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Does SSA Care If Your Doctor Thinks You Are Disabled?

By Jon Ressler, Attorney, Roose & Ressler

For well over 20 years, Social Security acknowledged that your treating doctor has unique insight in assessing your medically-caused functional limitations. Not anymore.

If you filed a Social Security disability application since March 27, 2017, the voice of your treating doctor is now just one among many. Social Security adopted new rules about how it will weigh opinions from medical sources. This change will make proving disability more difficult in many cases and is likely to result in increased denials for claimants with genuine disability.

Social Security has never unquestionably relied on treating doctor opinions. It has never given much weight to your doctor’s opinion that you are “disabled.” But Social Security would give weight to your doctor’s opinions about specific functional limitations, such as how much you could lift, how long you could sit and stand, or whether you could stay on task long enough to complete a task. Social Security would adopt your treating doctor’s opinion if it was well-supported by the medical evidence and was not inconsistent with other substantial evidence.
When your treating doctor’s opinion was compared against opinions from other medical sources, it was given deference because of the treating doctor’s special position, especially if there was a long treating relationship or if the doctor was a specialist. The underlying assumption was that your treating doctor knows you best, and her opinion would be accepted unless there were good reasons not to accept it.

This changed on March 27, 2017. Social Security’s new rules level the playing field between the opinions from your treating doctor, one-time examining doctors (often from an examination that Social Security paid for), and opinions of Social Security’s doctors who review your case but never see you. Now, Social Security says, “We will not defer or give any specific evidentiary weight” to your treating doctor’s opinion. Rather, all medical source opinions must be “considered” based on several factors but with the two most important being “supportability’’ (how well explained) and “consistency” (as compared to other medical and non-medical sources). Social Security no longer assumes that your treating doctor’s opinion is likely to be more accurate than doctors that they paid to give you a superficial 10-30-minute examination or the doctors they paid to review your record as quickly as possible (they have a lot of claims to review).”

This is a seismic change. The doctors that Social Security pays to examine claimants or review claimant’s records are likely to often win on the supportability factor. They are required as part of their job to try to support their opinions with an explanation. Treating doctors are not. They can’t bill insurance for time giving opinions (and more time explaining them) and often do it without any or minimal compensation. They tend to state their conclusions without spending time explaining their reasoning. This reality likely tips the playing field of competing medical source opinions against the treating doctor. Claimants and their legal representatives will need to work with their treating doctors to obtain opinions supported by well-reasoned explanations to overcome this obstacle.

It will take time to fully assess the impact of the new rules, as cases filed after March of last year have not yet made their way through the appeal process.

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Winning Your Disability Case by Combining Impairments

People who apply for Social Security disability have severely disabling conditions, which, unfortunately, do not automatically qualify them for benefits under the Social Security Disability rules.

Social Security Administration lists a number of impairments that automatically qualify an applicant for disability benefits. Most of these require very specific medical or laboratory findings. If your medical evidence meets the requirements of an impairment listing, you will automatically be found disabled. However, even if you do not meet the detailed criteria of a listed impairment, you may still qualify for Social Security disability benefits if your symptoms and diagnosis are “medically equivalent” (i.e. equal in severity) to the listed impairment may have a condition which is not found in the listed impairments but is equally severe in its debilitating effect. Or you may have a combination of impairments which are found on the list but lack one or more of the detailed criteria to qualify you under the Rules for disability; added together, though, they are medically equivalent to the listed impairments.

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The Order in Which Things Happen at the Hearing

What happens in the hearing room? Most judges commence Social Security disability hearings by recounting the “case history” of the disability claim and reciting the issues to be decided.

Although judges often recite what a claimant needs to prove in order to prove the case, they rarely give a well-defined and simple explanation. Rather, they usually state that the claimant must be “unable to perform substantial gainful activity which exists in significant numbers in the economy, considering your age, education and work experience.” Such a statement may give the claimant the false notion that they have to be bedridden to get disability benefits. This is the precise reason why you should seek the assistance of an Ohio disability lawyer.

The judge may question the claimant first and then give his or her disability lawyer the option to ask questions. Sometimes, if a claimant is well prepared to testify, the lawyer does not need to ask any questions.

