regarding age are contained in the Medical Vocational Guidelines, which are rules used by the Social Security Administration to determine whether an applicant can adapt to a new job. Social Security Disability Lawyers commonly referred to these rules as: "the Grids".

Once a person turns 60, the Grids play a pivotal role in the Social Security Disability Process. In many instances, the Grids specifically establish that certain applicants qualify for Social Security Disability Benefits as a matter of law. For example, if your condition limits you to sedentary work but have not had a “sit down” job in the past 15 years and you are 60 or older, you have very good chance of winning benefits.

Age makes a huge difference in determining disability. Based on the Grids, a person that can only do simple sedentary work at 48, will loose, but would have a much better chance of obtaining Social Security Disability Benefits at age 60.

Social Security Rules call claimants between 60 to 65: “Claimants Closely Approaching Retirement Age”.  In determining whether a person is disabled, Social Security must determine whether the claimant who is unable to perform the work that he or she has performed in the past, has skills than can be transferred to another occupation. SSR 82-41 sets forth a very strict transferability standard in situations where a Claimant is Closely Approaching Retirement Age (60 to 65 years old).  SSR 82-41 states:

 [T]here must be very little, if any, vocational adjustment required in terms of tools, work process, work settings, or the industry.
[J]ob duties of their past work must be so closely related to other jobs which they can perform that they could be expected to perform these other identified jobs at a high degree of proficiency with minimal amount of job orientation.

Therefore, a claimant who is over 60 is likely to be found disabled if he or she needs to take special training or has to make special job adjustments in order  to find a new job.
As an attorney, I use the legal presumptions contained in the Grids to help persons over 60 win their Social Security Disability Benefits. If you are considering filing for Social Security Disability Benefits or would like to know how your age might impact the possibility of obtaining benefits, feel free to call me at (855) WIN-Ramos or (855) 946-7266  and ask for a free case evaluation. You may also fill the brief questionnaire at the top right corner of this page and submit it to my office. I will try to get back to you within 24 hours.

Monday, September 23, 2013

Social Security Announces New Mobile Site for Smartphone Users

Carolyn W. Colvin, Acting Commissioner of Social Security, announced that the agency is offering a new mobile optimized website, specifically aimed at smartphone users across the country.  People visiting the agency’s website,, via smartphone (Android, Blackberry, iPhone, and Windows devices) will be redirected to the agency’s new mobile-friendly site. Once there, visitors can access a mobile version of Social Security’s Frequently Asked Questions, an interactive Social Security number (SSN) decision tree to help people identify documents needed for a new/replacement SSN card, and mobile publications which they can listen to in both English and Spanish right on their phone.
“We are committed to meeting the changing needs of the American people and the launch of our new mobile site helps reinforce our online presence and adaptability to advances in technology,” Acting Commissioner Colvin said.  “I encourage all smartphone users looking for Social Security information to take advantage of our new mobile site.”
In addition, visitors to the new mobile site can learn how to create a personal my Social Security account to get an online Social Security Statement, learn more about Social Security’s award-winning online services, and connect with Social Security on Facebook, Twitter, YouTube, and Pinterest. For people unable to complete their Social Security business online or over the telephone, the agency also unveiled a new mobile field office locator. The new mobile office locator has the capability to provide turn-by-turn directions to the nearest Social Security office based on information entered by the person.
“With significant budget cuts of nearly a billion dollars each year over the last few years, we must continue to leverage technology and find more innovative ways to meet the evolving needs of the American public without compromising service,” said Acting Commissioner Colvin.
Each year, more than 35 million Social Security web page views come via smartphones.

Monday, September 16, 2013

Social Security is Now Accepting Claims for Same Sex Couples

Following the recent U.S. Supreme Court Decision in United States v. Windsor, the Social Security Administration has announced that it will begin processing Social Security claims for same sex couples.      
In the coming weeks and months, the Social Security Administration will be working with the Department of Justice to develop and implement additional policy and processing instructions. If you believe you may be eligible for Social Security benefits, we encourage you to apply now to protect you against the loss of any potential benefits.  Applying as soon as possible will establish a “protective filing date”; while waiting to file might end up costing benefits to claimants.
However, it appears that it will take a long time before the SSA establishes a new policy for processing these claims.  Anything that the SSA does must first be approved by the Department of Justice. 
SSA’s website has a link to information for same-sex couples:

Monday, September 9, 2013

Can I Expedite My Social Security Disability Hearing Due to "Dire Need"?

A client who is on the verge of loosing her house due to foreclosure recently asked me whether I could write a "dire need" letter requesting that her case be expedited. 
Unfortunately, a large percentage of my Social Security Disability clients endure great financial hardship as a result of the long period of time that they must wait to have their case adjudicated by an Administrative Law Judge.  Many spend up to two years sick and without any income; waiting for a hearing.  Under certain circumstances, it might be appropriate to write a "dire need letter" to the Office of Disability Administration and Review (ODAR) handling your Social Security Disability case, explaining the reasons why there must be an early review of your claim.   
Pursuant to Hallex 1-2-1-40 expediting a hearing for dire need is appropriate when a claimant is without (and unable to obtain) food, medicine or shelter.  Note that dire need is much more than mere hardship.  Mere allegations of hardship that are common to must Social Security Claimants will not be sufficient to expedite a Social Security Disability hearing.
All dire need letters must be accompanied with detailed documentation showing the specific circumstances-- (not general allegations of financial hardship).  Hallex 1-2-1-40 Section 4.b. states:
"The claimant must allege specific, immediate circumstances: (1) lack of food (i.e., without and unable to obtain food), (2) lack of medicine or medical care (e.g., the claimant expresses that he/she needs medicine/medical care but is without and unable to obtain it; the claimant does not have any health insurance, or indicates that access to necessary medical care is restricted because of lack of resources), and/or (3) lack of shelter (e.g., shut-off of utilities such that home is uninhabitable, homelessness, expiration of shelter stay, or imminent eviction or foreclosure with no means to remedy the situation or obtain shelter)."

Monday, September 2, 2013

The Labor Day Issue: The Sail CT Access Program

I have worked very hard at updating the Connecticut Social Security Disability Lawyer Blog on a weekly basis.  Today is Labor Day and I figure that it is OK to blog about a subject that is a bit lighter than my usual Monday night commentaries about the fascinating world of Social Security Disability Law in Connecticut and Massachusetts. 
This week I want to tell you about my sailing trip with a wonderful group --called CT Sail Access-- that offer persons with special needs the opportunity to enjoy sailing.      
As my readers know by now, from time to time, I like to use this blog to acknowledge the work of organizations in our community that are helping persons with disabilities and/or chronic illnesses.  I was very well impressed with CT Sail Access and encourage my readers to visit their site at and, consider volunteering and/or participating in their programs. 
As a Social Security Disability Lawyer I hear many unfortunate stories of how my clients have lost the ability to enjoy the outdoors as a result of their disabling conditions.  This organization allows persons with disabilities the opportunity sail a fully adapted and equipped sailboat: allowing "challenged persons to move beyond disabilities so that they may focus on abilities".


Monday, August 26, 2013

How a Symptom Diary Can Help You Win Your Social Security Disability Case

As a Connecticut and Massachusetts Social Security Lawyer, I often recommend that my clients keep a symptom diary.  A symptom diary can be kept in many different formats: journals, calendars, charts and spreadsheets.  Now, there are even some great phone apps that allow patients to routinely keep track of their symptoms!  
A symptom diary can be particularly useful in a social security disability hearing.  Judges often ask questions about a claimant’s limitations, particularly with respect to certain daily activities such as: sitting, standing, walking, lifting and carrying. The more specific details and descriptions a claimant tells the judge, the more credible his or her testimony will be.  A good diary can assist a claimant when testifying about symptoms that occurred several months or even years before the hearing.
As I explain to all my clients, in Connecticut and in Massachusetts, it takes about a year to get in front of a social security judge from the date that the request for a hearing is made.  (It usually takes about two years to get a hearing from the date of the initial application.)  For this reason, a good diary can help improve the accuracy of your testimony.
One of my disability clients recently had a great experience using an android app to keep a record of his symptoms.  The name of the app is called: “Manage my pain” and it can be downloaded at  I welcome any feedback regarding this app.  Please let me know if you think it is helpful, whether it is user friendly and whether the free version gets the job done as well as the one that you have to purchase.

Monday, August 19, 2013

Social Security Will no Longer Use the Term "Mental Retardation"

In a final rule published in the Federal Register on August 1, the Social Security Administration (SSA) announced that it will abandon the use of the term "mental retardation" and adopt the term "intellectual disability" in its Listing of Impairments used to evaluate claims involving mental disorders in adults and children and in other appropriate sections of its rules.  
The change in language adopts the term that Congress unanimously agreed to in October 2010 when it passed Rosa's Law.  The law stripped from federal health, education and labor policy reference to "mental retardation" and "mentally retarded" and replaced these terms with "Intellectual disability" and "individual with an intellectual disability."  The law was named for Rosa Marcellino, a Maryland girl with Down syndrome. 
Although SSA was not part of the mandate in Rosa's Law, its new regulation acknowledges the negative connotations and misunderstandings about the nature of the disorder, and recognizes the importance that such a name change can have on public understanding.

Monday, August 12, 2013

Our Office will be at the Charter Oak Health Center's Fair

Our office will be at the Charter Oak Health Center's Annual Health Fair.  Stop by our table to learn more about the services provided by the office to Social Security Disability claimants.  We will be giving away key chains with our office logo.  (See pictures below.)
On Wednesday, August 14th, and Thursday, August 15th, 2013, Charter Oak Health Center will be hosting its annual health fair event, which will take place in front of 21 Grand Street (located between Hungerford and Parks Street), Hartford. This two-day event will take place from 10:00 a.m. to 3:00 p.m.
Charter Oak Health Center’s health fair is interactive, fun, and worthwhile event to promote healthy lifestyle choices, health education, and preventative medical care for greater Hartford’s residents. The event showcases health-related resources within our local community, plus free healthcare screenings and opportunities to talk with health professionals in different fields of expertise.
Event exhibitors include health care and social services agencies providing health screenings for STD and HIV, blood pressure, sugar, glucose, vision, cholesterol, dental screenings, health-related educational information, nutritionists, and of course our FREE farmer’s market. The celebration also features live music from Hot 93.7 on Wednesday, La Bomba 97.1 on Thursday, and return of the very popular photo booth, airbrush tattoo artists, and face painters!

The free key chains are back by popular demand!  

Monday, August 5, 2013

Winning a Closed Period SSDI/SSI Case

Last week, a Social Security Disability Judge ruled in my favor in a "closed period case".  A closed period is a term used to describe a Social Security Disability claim involving a claimant who is granted benefits for a fixed period of time.  Asking for a closed period, rather than for ongoing benefits is usually a wise strategy for winning benefits.
It is a good idea to exercise this option when there isn't enough medical evidence to show that the disabling condition will continue for an extended period of time.  Unfortunately, in many instances claimants loose their health insurance and can no longer afford the medical treatment necessary to show an ongoing condition.  In these circumstances, I often encourage my clients to consider asking that their benefits be granted for the specific time period that they were unable to work as a result of their physical or mental condition.  
Many judges seem to look favorably at closed period cases due to the fact that claimants who are willing to go back to work after a long injury or illness are presumed to be honest when testifying about the severity of their symptoms.  Closed period cases are also favored because these claims impose less of a financial burden on the Social Security Trust Fund.
It is important to note that to be eligible to receive benefits for a closed period, a claimant must show that his or her disability lasted a period of 12 consecutive months or more.  As I have indicated in previews blogs, Social Security Disability Benefits are not granted on a short term basis.

Monday, July 29, 2013

What is Considered a "Substantial Gainful Activity" by the Social Security Administration?

