Do I qualify for social security benefits ?
To qualify for Social Security benefits, you must first have worked in jobs covered by Social Security. Then you must have a medical condition that meets Social Security’s definition of disability. In general, SSA pays monthly cash benefits to people who are unable to work for a year or more because of a disability.
Benefits usually continue until you are able to work again on a regular basis. There are also a number of special rules, called “work incentives,” that provide continued benefits and health care coverage to help you make the transition back to work.
If you are receiving Social Security disability benefits when you reach full retirement age, your disability benefits automatically convert to retirement benefits, but the amount remains the same.
Can My Family Get Benefits from Social Security?
When you start receiving disability benefits, certain members of your family may also qualify for benefits on your record. Each family member may be eligible for a monthly benefit that is up to 50 percent of your disability rate. However, there’s a limit to the total amount of money that can be paid to a family on your Social Security record. The limit varies, but is around 150 to 180 percent of your disability benefit. If the sum of the benefits payable on your account is greater than this family limit, the benefits to the family members will be reduced proportionately. Your benefit will not be affected.
Credibility assessment
An ALJ is not required to believe every allegation of disabling pain or other nonexertional impairment.” Orn, 495 F.3d at 635 (internal quotation marks and citation omitted).Sometimes a credibility assessment must be done. When a medical impairment has been established, however, the ALJ must provide “specific, cogent reasons for the disbelief” and may not discredit a claimant’s testimony as to subjective symptoms merely because they are unsupported by objective evidence. Lester, 81 F.3d at 834.
Continue…
Can I Work While Receiving Benefits?
If you are receiving disability benefits and are interested in working, Social Security’s Work Incentives Program can help you. Special rules make it possible for people who are receiving Social Security disability benefits or Supplemental Security Income (SSI) to work and still continue to receive monthly disability payments until they are able to work on a regular basis.
In addition, if you cannot continue working because of your medical condition, your benefits can start again—you may not have to file a new application.
Work incentives include:
– Continued cash benefits for a time while you work;
– Continued Medicare or Medicaid while you work; and
– Help with education, training and rehabilitation in order to start a new line of work.
The rules are different under Social Security and SSI.
Is Alcohol Abuse A Disability?
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The commissioner erred as a matter of law in determining that alcohol abuse was a material factor in causing Plaintiff’s disability.
An individual shall not be considered disabled if alcoholism or drug addiction would be a contributing factor material to the Commissioner’s determination that the individual is disabled.42 U.S.C. § 423(d)(2)(C). The 9th circuit has determined that the “key factor in determining whether drug addiction or alcohol abuse is a contributing factor material to the determination of disability is whether an individual would still be found disabled if [he] stopped using alcohol or drugs.” Sousa v. Callahan, 143 F.3d 1240, 1245 (9th Cir.1998) ;see also 20 C.F.R. § 404.1535(b)(1) (same). The test therefore as to whether alcohol is a material factor is the following:
Veterans’ claims: HH v. Shinseki 11-1612
How We Appeal Your Case – Long Term Disability
1. Demanding documents from the Insurance Company. We write the insurer demanding a copy of: the plan; the policy; the SPD; the claim file; all documents relied on by the insurer in denying the claim; any internal guidelines used by the insurer; the reports of all medical and vocational reviewers; audio or videotapes of the claimant; and notes of any telephone conversations.
2. Demanding Specific Reasons for Denial. By law the insurer is obligated to provide specific reasons for their denial. We write the insurer demanding that they provide us with a more specific description of the reasons for denial. Often the initial denial letter only states that there was insufficient objective evidence in support of your claim.
Strategies Used Insurance Companies to Deny Benefits
The clients I most often see are clients who were approved for benefits by the insurance company but shortly thereafter the plan terminates their benefits. The most common arguments raised by the plan are:
• * The Claimant’s medical condition has improved
• * The Claimant is not receiving adequate medical care
• * Surveillance by a private investigator found that Claimant is not disabled
The Claimant’s Medical Condition Has improved
The initial approval by the plan has legal significance.
In order to deny benefits at a later time the plan has to show a major change in circumstances. In McOsker v. Paul Revere Life Ins. Co., 279 F.3d 586 (8th Cir., 2002) The Court of appeals held:
Social Security and Long Term Disability under ERISA
Prior to the Supreme Court’s decision Black & Decker Disability Plan v. Nord, 538 U.S. 822, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003), the Ninth Circuit applied the treating physician rule in ERISA disability cases. SeeRegula v. Delta Family-Care Disability Survivorship Plan, 266 F.3d 1130 (9th Cir.2001), vacated, 539 U.S. 901, 123 S.Ct. 2267, 156 L.Ed.2d 109 (2003). Under this rule, the opinions of a claimant’s treating physician are given special deference and may be disregarded only for clear and convincing reasons based on substantial evidence in the record. In Nord, the Supreme Court rejected this rule, holding that ERISA and the Secretary of Labor’s regulations implementing the statute do not command plan administrators to credit the opinions of treating physicians over other evidence relevant to the claimant’s medical condition.Nord 538 U.S. at 825, Following the rejection of the treating physician rule in ERISA cases, planadministrators almost uniformly ignore the favorable decision by the SSA when denying applications for disability benefits under ERISA.
Do You Need Representation for Long Term Disability Benefits?
Do you need representation for LTD benefits
While the process described above is relatively straight forward , many claims are denied.
There are three primary reasons why your claim may be denied:
1. You misunderstand the policy language.
2. You are unable to overcome the “hired gun” experts hired by the insurance company to defeat your claim.
3. You are denied by the internal appeal process and need to file a law suit under ERISA.
The policy requires that you appeal the denial in 60 days. Many of my clients believed that the requirement is satisfied by a letter stating that they are dissatisfied with the decision. This kind of “appeal” rarely if ever leads to reversal of the decision. Hiring a lawyer after the second denial is a waste of time as the Court will not accept any material not previously provided to your insurance claim representative and your Court filing is doomed to fail.