Showing posts with label Attorney. Show all posts
Showing posts with label Attorney. Show all posts

Wednesday, February 4, 2015

Worn-Out-Worker Rule – Another Path to Disability Benefits

There is a lesser-known Social Security Regulation that provides a clear path to disability approval for marginally educated individuals who have performed arduous unskilled labor for a period of 35 years or longer, and are no longer able to do so due to severe impairments.  The so-called “Worn-Out-Worker Rule” may be found at 20 C.F.R. §§ 404.1562 and 416.962.

When evaluating a case under the Worn-Out-Worker rule, one must be very careful to establish each of the criteria.

1) Marginal education – This level of education is generally no more than a 6th grade education, but when considering the impact of education, other factors may come into play including the nature of the person’s responsibilities and tasks on the job (see SSR 82-63).

2) 35 years or more of arduous unskilled labor – Arduous does not necessarily mean Heavy or Very Heavy exertional capacity work, but lower exertional capacity work may qualify if the nature of the work can be considered arduous (see SSR 82-63).  The work must be also consistently regarded as unskilled, though brief periods of semi-skilled or skilled work will not necessarily prevent a person from qualifying under this provision.

3) Not currently working

4) Unable to perform arduous unskilled labor due to severe impairments – Medical evidence establishes proof of severe impairment(s) that prevent a return to past relevant work.

This information does not create an attorney-client or physician-patient relationship or any kind, and is for informational purposes only. For advice regarding your specific circumstances, contact Disability Attorney Thomas O’Brien.

Tuesday, February 3, 2015

Tax Information Now Available on "my Social Security" Website

Social Security has made advances over the past several years with regard to filling applications, retiring, and checking one's "green sheets".  The website through which one may access this information may be found here: http://www.ssa.gov/myaccount/

I have recently been informed that there are some new services available from the same website.  According to Social Security,

"We are excited to offer a new online service to people who receive Social Security benefits. If you need to replace your form SSA-1099 or SSA-1042S for tax purposes, you can now get a copy instantly by using your personalized my Social Security account. If you don’t have an account, you can create one online today."

Anything that gets my clients and readers connected with their information more quickly is a good thing.  To see their press and social media releases about this service, click below:


Monday, November 4, 2013

The Interplay of Social Security Disability and Workers’ Compensation, by: Matthew Queen, Esq.

If you are disabled from an on-the-job injury then you may have numerous benefits available in order to compensate for lost wages and to help finance medical expenses.  The first benefit is Workers’ Compensation (“WC”).  The second is Social Security Disability Insurance (“SSDI”).  Each of these has its unique considerations and you may qualify for or need both.  The interplay between these two benefits is complex and requires the skilled guidance of an attorney to navigate around several pitfalls, including offsetting benefits as well as Medicare Set Aside (“MSA”) accounts.

The purpose of this article is to outline considerations of which the claimant should be aware when considering combining SSDI to a WC claim.

Social Security Disability Insurance Offset


The State of Georgia prohibits claimants from receiving 100% of their SSDI benefits in addition to their WC.  Claimants’ WC benefits reduce their SSDI benefits by any amount in excess of the claimant’s best year’s earnings for the past 5 years.  Here is a sample calculation:

Suppose you make $50,000 as your highest year’s earnings.  Divided by 12, this amounts to $4,166.67 per month.  80% of your monthly income is $3,333.  Therefore, Social Security’s monthly limit is $3,333 per month. 

Further assume that you receive $2,000 per month from SSDI and $1,500 per month in WC.  The total allowable income is $3,333 per month, but you are receiving $3,500 per month.  There is an excess of $167 per month.  This means that your SSDI monthly cash benefit will be reduced to $1,833 per month.  This reduction continues until the WC benefits are extinguished.

The best way to mitigate the SSDI offset is for the WC attorney to structure the WC settlement amount to be calculated for the life of the impairment.  This language requires the settlement to be calculated over the total life expectancy of the claimant.  This can reduce the monthly WC monthly benefit, extend the WC benefits, and retain SSDI more cash benefits.  

Medicare Set Aside


Medicare Set Aside (“MSA”) is money from a settlement put into an annuity for medical bills related to your injury.  The MSA applies in situations where Medicare would pay for injuries that could be covered by a private insurance policy.  In other words, the law seeks to prevent the privatization of profits and socialization of costs.  Medicare is the secondary payer in cases where there is another liable party, such as an employer or its Workers’ Compensation Insurance carrier.  42 USC § 1395y.  If the actual expenses exceed the set aside amount, then Medicare covers the difference. 

The MSA is only a concern in two situations.  First, if the claimant is Medicare eligible then an MSA must be created.  Medicare eligible patients are generally defined as those between ages 62.5 and 65, those receiving SSDI, those who have applied for SSDI, and those suffering from end state renal disease.  Second, if the case is settled for $250,000 or more and there is a reasonable expectation of Medicare expenses within 30 months of the settlement, then an MSA must be created.  (Note: the Centers for Medicare and Medicaid (“CMS”) do not review MSAs for $25,000 or less.)

The MSA funds are kept in an interest bearing account with distributions only made for medical expense.  The account administrator must keep accounting records for the CMS.  Once the funds are exhausted, a final accounting is performed before the claimant’s Medicare benefits are reinstated without any risk of termination.  The interest bearing account is either administered by the claimant or a third party administrator. 

Claimants should be aware that funds for an MSA will be taken out of the claimant’s settlement.  If a claimant is entitled to $100,000 for a settlement with a $50,000 MSA, then the claimant will only receive $50,000, minus attorney’s fees. 

For example, if there were no MSA, then the usual settlement amounts work out to 25% of the settlement to the attorney and the remainder to the client.  This works out to $25,000 for the lawyer and $75,000 for the client for a $100,000 settlement.  In the event of a $100,000 settlement with a $50,000 MSA, then the attorney’s fees are 25% of $50,000, which amounts to $12,500.  The remaining $37,500 goes to the claimant.

The effect of an MSA can result in enormous costs for both attorney and client.  As such, an understanding of the effects of Medicare eligibility is necessary in order to prevent the claimant from forfeiting more money from their case than is necessary.

The Least You Need to Know


The interplay between Social Security and Workers’ Compensation cases is complex.  Disability attorneys should be aware of the basics of how SSDI applications may affect Workers’ Compensation settlements.  Moreover, Workers’ Compensation attorneys should be aware of the offset provisions against SSDI.  Knowing the rules allows for prudent planning in order to maximize the available funds to go to the client.

Matthew Queen is an Associate Attorney with The Law Firm of Feiler & Associates. His practice focuses on representing disability claimants for both SSDI and SSI claims in front of the Social Security Administration. In addition, Matthew assists families to create sophisticated estate plans for people with a chronic condition or disability. Matthew is a veterans accredited attorney with the U.S. Department of Veterans Affairs and helps veterans to manage disability denials and to structure their assets so as to maximize available public benefits. Prior to joining the firm, Matthew was an associate with a Big 4 accounting firm in Los Angeles, California specializing in state and local corporate tax planning and compliance. Matthew received his Doctorate of Jurisprudence from the Georgia State College of law, graduating with Pro Bono Honors as well as his Masters of Taxation from the Georgia State Robinson College of Business. For undergraduate studies, Matthew attended the Georgia Institute of Technology and earned a Bachelor of Science in Management with a concentration in Finance, graduating With Honors.

Wednesday, October 24, 2012

The Importance of Cross-Examining the Vocational Expert about DOT Job Descriptions in a Social Security Hearing


For many Claimants, especially those less than age 50, one of the most unnerving portions of a Social Security Hearing is the testimony of the Vocational Expert (VE).  Generally speaking, the VE’s role in the hearing is to provide insight about the Claimant’s past relevant work as performed and as listed in the Dictionary of Occupational Titles (DOT), and also to provide information about the ability of hypothetical workers to engage in jobs, as well as how many of those jobs occur in the national or local economy.  The purpose of this note is to discuss the portion of VE testimony that focuses on the hypothetical Claimant.
As you may recall, the Vocational Expert is presented with a set of limitations to apply to a hypothetical individual with age, education, and work experience that may or may not mirror the condition of the Claimant.  These limitations are often presented in one or more hypothetical bundles by the Judge or the Claimant’s attorney.  Many Judges take this opportunity to test varying levels of medical limitations with regard to the Claimant’s ability to maintain employment.  They often accomplish this by presenting a hypothetical with a bare minimum of effects, and then a hypothetical with more severe effects.  The purpose of these multiple variants is to find the point at which the hypothetical person becomes too burdened to engage in Substantial Gainful Activity.  There are an awful lot of variables that may or may not be considered during this kind of testimony, and a well-prepared Claimant or their attorney can sometime capitalize on these variables to positive effect.
Hearing a stranger who is not a treating physician provide testimony about the hundreds and hundreds of jobs that a “hypothetical” Claimant can perform can be disturbing to a Claimant.  The word hypothetical is in quotes in the prior sentence because it is not a secret that the hypothetical individual is nothing but a straw-man representation of the Claimant in various forms.  The following section discusses an actual set of hypothetical parameters for a Claimant that I represented recently, who granted me permission to share this information.  The names are removed to protect the privacy of those involved, and the dialog is not exact, but these changes should negatively affect the message.
My Claimant experienced an amputation as a result of an industrial accident.  He experiences significant phantom limb pain, which is treated by narcotic pain medication, and also deals with other provable shoulder and back issues, for which we presented multiple medical records.  This portion of the hearing occurs immediately after verifying the VE’s credentials, and asking if Claimant had any objections to the information therein.