Some judges may expect lawyers to do most of the questioning. If this is the case, the claimant should answer the lawyer’s questions with the utmost detail, as if talking to a stranger. The claimant should refrain from responding in incomplete answers simply because his or her lawyer already knows a lot about the case. Even though the judge may have read the file prior to the hearing, the claimant should assume that the judge knows very little about the case. As such, the claimant should give details, details, details.

So if you have been denied Social Security disability benefits, please fill out the claim evaluation form on this page to contact Ohio disability lawyers Roose & Ressler.

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How Does the Social Security Administration Define a Disability?

The Social Security Administration has specific requirements for finding that a claimant disabled. For advice on whether you may be considered disabled, call your Ohio Social Security disability attorney to discuss your claim.

To be found disabled, a claimant must have a medically determinable impairment. A medically determinable impairment is a physical or mental impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. The claimant’s age, education and work experience must be taken into account. The impairment must meet the following requirements:

Duration. The impairment must be expected to result in the claimant’s death or it must have already lasted or can be expected to last for a continuous period of not less than 12 months.
Past Work. The impairment must prevent the claimant from performing any past relevant work.
Future Work. The impairment must prevent the claimant from performing any other substantial gainful work that exists in the economy in significant numbers.

The Social Security Act expressly states that a claimant is not disabled if drug addiction or alcoholism is a material contributing factor to the individual’s impairment.

The Supplemental Security Income program applies this same definition of disability. This program provides a minimum income level to disabled people who do not qualify for Social Security disability benefits.

For advice on whether you may be considered disabled, call Ohio Social Security disability attorneys at Roose & Ressler to discuss your claim.

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Why are more Americans receiving Social Security disability insurance benefits?

You hear a lot of talk about this. But the reasons are logical and not mysterious. It is certainly not because people don’t want to work any more.

The baby-boomers have reached the age where disability is more likely. This is just a bulge in the population that was expected.

More women have earned enough work credits to qualify for this program. Before, they would be disabled but the SSI disability program or their families would support them.

The full-retirement age for Social Security increased from 65 to 66. So people who already get Social Security disability at age 65 stay on it for another year until age 66, instead of their checks being renamed “retirement.” And people who become disabled between their 65th and 66th birthdays will have to try to get “disability” checks instead of “retirement” checks, and now have to prove disability and lose a 5-month waiting period.

Other public or private programs have been cut back, so disabled people who were hidden in those programs now have to qualify for Social Security disability. Welfare, unemployment, pensions, and many other benefits have been scaled back, not fully protecting people who are affected by the recession.

For more, take a look at the testimony of Social Security’s chief actuary, the person who is supposed to figure this out: http://www.ssa.gov/legislation/testimony_120211.html
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Factors Our Toledo Social Security Attorney Looks for in an Appeal

When our Toledo Social Security attorney considers a case for appeal to federal court, there are several factors that the lawyer will assess. Here is a short list that he or she may consider.

Presence of Disability

Before a Toledo Social Security attorney files a case in federal court, he or she will begin an assessment of the case just as he or she would if the case was going in front of an administrative law judge. He or she will go through the sequential evaluation and consider multiple theories about why the claimant is disabled. If the appeal is successful, the case will likely be sent back for a new hearing in front of an administrative law judge in which the attorney will have to convince the judge that the claimant meets the definition of being disabled.

Legal Errors

The Toledo Social Security attorney will have to articulate why the administrative law judge’s decision is erroneous. As such, he or she will look at the evidence that the judge cited in his or her ruling. The lawyer will see if there is contradictory information in the judge’s opinion or if there is inadequate information that is cited as evidence in the opinion. Successfully making this argument requires the Social Security disability attorney to be familiar with Social Security rulings and regulations. By showing that the administrative law judge deviated from precedent, the lawyer is more likely to be successful than if he or she claims that the judge erred by not showing that there was substantial evidence to support his or her decision. Additionally, the lawyer must be able to show that the error that the administrative law judge caused him or her to make the erroneous decision. Simply because the judge did not apply a law correctly does not mean that the lawyer will succeed in the appeal. Instead, the lawyer must show that had the administrative law judge not made the mistake, he or she would have reached a different decision.

