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Questions after a Favorable Decision: Medicare Eligibility and Overpayment Problems Medicare eligibility

Thursday, February 9th, 2012

A common question from claimants after a favorable decision is “When will I be eligible for Medicare?’  Medicare will be available to you after you have received Social Security disability benefits for 24 months. However, if you would like to sign up for Medicare Part B, you must pay a premium that the SSA will deduct from your monthly check.

Depending on your income and assets, you might qualify for other programs that will pay for all, or part, of your Medicare premium or medical expenses that are not covered by Medicare. Check with your county welfare department to see if you might qualify for any of these programs.

If you have health coverage through a spouse or due to a part time job, you will need to figure out how Medicare and your health insurance work together.  Your health insurance policy may provide that Medicare is your primary insurance and your health insurance will only pick up expenses not covered by Medicare.  You will need to check with your health insurance company once you get your Medicare card.

Overpayments

Once you begin receiving your monthly benefits, be on the lookout for overpayments.  Sometimes errors occur, causing the SSA to pay you too much. The SSA will quickly discover if you have been overpaid and will notify you by letter if an overpayment occurs. The SSA will ask you to repay the overpayment of disability benefits immediately. The problem is that you may have spent the money already.  If you cannot repay the overpayment, the SSA may threaten to discontinue your disability benefits until it has recovered the overpayment. An Ocala disability lawyer may be able to arrange a reduction in your monthly benefits to repay the overpayment, but you may have trouble meeting your expenses during the time your benefit is reduced. In addition, in rare cases, the SSA may even waive the overpayment.

If you are not already represented and would like to consult with an experienced Ocala Social Security attorney at the CJ Henry Law Firm, call (352) 304-5300.

 

Chronic Pain as a Basis for Social Security Disability Benefits: Your Credibility

Wednesday, February 1st, 2012

Your credibility is the extent to which your statements regarding your pain can be believed and accepted as true. There are two significant factors that can increase the credibility of your statements concerning your pain:

  • The consistency of your statements to each other and with other information in your case record. All statements made by you regarding your pain that are in your case record will be examined by the Social Security Administration. These include statements made to your doctors that have been recorded in your medical records, statements made in Social Security disability forms and questionnaires that were prepared during the application process, statements made in connection with claims for other types of disability benefits, and testimony at your hearing. Consistency in your statements is key to your credibility. However, inconsistency does not necessarily mean that your statements are not credible as long as the inconsistency can be explained, such as if your pain fluctuates over time or your treatments stop working. The Social Security Administration will also compare your statements to reports and observations of other persons concerning your daily activities, behavior, and efforts to work, including any observations recorded by Social Security Administration employees.
  • A history of seeking and following treatment for your pain. If you are able to present evidence that shows you sought treatment for your pain and followed the prescribed treatment, this will support your allegations of intense and persistent pain. Continual efforts to achieve pain relief, such as through consultation with pain specialists, and testing the effectiveness of different medications or treatments, increase your credibility. Conversely, your statements concerning the severity of your pain may lose credibility with the Social Security Administration if you delayed seeking treatment, or if the medical records indicate that you have not followed the prescribed treatment, without reason.

Contact experienced Ocala disability lawyer Claudeth Henry to discuss establishing a claim based on chronic pain or for a free initial consultation. To schedule your appointment, fill out the form on this page or call (352) 304-5300.

 

Requirements for Your Doctor’s Opinion to Be Controlling

Tuesday, January 31st, 2012

If three requirements are met, the Administrative Law Judge (ALJ) must give your treating doctor’s opinion controlling weight,which means he will adopt your doctor’s opinion regarding the extent of your disability.

The three requirements are:

  1. The doctor must be an acceptable medical source,
  2. The doctor must be a treating source, and
  3. The doctor’s opinion must be well supported.

Acceptable medical source. Not all health care providers are acceptable medical sources. According to the SSA, the doctor providing the opinion must be a physician (M.D.or D.O.), psychologist, optometrist, a speech language pathogist, or a podiatrist. The opinion of any other type of provider, such as a chiropractor or nurse practitioner, will not be given controlling weight by the SSA, but may be considered along with other available medical evidence in your file.

Treating source. Next, the doctor must be a treating source, which means that the doctor must be caring for you.  If you go to see the doctor for an evaluation just to get a medical opinion for Social Security, the doctor will not be considered a treating source.

Well-supported opinion. The treating doctor must use standard, medically recognized techniques to assess your condition and formulate his or her opinion. In addition, the doctor’s opinion must not be inconsistent with other substantial evidence in your medical record.

A medical opinion from your treating doctor that has controlling weight is highly desirable evidence that often leads to a favorable result.

If you are applying for Social Security disability benefits in the state of Florida, call (352) 304-5300 to get in touch with an experienced Ocala Social Security attorney at the CJ Henry Law Firm.  We can assist with all aspects of your case, including obtaining an opinion from your treating doctor.

What is the difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)?

Monday, January 30th, 2012

The Social Security Administration manages two programs that provide benefits based on disability or blindness:  the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program.

Social Security Disability Insurance (SSDI)

SSDI provides benefits to disabled or blind individuals who are “insured” by workers’ contributions to the Social Security trust fund. This program is financed with Social Security taxes paid by workers, employers, and self-employed persons. These individuals have worked recently enough and long enough (normally, 40 quarters of work and disability beginning within 5 years of the qualifying work), to become eligible. SSDI operates like a private Florida disability insurance policy. Your Social Security contributions are based on your earnings and your Social Security taxes are deducted from your paycheck, in the same way that you would pay premiums on an insurance policy. Consequently, if you stop working and, therefore, stop paying Social Security taxes, your insured status will lapse, just as it would on a private policy if you stopped paying the premiums. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker.

Supplemental Security Income (SSI)

In comparison to SSDI, SSI is a needs-based program that pays Florida disability benefits. SSI benefits are not based on your prior work history. Rather, the Federal Government funds SSI from general tax revenues. You must meet the following basic criteria to qualify for SSI:

  1. You are disabled or blind.
  2. You have limited income.
  3. You have limited assets.

The Social Security regulations define “disability” and establish how much income and assets you can have and still be eligible for the program.

If you would like more information about Social Security Disability (SSDI) or Supplemental Security Income (SSI) cases, contact experienced Ocala Social Security disability attorney CJ Henry for a consultation. Complete the form on this page or call (352) 304-5300.

Your Denial Letter Will Help Your Florida Disability Attorney Piece Together the Puzzle of Your Case

Monday, January 30th, 2012

If your initial application for Florida Social Security disability benefits is denied, your denial letter is a key piece of the puzzle that will assist your Ocala disability lawyer in pursuing your appeals. Make sure to save all your denial letters and show them to your Social Security attorney.

Your denial letter contains important information that will help your Ocala Social Security disability attorney determine whether your claim for disability benefits was denied in error and, if that is the case, how best to address that error on appeal. For example, your denial letter may say that your Florida Social Security disability claim was denied because you are able to “engage in normal activities.”  This is Social Security’s way of saying that their evaluators do not believe you have a “severe” physical or mental impairment.  A common reason why disability evaluators reach this conclusion is that they don’t have a claimant’s complete medical records.  Knowing this information, your Ocala Social Security disability attorney can work with your health care providers to complete the record.

Here is another example of helpful information that may be provided in your denial letter.  Your denial letter may state you were denied benefits because you are able to perform past relevant work or “lighter” work.  However, the letter may not specify which former job you are purportedly able to perform. Your Ocala Social Security disability attorney will likely be able to determine this by talking with you about your work history and determining your easiest job. Your Social Security attorney can then talk with you about your former job duties, the Social Security Administration’s definitions of “light” and “sedentary” work, and the limitations caused by your impairment. All of this information will help your disability attorney develop a persuasive and cohesive theme for your appeal.

If you would like to speak with an experienced Ocala Social Security disability lawyer about appealing the denial of your application for Florida disability benefits, please contact Claudeth Henry to discuss your case.

 

Keeping a Symptom Diary to Assist in Obtaining Disability Benefits

Sunday, January 29th, 2012

As an experienced Florida Social Security disability lawyer, I suggest that you keep at least one symptom diary to assist you in obtaining disability benefits in Florida.

What is a symptom diary?

A symptom diary can come in many written forms: notebook, journal, wall calendar, chart, or spreadsheet. Routinely recording the nature (frequency, duration, intensity, etc.) of your symptoms and the impact of your symptoms as they occur will serve as your “symptom diary.”

For example, pain is a disabling symptom of many impairments that result in Social Security benefits for Florida disability claimants. A pain diary will allow you to track your pain on a daily basis including where the pain localized, the intensity of the pain on a scale of 1-10, the duration of the pain, and what eventually alleviated the pain.

Besides pain, symptom diaries can be used to record other symptoms. For example, it may be appropriate for you to keep a fatigue diary, sleep diary, headache diary, hypoglycemic event diary, or an asthma/nebulizer diary.

Why is a symptom diary important?

There are several reasons that make a symptom diary important to the success of your case when it comes to the Social Security disability appeals process. First, your ability to give detailed testimony at your hearing will be a significant factor in the success of your claim. Second, the back log of Social Security disability claims results in a long wait between your initial application for benefits and the date of your hearing. Regardless of how sharp your memory is, your testimony will be more accurate, precise and, ultimately, more compelling, if you have a written record, such as a diary, on which to rely.

Contact a Florida Social Security disability lawyer

Contact experienced Florida disability lawyer Claudeth Henry to review the facts of your case, help you get started on a symptom diary, or to discuss your claim for benefits.

“Substantial Gainful Activity” For Self-Employed Claimants

Friday, January 27th, 2012

As an Ocala disability lawyer, I have helped many individuals who are self-employed with their Social Security disability applications and appeals. In every case, the Social Security Administration uses a five-step process to determine disability. The first step requires the applicant to prove that he or she is not currently engaged in “substantial gainful activity” (SGA).

For most employees, this step is relatively straightforward and involves checking their employment records to see how much they are earning each month.  If the monthly total is below a specified amount ($1010 in 2012), as a general rule, they are not engaged in SGA.  The SGA amounts change every year with changes in the national average wage index.

However, any work, regardless of income level, can be used as evidence that a claimant is able to work because the Social Security Administration can decide that the claimant is able to work more but has chosen not to in order to receive disability benefits.

For self-employed applicants, overcoming the SGA requirement can be a challenge.

If you are self-employed, the Social Security Administration uses three tests to determine if you are engaged in SGA by evaluating your work activity and its value to your business. Your self-employment work activity is SGA if:

  1. You render significant services to the business and receive substantial income (income greater than the Earnings Guidelines set forth in the Social Security regulations); or
  2. Your work activity (measured in terms of hours, skills, responsibilities, duties, efficiency and other relevant factors) is comparable to the work activity of persons without disability in your community who are engaged in the same or similar businesses; or
  3. Your average monthly work activity is worth the SGA level earnings in terms of its effects on the business or when compared to the salary an owner would pay an employee to do the work.

If you are self-employed and would like more information about your eligibility for Social Security disability benefits, you are encouraged to contact experienced Ocala disability lawyer Claudeth Henry for a free initial consultation.  To schedule an appointment, fill out the form on this page or call (352) 304-5300.

 

Was My Social Security Disability Benefits Claim Denied in Error?

Wednesday, January 25th, 2012

You try to work but cannot because of your medical condition. You apply for Social Security disability benefits and are shocked when your claim is denied. Do not let the denial of your claim discourage you. Appeal until you get a hearing before an administrative law judge.  Many claims are denied initially, but then granted after a hearing. It is quite possible that the Social Security Administration made a mistake in denying your claim for disability benefits. In fact, common mistakes found in claims denied by the Social Security Administration and later granted on appeal include:

  • Failing to gather your complete medical records and other medical evidence to establish that you are disabled because your impairment “meets or medically equals” a Listing impairment;
  • Not considering the effect of all your impairments on your ability to work;
  • Not considering the effect of all of your symptoms on your ability to work;
  • Underestimating the severity of your pain and other symptoms;
  • Overestimating your education level by relying on school records that show what grades you have completed when your actual current education level is lower;
  • Underestimating the level of exertion required by your former jobs and incorrectly concluding you are still capable of performing them; and
  • Overestimating your current ability to work, i.e., your residual functional capacity, by failing to consider limitations on your ability to perform work-related tasks such as walking, standing, sitting, lifting, carrying, and following directions.

An experienced Florida disability lawyer can review your denial letter, speak with you and your doctors about the facts of your case, and take steps to correct an erroneous denial of benefits. If you believe your claim for Social Security disability benefits was improperly denied, contact Ocala disability lawyer Claudeth Henry to assist you with your appeal.

 

Six Simple Steps to Help You Through the Social Security Disability Benefits Process

Friday, January 20th, 2012

Following these six simple steps will help ease your way through the Florida Social Security disability benefits process:

  1. See your doctors regularly and cooperate with their treatment plans: The Social Security Administration requires medical evidence to prove you are disabled.  The best way to ensure that you have that evidence is to visit your doctors regularly and to tell them about all your symptoms.  You should see your doctors as directed and comply with their treatment plans because the Social Security Administration expects that your goal is to become healthy again so you can go back to work.
  2. Monitor your symptoms: Your symptoms (pain, fatigue, shortness of breath, etc.) and how they affect your daily activities are important indicators of why you are unable to work. A symptom diary is a good way to keep track of your symptoms.
  3. Keep your records organized: In order to be awarded Florida Social Security disability benefits, you will need to complete a significant amount of paperwork and provide supporting documentation. At a minimum, you will need to gather all of your medical records and records from your past employers. To assist you in the organization of your records, you should adopt a filing system that is easy for you to understand and store these documents in a safe place that you can access easily. These records will be essential to you throughout the Florida Social Security disability claims process and, therefore, I recommend that you organize them early on.
  4. Keep your records current: It is important to update your records on a regular basis. For instance, if you treat with a new doctor, add the doctor’s business card to your files. Keep track of your medications by keeping all of your empty prescription bottles.
  5. Cooperate with the Social Security Administration: It is important to promptly and completely comply with the Social Security Administration’s requests for additional information or documents.  Similarly, make sure you attend any medical or psychological examinations scheduled for you by Social Security.
  6. Plan for your disability hearing: You will probably be required to testify at a disability hearing before a judge before your claim for Florida Social Security disability benefits will be approved. You can prepare for your testimony by writing down any activities that you used to do, but can no longer manage because of your condition. These can be hobbies and leisure activities, or household chores, for example. You can also make a list of potential witnesses — friends, family, neighbors, co-workers –who can testify on your behalf regarding how your disability affects your daily activities. It is important for you to learn about the hearing process before your hearing date.

If you would like more advice on navigating the Florida Social Security disability benefits system, contact dedicated Ocala disability lawyer Claudeth Henry for a consultation.

 

Consultative Examinations (Part 4)

Thursday, December 22nd, 2011

What happens if my consultative examination does not go well?

(continued from Consultative Examinations (Part 3))

You may be asked to undergo a consultative medical or psychological examination while your claim or appeal for disability benefits is pending. The purpose of the exam is to provide the Social Security disability decision maker with medical evidence about your impairment. Of course, you hope that the doctor will perform a thorough examination and his or her report will support your claim. Unfortunately, sometimes the examination is unsatisfactory and sometimes the results are unfavorable.

If the consultative examiner delivers an unfavorable report, there are some things that both you and your Ocala disability attorney can do to counter it.

One possible reason for an unfavorable report is that the examiner simply did not spend enough time with you. On occasion, consultative examiners have been known to rush through the exam, paying little attention to the claimant’s complaints. For this reason, many disability lawyers recommend that you bring a family member or friend with you who can time the exam and further serve as a witness to what happened.

If your exam seems cursory, you should complain to your disability examiner or Administrative Law Judge. It’s a good idea to put your complaints in a letter that can be added to your file. Your Ocala disability lawyer can help you prepare the letter.

If the consultative examiner’s report is vague, ambiguous, or inconsistent, your disability lawyer can discuss these problems with the examiner. Your lawyer can then develop questions that can be sent to the examiner. The examiner will answer the questions in writing to clear up the confusion.

If your treating doctor disagrees with the examiner’s opinion, your lawyer can ask your treating doctor to respond to the report. If your treating doctor can explain why her conclusions are different from the examiner’s, the Social Security decision maker should accept your treating doctor’s opinion.

Your disability lawyer can even have the consultative examiner subpoenaed so he will appear at your hearing where your lawyer can cross-examine him.

If you are unable to work because of your disability and would like help from an experienced Ocala disability lawyer, please call the C.J. Henry Law Firm at (352) 304-5300 for a free claim evaluation.

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CJ Henry Law Firm, PLLC
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Phone: 352.304.5300
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