Anyone have questions about Disability? Seems to be a scarce topic.

It you are reading this then you're either thinking of filing or already have it.

I just wanted to let people know that I went through the entire process. I won my claim with SocSec and with a Private Disability Company. (Their initials a SI and they headquarters in Portland).

My private disability company collected payments from my employer and me with no intention of ever honoring the contract. It took 2 years and 5 months to win my claim and get the first check. The second check was also the last. They limited the payout to 6 month Short Time Disability and two years Long Term Disability. It's really slimy and I wanted to fight it but my lawyer said it would cost $40,000 to $50,000 with a very slim chance of getting the time limit overturned.

As I said Private Disability insurance companies don't want to payout, but I did win my case. My lawyer said the company I had NEVER pays out without going to court. She said if you make it to court, you almost always win but it's because they don't fully inform the local lawyers they employ. I did get them to payout, but it was brutal and luckily, I got good advice from a lawyer who gave me a lot of advice for only a $180 fee. He walked me through the process and told me about all the tricks.

Social Security is a different animal all together. They count on limiting the payouts through attrition. You have to be out of work for 12 months before you can even apply, unless your doctor writes a letter stating you will still be unable to work after 12 months. This is rarely excepted. There are some very firm deadlines you have to met and you need to make sure you know what you are.

Social Security Disability counts on two things first is that the wait times for an answer or a hearing are so long most people give up. The second is that most people assume that getting denied on the first try means they don't meet the requirements. NO ONE gets approved on the first or even second try (Appeal). The percentage of people approved at a hearing can be very dramatically high depending on the ALJ you have. The reason for this is the the decisions made by Disability Determination Services (DDS) are forgone. DDS is a separate company, state-based, that is responsible for reviewing claims and determining if it is approved or denied.

There is no incentive for anyone at DDS to approve a claim. In fact, the opposite is true. I spoke with someone who worked for DDS in my state. She told me anyone who approves a claim is automatically audited. Too many audits and you are fired. Their job is not to review the file and determine if you should be approved. Their job is to review the file and find a reason to deny your claim. So don't expect a fair review. According to my casefile, I was first denied because I provided "pet care". I was denied the second time because I "attended" church.

Both of those were answers from a questionnaire they sent to my husband. Both were also suggestions for the activities question. They only used the "pet care" on the initial claim and saved the "attends church" for the second denial.

You are always entitled to a copy of your case file. Both private disability and Social Security. I got both and read every single line of text. I requested it for pd after the first denial and used the information to point out why they were wrong. It came down to a single piece of paper with no name on it and no indication of where it came from. It basically said " 'fill in condition' is all in the person's imagination and if it is not in their imagination. But if it is not, then the person is still able to work at a sedentary level. This opinion was only backed up by one paper in which the authors name a long sequence of conditions in the abstract and then proceed to say that all these conditions are psychosomatic. All papers they wrote dealt with psychosomatic illnesses. There were never any conditions that they attributed to actual physical illness.

To get a copy of your case file from a pd, you just have to ask. They are required by law to provide it to you. For SSD, you have to make an appointment to go to the local office and copy it in their lobby (where there is a cop to insure you don't take it or add anything to it). They even made me bring my own paper.

If you win your private case, and I did after being put through lots of hoops, they will hound you about your case for SSD because the contract they have with the employer states that you have to pay them back for any portion paid to you by SSD. They will be very accommodating and do everything they can to help you. The major surprise to me was that in the policy your employer supplied on your behalf, they promised you would repay any benefits paid to your minor children. So if you are awarded SSD and have children under 18, they will also receive benefits. They split 1/4 of your benefits. So my son and daughter each received 1/8 of my benefit, until my daughter turned 18. Then my son collected 1/4.

The benefits are your children's money. It is not paid directly to them but to a representative, which can be you, and is only to be spent on them. The money CANNOT be used to repay your private disability insurer. That is an obligation that must be paid by you. I had to take money out of my pocket to pay the portion which was my children's benefit. The repayment to the insurer is tax deductible in the year you repaid it on schedule A under misc. Do NOT let a CPA tell you that the portion you repaid that was for your children's benefits must be claimed on their tax form. You repaid that money with your own money and the deduction belongs to you.