Compelling Facts

Although it is not essential that there be compelling facts or a claimant who is sympathetic, these factors can assist the Social Security attorney.
Legal Assistance from a Toledo Social Security Attorney

If you would like to know if any of these factors are present in your case, a Toledo Social Security attorney may be able to help. Contact Roose & Ressler at (800) 448-4211.

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Migraines and Filing for Disability in Ohio

When it comes to filing for disability in Ohio, there may be a variety of reasons that you are doing so. If you plan on filing for disability in Ohio, then it is recommended that you contact a disability attorney to help you through the process. Not all disabilities are as easy to qualify for and the process could be lengthy. If you suffer from chronic migraines, then you may want to plan on filing for disability in Ohio. Proving this sort of claim is not easy, however having a well-documented medical history of dealing with migraines will help to prove your medical condition.

The Diagnosis and Treatment of Chronic Migraines

By definition, a migraine is a neurological condition that is accompanied by symptoms such as dizziness, nausea, vomiting or even visual disturbances. Before the migraine sets in, you may first experience the visual disturbances anywhere from a few minutes to hours beforehand. Those who suffer from migraines also suffer from debilitating pain when they have a migraine. Often, the person suffering from the migraine will need to stay in a dark, quiet room until it passes. In most cases, a migraine will be diagnosed by your medical provider based on the symptoms you describe as well as your past medical history. In order to prove that you are suffering from migraines, your doctor may recommend keeping a journal of your symptoms. This journal will also strengthen your case if you are filing for disability in Ohio. Your journal may include information such as:

what date you experienced the migraine
how long the migraine lasted
how intense the pain from it was
if you had any visual disturbances and a description if you did
any symptoms you experienced before the onset of the migraine
what may have triggered it
how it was treated, ie: medication
how you felt after the treatment

When it comes to treating a migraine, your doctor can prescribe different medications for your relief. What the doctor prescribes will depend on how frequently you get migraines and how intense they are.
Migraines in the Social Security Listing of Impairments

If you plan on filing for disability in Ohio, be aware that the Social Security Administration (SSA) has a blue book of the Listing of Impairments that your condition will be compared to. There are hundreds of medical conditions that are listed that are automatically approved for disability benefits. Migraines are not one of the conditions listed. However, if your symptoms from the migraine equal the symptoms of another condition, then you may qualify for disability benefits.

If Your Condition Does Not Meet or Equal a Listing

If your migraine condition does not meet or equal a listing in the blue book, it is possible that you could still be approved for benefits through a “medical-vocational allowance.” In this case, the SSA will take several factors into consideration including your age, education level, employment history, and your Residual Functional Capacity. Your doctor will be able to fill out a Residual Functional Capacity form for you to present to the SSA for your case. The more written proof you have, the stronger your case will be.

What Happens If My Benefits Are Denied

If you receive confirmation that the SSA has denied your disability claim, then you will be able to file an appeal for your case within a 60-day time limit. It is important that you be sure to file your appeal within those 60 days or you will have to reapply for your disability benefits and you will lose any back benefit pay entitled to you. The letter that you receive from the SSA denying your benefits will also give you instructions on how to file for your appeal. The first appeal you will file is a reconsideration. If your reconsideration appeal is denied, the next step is to file for a hearing within 60 days. There are three ways that you will be able to file for your appeal:

You can call your SSA office to file.

You can make a trip to your local SSA office to file in person. Be sure to bring all documents from the SSA with you.

You can go to their website to file. Print your confirmation page to prove you filed with the 60 days.

Contact Our Ohio Disability Lawyer

When filing for disability in Ohio, you will want an experienced professional by your side. Call Roose & Ressler for your consultation today at (800) 448-4211. Roose & Ressler have the disability attorneys that will help you get the best possible outcome in your case when you are filing for disability in Ohio.

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Media

To members of the media, if you need expert information, insight or background research for a story you are working on regarding Social Security Disability Benefits and other factors related to Social Security legal issues, please contact our media relations firm at 440-695-0817 or email RRoeser@TheEisenAgency.com to set up an interview or call.

Speaking Engagements

To organizers of business events and seminars, our legal team looks forward to sharing insights and educational expertise regarding issues of Social Security Disability Law that affect Ohioans and other issues related to Social Security. If you need an educational speaker for an upcoming event, please fill out the following form: