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2019 In Review - SSDI Claims

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    2019 In Review - SSDI Claims

    As the year comes to a close, I wanted to post some observations of the changing landscape for Social Security Disability claims.

    1. Faster hearings. The number of applications for disability, and the wait times for decisions, continue to drop. With unemployment continuing at record lows, the SSA is resolving more cases than are being filed. In my region, the wait for a hearing has dropped from over two years to approximately six months. In fact, I recently had a judge tell me that his office is running out of cases to schedule. This is great news for claimants.

    2. Fewer approvals. The approval rate continues to fall. Over the past 20 years, the SSDI approval rate has dropped from around 67 percent to approximately 46 percent. This has resulted from changes to the disability rules (including for MS claims), and a more technical review of claims. This is one more reason to be sure that your claim has medical support and is well built at the time of filing.

    3. Continuing disability reviews have arrived. Although the SSA has always had the option of reviewing a disability claim in the years after approval, such reviews were not common, and would often occur many years after the claim was approved. A new push by the executive branch has increased funding for disability reviews, and now claimants are regularly being reevaluated for disability as little as one or two years post-approval. Although I have never -- knock on wood -- had an MS client thrown off of disability who didn't return to work, it is important that you promptly respond to any SSA requests for an update on your treatment, and that you continue your medically appropriate MS treatment even after being approved for disability.

    4. Video hearings are here to stay. Many hearings are now being conducted by video teleconference, wherein the judge is located in another region, and sees the claimant for the hearing on a tv screen. The SSA is pushing claimants to have their hearings by video; a claimant has to opt out of a video hearing when they receive a warning notice approximately one month after requesting a hearing. I rarely allow my claimants to do video hearings, and would rather they have face-to-face interaction with a local judge.

    5. Hearings are more technical. The SSA has slowly increased the requirements on claimants and their counsel for hearings, including requiring records to be provided in certain timeframes and individual judges requiring pre-hearing briefs. There are also now vocational witnesses in virtually all hearings, which is a major change over the past ten to fifteen years.

    6. Wednesday afternoon hours are back. The SSA has been closed to the public on Wednesday afternoon for years, allowing staff to catch up on tasks. Starting very soon, however, you will be able to call your local office for questions on Wednesday afternoons, just like every other day.

    Have you experienced any of these changes? Have your friends approved years ago described a different process than you are going through? Feel free to share in the comments!
    Attorney Jamie R. Hall's practice is focused on assisting individuals with claims and appeals for Social Security Disability and Long Term Disability benefits. He has assisted claimants nationwide, approximately half of whom are MS patients, from his Pennsylvania and Ohio locations. **No attorney/client relationship is created by this communication, and information provided herein is not a substitute for formal advisement.**

    #2
    Thanks Jamie!

    I was offered a video hearing in 2016 for appeal, but like you, my attorney said to opt out and have in person hearing. The hearing went well and I was approved.

    At my hearing, there was a vocational witness. When the judge asked for her input on potential employment, she had nothing.

    I did receive a letter saying I would be reviewed this year. I sent my part back to SSDI ASAP. I then received another one saying they weren't reviewing my case. I may have come up for review since my disability date was 5 years, but appeal took so long, hearing was 3 years ago.

    I am really glad that the review and hearing time-frames have improved, but hope the approval rates don't affect those who really need it. Curious if the decline in approval rate is at the filing, hearing, and update review stages. Are there separate stats for that?

    I personally am a little nervous. I have a new Neuro who thinks I am doing great. But he has only seen me once, and is seeing me well rested. He didn't see me and the impact working had on me. I plan on spending the bulk of my next appointment to make sure he understands my history. I know it is only a matter of time until SSDI and LTD want updates.
    Kathy
    DX 01/06, currently on Tysabri

    Comment


      #3
      PennStater,

      The drop in approval rates from 67% to 46% is harming legitimate claims, especially individuals under age 50, non-orthopedic claims (those based on fatigue or cognition, etc.) and those proceeding without counsel. There are certain hearing offices where the approval rate is extremely challenging. In such cases, the claimants and counsel have a responsibility to thoroughly develop the record to prove the claim.

      The vocational witnesses often make or break a claim. I've had hearings where I have spent 30 minutes developing this testimony, with the witness ultimately reversing an initial statement of 'yes he can work' to 'no he cannot work.' Counsel has to know their sources and the case in depth. There is also a growing trend of judges asking vocational witnesses two questions supporting a denial, then one supporting an approval. The judge will likely deny the claim, but the claimant walks out of the door having last heard that there are no jobs available and assumes that they will be approved.

      As to reviews, the SSA rarely challenges MS patients who continue to treat and are symptomatic. The process is generally like your case; they simply confirm ongoing treatment and symptoms. Your best protection is to be honest with your doctor, but let them know what issues you have. ("I feel better and can walk my dog, BUT only on a good day, for a short distance, when it's not too hot."). This will also help for long term disability, as insurers are much more aggressive in their reviews.

      -Jamie
      Attorney Jamie R. Hall's practice is focused on assisting individuals with claims and appeals for Social Security Disability and Long Term Disability benefits. He has assisted claimants nationwide, approximately half of whom are MS patients, from his Pennsylvania and Ohio locations. **No attorney/client relationship is created by this communication, and information provided herein is not a substitute for formal advisement.**

      Comment


        #4
        Good info here. Thanks Jaime. I have declined treatment in the form of dmd's and was wondering, in your opinion, if I went up for a disability claim would that decrease my chances of approval.
        The future depends on what you do today.- Gandhi

        Comment


          #5
          Thanks Jamie.