To be eligible for disability benefits, a person must be unable to engage in substantial gainful activity (SGA). A person who is earning more than a certain monthly amount (net of impairment-related work expenses) is ordinarily considered to be engaging in SGA. The amount of monthly earnings considered as SGA depends on the nature of a person's disability. The Social Security Act specifies a higher SGA amount for statutorily blind individuals; Federal regulations specify a lower SGA amount for non-blind individuals. Both SGA amounts generally change with changes in the national average wage index.
Amounts for 2013
The monthly SGA amount for statutorily blind individuals for 2013 is $1740. For non-blind individuals, the monthly SGA amount for 2013 is $1040. SGA for the blind does not apply to Supplemental Security Income (SSI) benefits, while SGA for the non-blind disabled applies to Social Security and SSI benefits. See historical series of SGA amounts below.
Trial work period
After a person becomes eligible for disability benefits, the person may attempt to return to the work force. As an incentive, we provide a trial work period in which a beneficiary may have earnings and still collect benefits.

Monday, July 22, 2013

Reopening a Prior Social Security Disability Claim

Today I received the great news that one of my SSI clients from Springfield, MA was awarded benefits retroactive to 2010, even though her case was filed in 2012.  I was able to get benefits this far back by asking the judge to reopen a prior claim and join it to the new claim that was pending before the administrative court.  
Obviously, my client is delighted since the reopening of the earlier claim will result is substantially more backpay benefits than originally expected.
Reopening a prior claim is one of the most rewarding things that a Social Security Disability Lawyer can do.  Believe me, its not just about the money...  I feel a special sense of accomplishment because reopening a prior claim goes against the concepts of res judicata and issue preclusion that are paramount to our judicial system.  When a lawyer reopens a prior case, he or she has a true feeling of "beating the odds" or "changing the norms" in favor of a disabled person.  Social Security Law is unique with respect to the opening of prior cases and not all lawyers seem to be aware of this peculiarity.  This is why, in Social Security cases, it is always a good idea to hire a Lawyer who spends a considerable part of his or her practice in this area of the law.   In circumstances such as the one mentioned in this blog, an experienced Social Security Disability Lawyer can make a significant difference in the amount of backpay that is awarded to a claimant.
Reopening of prior claims is allowed by virtue of 20 C.F.R. 404.988 for Social Security Disability Insurance Benefits and 20 C.F.R. 416.1488 for SSI claims. 
A prior claim may be reopened within 12 months for any reason.  The 12 month period runs from the date of the initial denial of the prior claim.
A prior Social Security disability claim can be reopened within 4 years if there is good cause.  An SSI claim can be reopened within 2 years for good cause.  One way that a claimant can show good cause is by presenting "new material" evidence to the Social Security Administration. 

Monday, July 15, 2013

SSDI/SSI Representative Payees: Rules to Remember

I often get phone calls from individuals, particularly parents, who serve as "Representative Payees" for Social Security Disability beneficiaries.  They ask me to give them information regarding their duties and responsibilities when they serve in this role.  I will use this blog to provide some basic information regarding the role of Representative Payees in the Social Security Disability Process.
A Representative Payee is an individual or organization appointed by SSA to receive Social Security and/or SSI benefits for someone who cannot manage his or her money. 
It is very important that a Representative Payee keep records of all the expenses incurred on behalf of the Social Security Disability beneficiary, even when the beneficiary is the child of the Representative Payee.  When the SSA requests a report, a payee must provide an accounting to the SSA of how the benefits were used or saved.
It is important to note that having a power of attorney, being an authorized representative or having a joint bank account with the beneficiary is not the same thing as being a Representative Payee.  These arrangements do not give legal authority to negotiate and manage a beneficiary's Social Security Disability and/or SSI payments.  Only persons or organizations that have applied and have been appointed by the Social Security Administration can act as Representative Payees.
As part of his or her duties, the payee should set up a separate bank account.  A checking account is probably best because this way the payee will be able to obtain cancelled checks and/or statements that show how the funds are spent.  When someone is a payee for a child, the Social Security Administration notifies the payee that the funds have to be placed in a dedicated account.  It is probably a good idea to ask the SSA how much money must be set up in this dedicated account.
It is extremely important for Representative Payee's to be aware that the Social Security Administration will send by mail a "Representative Payee Report" once  a year  and that it is important to accurately report all financial information to the Agency.  When the report is received, the Payee should either fill it out promptly and mail it back.  You can also complete the report online if you wish to.  However, you must keep a copy of for your records and have back up documentation showing how the money was spent throughout the year.