Judge:   Madam VE, I would like you to assume the following about a hypothetical Claimant
1.  A younger individual, with limited education
2.  Capable of light work, occasionally lifting 20lbs, and frequently lifting 10lbs.
3.  Capable of standing for 6 hours of a workday, and sitting for 6 hours of a workday.
4.  No activities capable with right arm, which was dominant, left arm capable of frequent overheard reaching, and vibration should be avoided.
5.  No pushing, pulling, reaching, handling, fingering, or feeling.
6.  Never use ladders, ropes, or scaffolds.
7.  Occasionally able to use ramps and stairs, and balance.
8.  Frequently able to stoop, kneel, and crouch.
9.  Never able to crawl.
Given these restrictions, is there any work that this hypothetical Claimant can do?

VE:         Yes there are jobs that this hypothetical person can do.  They are:
1.  Chaperone - DOT Code 359.667-010, Exertional level = light, SVP of 2, 700 jobs locally, 71,000 in the national economy.
2.  Usher - DOT Code 344.677-014, Exertional level = light, SVP of 2, 3.300 jobs locally, 107,000 in the national economy.
3.  Research Subject - DOT Code 359.677-030, Exertional level = light, SVP of 1, 700 jobs locally, 71,000 in the national economy.

Judge:   Thank you Madam VE, Counsel do you have any questions?

               The question posed by the judge is emotionally challenging, yet important, and the answer should be a resounding “YES”.  The Claimant just heard about the thousands of jobs available to him, and now he has an opportunity ask questions about how this testimony was reached.  More importantly, does the Judge believe that a Claimant has thousands of jobs from which to choose given the testimony of the VE?  Possibly, but with a few well targeted questions, the impressive number of jobs may be winnowed down significantly.   
Please note, there are several items that should be questioned about the testimony above.  This article is going to focus on the actual job listings in the DOT, but one should also question the source of the job numbers, the date they are pulled, and how jobs 1 and 3 seem to have the same number of occurrences.  With regard to the job counts, the answer is that the counts are often driven by census codes, which do not often neatly crosswalk over to DOT codes and are usually aged.  Also, it should be noted that the DOT is an aging text, and often out of step with the job market of today.  There are several ways that this can be used to a Claimant’s benefit, but this article focuses strictly on job descriptions.
               With regard to the actual jobs cited by the VE, I highly recommend having access to a Dictionary of Occupational Titles when at a Social Security hearing.  Many details may be found in this text that can help erode the actual number of jobs under a certain title that may be performed.  Here are the DOT descriptions for the jobs that were cited.

1.       Chaperone – Accompanies minors on trips to educational institutions, public functions, or recreational activities such as dances, concerts, or sports events, to provide adult supervision in absence of parents. Follows parents' instructions regarding minors' activities and imposes limitations and restrictions to ensure their safety, well-being, and conformance to specified behavior standards. May plan free-time activities. May arrange for transportation, tickets, and meals.

2.      Usher - Assists patrons at entertainment events to find seats, search for lost articles, and locate facilities, such as restrooms and telephones. Distributes programs to patrons. Assists other workers to change advertising display

3.      Research Subject - Submits to scientifically conducted research relating to such fields as medicine, psychology, or consumer-product testing: Participates in activities such as performing physical tasks, taking psychological tests, or using experimental products, following instructions of researcher. Replies verbally or records responses to questionnaire to provide researcher with data for evaluation.