          Mine was predominantly fatigue and cognition, and then the paroxysmal symptoms brought on by the combination. So "invisible" symptoms. I do have a good letter from my former boss in the file with his observations on my performance decline over the years and all the accommodations tried and failed. Also neuropsychs evals.

          I have days/periods where I can do alot, I just can't on a consistent, ongoing basis. I can't sustain 8 hour work days day in and out for any extended period. And it's not like I am outside blowing leaves for 8 hours, but it might add up to 2 hours over an 8 hour period.

          Being on disability sometimes makes me afraid to live my life, wondering if someone is watching, especially LTD. So if they catch me blowing leaves or exercising, which helps manage fatigue, they will then say not disabled. But I try to, hoping that if any problems, eventually, I will win out again since MS can be so variable. But every now and then, it does cause some angst.
          Kathy
          DX 01/06, currently on Tysabri

          Comment


            #6
            Boudreaux,

            I've always practiced with the belief that medical drives legal, not the other way around. As such, you should follow your doctor's advice regarding multiple sclerosis medication and treatment.

            That being said, it is much easier to argue that a person's MS is advanced and that he/she is doing everything possible to combat the disease if the person is taking medication (or has progressed through multiple medications). If you are not taking a medication and your doctor agrees with this stance, the best practice would be to ask your doctor to explain in a note why this is a reasonable medical decision.

            There are many factors that impact whether an approval is appropriate in a disability claim, but medication usage can be an important signal to the Judge as to your condition's progression.

            -Jamie
            Attorney Jamie R. Hall's practice is focused on assisting individuals with claims and appeals for Social Security Disability and Long Term Disability benefits. He has assisted claimants nationwide, approximately half of whom are MS patients, from his Pennsylvania and Ohio locations. **No attorney/client relationship is created by this communication, and information provided herein is not a substitute for formal advisement.**

            Comment


              #7
              Make sure your Neuro is making notes during your appointments, if there is online access check and verify that the notes state what you told the neuro.

              I got to my hearing and found that in the 4 years I had been with the Neuro only 1 note was on the chart. I had requested the info for myself multiple times before the hearing to review but she never sent it to me. So I was blindsided by the no notes. Shouldn't have been shocked in hindsight since pretty much every new issue was met with a response of that's normal for MS and no treatment plan change.

              They did have a vocational witness and the judge did do the 2 denial 1 approval question and I did think that the final question meant I would be approved. I was oh so wrong.

              On the plus side finding out how worthless my neuro had been got me to a new one who spent 45 min the first appointment listening to me, made two pages of notes and besides the DMD completely changed up my treatment plan (which was pretty much non-existent) within a month I was back at work part-time and 3 months and I was working full time. So overall getting denied was the best thing that could have happened to me.

              I assume for most people denial would be catastrophic so make sure your doctors are noting what you tell them if they aren't get a new doctor, or follow up with them until they do.
              Rise up this mornin, Smiled with the risin sun, Three little birds Pitch by my doorstep Singin sweet songs Of melodies pure and true, Sayin, (this is my message to you-ou-ou

              Comment


                #8
                Jamie thank you for keeping us updated.

                Originally posted by TheMSLawyer View Post
                3. Continuing disability reviews have arrived. Although the SSA has always had the option of reviewing a disability claim in the years after approval, such reviews were not common, and would often occur many years after the claim was approved. A new push by the executive branch has increased funding for disability reviews, and now claimants are regularly being reevaluated for disability as little as one or two years post-approval. Although I have never -- knock on wood -- had an MS client thrown off of disability who didn't return to work, it is important that you promptly respond to any SSA requests for an update on your treatment, and that you continue your medically appropriate MS treatment even after being approved for disability.
                I've been on disability since 2012 and received a review letter in October. I promptly returned the forms, but was wondering how many MS patients are suddenly well enough to return to the workplace.

                I sure wish I could return to work, but I get physically and mentally overwhelmed so easily just here at home. I can't imagine what the stressors of a job would do. Heck, even traffic is enough to overwhelm me even when I am not driving.

                Comment


                  #9
                  Wondering now when it says 5-7 years for a review if that is from the date that SSA says the disability started or from the date that they approved the SSDI. Anyone know?

                  Looking at the other thread that mentioned a level 5 beneficiary, I went back and looked at my SSA letter and there is no mention of a level, just says approved. So, how does one know?

                  Jamie, if the original letter says 5-7 years before a review, is that now no longer true?

                  Comment


                    #10
                    Temagami,

                    The time frame has never limited the SSA's ability to review (despite what the letter suggests), but nevertheless the SSA almost always failed to meet this suggested timeline. With the new funding, the SSA is much more on time with their reviews, and could conduct them earlier than the letters state. Currently, I would not expect earlier reviews without good reason.

                    -Jamie
                    Attorney Jamie R. Hall's practice is focused on assisting individuals with claims and appeals for Social Security Disability and Long Term Disability benefits. He has assisted claimants nationwide, approximately half of whom are MS patients, from his Pennsylvania and Ohio locations. **No attorney/client relationship is created by this communication, and information provided herein is not a substitute for formal advisement.**

                    Comment


                      #11
                      Originally posted by Temagami View Post

                      Looking at the other thread that mentioned a level 5 beneficiary, I went back and looked at my SSA letter and there is no mention of a level, just says approved. So, how does one know?
                      Hi Temagami,

                      My letter did not mention a level. But it did reference the specific MS listings I was approved under. So in the 5 step decision process used by SSDI, that would appear to satisfy Step 3 - disabled meeting specific impairments listing.

                      That is just my interpretation as to how it would work.
                      Kathy
                      DX 01/06, currently on Tysabri

                      Comment

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