Monday, July 8, 2013

Immigration Reform Will Boost Social Security

During the May conference of the National Organization of Social Security Claimants' Representatives ("NOSSCR") in Washington D.C., I had the opportunity to listen to several government analysts and Social Security Disability Lawyers discuss the impact that the passage of immigration reform will have on the Social Security Trust Fund.  Back then, most experts were of the opinion that immigration reform would be beneficial for Social Security.  However, most of the studies conducted on this issue were not yet widely available to the general public and the media. 
Just about a week ago, the independent Social Security Office of the Chief Actuary provided a long-term analysis of the proposed immigration reform bill that demonstrates that immigration reform will bolster the solvency of Social Security over the long-term.  This report follows another recent report generated by the nonpartisan Budget Office which shows the positive impact that immigration reform will have on the general budget.  Almost immediately after these reports were published, the White House issued a statement emphasizing the importance of its findings.  The White House said:  "The Actuary found that the Senate-passed immigration reform bill will keep the Social Security Trust fund fully solvent through 2035."   
The main reason why immigration reform will help Social Security is that a new wave of citizens will balance out the "aging population problem".  As I stated in prior blogs, the greatest problem faced by Social Security is that the population of the U.S. is reaching advanced age at a disproportionate rate.  "Never before in history has the U.S. contained so many older people.  Today, one out of every 9 Americans is "old"."   See Blog from Oct. 22, 2012  Statistically, the immigrants that will be allowed into the country as a result of immigration reform are significantly younger than the rest of the population.  In this respect the White House stated that: "Because most immigrants are young, additional immigration helps balance out the increase in retirees-per-worker that will occur when the Baby Boom generation retires."  Moreover, it also pointed out that the new immigrants will bolster the Social Security Fund when currently undocumented workers start paying their share of payroll taxes once they leave the underground economy. 

Monday, July 1, 2013

Some Clarifications on Creditor Garnishments of SSDI / SSI Benefits

One of the good things of having a blog is that I learn a great deal from the feedback that I receive from its readers.  Last week, a learned a lot from the comments made my Paralegal Jessica Smith regarding my last post.  Jess is awesome!  I don't know what I would without her.  My clients are extremely fortunate to have her on their side. 
Jess pointed out that on May 29, 2013, the Social Security Administration issued some "final" rules regarding garnishment from benefits.  Moreover, she made me aware of the fact the rules regarding garnishments are far more complicated than I originally thought.  Under these rules, your bank may be required to protect only a certain amount of your Social Security Disability benefits.  Generally, the rules are intended to protect the last two payment cycles of benefits received by a Social Security beneficiary.  The rule can be summarized as follows:
Upon receipt of a garnishment order the financial institution must review the history of the account and determine what SSDI or SSI benefits were deposited into the account for the two month period prior to the account review ( the "lookback period").
The lessor of the sum of all benefit payments posted during the lookback period or the balance of the account on the date the account review is performed will be deemed the "protected amount".
The financial institution must notify the account holder of the garnishment order and the protected amount and must allow the account holder full access to the protected funds. In the past if there was confusion related to protected benefits being commingled with other funds the account could be frozen and the account holder would have to contest the garnishment in court before they could have access to their benefit money.
Moreover, it should be noted that if the benefit is directly deposited into a checking account and then transferred into a savings account, only the benefit money in the checking account will be considered protected funds.

Monday, June 24, 2013

Can a Creditor Garnish Your Social Security Disability Benefits?