My CPA tried to do that and I explained why he was wrong. He ignored me and gave me a second copy of my taxes (and my kids taxes) on which he claim the amount I repaid for the benefits they received. It made a difference of $10,000 in my taxes (the write off was in one year, but the payment of taxes on benefits is paid in the year they would have been paid. I had 5 years worth of taxes to redo after i got my payment.

So, it took 5 years before I received any payment on SSD. The 12 month wait and the length of time I was on a wait list for a hearing with an ALJ (2 years) were just downtime for me but pushed the approval out.

It's not easy, but it is doable.

Sorry this is scattered. But I have been through this and it's hard when you have cognitive issues. I pass this info on in thanks to the people who helped me. Without the information they gave and their advice I wouldn't have been successful.

Don't go through this alone, but if you get to the ALJ hearing stage don't do it without a lawyer. SSD limits the lawyer's fee to 25% or $5300 (probably higher now) so that your entire award doesn't go to the lawyer. Go with a local SocSec Disability specialist, they know the courts and the judges. Don't call one of the nation wide companies you see advertised. They just call a local lawyer and take part of the fee. If you lawyer gets the entire fee, they work harder.

I hope this is helpful. I'm happy to ask questions, if anyone needs help.

Good night, Kim

Thanks for sharing. Great info. :)

Hi,

I lost the first time, got a lawyer the second time, and won. My lawyer said the Lyme thing wouldn't go over, so she used Fibro. and CFS.

The judge heard my stories and was convinced almost right away.

Margaret

Sorry that I posted that twice.

What most people don't know is that your diagnosis really has nothing to do with why/if your claim gets approved. It really is dependent on what evidence is in your medical file to show that you are unable to do basic tasks that are required to do any job at out there.

Your diagnosis mat slant things one way or the other, but only because they're judges not doctors. They have some of the same misperceptions. A lot of what they learn is what they hear on TV, like commercials and news programs. For a long time, no one knew what Fibromyalgia was and many doctors thought it was in our heads (some still do). Then it became one of the more main stream diseases and so Judges started learning about it. In one state, there were day long conferences that the judges had to attend to learn about Fibromyalgia because all of a sudden they were seeing a lot of claims with Fibromyalgia as the disease.

They would see Fibromyalgia with reports of pain, difficulty with sleep, .... and say Oh, yeah, I know about that. Look this person complains of pain, sleep issues, ... They have Fibromyalgia. Claim Approved. Unfortunately, it's not quite that easy.

Because I had to fight so hard for my private disability there was a lot in my records. After my first denial, I did a lot of research to show that Fibromyalgia is disabling and is definitely not in people's head. I backup up my claims with scientific literature from well respected doctors. All of this was in my private disability file so that if it came to a court trial, I would have everything necessary in the file. I ended up getting denied twice by the pd company. I got a call from their audit department. She was the equivalent to an ALJ. She told me to get a couple of tests done. They were actually tested the pd company should have ordered and paid for but that would have been a whole nether battle. One was a Functional Capacity Evaluation where they test what you are physically capable of doing. The standard test showed that I was pretty pitiful, but it didn't show that I was not capable of doing MY job which was mostly intellectual. But as we all know, there are problems both physical and mental and they effect each other.

The other test was a Neurological test that I preformed very well on. In one of the last tests, I had to add numbers together. Like the numbers that were said would be 10, 12, 24, 72, 23, 45. I was supposed answer the value of 10+12, then 12+24, then 24+72, then 72+23, then 23+45. You had to be able to do the math, while still holding that second number in your memory to add to the next number. It was a pretty impossible task. I figured that out pretty fast. So I figured out a way to get the best score I could. I skipped the part of holding one number in my memory. I hear 10, 12 and answered 22, then I heard 24, 72 and answered 96, etc. I knew that that would give me the highest score I could receive.

I'm an Engineer by training and a Test Engineer by choice. I solved problems. I put puzzles together, but without a body that works all the smarts in the world wouldn't keep me from being disabled.

