Recently in Social Security Disability Insurance Category

Disability Due to Spinal Injuries and Disorders

July 15, 2014

Spinal injuries or disorders may cause a great deal of pain or limit a person's movement. There are many causes of spinal conditions, including infections, injuries, degenerative bone changes, spondylitis, scoliosis, and tumors. Some of these disorders can be disabling in nature. Spinal injuries or disorders are relatively common. In fact, spinal conditions and back pain are one of the leading causes of disability.

When a back condition forces someone to miss work, it is necessary to carefully document how the back condition is disabling. First of all, objective testing is required to make a correct diagnosis and reveal the severity of the condition. Objective testing may include x-rays, MRIs, and CT scans, among other tests. One overlooked form of objective evidence is a list of signs observed by the treating physicians. Observable signs may include an abnormal gait when ambulating, pain with movement, and noted areas of the spine which are tender or painful on palpation. Range of motion testing is another type of evidence that is helpful to demonstrate disability. A range of motion test shows the degree to which a person can move each of their joints.

After objective evidence has been used to make a diagnosis, all treatment options must be considered. In most cases, conservative treatment is attempted prior to surgical intervention. Conservative treatment usually means rest, heat or ice therapy, physical therapy or home exercises, pain medications (NSAIDS and/or steroids), injections (nerve blocks and steroids), and non-traditional treatment such as massages, chiropractic adjustments, and acupuncture. If a spinal condition remains severe after conservative treatment and surgery is a possibility, a referral may be made to an orthopedic surgeon or neurosurgeon. Available surgical procedures include laminectomy, discectomy, or a spinal fusion. If surgery is not an option for the patient, then they may be referred to a specialist in pain management.

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Persistent Lyme Disease Symptoms May Cause Disability

June 30, 2014

The Center for Disease Control (www.CDC.gov) reported 17,730 cases of Lyme Disease in the year 2000 and as of 2012, over 100,000 cases have been reported. Lyme Disease is a growing epidemic in America and was first recognized in 1975 in Lyme, Connecticut, where the first outbreak occurred. Lyme Disease is the illness that results from the bite of an infected tick and it is the most common tick-born infectious disease in the United States.

Several related species of Borrelia cause Lyme Disease (Lyme Borrelia). Virtually all patients in the United States are infected with a single species called Borrelia burgdorferi, the spirochete that infects the deer tick and causes Lyme Disease. Worldwide, there are about 850 tick species and 30 major tick-borne diseases.

The infection usually starts with a painless, spreading "bull's eye" rash where the tick had attached itself to the skin. If you notice your tick bite right away and you are treated with antibiotics, this infection can be cleared fairly easily. If the cause is not found until later, people with Lyme Disease are more likely to feel fatigued, suffer from poor sleep, and muscle and joint pain, even after treatment. Other symptoms might be an acute fever, rash, Bells' palsy (paralysis of the face), headache, and joint and muscle pain. Some patients may complain of sensory symptoms such as burning, shooting pain or numbness. Your doctor may administer blood tests to determine if Lyme Disease is causing your symptoms and to rule out other diagnoses.

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Eligibility for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)

June 17, 2014

When applying for Social Security disability benefits, claimants should be aware of the two types of disability programs available. The Social Security Administration (SSA) offers Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
For both programs, the SSA reviews whether the claimant meets the applicable definition of disabled. The SSA defines "disabled" as follows:

An individual shall be considered to be disabled for purposes of this title if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months.

On the SSA's website, the SSA further describes its standard of disability and how it decides whether the claimant is disabled. If adequate proof of disability is not provided, a claim for either SSDI or SSI benefits will be denied. If a claim for SSDI or SSI benefits is denied, the claimant has a maximum of 65 days to timely appeal.

Social Security Disability Insurance (Title II)

SSDI benefits act as a federal insurance program to workers. Taxes are deducted out of workers' payroll checks. The tax deductions serve as a premium to qualify for SSDI. If a worker has earned 20 Social Security credits in 10 years, then they will have enough work credits to be eligible or SSDI benefits. The SSA's website provides more details on how work credits are earned.

To be eligible for SSDI benefits, the claimant must also be under 65 years old. For SSDI claimants, there are no requirements that the claimant have a limited amount of resources. However, as of June 2014, the SSDI claimant cannot be earning $1070 per month in wages. Of course, to be eligible for SSDI benefits, claimants must meet all other work earnings requirements and proof of disability requirements.

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Functional Capacity Evaluations in Disability Claims

May 14, 2014

Functional Capacity Evaluations ("FCEs") are a type of test used to determine the severity of someone's physical impairments. FCEs are common in disability insurance claims, workers compensation claims, and other contexts where the level of a claimant's injury or sickness needs to be evaluated.