It is common for SSDI and/or SSI beneficiaries to contact their Social Security Disability Lawyers when they are hounded by bill collectors.

Social Security Disability Lawyers are often asked whether credit card, mortgage or auto loan companies can garnish Social Security Benefits to pay a debt. 

Fortunately, the answer to this question is: No.

If a creditor other than the federal government tries to garnish your Social Security benefits, you should inform them that such actions are in violation of federal law.  Section 207 of the Social Security Act (42 U.S.C. 407)

Section 207 bars garnishment of your benefits.  It can also be used as a defense if your benefits are incorrectly garnished.  Our responsibility as Social Security Disability Lawyers is to prevent abuses from creditors against Social Security beneficiaries.  We get a lot of calls regarding these type of problems and can't always provide those in need with legal assistance.  If you live in Connecticut and creditors have tried to garnish your Social Security Disability benefits, we suggest you contact the Connecticut Department of Banking and complete the form on this link.  In you live in Massachusetts, you can consider filing a complaint with the Attorney General's Public Inquiry and Assistance Center.

NOTE: That Supplemental Security Income (SSI) payments cannot be levied or garnished.

Monday, June 17, 2013

Will Medical Marijuana Hurt Your Chances of Obtaining Social Security Disability Benefits?

Over the past few weeks, I have been asked --on several occasions--, to comment on the implications of the use of medical marijuana in the Social Security Disability process.  This is definitely a hot new issue.  I'm sure that there is going to be a lot of debate on Medical Marijuana (MMJ) and SSDI in the upcoming months.  I'm particularly curious as to what other Social Security lawyers are telling their clients and whether disability claimants are fully aware of the possible implications of MMJ in their cases.   
I must confess that I am not particularly thrilled about the use of marijuana by some of my clients, regardless of whether the use is medical or recreational.  Its not that I'm old fashioned or uncool.  (Am I?)  It's that I'm a pragmatic kind of guy.  My role as a Social Security Disability lawyer is to obtain for my clients the maximum amount of benefits allowed by law, not to make political statements or to advocate in favor of alternative medical treatments.    
Due to these concerns brought recently to my attention, I would like to use this week's blog to discuss some of the pros and cons of medical marijuana in the context of SSDI or SSI cases.
Some of the Cons...
  • Bear in mind that Social Security is a federal program and that federal law does not recognize the use of medical marijuana.  Understand that under federal law the use of marijuana is still illegal.  Social Security judges (ALJ's) are required to abide by federal law.  Potentially, an ALJ could find that a claimant and/or a doctor who repeatedly breaks federal law is not totally credible.
  • I usually like to argue that medication side effects are contributing to my client's disability.  Given the fact that marijuana is not a legal medication under federal law, I don't think I'm going to be able to argue that being constantly "high on pot" is a symptom that contributes to my client's disability.   
  • I believe that, in many instances, medical marijuana can be very detrimental to a claimant who is seeking to obtain benefits based on a mental disability.  I often argue that my client's unusual behavior is evidence that he or she suffers from mental illness.  Unfortunately, if a person is under the influence of MMJ, it might be harder to asses the real reason why the person is acting strangely.  Keep in mind that there is a the popular belief that people act "weird" when they smoke marijuana if even when that is not the case in most circumstances.
Some of the Pros
  • I am convinced that, in some instances, pot is the only medication that really works.  Under these circumstances, the claimant must be prepared to tell the judge that he or she tried all other traditional medications available and that none of them offered any relief of the symptoms.  This scenario could ultimately bolster a Social Security Disability claim.  However, it is important to point out that under these circumstances, the claimant must have sufficient medical records to be able to make this argument.
  • Finally, under the latest Social Security ruling on drug addiction and alcoholism (SSR 13-2p), marijuana use is not material to a Social Security Disability case unless its use is considered an addiction and is "a contributing factor material to the claimant's disability".   (See my blog from Feb. 25, 2013)  I would argue that under this ruling, a judge cannot consider medical marijuana at all when making a decision, unless there is evidence that the marijuana use raises to the level of an addiction and that marijuana is contributing to the claimant's limitations. 