She assured me that if I had those tests done she would make sure that my claim would be reviewed (Fairly). So I did and then didn't hear anything. I called to find out what the hold up was and was told that they were going to send me for a Independent Medical Exam. They were just having trouble finding a doctor. Eventually, I got a notice about the exam. In the mean time, I was talking to a lawyer because I knew it would probably end up in court. We talked for a while and he said that he wouldn't represent me. Not because my case was bad, but because he felt I was capable of doing it myself and he would also have to charge me too much. It was obvious to him that I understood my disease better than he ever could and the catch up time for him would be too long and he would still not be able to do as good a job as I would. So he charged me the hourly rate and told me to call if I needed anymore questions answered. He also told what I needed to do and what tricks the insurance company would try playing on me.

One of the things he told me was to make sure that they sent my entire file to the doctor who was doing the IME. Sometimes they will only send a few pages with a list of questions. He also told me to read the list of questions. Sometimes they put questions in the list that either are unrelated or no matter how they answer would diminish the scope of their liability. He also told me that he would not be able to tell me anything about his report, but to request a copy from the insurance company.

He told me that he hasn't done an IME in a very long time. They don't pay for the number of hours to do it properly and unfortunately the insurance companies use lots of tricks. For example, he was asked by an insurance company to review a case and determine if a specific mediation was appropriate. He did and wrote a report stating that the medication was the correct and most proper medication for that patient. He then got a call from an irate doctor saying "how dare you tell them the medication was not recommended?" So the doctor had recommended the same medication. When they looked at the response from the insurance company it said, "after consultation with Dr. X we have decided NOT to approve this medication." They played word games to make it look as if he said no, when it was the insurance company and they never had any intention of paying for the medication.

So he did the exam and then he said "I have one question for you, how long did it take you write the letter appealing the first denial? Most people would read that and say, of course this woman is capable of working. But it really depends how long it took."

My answer was, "I had 180 days and they got it on the 179th day. I could work more than 15 minutes at a time and rarely more than an hour a day. Except for those days that I went to the Medical library. The nearest medical library was 45 minutes away and that's where I had to go to get copies of the articles and papers. Those days, I would sleep for days afterwards." So he said, that doesn't make you very employable. Nope.

So I got my approval for the private disability and that was included in my SSA file (I gave it to them with other medical records).

So when it came time for my SSD hearing, my lawyer asked me a couple of things. First she said, that I had probably the best file she had seen for Fibromyalgia. Second, she asked why I wanted a lawyer when I knew my file so well? I said that I don't know the law and I also don't know what will happen during the hearing. In all likely hood, I will break down crying and be completely coherent. She smiled. Not because she was going to get her fee, but because she knew that I had a better chance with a lawyer and that I was clear headed enough to see that.

The fact is we DON'T know the law and when you get to the hearing stage that's what the case is all about. The hearing is about whether or not you case file meets the criteria set forth in the law for you to collect Social Security Disability. That's why it's so important to get a lawyer. They know the judges and depending on what judge you get assigned they can determine what is the best way to present your case.

The fee is 25% of your back benefits or $5300 (that amount might have changed since I got my award), whichever is least. It seems like a lot, but the alternative is nothing. I was very happy to pay that.

So we sat down a few days before my hearing and she practiced asking me questions (rather I practiced answering). Like I said, I am a puzzle solver by nature and trade. When someone asks me a question, all kinds of things go through my mind. Why are they asking? What do they really want to know? One of the set of questions she asked me was do you have any pets? yes. what kind? a dog. Do you walk your dog? no, he's 64 pounds and too strong for me to hold the leash. Ding! Ding! Ding! If I had said yes, then end of hearing. If I could walk a 654 pound dog then there are many jobs I could do.

Some judges will try and trick you. Their job is to ensure that you are for real. So much of the evidence in our case files are self report of symptoms which is given equal weight to any tests results and doctor's opinions, that it's fair they see if we are for real.

The other thing she said was that by law, I was entitled to 60 minutes for the hearing. The judge if he chose to could have other witnesses like a vocational expert. That time was taken out of my 60 minutes and the judge is in charge. Some judges will take over an ask their own questions and that's their right. It's the judge's courtroom and he runs it the way he/she wants. The only reason you can get a new hearing is if you can prove that the judge did not follow the law, like not giving you the entire 60 minutes for the hearing. I don't know if the 60 minutes is a state stipulation or federal.

