Calling the Social Security Administration (“SSA”) office is unlikely to help you understand whether or not you qualify for Social Security Disability. This is because when you call the SSA office you will be speaking with a service representative, who is not qualified to make a determination regarding a person’s disability. That is a decision that is assessed by disability examiners who work at DDS, Disability Determination Services, a state agency which is entirely separate from SSA.
DDS assesses many factors in determining a person’s ability to return to the workforce. First, the determination is made whether the claimant can return to their old job. If they can, their claim is denied. Next, DDS will consider whether the claimant has transferrable skills, and will consider factors such as the claimant’s level of education, past work experience, and age. After the age of 50, a person is generally not expected to learn a new trade or skill. Assessing these factors along with a claimant’s physical or mental disabilities or limitations is part of a complex process that service representatives at SSA cannot and should not attempt to inform potential claimants on. This is why you are better off seeking an attorney who is knowledgeable and experienced in navigating the process of proving one’s qualifications to obtain SSD benefits from the SSA.
The Social Security Administration requires that you have earned enough “work credits” in the past in order to be eligible to apply for Social Security Disability benefits.
What are work credits?
When you work and pay Social Security taxes, you earn up to a maximum of four “credits” for each such year.
The amount of earnings it takes to earn a credit has changed since 1978. In the year 2016, you must earn $1,260 in covered earnings to get one Social Security or Medicare work credit and $5,040 to get the maximum four credits for the year.
The number of work credits needed for disability benefits depends on your age when you become disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.
This is why, when you call a Social Security Disability attorney about filing for disability, they will probably ask you the following question:
“Have you worked on the books for at least five of the ten years before you became disabled?
If you worked LESS, you may not even be eligible to apply for Social Security Disability Benefits (SSDB.)
In addition, the more you worked and earned over your lifetime, the higher your monthly benefit amount will be!
The most common complaint I receive from my New York Workers’ Compensation clients is that they are improperly examined by IME’s.
What is an IME?
An IME or “Independent Medical Examiner” is a doctor hired by the insurance company for the purpose of checking on, and limiting, the injured worker’s claim against the insurance company.
IME’s are certainly NOT “independent”. The word “independent” is a complete misnomer.
Here are some common things I hear from my clients after seeing an IME:
- He didn’t touch me.
- He examined me for only three minutes.
- She asked me inappropriate questions.
- He didn’t have my records.
- She didn’t know anything about my case.
- He was nasty and rude.
- His office was a mess and he seemed unprofessional.
- His medical report contains many, many errors.
Recently, a client called to tell me that she had been to an IME examination for her Workers’ Comp case involving a shoulder injury. The doctor had her sit down in a chair and asked her a few questions. He then asked her to raise her arms above her head and then asked her to put her arms behind her head as far as they would go.
Those two requests comprised his ENTIRE EXAM.
When the medical report came in from this doctor, he stated in his report that the injured worker has “zero permanent injury.”
Meanwhile, my client says she still has trouble raising her injured arm all the way.
The IME never touched my client.
This stuff happens all the time. The best way for injured workers to protect themselves is to videotape their IME exams or to bring a witness.
In this case I intend to have my client TESTIFY regarding the fact that the IME never actually examined her.
This kind of bogus IME exam, unfortunately, happens all the time. Having an experienced Workers’ Comp attorney on your side can help injured workers fight the injustices that go on way too often, in the Workers’ Comp system.
Most people have heard the old adage that ” everyone gets denied at first” when applying for Government Disability—more correctly called Social Security Disability (SSD.) This is not actually correct.
The actual nationwide denial rate is around 65% for the first application… meaning you have a 35% chance of winning the case by simply filing an application for benefits.
Obviously the odds are against you in the beginning.
The GOOD NEWS is that on appeal, the 65% goes the other way: 65% of cases that have been appealed then result in an award. (Nationwide average.) The bad news : Appeals take up to a year and a half to be heard!