FCEs are usually administered by a physical therapist or physician who specializes in occupational medicine. Common measurements during an FCE include how much the claimant can lift, how much they can push and pull, how long they can walk and stand, how long they can sit, the ability to reach in all directions, the ability to grasp and manipulate with each hand, the degree to which a claimant can move all joints, the ability to squat and bend, and the ability to stoop and balance. FCEs can vary in duration: some FCEs are very brief - only a couple of hours - and some FCEs are actually performed over the course of two days.

In long term disability insurance cases, many insurance policies allow the insurance company to request that a claimant undergo an FCE at a facility of their choosing. A claimant's refusal to undergo such testing may give the insurance company grounds to deny disability benefits. Therefore, it is likely that the claimant will have to comply with the insurance company's request for an FCE. However, a claimant may want to consider the following tips before attending an FCE:

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Disabling Neuropathy

April 15, 2014

As type II diabetes becomes more and more common, many people suffer from peripheral neuropathy, which is a result of nerve damage. Neuropathy may cause weakness, pain, or numbness in the hands and feet, although it may occur in other parts of the body. Sometimes this nerve damage becomes so severe that it prevents people from maintaining their normal lifestyle, including the ability to work.

If neuropathy forces someone to stop working and they apply for disability benefits, there are some important tips to help document the disability. First, establishing treatment with a neurologist is very important. A Neurologist is the appropriate specialist to diagnose and treat neuropathy. If a person does not properly document their neuropathy, they will face a tough challenge in having their disability claim approved. Diagnosis requires considering full medical history, neurological examination (such as checking reflexes, sensation, and coordination), physical examination, and appropriate testing. The testing most commonly used for diagnosing neuropathy includes electromyography, nerve conduction tests, nerve biopsy or skin biopsy, blood tests, MRIs or other medical imaging tests, and lumbar puncture (or spinal tap).

Second, it is necessary for the disability claimant to maintain regular treatment with their neurologist and other medical care providers. If it is shown that the disabled person has not complied with recommended treatment, then disability benefits may be denied.

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Social Security Disability Claims at the Appeals Council and District Court

March 17, 2014

Applying for disability benefits from the Social Security Administration is a layered process. If a claimant is denied initially, then they must file a request for reconsideration. If their request for reconsideration is denied, then they must file a request for a hearing before an Administrative Law Judge. Claimants should be aware that each of these appeals must be filed within 60 days of receiving a denial letter.

At the hearing level, the claimant's chances of success improve. However, even strong claims can be denied by an Administrative Law Judge for a variety of reasons. It is a nationwide trend that more Social Security disability cases are being denied.

Appeals Council

When an Administrative Law Judge denies a claim, then the next step is to request a review from the Appeals Council. This request must be made within 60 days of the denial notice. The Appeals Council is located in Falls Church, Virginia and performs a review of the claimant's evidence. There is no hearing at this stage, and requests for review must be made in writing. Unfortunately, the time it takes for the Appeals Council to make a decision is extremely long. The Social Security Administration's website states that "the average processing time was 395 days" for the period of October 2011 - September 2012.

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Disability and Retirement Benefits under the Indiana Public Employees' Retirement Fund (PERF)

January 16, 2014

If a disability forces someone to stop working, he or she may be unsure of available disability benefits. In Indiana, some employees may be eligible for the Public Employees' Retirement Fund (PERF) and Indiana Public Retirement System (INPRS). Indiana employees who may be eligible for these benefits include those working at public universities, school corporations, municipalities, and state agencies.

Disability Benefits under PERF

As of January 2014, the PERF Employer Handbook is available online at the following link: http://www.in.gov/inprs/2416.htm#. According to the PERF Employer Handbook, employees are eligible to apply for disability benefits if they meet the following criteria:

Have five or more years of creditable service under PERF before the termination of salary, or employer provided income protection benefits (disability insurance), or leave under the Family and Medical Leave Act (FMLA), or worker's compensation benefits,

Are determined by the Social Security Administration to be disabled, and

Are receiving salary, or employer provided income protection benefits, or are on leave under the Family and Medical Leave Act (FMLA) as of the onset date established by the Social Security Administration.

If an employee is eligible for PERF disability benefits under the above criteria, they should apply for disability benefits as soon as possible. As mentioned in the first requirement, the employee may first receive "employer provided income protection benefits" or disability insurance. Employer provided income protection benefits differ from PERF disability benefits and requires a separate disability application - usually this application should be filed as soon as the employee stops working due to disability.

Even though the PERF Employer Handbook sets out the above criteria, Indiana Code actually lists an additional requirement once PERF disability benefits have been approved: "at least once each year until the member reaches age 65, PERF verifies the member's continued disability." Ind. Code 5-10.2-4-6. If an employee is approved for disability benefits, then they will continue to receive benefits until age 65 so long as the Social Security Administration continues to approve disability and the employee provides the appropriate information to PERF.