Monday, June 10, 2013


As a Social Security Lawyer, I am frequently asked whether a person's eligibility for benefits is ever reviewed again sometime after benefits have been granted.  In Connecticut and Massachusetts many Social Security claimants mistakenly believe that Social Security benefits are “permanently” granted to claimants.  I must caution Social Security Disability beneficiaries that this notion is incorrect.

Social Security periodically reviews your disability or blindness to decide if you are still disabled or blind. If you are no longer disabled or blind, Social Security will stop your benefits.

Social Security calls this review a Continuing Disability Review (CDR). As a Social Security Disability Lawyer in Connecticut and Massachusetts, I often get nervous calls from Social Security Disability beneficiaries who act totally surprised when they get a “CDR” letter from Social Security. 
It is important to note that the law requires the SSA to perform a medical CDR approximately every three years, unless the agency determines that you have a condition that is expected to improve sooner than that. However, if you have a condition that is not expected to improve, the SSA will still review your case, but not as often as every three years.

If you are eligible as a child, during the month before the month you attain age 18, Social Security will redetermine whether you are disabled. When Social Security does the CDR at age 18, it uses the rules used for adults who are filing new applications for SSI.
If you have any questions about a continuing disability review you should consult with a Social Security Disability Lawyer.  As you all know, I am always available for a free initial consultation on Social Security Cases in Connecticut and Massachusetts.

Monday, June 3, 2013

Qualifiying for SSDI / SSI with Scleroderma

June is Scleroderma Awareness Month!
A diagnosis of scleroderma does not automatically entitle a person to disability benefits. The Social Security Administration recognizes scleroderma as a potentially disabling illness and includes scleroderma in their listing of impairments. Nonetheless, if you have been diagnosed with scleroderma and the disease is affecting your activities of daily living, it is a good idea to be proactive and schedule a consultation with a Social Security Disability Lawyer. We are always available for free consultations and don’t mind learning about a person’s case well in advance of the actual date of the “onset of disability” (the date when you can no longer work). We believe that a conscientious disability attorney should be willing provide you with a free consultation, particularly when you suffer from a serious condition such as scleroderma.
One of the reasons why we like to talk to clients well in advance of filing for Social Security Disability Benefits is that, in order to successfully obtain social security benefits, an applicant must have the support of his or her doctor(s). Consequently, we urge our clients to ask their doctors if they are willing to fill up social security questionnaires and provide letters in support of their patient’s applications for social security benefits. Unfortunately, many doctors don’t cooperate with their clients and refuse to fill up these forms regardless of the severity of their patient’s condition.
There are two basic ways that a person can qualify for Social Security benefits due to scleroderma. An individual can meet the requirements of a listing set out in Social Security's list of qualifying impairments or show that he or she is unable to work.
The list of impairments is essentially a "blue book" used by the Social Security Administration to determine whether an individual meets the Social Security definition of disability. If a person’s condition “meets or equals” the listing, then that person is automatically deemed to be disabled. The listing for scleroderma (systemnic sclerosis) is contained in Section 14.04 of the listing:
14.04  Systemic sclerosis (scleroderma).As described in 14.00D3. With:
A. Involvement of two or more organs/body systems, with:
1. One of the organs/body systems involved to at least a moderate level of severity; and
2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).
B. With one of the following:
1. Toe contractures or fixed deformity of one or both feet, resulting in the inability to ambulate effectively as defined in 14.00C6; or
2. Finger contractures or fixed deformity in both hands, resulting in the inability to perform fine and gross movements effectively as defined in 14.00C7; or
3. Atrophy with irreversible damage in one of both lower extremities, resulting in the inability to ambulate effectively as defined in 14.00C6; or
4. Atrophy with irreversible damage in both upper extremities, resulting in the inability to perform fine and gross movements effectively as defined in 14.00C7.
C. Raynaud’s phenomenon, characterized by:
1. Gangrene involving at least two extremities; or
2. Ischemia with ulcerations of toes or fingers, resulting in the inability to ambulate effectively or to perform fine and gross movements effectively as defined in 14.00C6 and 14.00C7.
D. Repeated manifestations of systemic sclerosis (scleroderma), with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
1. Limitation of activities of daily living.
2. Limitation in maintaining social functioning.
3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then the Social Security Administration must determine if it interferes with your ability to do the work you did previously (during the last 15 years).
If you cannot do the work you did in the past 15 years, the Social Security Administration will see if you are able to adjust to other work. The Social Security Administration will consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.

Monday, May 27, 2013

CIGNA is Required to Give Significant Weight to Social Security Disability Insurance (SSDI) Awards as Part of Settlement

Settlement Also Requires CIGNA to Pay $1.6 in Fines/Fees and Up to $70 Million to Disabled Claimants Who Were Denied Benefits

On May 22, 2013, Connecticut Insurance Commissioner Thomas B. Leonardi announced that Connecticut, along with insurance regulators from Massachusetts, Maine, California and Pennsylvania, had reached a settlement with the CIGNA Companies over allegations that the Insurance giant had been improperly handling and unfairly denying Long Term Disability Claims.  This settlement is an important victory for thousands of disability claimants who, over the years, have seen their claims denied without sufficient basis.   
Pursuant to the settlement, any person from Connecticut, Massachusetts, Maine or Pennsylvania who had their LTD claim denied from January 1, 2009 to December 31, 2010 is entitled to have their claim reviewed pursuant to a "Remediation Program" set forth in the agreement.  (Remediation for California residents will cover claims from a longer time period: from January 1, 2008 to December 31, 2010.)  It is advised that persons who were denied during this time period seek the assitance of a Long Term Disability Lawyer. Connecticut LTD Lawyer
The agreement entered between CIGNA and these five states requires that the company change several of its practices with respect to the handling of claims.  Perhaps one of the most important changes that CIGNA must make is that, from now on, it must give "significant weight" to awards of Social Security Disability Insurance (SSDI) Benefits.  In the past, CIGNA gave very little weight to Social Security Disability Insurance awards.   In most denial letters CIGNA did not provide any specific reasons why it was disregarding Social Security's determination.  In many instances, the denial letters drafted by CIGNA Disability Claim Managers contained boilerplate language that merely stated in vague terms that CIGNA was not bound by SSDI awards becuase the standards used for determining eligibility under SSDI are different from the standards used to award benefits pursuant to the LTD policy.  This language used by CIGNA in its denial letters usually read as follows:
"We are aware that you were awarded Social Security Security Disability Benefits; however, the standard for determining disability under this policy may be different from standards used by the Social Security Administration (SSA)."
Other denials by CIGNA were even more shocking.  These denials simply stated that the award for disability benefits by the SSA was "considered" in making the determination for LTD benefits without specifically saying what weight if any was given to the award.  These denial letters usually stated:
"We are aware that you have been awarded Social Security Disability Insurance (SSDI) benefits by the Social Security Administration, and have considered that fact in our claim review."
If you have received such a denial letter, it is important that you contact a long term disability attorney.  Long Term Disability Appeals are quite complicated and it is probably not a good idea to try to go at it alone.  (See articles from my web page where I explain some the complexities that are involved in a long term disability appeal.)  Keep in mind that many long term disability lawyers, like myself, are willing to take these difficult cases on a contingency basis.  
I have noticed that in many instances, long term disability claimants become frustrated with the unfairness of the LTD claim process and give up too soon. Unfortunately, not all Social Security Disability Lawyers are willing to take on LTD appeals.  In the last NOSSCR* conference there was a great session about ERISA LTD appeals.  I know that NOSSCR members can do a great job at educating their clients and empowering them to obtain the disability benefits that they have earned.  I urge Social Security Disability Lawyers to learn more about this area of disability law and encourage their clients to take aggressive steps to protect their rights under the Long Term Disability policies issued by CIGNA. 

*NOSSCR is one of the largest organizations of Social Security Disability Lawyers and Representatives (SSDI and SSI).