February, 2015: Recipe for a Smooth and Easy Application Process

February, 2015

Given the amount of time I’ve spent over many years detailing some of the more difficult and involved cases we’ve brought to successful conclusions, I thought I would reference a couple of examples of how smoothly an initial application can go with some good guidance and assistance from an experienced Social Security disability lawyer.  

The two cases this month involve: 1) Jeffrey, a fifty-four (54) year old maintenance mechanic with a long history of back and knee problems and 2) Martin, a thirty-seven (37) year old with severe mental health problems.  Both cases were taken on at their initial application level and were approved and paid within four (4) months of our involvement.  Ensuring that our clients are receiving the appropriate treatment with appropriate specialists and that the application documents properly reflect an accurate past work history and the true extent of our client’s disabling conditions can help to ensure a smooth and expedited favorable decision.  That was certainly the case for both Jeffrey and Martin. 

From a very basic standpoint for both of these individuals, we were able to work with the claimant to ensure that helpful documentation was obtained from their medical providers in support of their claim.  Certainly, in both Jeffrey's and Martin’s claims, this proved essential to such an early approval of their respective claims.  This is just the beginning, however, in terms of the types of work undertaken at the early stage of representation in a claim.

There are multiple benefits to obtaining an attorney from the outset: 1)  it will avoid the need to undertake what can be multiple appeals processes that could potentially take years (and, ultimately, still result in a denial) and 2) it may reduce the amount of the attorney’s fees one needs to pay, as fees are typically limited to 25% of the past due benefits awarded (and capped by Federal law at $7,200.00).  Thus, if your lawyer were to  obtain benefits for you at an early stage such that it results in only 6 months or a year of retroactive benefits, the result would be paying your lawyer far less in fees than if you needed to proceed through the entire appeals process  (which, in Maine, Massachusetts and New Hampshire, can take up to an additional 15 to 24 months from the time of an initial denial letter). 

In each case, we work with the client to ensure they understand what is being asked by the initial application and the subsequent forms requested by the Social Security Administration (SSA).  We’ve represented a number of individuals over the years who started their case by providing SSA the wrong onset date, failing to understand the rules having to do with unsuccessful work attempts in situations where they have been in and out of work a number of times.  Instead of understanding that they may be entitled to allege an onset date that goes back to when they initially went out of work.  One would think that SSA would inquire sufficiently of claimants to ensure the correct onset date is used.  We have found all too often this is not the case. 

Unfortunately, a failure to be complete with your application can result in SSA’s failure to obtain all of the relevant information in one’s claim.  We have seen many cases over the years where a denial might have been avoided by simply providing SSA with a comprehensive list of the medical providers that have been seen in the past (with the appropriate details as to what they treated the claimant for, where the treatment was received along with when the treatment took place, so as to allow SSA to obtain these records). 

Too many times we find that claimants who have been denied have failed to provide the appropriate specifics being asked for by SSA in their forms or have failed to be clear in their answers as to how they are impacted by their condition (Adult Function Report and  Third Party Function Report, etc.).   For example, suggesting that one is capable of performing tasks over the course of a number of hours, but without specifying the need for breaks or the extent to which there are days during the week that are bad days where the task cannot be completed, can provide a huge misimpression to SSA as to one’s capabilities.  

In cases involving an applicant who is 50 years old or older, and thereby implicating the Grid rules, the failure to properly describe one’s past relevant work history (that is to say, the work one has performed during the 15 years prior to becoming disabled) can cause SSA to improperly designate the exertional level of your prior work and draw the conclusion that you are capable of returning to work you’ve performed previously.   Certainly, this was especially important to Jeffrey’s claim as, given his age, education and work experience that involved heavy lifting, difficult postures and constant standing/walking, along with the functional limitations that were set forth by his doctors, there was clearly going to be no way in which he could return to his prior work or (as is made clear by the Grid Rules) was there any way he could be expected to find other work in the national economy that exists in significant numbers in either his region or other regions of the national economy.

Obtaining a lawyer early on in the process proved beneficial to both Martin and Jeffrey, allowing them to avoid the financial strain and frustration of what could have been very lengthy appeals processes.