If I could offer Claimants once piece of advice as they advance to the hearing stage, it would be to understand their case as thoroughly as possible as it fits into the Social Security Five-Step construct. Effective arguments extend well beyond simply having a command of a medical situation, and includes understanding the provable impact of age, education, resources, work history, and residual functional capacity on a case before Social Security. One of the best exercises that one can undertake in pursuit of such an understanding is building a Pre-Hearing Memorandum. This document is prepared by the Claimant (or their Counsel) and really sets the table for the issues to be discussed at hearing. This is a great opportunity to get to the Judge early and not only present strengths, but address potential weaknesses with one's case. Preparing such a document not only forces one to gain familiarity with the medical and procedural records, but it forces a level of organization that will telegraph well to the hearing room, when the Judge will walk down a similar path of analysis when evaluating the case.
For Claimants who are seeking specific advice on drafting their brief, I am linking to a fantastic article on this subject by Disability Attorney Gordon Gates, who practices in Maine and New Hampshire. The article is titled "Ten Tips for Writing Effective Hearing Briefs", and it really distills what is important when drafting a Pre-Hearing Brief.
For questions about your Georgia Disability Case, contact Thomas O'Brien at Feiler & Associates.
Tuesday, October 26, 2010
There are overpayments, and then there's this...
A man in Fresno California was recently arrested for collecting more than $200,000 in Social Security benefits that were being paid to a woman who passed away in 1988. The man apparently was a friend of the deceased and shared a checking account with her, which facilitated the fraud. He has plead not guilty to the charges.
Incidents such as this are covered by the popular media every so often, and never once has the story ended with Social Security getting their money back. I imagine that this story will end the same way.
The question then becomes, what can be done about this, and it this an isolated case or are there numerous cases like this being perpetrated around the country? It would seem that there are some simple solutions that could at least manage the fraud to a level lower than 22 years of deceit. Though Social Security is notoriously overworked, requiring Claimants to check in every 3-5 years would be reasonable, and such a practice could even be automated with biometrics (though privacy advocates would have a field day with this one). Even if not automated, making benefits contingent on a visit to the local Social Security office every 3-5 years with a picture ID would help prevent fraud cases such as these from occurring at relatively small cost to the government.
For questions about Social Security, contact Thomas O'Brien at Feiler & Associates.
Incidents such as this are covered by the popular media every so often, and never once has the story ended with Social Security getting their money back. I imagine that this story will end the same way.
The question then becomes, what can be done about this, and it this an isolated case or are there numerous cases like this being perpetrated around the country? It would seem that there are some simple solutions that could at least manage the fraud to a level lower than 22 years of deceit. Though Social Security is notoriously overworked, requiring Claimants to check in every 3-5 years would be reasonable, and such a practice could even be automated with biometrics (though privacy advocates would have a field day with this one). Even if not automated, making benefits contingent on a visit to the local Social Security office every 3-5 years with a picture ID would help prevent fraud cases such as these from occurring at relatively small cost to the government.
For questions about Social Security, contact Thomas O'Brien at Feiler & Associates.
Tuesday, October 12, 2010
Compassionate Allowances - More to come?
In today's Federal Register, the Social Security Administration served notice of an upcoming hearing regarding the identification of Compassionate Allowances for Cardiovascular Disease and Multiple Organ Transplants. For those that may not be familiar with the term, Compassionate Allowances are a way for Social Security to issue favorable decisions on "easy" cases by identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate Allowances allow Social Security to quickly target the most obviously disabled individuals for benefits based on objective medical information that can be obtained quickly.
Currently there are 88 such allowances ranging from Acute Leukemia to Early Onset Alzheimer's and a variety of cancers. Originally the list of allowances was 50, and the list has extended now to 88. Cardiovascular Disease and Multiple Organ Transplants will be the subject of these latest hearings.
This is significant on a couple of fronts. Compassionate Allowances are made for the purpose of eliminating the time and resources spent on evaluating certain conditions that are "slam dunks". However, this latest set of maladies has it's own features that will definitely affect their suitability for inclusion on this list. For example, many Organ Transplants will almost certainly require at minimum a closed period of disability while recovery occurs. Transplants are typically not offered where there is to be no lifestyle improvement for the patient. As such, it would seem that Social Security will be forced to review each of these cases closely at some point in the case's progression. By swapping "sooner" for "later", is there any additional benefit?
Also, cardiac cases are a difficult category to evaluate. For example, Blue Book Listing 4.02A(1) contains what appears to be a very objective standard (<30%) regarding a left ventricular ejection fraction. I have had numerous clients demonstrably meet this standard over time, and meet the requirements in 4.02B, yet still be forced to qualify by gridding out, or by demonstrating that their symptoms erode their vocational base to zero. The essence here is that cardiovascular cases historically appear to have objective standards, but do not seem to be consistently evaluated as such. With this in mind, it is this practitioner's hope that any cardiac Compassionate Allowances made will be straightforward in their requirements and granted as such.
For questions about Social Security Disability contact Thomas O'Brien at Feiler & Associates.
Currently there are 88 such allowances ranging from Acute Leukemia to Early Onset Alzheimer's and a variety of cancers. Originally the list of allowances was 50, and the list has extended now to 88. Cardiovascular Disease and Multiple Organ Transplants will be the subject of these latest hearings.
This is significant on a couple of fronts. Compassionate Allowances are made for the purpose of eliminating the time and resources spent on evaluating certain conditions that are "slam dunks". However, this latest set of maladies has it's own features that will definitely affect their suitability for inclusion on this list. For example, many Organ Transplants will almost certainly require at minimum a closed period of disability while recovery occurs. Transplants are typically not offered where there is to be no lifestyle improvement for the patient. As such, it would seem that Social Security will be forced to review each of these cases closely at some point in the case's progression. By swapping "sooner" for "later", is there any additional benefit?
Also, cardiac cases are a difficult category to evaluate. For example, Blue Book Listing 4.02A(1) contains what appears to be a very objective standard (<30%) regarding a left ventricular ejection fraction. I have had numerous clients demonstrably meet this standard over time, and meet the requirements in 4.02B, yet still be forced to qualify by gridding out, or by demonstrating that their symptoms erode their vocational base to zero. The essence here is that cardiovascular cases historically appear to have objective standards, but do not seem to be consistently evaluated as such. With this in mind, it is this practitioner's hope that any cardiac Compassionate Allowances made will be straightforward in their requirements and granted as such.
For questions about Social Security Disability contact Thomas O'Brien at Feiler & Associates.
The Freeze is Official
It appears that the guidance given a few weeks ago has become official. For the second year in a row, there is to be no increase in the monthly sums paid to recipients of Social Security. The reason that there is no increase is because the Consumer Price Index (CPI) tracks with overall inflation. For the past two years, inflation has been negative, in part due to machinations by the Federal Reserve to prevent stagflation. As a consequence, the monthly payments to seniors remain at the current average rate of $1072.
Unfortunately for seniors, the prices of everything else have not stayed static. Even ignoring luxury items, essentials such as utility payments, food costs, transportation costs and insurance premiums have continued to rise. In effect, when costs increase at a rate that is higher than income, what results is a salary decrease, and this effect could imperil the already tenuous existence of many elderly Americans. Seniors are not the only ones experiencing this effect as salaries are frozen for those lucky enough to have jobs, while the cost of health insurance (and everything else) rises.
The timing of this "decrease" is significant as well. With midterm elections occurring in less than one month, and discontent on the rise, it would not be surprising to see senior citizens turning out in greater than average numbers to express their displeasure at the ballot box. Whether either party can solve the problem of an eroding tax base (due to unemployment and a lack of available funds for lending), and an endangerment of government programs remains to be seen.
For assistance with your Social Security Disability claim, contact attorney Thomas O'Brien at Feiler & Associates.
Unfortunately for seniors, the prices of everything else have not stayed static. Even ignoring luxury items, essentials such as utility payments, food costs, transportation costs and insurance premiums have continued to rise. In effect, when costs increase at a rate that is higher than income, what results is a salary decrease, and this effect could imperil the already tenuous existence of many elderly Americans. Seniors are not the only ones experiencing this effect as salaries are frozen for those lucky enough to have jobs, while the cost of health insurance (and everything else) rises.
The timing of this "decrease" is significant as well. With midterm elections occurring in less than one month, and discontent on the rise, it would not be surprising to see senior citizens turning out in greater than average numbers to express their displeasure at the ballot box. Whether either party can solve the problem of an eroding tax base (due to unemployment and a lack of available funds for lending), and an endangerment of government programs remains to be seen.
For assistance with your Social Security Disability claim, contact attorney Thomas O'Brien at Feiler & Associates.
Tuesday, October 5, 2010
Too Sick to Work, Too Poor to Get Treatment…Breaking the Cycle
A common concern encountered when representing Claimants before Social Security, and in making the preparations to appear before the Administrative Law Judge, is gaps in the patient's medical treatment. As one might imagine, a Claimant gives their case the best chance of succeeding when there is a provable (and preferably multi-sourced) set of medical records that describes the patient’s debilitating condition in clear and rational detail over time. While cases without these features may succeed, and cases where these records exist may fail, treatment gaps not only are unhealthy for the seriously ill, but they also make claims for benefits more complex to navigate.
It is not difficult to imagine that such gaps would exist for someone who is unable to work (and earn money or have employee health benefits), especially if they are not blessed with supportive friends or family. Cases are even further complicated when the diagnosis is a medical condition that might possibly be mitigated by prescription medication. Social Security cannot force a Claimant to “be at their medically best” when seeking benefits, but not seeking treatment may plant the idea that a Claimant receiving treatment may not actually be disabled, which is clearly not a helpful proposition. So what can someone in this position do?
1. Contact local DFCS and Medical Providers
A meeting with their local DFCS would be in order. In addition to evaluating the Claimant for eligibility for other avenues that might provide health benefits, they will be able to suggest free or reduced cost clinics and prescription programs. Many cities have hospitals with Charity programs the Claimants should explore as well, and it is important to note that Federal Law (EMTALA) requires that hospitals evaluate and stabilize (if needed) patients that visit the Emergency Room, regardless of their ability to pay for treatment, so emergency care is always an option.
2. Contact the VA (if applicable)
If the Claimant is a Veteran, it would be advisable to discuss their options with a VA representative.
3. Discuss retroactive Medicaid with medical provider.
Finally, in Georgia (and other states as well), a Claimant or their Attorney can discuss with their medical providers the ability to retroactively file for payment through Medicaid once benefits are granted. If a specific set of steps are followed and the proper paperwork is filed starting at the time of treatment, a Medical Provider may secure payment for a patient that was otherwise self-pay, but who later secures Medicaid by way of their Social Security benefits. This is not a transparent process, but payment by Medicaid for services rendered may be secured well after the treatment is received.
The moral of the story is to consider all options when seeking treatment, and above all else, Claimants should take care of their health. The rest is incidental.
To discuss your Disability Case or Retroactive Georgia Medicaid Benefits with an experienced attorney, contact Thomas at Feiler & Associates.
It is not difficult to imagine that such gaps would exist for someone who is unable to work (and earn money or have employee health benefits), especially if they are not blessed with supportive friends or family. Cases are even further complicated when the diagnosis is a medical condition that might possibly be mitigated by prescription medication. Social Security cannot force a Claimant to “be at their medically best” when seeking benefits, but not seeking treatment may plant the idea that a Claimant receiving treatment may not actually be disabled, which is clearly not a helpful proposition. So what can someone in this position do?
1. Contact local DFCS and Medical Providers
A meeting with their local DFCS would be in order. In addition to evaluating the Claimant for eligibility for other avenues that might provide health benefits, they will be able to suggest free or reduced cost clinics and prescription programs. Many cities have hospitals with Charity programs the Claimants should explore as well, and it is important to note that Federal Law (EMTALA) requires that hospitals evaluate and stabilize (if needed) patients that visit the Emergency Room, regardless of their ability to pay for treatment, so emergency care is always an option.
2. Contact the VA (if applicable)
If the Claimant is a Veteran, it would be advisable to discuss their options with a VA representative.
3. Discuss retroactive Medicaid with medical provider.
Finally, in Georgia (and other states as well), a Claimant or their Attorney can discuss with their medical providers the ability to retroactively file for payment through Medicaid once benefits are granted. If a specific set of steps are followed and the proper paperwork is filed starting at the time of treatment, a Medical Provider may secure payment for a patient that was otherwise self-pay, but who later secures Medicaid by way of their Social Security benefits. This is not a transparent process, but payment by Medicaid for services rendered may be secured well after the treatment is received.
The moral of the story is to consider all options when seeking treatment, and above all else, Claimants should take care of their health. The rest is incidental.
To discuss your Disability Case or Retroactive Georgia Medicaid Benefits with an experienced attorney, contact Thomas at Feiler & Associates.
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