So we brought along my husband and he stayed in the waiting room. He was there in case the Judge wanted to ask any questions. We went in and my lawyer started. She introduced me and started going through my background. The Judge interrupted and started with his own questions. A little after 30 minutes he asked me what the current state of treatment is for Fibromyalgia. I took a minute and said that it came down to antidepressants, exercise and medications to treat pain and other symptoms. Then I took a gamble and a deep breath. I said I think what you really want to know has to do with the commercials that had recently come out about Lyrica. It had been about 3 months since it got approved and the commercials and print ads had been running non-stop. I said I had tried it and it had not worked for me. I said what the commercials don't tell you is that a medication is only effective for about 30% of people. The other 70% either have no response to the medication at all or the side effects are so severe that they can't use the medication.

The Judge stood up and picked up his papers. My lawyer asked if he had any questions or wanted to speak with my husband. He said no, that she has a very well educated client who was very credible.

Same thing Margaret said!

At this point I had 20 minutes left, but we got up in left. We picked up my husband and he was like, what happened, why are you done so soon. We said we would tell him out side. We got out of the building door and my lawyer and I did a tiny happy dance. She said to me you know what this means? I said, yeah he's going to approve it. She said, yep. She then said to me "you had an opportunity many people to have. He gave you the opportunity to educate him about Fibromyalgia. You have done a lot of good for a lot of people." My husband was still in the dark and I explained that because he ended the hearing early if he denied it I could get a new hearing. So he was going to approve.

about 4 days later, I got the approval. It was date stamped the day after the hearing. It was almost 40 pages long and detailed every point of law and how my case file supported it. It was very clear that it was written days before my hearing. The judge only wanted to see if I was the same in person as I was on paper. My lawyer also said it was the fasted approval she'd ever seen. The judge did his job ahead of time and everything was ready. I can only say thank you to the judge because he took the time to read my case file a head of time and so thoroughly that once he met me he was able to formalize the approval.

It was well worth the $5300. If you enter the courtroom without a lawyer some judges will take this as a sign of weakness. The lawyer only gets the fee if you are approved, so if you don't have a lawyer it's possible that no lawyer thought you could win your case.

My judge and Margaret's were fair and honest and did their job. Please take this info and use it to help yourself. Ask questions if you'd like. Every case was different. I'm sure anyone who's been through this would be happy to help.

My case has come up for review 3 times. The first time they sent me to two doctors for an independent exam. One doctor spent 15 minutes and the only thing he determined was that I met the criteria for Fibromyalgia. He didn't take the time and wasn't qualified to determine that I was disabled. The second doctor was a psychologist so I got the what day of the week is it list of questions. Again nothing that really needed to be checked. The second time it was only a psychologist and he told me that if I were to apply now I would never be approved for Depression. My primary diagnosis was Fibromyalgia and depression was only secondary. I was approved based on the Fibromyalgia. The third time just said that they would not be reviewing my case at this time.

The most important thing though is if you apply, you must keep seeing the doctor all the way through the process. If your hear comes up and you are not seeing a doctor (or haven't been) you will be denied. My lawyer also said that the only clients that she knew of who weren't renewed were ones who stopped seeing their doctors after winning their case. I know money can be an issue, but after two years of collecting benefits you become eligible for medicare. That includes back payments so if you get approved and get 2 1/2 years back payments, you will get medicare. If you don't have insurance from another source (a spouse in my case) then the medicare will come in handy. Don't stop seeing a doctor because you get your approval.

Reviews of your status will depend on age. I'm young by comparison to many people on disability (52 now, and about 40 when I stopped working) so that means that I get reviewed more often.

Good Luck,
Kim

P.S. I'm thinking good thoughts for everyone in the process. It is tough to keep working through it, but maybe some good thoughts will help.

It could be a little more coherent and I'm sure there are other tips I missed.

It helps me too. Putting everything together in a manner others can understand helps to organize in my brain so it can be filed away in a cubbyhole in my brain. Each time the cubbyhole gets a little smaller and makes room for more information.

It's also one of the hardest things I've ever had to do and at times when you feel useless bringing it out to help others gives me something to feel good about.

Kim