(Interestingly, the fees that are payable to attorneys are based upon the retroactive number of months and the amount of retroactive payments that are recovered. The more retroactive money recovered, the closer the attorney can get to receiving the maximum fee which is usually $6000. This means many attorneys won’t even TAKE a case at the application stage because there won’t be enough retroactive money if they win right away!)
We have filed MANY applications for disabled clients that are accepted IMMEDIATELY without having to appeal and/or go in front of a SSD Judge!
Feel free to call us if you know someone who plans to file a Social Security Disability!
Did you know?
Applying for and receiving Social Security Disability Benefits, ( when one is UNDER retirement age and unable to work for at least 12 months,) bestows perks from the Government that many people don’t know about. These include (if you win):
*Wage Freeze: If there is a period of time you are not paying into your Social Security account due to being disabled, Social Security IGNORES this and computes your benefits as if you had been working! *Medicare: Two years after being approved for Disability Benefits, disabled workers may elect to receive Medicare coverage, regardless of age. *Children: When you qualify for Social Security disability benefits, your children may also qualify to receive benefits on your record. Your eligible child can be your biological child, adopted child or stepchild. A dependent grandchild may also qualify. To receive benefits, the child must be unmarried and be:
- under age 18; or
- 18-19 years old and a full-time student (no higher than grade 12); or
- 18 or older and have a disability that started before age 22.
Within your family, each qualified child may receive a monthly payment up to one-half of your full disability amount.
Bet you didn’t know these things… Feel free to call my office with any questions about Social Security Disability or NY Workers’ Compensation.
There’s an insurance industry radio ad campaign currently running, containing the following warning: Don’t commit Workers’ Comp insurance fraud or you’ll end up in jail and you will shame your family. It’s clearly aimed at injured workers. I get it.
What the public generally does NOT see is the other side of the coin…when insurance companies overstep their bounds and infringe on injured workers’ rights (happens all the time—sometimes with bad results, especially when injured workers are unrepresented .)
This happened to my client and me YESTERDAY:
My client, a nurse’s aide, was receiving weekly Workers’ Comp checks for a severe back injury (she now needs surgery for it) that she incurred at work. At the last hearing, the insurance company attorney for the employer accused my client of fraud and told the Judge they were stopping her benefits because they have a private eye who followed her and videotaped her doing something bad (presumably, working while collecting comp checks.) They were ordered to produce the investigator and his evidence. My client flatly denied committing fraud. A mild-mannered woman, she has been beside herself with stress because of this fraud allegation. She could not understand it. Luckily, in this country, you get to face your accuser in court, face-to-face. At the next hearing (yesterday) , I made a simple request: call in both my client and the investigator into the courtroom and let the investigator look at my client, face-to-face. When they were called in, the Judge asked the private eye: “Is this the woman you have been following?” The investigator turned red. ” No, Your Honor, it isn’t, “we must have been following the wrong person.”
You simply can’t make this stuff up. I got my client’s benefits reinstated (she was crying with relief, she could not understand what she had done wrong) but unfortunately there is no penalty against an insurance company for such shoddy work and behavior……………
Call us if you have questions about Workers’ Comp or Social Security Disability benefits!
While everyone knows that an accident that happens to an employee inside a workplace or work building is clearly a Workers’ Comp case in New York, what about accidents that occur OUTSIDE the office building or workplace?
This winter was particularly cold and there is a lot of ice everywhere. It’s likely that employees somewhere have sustained slip and fall injuries in an employee-designated parking lot. The law IS CLEAR: injuries sustained in a parking lot designated for use by employees ARE COVERED BY WORKERS’ COMPENSATION. This is true even if the employee has not yet clocked in or has already clocked out!
The reason behind this is that if an employer designates an area for employees to park in, such a place becomes “part of” the work premises. Based on the same logic, accidents that happen on the way from the parking lot into the main workplace or accidents that happen on the way from the main workplace into the employee parking lot are ALSO covered, just as if they had taken place inside the main workplace location!
