How Examiners Consider Medical Records

Medical evidence is the single most powerful component of a disability claimant’s case, and a treating physician’s assertion that a claimant is disabled is important to approval, but is not the deciding factor. The examiner’s opinion of a claimant’s disability is what matters most, as he/she will decide if a claimant meets the SSA’s definition of disability. Qualifying for SSDI benefits requires a claimant satisfy a high bar that defines disability to mean a claimant is unable to perform past work or be retrained to perform other types of work due to the effects of a physical or mental impairment that will last for at least one year. Consequently, the medical records must reflect this level of impairment, in the examiner’s eyes, to win approval. Examiners will first look to the guidelines for the applicable disabling disease or condition listed in the SSA’s Listing of Impairments (Blue Book), which outlines what limitations a claimant must have to be considered disabled. If the examiner decides the claimant does not have medical support to satisfy the guidelines, the examiner then moves to the claimant’s functional capacity to perform past work and other types of work, if past work is no longer possible.

In addition to medical records from a claimant’s personal physicians, doctors that that work with the SSA will also provide opinions on a claimant’s condition, which often conflicts with findings of the personal physicians. Further, examiners typically give more weight to the opinions of the SSA doctors over the findings of a claimant’s physicians, so the more medical evidence that supports a finding of disability, the better the claimant’s chance for success.

Components of Strong Medical Evidence

Building a file of strong medical evidence is the only way an SSDI claimant will win. Many times, a denial stems from a claimant not providing his/her complete records to the SSA, or the records do not specifically address symptoms and the probable effect they would have on a claimant’s ability to work. Thus, working with one’s physicians to ensure medical notes are detailed and accurately reflect the physical and mental limitations the claimant experiences daily is crucial to convincing the SSA a disability exists. An experienced disability insurance attorney can help a claimant obtain the records he/she needs to have the best chance of winning approval.

Talk with a Disability Insurance Attorney

Winning an SSDI appeal is not easy, but your chances are substantially better if you have a disability insurance attorney on your side to coordinate and argue your claim. Farrell Disability Law has years of experience handling a variety of disability claims, and knows how to get the benefits you need even if your claim was initially denied. If you live in Jacksonville, Atlantic Beach, Callahan or the surrounding area, call the office today for a free consultation.

Resource:

cecildaily.com/news/state_news/article_93f6ee46-b8c1-5467-8797-70c6e52de0c4.html

Disability insurance generally comes from three sources: employer-provided group policies, private individual disability policies and the benefits offered by the Social Security Administration. This coverage is intended to cover necessities, but not to replace the need for a person to work. Thus, while everyone should recognize the need to plan for this possibility and protect themselves accordingly, it is equally important to assess how these disability insurance options interact with one another in order to maximize benefit payouts and to determine how much additional income is necessary for financial stability.

Policy Review

The most important thing anyone with disability insurance coverage can do is review the terms of the policy. Clauses related to the percentage of income the insurance company will pay are a crucial provision that impact the level of benefits offered. For example, employer-provided disability insurance will typically pay up to only 60 percent of an employee’s salary, which leaves a significant amount that must be found elsewhere. A private disability policy could supplement this gap. In addition, how the policy defines “income” is also key information to know. Depending on an individual’s pay structure, the exclusion of bonuses or commission could greatly impact how much money an individual receives if he/she becomes disabled and consequently, whether the policy truly provides sufficient coverage. Further, many policies, both employer-provided and individual, place caps on the maximum amount the insurance company will pay each month, which could fall short of the percentage of income the policy is designed to replace. One final consideration for group or individual policies is how long the benefits are paid. Is it measured in months, to age 65, or beyond? Knowing this information is key to long-term financial planning.

Social Security Disability Insurance

The other alternative, Social Security Disability Insurance (SSDI), may seem like the easiest way to replace lost income in the event of a disability because it does not require an individual to pay a separate premium to obtain coverage, but merely to work a certain number of years. However, qualifying for SSDI is extremely difficult and time consuming, and almost always pays much less than any policy offered through an employer or purchased privately. Also, assuming a person does qualify, another important consideration in the overall picture of person’s disability coverage is the fact that receiving SSDI benefits can reduce the amount a person receives from group or individual policies. This adjustment offsets the total amount of money received, and could leave someone receiving less money than expected.

Contact a Disability Insurance Attorney

If you suffer from a disability that affects how much you can work, talk to a disability insurance attorney about your options for receiving benefits through SSDI or a disability insurance policy. Securing regular income during this difficult time is a top priority that deserves the careful and knowledgeable services of a disability insurance attorney. Farrell Disability Law helps clients throughout Florida and South Georgia get the money they need, and can assist you with your disability claims. Contact us for a free consultation.

Resource:

ssa.gov/pubs/EN-05-10029.pdf

Ask just about anyone dealing with a disability what their life is like, and the response is almost guaranteed to include never-ending descriptions of hospital and doctor visits aimed at trying to manage and/or improve their condition. All of this medical treatment is costly, and leads many in this situation to apply for Social Security Disability Insurance (SSDI) if/when working is not possible. The constant rounds of medical appointments quickly becomes overwhelming and exhausting, but the Social Security Administration (SSA) commonly requires SSDI applicants to undergo medical/psychological exams with physicians selected and approved by the Administration.

Many people in these difficult circumstances are invisible to much of the country because they leave the workforce, and then tend to spend most of their time at home due to debilitating ailments. In spite of flying under the radar, the number of people applying for and receiving SSDI benefits has gone up in the past 15 years due to an aging population and the loss of blue collar jobs, according to recent studies by economists. A Congressman from West Virginia wants to make it easier for disabled individuals to work but still retain some SSDI benefits, and plans to introduce a bill to that effect next year.

The reports issued by SSA doctors are crucial to the approval of a claim, so knowing what to expect during the exams and what the doctors are specifically assessing is important information to have.

Purpose of the Exams

The purpose of these medical exams is to obtain additional information related to an SSDI applicant’s debilitating condition so a decision on benefits can be made. Typically, these exams are requested when the applicant has not received medical treatment for the disabling condition within the past 60 days or the application lacks sufficient medical evidence to support the disability claim. These exams are not designed to provide medical treatment, but rather to get a picture of a person’s limitations so the examiners assessing the application can understand how much work the individual can perform. These doctors are independent physicians who contract with the SSA, not SSA employees.

Things to Know Ahead of Time

The exams themselves are typically very brief, lasting only five to ten minutes, and can include physical exams, blood work, X-rays and psychological/mental evaluations. The content of the exams is at the discretion of the SSDI application examiner, and is limited to whatever information is needed to make a decision. The exam is provided at no cost to the applicant, and some travel expenses are reimbursed. The doctor does not have a say in the decision for disability benefits, but merely sends a report to the examiner noting his/her findings and test results. The doctor may also look for signs of malingering, or exaggerating symptoms, in hopes of increasing one’s chances for approval, and may note if he/she believes the symptoms described by the applicant are as serious as claimed. Attending these appointments is extremely important because not showing up gives the examiner grounds to deny the application, and makes getting approval on appeal more difficult.

Talk to a Disability Insurance Attorney

Disability benefits are an essential source of financial support for many people, so do not leave approval of a SSDI application to chance. Contact a disability insurance attorney familiar with the SSDI process to assist you. Farrell Disability Law helps disabled individuals across Florida and South Georgia get the benefits they need, and can help you navigate the complicated application and appeal process. Contact us for a free consultation.

Resource:

bloomberg.com/news/features/2016-12-16/mapping-the-growth-of-disability-claims-in-america

Most people are familiar with the disability benefits offered through the Social Security Administration, but an entirely separate arm of disability coverage is employer-sponsored private coverage that comes with its own set of regulations. One federal law that particularly impacts how employer-sponsored disability policies are handled is the Employee Retirement Income Security Act (ERISA). While ERISA regulations mainly address retirement plans, the law also has provisions related to other employee benefits, including disability insurance. Note that ERISA only applies to employer-sponsored disability policies, and not those purchased by someone separately. Some employers even offer some level of disability coverage to employees at no cost to the employee, with the option to add additional levels of coverage at the employee’s discretion. ERISA’s complicated regulations affect almost every aspect of an employer-sponsored disability insurance plan, and therefore need to be understood by any employee with this type of coverage. While employees hope it is never necessary to file a claim against a disability policy, knowing about the key provisions in ERISA that govern such coverage beforehand will prevent a mad scramble to gather all necessary information in the event a claim must be filed.

Filing a Claim

Understandably, what most people care about with employer-sponsored disability insurance is how to file a claim, but before one gets to that step, every employer who offers this benefit is required to provide each covered employee with specific information on the substance of the disability insurance policy. Specifically, the employer must supply documents explaining the following:

• detailed descriptions of what is and is not covered by the policy;
• instructions on how to file a claim once an employee becomes disabled; and
• how to appeal if a disability claim is denied.

With respect to filing a claim, ERISA explicitly regulates how claims are processed, the time restrictions on deciding claims, and the employee’s rights if a claim is denied. Insurance companies must issue a decision on disability within 45 days, though providers can extend the decision time up to 60 days. In order to get an extension, the provider must give notice before the initial 45-day period expires, ask for additional information if necessary to process the claim, and state when a decision will be made.

If a claim is denied, the provider must notify the employee of this decision in writing or via email. The employee is entitled to a detailed explanation of the basis for the denial and how to file an appeal. Employees have at least 180 days to appeal, though some plans give employees more time. In addition, the employee has the right to request any documentation the provider used in making its decision, as well as the names of any medical professionals consulted during the analysis of the disability claim. Employees can file for an appeal on their own, but this process is extremely complex, and has a better chance of success if handled by an experienced disability insurance attorney.

Lawsuits

If an employee exhausts the appeals process, he/she does have the right to file a lawsuit to obtain disability benefits. However, ERISA provisions limit a judge’s review to whether the insurance company abused its discretion when denying the claim. Effectively, this restriction makes it very difficult to succeed at this stage. Further, the judge’s decision is based entirely on the insurance company’s records. Thus, if the employee failed to provide any supporting documents during the administrative stage, the judge cannot consider this information, which is likely to influence the outcome.

Get Help

If a disabling condition has forced you to stop working, contact a disability insurance attorney about the most effective way to file a claim. These benefits are crucial to the financial stability of most individuals, and you want to give yourself the best possible chance at approval. An experienced disability insurance attorney can guide through the process, taking away some of the burden of your situation. Farrell Disability Law helps clients throughout Florida and South Georgia on a variety of disability issues, and is available to assist you with your case. Contact us for a free consultation.

Resource:

dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/filing-a-claim-for-your-health-or-disability-benefits