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.
Wednesday, September 29, 2010
A Social Security PASS for Medicaid Benefits and Much More
One of the rewarding elements of a Social Security practice is the idea that when one a practitioner succeed on behalf of a Claimant, that Claimant’s life is improved in perpetuity, or at least until they are well enough to work again. Unfortunately in some cases, even a grant of benefits is not enough to ensure that the Claimant has access to proper health care. SSDI requires a two year wait before Medicare benefits kick in, and those two years can bring serious health events that require treatment. SSI will frequently open the door to Medicaid benefits immediately, which are worth more to many Claimants than the monthly payment that Social Security makes. Medicaid generally requires smaller patient outlays, and has comparable benefit levels to other government plans. The question is, when an RSDI Claimant earns too much to qualify for SSI (and consequentially Medicaid), and can find no other way onto the Medicaid registry despite being indigent by all other measures, what are the options for healthcare, especially during the Medicare waiting period? Enter the PASS, otherwise known as the “Plan for Achieving Self-Support”.
In Georgia, and in other states where SSI grants Claimants access to Medicaid, SSDI recipients who are otherwise earning too much to qualify for Medicaid may be able to get coverage if they have minor children living with them, or if they earn an amount over the limit that may be “spent down” by medical bills, which would push them under the limits. These are not the only ways that a non-SSI recipient may unlock benefits, but it is safe to state that each gateway to Medicaid is narrowly tailored and does not serve every element of the disabled and poor population, especially those that are close to the line. To further restrict access to Medicaid, SSDI payments are generally made in greater amounts than the earnings limits set by SSI. As such, Claimants that would otherwise qualify for SSI, and thus Medicaid, are thereby precluded from tapping into these benefits. PASS can benefit those that are poor, but on SSDI, by carving off a portion of their SSDI earnings to be set aside in a pot of funds to be used to assist the Claimant in pursuit of a work goal.
The benefits of PASS are multi-fold. For the hypothetical “almost poor enough” SSDI recipient that I discussed above, the benefits are clear. If their PASS were crafted correctly and approved, this person would receive a larger monthly allotment of money since they would qualify for SSI benefits, Medicaid benefits would begin immediately since they are now under the earnings limit, and they would begin contributing to a growing a pool of funds that may be used for a variety of purposes, including starting a business, getting training, buying equipment, and other activities appurtenant to getting back on one’s feet. This is a great scenario for the Claimant, and can truly make their lives better.
So what are the requirements of participating in the PASS program? The primary requirement is an approved PASS plan. A PASS plan may be submitted on the SSA-545 form, which may be found at here. A PASS plan is not something that may be simply thrown together. There must be an actual plan including goals and time frames specific to the Claimant that must be met in furtherance of the work goal. This plan must designate what amount money will be used to reach the goal and how that money will be used. Finally the plan must set clear lines on the steps to be taken to avoid co-mingling the PASS funds with the Claimant’s other money, the SSA must approve the plan and reserves the right to conduct future reviews to assess compliance and progress. For information about the PASS program, one can find the appropriate telephone number by visiting http://www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm. Another helpful website with more written detail may be found at http://www.ssa.gov/pubs/11017.html.
To speak with an attorney about your Social Security claim, please contact Thomas O’Brien at Feiler & Associates.
In Georgia, and in other states where SSI grants Claimants access to Medicaid, SSDI recipients who are otherwise earning too much to qualify for Medicaid may be able to get coverage if they have minor children living with them, or if they earn an amount over the limit that may be “spent down” by medical bills, which would push them under the limits. These are not the only ways that a non-SSI recipient may unlock benefits, but it is safe to state that each gateway to Medicaid is narrowly tailored and does not serve every element of the disabled and poor population, especially those that are close to the line. To further restrict access to Medicaid, SSDI payments are generally made in greater amounts than the earnings limits set by SSI. As such, Claimants that would otherwise qualify for SSI, and thus Medicaid, are thereby precluded from tapping into these benefits. PASS can benefit those that are poor, but on SSDI, by carving off a portion of their SSDI earnings to be set aside in a pot of funds to be used to assist the Claimant in pursuit of a work goal.
The benefits of PASS are multi-fold. For the hypothetical “almost poor enough” SSDI recipient that I discussed above, the benefits are clear. If their PASS were crafted correctly and approved, this person would receive a larger monthly allotment of money since they would qualify for SSI benefits, Medicaid benefits would begin immediately since they are now under the earnings limit, and they would begin contributing to a growing a pool of funds that may be used for a variety of purposes, including starting a business, getting training, buying equipment, and other activities appurtenant to getting back on one’s feet. This is a great scenario for the Claimant, and can truly make their lives better.
So what are the requirements of participating in the PASS program? The primary requirement is an approved PASS plan. A PASS plan may be submitted on the SSA-545 form, which may be found at here. A PASS plan is not something that may be simply thrown together. There must be an actual plan including goals and time frames specific to the Claimant that must be met in furtherance of the work goal. This plan must designate what amount money will be used to reach the goal and how that money will be used. Finally the plan must set clear lines on the steps to be taken to avoid co-mingling the PASS funds with the Claimant’s other money, the SSA must approve the plan and reserves the right to conduct future reviews to assess compliance and progress. For information about the PASS program, one can find the appropriate telephone number by visiting http://www.socialsecurity.gov/disabilityresearch/wi/passcadre.htm. Another helpful website with more written detail may be found at http://www.ssa.gov/pubs/11017.html.
To speak with an attorney about your Social Security claim, please contact Thomas O’Brien at Feiler & Associates.
Tuesday, September 28, 2010
Congratulations to Georgia State University College of Law!
GSU Law School's stock continues to rise. In addition to the Health Law program recently receiving a ranking of 4th in the nation from U.S. News & World Report, the good news continues. National Jurist, a publication aimed at law students and those contemplating law studies, recently designated GSU Law to be at the very top of the list of best value law schools. Factors driving these rankings included bar passage rate, indebtedness, and employment statistics. This is fantastic news both for alumni as well as those deciding to continue their education with a law degree. Keep it up GSU!
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