Winning. It’s the focus of professional athletes, and lawyers, too. Winning the case is paramount. So what goes into winning a Social Security Disability (SSD) case? After all, the Government can deny your case, and you could end up with nothing. My experience is that, especially when you get to the “hearing level” which means in front of a SSD Judge, there are several, sort of “hidden” (not obvious) factors that can enter into a Judge’s thinking that you as the claimant may not immediately think about. But a Judge will look at these things:
1. Is there a long , solid work history? Yes, believe it or not, judges look at how long the person has worked before they became disabled. If the work record is spotty—some years of work, some years of not much or no work—a Judge may feel the disabled worker is not a motivated individual, and hold it against them.
2. Is there regular treatment? If a disabled individual hasn’t seen their doctors on a regular basis or stopped going, causing large gaps in the medical records, that’s a bad thing. A judge may assume their medical conditions really aren’t as severe as they allege.
3. Is the claimant seeing the right kind of doctors? Treating with MD’s who specialize in the condition that they are suffering from- good. Only seeing physician’s assistants or family doctors—bad.
4. Is the claimant honest? Claimants who exaggerate their symptoms or try to “guild the lily” can be punished by receiving a denial. Credibility is key. The reason there is a Judge making a decision is because a Judge can look at and listen to the claimant and assess whether he/she is being truthful or not.
Judges almost always look at these “hidden” factors when deciding a SSDB case. Like the commercial says, “The More You Know……”
Did you know that some nursing homes have bariatric wards where Certified Nurse’s Aides (CNA’s) must care for obese patients? What happens when, due to staffing issues, the direct caregivers get little or no co-worker assistance with these patients and must care for these extra-heavy patients alone?? And must at all times ensure that their patients are safe?
Worker injuries can and do happen. Serious injuries. (Nursing home patients sometimes get hurt too, unfortunately, but they can sue. In cases where there is no one responsible for an injury except for the employer, injured workers cannot sue.)
My client Jean, a CNA in New York, tried to catch her 300 pound patient who was falling. Jean injured her neck and her back in that accident. As time went on she suffered “progressive quadriparesis” (loss of function of her arms and legs,) slowly lost bladder control and could not walk. She moved to Connecticut to be cared for by siblings and one day could no longer function at all. She went to a Connecticut hospital, was admitted as an emergency, and had an 8 hour emergency spinal surgery that showed severe spinal damage.
Truth #1: Jean has no right to sue anyone. Workers’ Comp protects the employer nursing home from being sued. She can only receive, at most, two-thirds of her CNA salary while she is out of work. Her only legal remedy? Workers’ Compensation.
Truth #2: The nursing home’s (employer’s) insurance company is not doing the right thing by Jean. It is refusing to pay for the surgery, for her recovery, or anything else related to the surgery, because Jean, it says, has not yet proven that the surgery was due to the work accident. (We are waiting for a hearing to argue this case before the Judge.)
Observation #1: Many different professions lay their bodies on the line day to day just performing their work (yes, our cops, firemen and emergency workers do, and should be thanked and thanked again. But other jobs—like those occupations that provide direct care for the elderly—can be quite dangerous too. Just ask bariatric direct care givers.)
If you or someone you know has been injured at work or can no longer work due to illness or injury, give us a call. Consultations are free. We handle BOTH Workers’ Comp and Social Security Disability cases.
“We Work for You When You Can’t Work”
Do you know someone who has been injured or become seriously ill and has been unable to work? Which of these should they apply for?
Sick time pay —–Vacation pay——-Workers’ Comp——- Social Security Disability —–Short-term Disability—– Long -term Disability—— Unemployment
Imagine your Holidays with no income coming in. Seriously ill and injured people can face that plight every day.
Our law firm can help the injured and sick choose their best option and can fight to obtain for them a liveable income, when they are unable to fight for themselves. We love what we do, which is helping people support their families through tough times. Give us a call any time. Consultations are free. We only get a fee if we win your case.
Happy Holidays to all.
Dan Morrin, Esq.