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Disabling Headaches

November 15, 2013

Headaches are an uncommon occurrence for most people. For some people, though, headaches occur frequently, and can be so severe and intense that they are debilitating. When headaches occur frequently, they can force a person to stop working altogether.
Disabling headaches are a non-specific symptom and may be caused by a range of conditions. Therefore, it is crucial for a person to seek medical treatment to learn the cause of their headaches. If a family doctor cannot diagnose the condition causing headaches, then the patient will likely be referred to a neurologist.

Objective testing that explains the cause of the headaches may strengthen the disability claim, so it is important for the patient to undergo any sort of applicable testing. However, the cause of headaches is often not detectable in CT scans or other testing. If the headaches are not explained by test results, then the patient should work with their physicians to determine if any environmental factors are contributing to their headaches.

In cases where the headaches are severe, a patient may be experiencing migraine headaches. Migraines are characterized by moderate to severe headaches along with some of the following symptoms: photophobia (sensitivity to light), phonophobia (sensitivity to sound), pulsating, pain on one side of the head, and nausea/vomiting. Again, it is essential for a patient to explain his or her symptoms to their physicians so that the best course of treatment can be planned. Treatment for migraines may include prescription medications, injections, and attempting to remove trigger sources.

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Disabilities Caused by Mental Health

October 15, 2013

Some may associate disability with physical impairments like the inability to walk or stand. However, disabilities are not limited to physical ailments and many people suffer from disabling mental health conditions. Proving that a mental health condition is disabling can be challenging because disorders like major depression and bipolar disorder may take time to conclusively diagnose.

In order to prove that a mental health condition is disabling, a person's medical treatment must document the severity of symptoms over an extended duration. This requires that the claimant regularly treat with a psychiatrist and/or licensed psychologist. Although a therapist or counselor may treat someone for mental health problems, the Social Security Administration and long term disability insurers give more weight to the opinions of licensed psychologists and psychiatrists rather than therapists or counselors. Generally, the Social Security Administration affords more weight to the opinions of accepted medical sources, like a treating psychiatrist or psychologist, while long term disability insurance companies more freely pick-and-choose which medical opinions they rely upon to make a determination.

Severe mental health problems can also be evidenced by visits to the hospital and inpatient treatment. Some mental health listings under the Social Security Administration require episodes of decompensation. Medical records of a hospitalization can serve as strong evidence of an episode of decompensation. Moreover, the opinions from third parties, like a family member or friend, may help show episodes of decompensation. Any person who has been able to observe the claimant's personality or behavioral health over time can provide relevant evidence revealing the severity of the claimant's mental health condition.

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The Importance of Objective Evidence in Your Disability Claim

September 12, 2013

Most disability insurance policies do not explicitly require that a claimant provide objective evidence to support their disability. Yet, it is all too common when a claimant receives a denial letter in the mail from their insurance company claiming that disability benefits have been denied due to a lack of objective evidence. Unfortunately, many courts have determined that insurance companies are permitted to rely upon objective evidence when making a determination of disability.

Objective medical evidence is documentation from tests including but not limited to: medical resonance imaging (MRIs), x-rays, blood tests and other chemical tests, electrophysiological studies (electrocardiogram, electroencephalogram, etc.), and psychological tests. Unfortunately, not all medical conditions are detected in these various types of objective testing, which can put some disability claimants in a challenging condition. For example, someone with fibromyalgia may not be able to produce traditional objective medical evidence of their condition. For more information about fibromyalgia, see this entry: Fibromyalgia Disability Claims.

In order to improve the chances of being approved for disability insurance benefits, a claimant should make sure that their treating providers have ordered all of the necessary tests to properly diagnose their condition. Without objective documentation, the insurance company is much more likely to deny benefits. For example, a claimant with Multiple Sclerosis should undergo any applicable testing, like an MRI of the brain, a spinal tap, and tests measuring electrical activity in the brain. For more information about Multiple Sclerosis, see this entry: Multiple Sclerosis Disability Claims.

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The Importance of Vocational Evidence in Disability Claims

July 29, 2013

In both private disability insurance claims and Social Security disability claims, vocational evidence is usually considered when determining whether an individual is disabled or not. Vocational evidence is information about an individual's occupation or the occupations they may be able to perform when considering their functional capacity, training, education, and work experience. This kind of evidence can consist of job descriptions from the employer, self-reported job duties, information from the Dictionary of Occupational Titles or other similar resources, and the opinions of vocational experts (also known as vocational rehabilitation consultants).

Long Term Disability Insurance

When someone becomes disabled and their employer provides long term disability insurance, then that person often applies for disability benefits under the requirement that they are unable to perform the duties of their "own occupation." Under this type of definition of disability, the individual must show to the insurance company that because of their medical condition(s), they cannot return to their previous job.

During this stage of the disability claims review, the insurance company may consider the individual's job duties and may gather information from the employer, the claimant, publications like the Dictionary of Occupational Titles, or a vocational expert. It is most common for the insurance company to at least gather the employer's job description as part of their claims analysis.

Most private disability insurance policies limit the time for which a person can receive disability benefits under the "own occupation" definition and after a predefined amount of time (often 24 months), the definition of disability requires that the individual prove that because of their medical condition(s), they cannot perform the duties of "any occupation". At this stage of the disability review, vocational evidence becomes even more important because the claimant has to prove that there are no occupations he or she can perform. The insurance company may use the opinions of vocational experts and resources like the Dictionary of Occupational Titles or ONET (Occupational Information Network) to find other occupations that the claimant may perform.

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Appealing the Denial of Your Social Security Disability Claim

June 17, 2013

After claimants go through the long process of completing paperwork to apply for Social Security disability benefits, it is common for them to receive the unfortunate news that their claim has been denied. The Social Security Administration (SSA)'s initial review is conducted by a state agency, the Disability Determination Bureau (DDB). The DDB is responsible for processing the claim, ordering consultative examinations if necessary, obtaining medical records, and determining whether the claimant meets the standards of Social Security disability benefits.

Request for Reconsideration

About 75% of claims for Social Security Disability Insurance and Supplemental Security Insurance are denied. A claimant has a maximum of 65 days from the date of the denial letter to appeal the decision. It is of the utmost importance to file a timely appeal. Otherwise, a denied claimant may be forced to file a new claim unless they can prove that there was an exceptional circumstance to explain why their appeal was not timely filed. When the claimant is appealing the DDB's initial denial, this is called a "request for reconsideration." A claimant has the right to legal representation and a qualified attorney can help a claimant file a request for reconsideration.

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Multiple Sclerosis Disability Claims

May 14, 2013

Multiple Sclerosis is an autoimmune disease that affects the brain and spinal cord. The symptoms and severity of Multiple Sclerosis (MS) can vary among those afflicted with the disease, but it is not uncommon for the condition to prevent a person from working. Symptoms can include fatigue, loss of balance, muscle spasms, numbness, weakness, tremors, problems with coordination, difficulty walking, vision problems, bowel/bladder difficulties, inability to concentrate, memory problems, and speech impairments.

When MS prevents a person from working and they file a disability claim with their insurance company or the Social Security Administration, there are a few things that can help prove that MS is disabling. The first step is to make sure that the patient has been diagnosed properly. That includes undergoing exams like MRIs of the brain and spine, nerve function studies, and lumbar punctures. These objective test results are essential to ruling out other conditions and determining whether a patient has MS. Moreover, these test results can also indicate the severity level of a patient's MS.

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Fibromyalgia Disability Claims

March 13, 2013

Fibromyalgia is a condition that may prevent someone from working. In these situations, the person may be able to apply for short term disability benefits, long term disability benefits, or Social Security disability benefits. When it comes to filing a claim for disability benefits, it can be challenging for claimants to prove that their fibromyalgia is disabling. These challenges appear in claims to both insurance companies and the Social Security Administration ("SSA").

Those who suffer from fibromyalgia experience chronic, widespread pain and fatigue, but the objective test results may not show this. Unlike conditions such as Multiple Sclerosis or degenerative disc disease, fibromyalgia does not appear in MRIs or x-rays. Because fibromyalgia is a disorder which does not appear in medical imaging or blood tests, it can be a difficult condition to diagnose. If a fibromyalgia patient is applying for disability benefits, they should follow these steps to document proof of their disability:

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Seventh Circuit Decision: Administrative Law Judge Must Properly Consider Treating Physician's Opinion

February 18, 2013

The Seventh Circuit issued its decision in Roddy v. Astrue on January 18, 2013. 2013 WL 197924 (7th Cir. 2013). In Roddy, the claimant appealed the Administrative Law Judge's denial of her Social Security Disability Insurance ("SSDI") claim. After the district court upheld the ALJ's decision, Ms. Roddy appealed to the Seventh Circuit. The Seventh Circuit held that the ALJ did not adequately explain why the treating physician's views should be set aside and that the ALJ wrongly based his credibility finding on 1) the claimant's failure to seek professional treatment for her back after 2006 and 2) her ability to perform household tasks.

Ms. Roddy suffers from severe lower back pain and was forced to stop working as a shift manager at Taco Bell. When she became unable to work, she applied for SSDI benefits, but her claim was denied both initially and at the ALJ hearing level. After her claim was denied by the ALJ, the Appeals Council declined review and the Southern District of Indiana affirmed the ALJ's denial. The Seventh Circuit, however, found numerous errors in the ALJ's decision and remanded her case back to the Social Security Administration.

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