When questioning the VE, there are two distinct classes of questions that can be posed.  One class of question can relate to the exact hypothetical as presented by the Judge.  The second class of question can be presenting one’s own scenario, or tweaking the Judge-presented scenario and asking questions.  Both may represent potent assistance to a Claimant, and it should be noted that there are certain times when it is best not to ask questions at all (generally where there is no testimony that has negative implications for your case).  It is also important to note that the VE should not be looked at as an adversary in these cases.  While it is true that their evidence may be harmful to your Claimant’s case, I have seen never seen a VE that “has it out” for Claimants.  In fact, in my experience, if presented with an appropriately targeted and persuasive question, the VEs testimony may strengthen a Claimant’s case considerably.
Here are some questions that, in my opinion, question the nature of the jobs proposed, and challenge the ability of my Client to perform them as they would be in the national economy.  Each practitioner is going to see this portion of the hearing differently, so this is not a “bright line” rule about how to examine VE testimony, but rather some direction that may help the reader make use of a source of potentially helpful testimony.  I recommend that when asking the VE questions, one should remain respectful and polite because an angry expert provides large hurdles to overcome.
You will see that the “Chaperone” must accompany minors on trips, and to dances, concerts, and sporting events.  When comparing this with the Judge’s hypothetical impairments listed above, there seems to be somewhat of a conflict.  Most concerts and sporting events take place in theaters and arenas.  Nearly every one of these locations features ramps or stairs, as does the bus used to transport folks to those locales.  The job of Chaperone does not neatly fit into the Judge’s limitations that the Claimant can “occasionally…use ramps and stairs”.  So the VE should be questioned about whether the jobs cited were full time positions, and whether or not in their vocation experience, chaperones encountered ramps and stairs when escorting student within arenas and theaters.  An honest VE will acknowledge the inherent conflict in this scenario.
With regard to the second position, the “Usher” must help folks find seats, distribute programs, and change the advertising display.  The issues discussed above regarding ramps and stairs still stand for this position, which occurs in places of public entertainment, with some notable additions.  An usher is required to hand out programs, and change marketing signs.  The VE should be questioned regarding a one-armed client’s ability to hand out programs and wrangle letters on a sign in the hopes of eroding the vocational base.  Additionally, with regard to changing letters on signs, it is reasonable to expect that ladders might be involved in this undertaking, which the Judge clearly prohibited in item 6 of his hypothetical.  These items erode the vocational base as well
Finally, the person performing the job ”Research Subject” must perform tasks, fill out responses, or use experimental products.  The VE should be questioned about the purpose of employing research subjects, and then asking, in my client’s case, if the physical restrictions noted by the Judge, including in my client’s case an amputated dominant hand, would interfere with the ability to perform tasks as generally required by those folks employing the research subjects.  Additionally, any job that would require “filling out responses” would be required to use a writing instrument to fill out a document.  Certainly a question about the loss of a dominant hand would be proper in ascertaining whether or not the vocational base was eroded.  Additionally, in the case of a Claimant who takes daily prescription drugs, it would be worthwhile to add this fact to the hypothetical and ask if this fact would affect the number of job available under this DOT title.
In closing, I want to note that there are multiple angles one can take when examining the testimony of the VE.  Sometimes it is appropriate to leave well enough alone, and sometimes heavy scrutiny is warranted.  In cases where it would seem that the Judge might be persuaded that the Claimant is capable of work that exists in significant numbers in the national economy, I would recommend scrutinizing every element provided by the VE and looking for holes.  Just because they are trained experts does not mean that they are perfect and rely on perfect data.  If this were the case, Social Security would not be pursuing other avenues of Vocational Information to utilize in the Social Security process.

For more information about this article, or to discuss your case with an attorney, contact Thomas O’Brien at Feiler & Associates.

Wednesday, August 10, 2011

A New Addition: Information for Veterans

A large number of my readership and clients are Disabled Veterans who are becoming informed about the differences between Social Security Disability and Veterans Service-Connected Disability. I have started another blog especially for the Veteran population at http://veteranaid.blogspot.com, where I will begin to offer information about this related and very complex process. One major difference between VA Service Connected Disability and Social Security Disability is that unlike Social Security Disability which is an "all-or-none" undertaking, there are varying degrees of Veterans Disability. These levels are expressed by diagnoses as percentages, which are then combined to create a composite disability rating that is then used to determine compensation.

A common concern that I hear from my clients is about the math that is employed when creating a composite disability percentage rating. The reason for much of this confusion centers on disability percentages not being added together, but rather applied sequentially to the residual capacity that the Veteran retains. The law that governs the calculations of these numbers may be found in the Code of Federal Regulations at 38 CFR 4.25.

I have also created a tool that may of of use when calculating or simulating various disability percentages. Click the blue link to use my online Disability and Bilateral Percentage Calculators. This tool is still in development, and is not a substitute for legal advice, so I would appreciate any feedback or compatibility issues you may have.

This blog, and the information herein is for informational purposes only, and should not be relied upon as legal advice. For more information about your particular situation, please contact Disability Attorney Thomas C. O’Brien.