Michigan Social Security Disability Law Blog

Health insurance companies are finding new ways to avoid paying claims of policyholders most in need of medical treatment.

One of the latest insurance company tactics is rescinding policies after individuals file claims, and encouraging them to pursue benefits from Medicare, Medicaid, or other sources.

Another serious problem is “dual-role insurers,” which are companies that not only pay benefits, but also decide who is entitled to receive them. While the federal Employee Retirement Income Security Act allows insurance companies to do this, many argue this dual role presents an inherent conflict of interest.

Some insurers are directing staff to scrutinize each claim, to find any hint of “misrepresentation” that would be an excuse to cancel a policy. For example, a company might try to revoke a policy, if an individual did not identify a previous health problem or medical procedure on his or her initial insurance application.

Increasing public attention has prompted state industry regulators to investigate and fine some health insurers for these unfair and unlawful practices. One recent investigation revealed that an insurer paid employee bonuses, based on the number of policies they cancelled.

In short, these companies increase profits by wrongfully denying claims of their sickest policyholders, and continuing coverage only to those who are healthy.

If you or a loved one has encountered similar problems with your insurance company, you need to protect your legal rights. Contact an experienced attorney who can help you receive the medical benefits and coverage that you deserve.

Starting a Claim for Social Security Disability Benefits
To make a claim for Social Security Disability benefits, you need to file an application with the Social Security Administration (SSA). The SSA provides an on-line application form on its website www.ssa.gov. You also can file for Social Security Disability benefits by going to a local SSA office. If you have trouble finding a Social Security Administration office close to your home, call the Social Security Administration toll-free hotline number at 1-800-772-1213. (Deaf and hard-impaired individuals can reach Social Security Administration by TTY at 1-800-325-0778.)

Submitting an Application for Social Security Disability Benefits
Take the time to carefully fill out your Social Security Disability application. Remember that the Social Security Administration will use whatever information you provide to decide if you qualify for Social Security Disability benefits.

Give complete answers to every question. This could help the Social Security staff fully understand the severity of your disability, the limitations that it places on your capacity to work, as well as the prospect that your disabling condition or illness might get better or worse in the future. In addition, the Social Security Administration may process your application more quickly, if you include all the required information on your application form.

If you have trouble understanding all the questions on the application, you have a legal right to ask the SSA to help you. To get assistance, call their toll-free number listed above, or visit a local Social Security Administration office.

Getting an Answer from the SSA about Your Social Security Disability Application
After you send in your application, the SSA may take several weeks or months to review your information and tell you its decision.

If your Social Security Disability benefits are approved, the SSA will send letters to let you know the amount of your benefits and your health coverage options. They will also tell you about your responsibility to report changes in your medical condition, employment status, and other factors that could affect your eligibility for benefits.

Be sure to read and follow all the instructions, to help ensure that your benefits continue for as long as you have a right to receive them.

If the Social Security Administration denies your initial application, you have the legal right to challenge the unfavorable decision by filing an appeal.

Appealing a Denial of Your Benefits
Do not give up, if the SSA denies your claim. In fact, the SSA often rejects the initial applications of individuals who meet all the requirements. Many of these people have to go through the appeal process to get their Social Security benefits approved.

To protect your right to appeal, you must act immediately after you find out that the Social Security Administration disapproved your application. You only have 65 days from the date stamped on the denial letter to ask for another review of your claim.

A Social Security Administrative Law Judge conducts this review, after taking another look at all your Social Security claim information, including your application form, medical records, and additional material you submit to support your claim, and after holding a hearing at which you can present evidence to support your case.

Do not delay filing an appeal. If you miss the 65-day deadline, and decide later to seek Social Security Disability benefits, the SSA will make you go back and start the application process all over again.

Presenting Your Social Security Disability Claim at a Social Security Hearing
When you properly file an appeal before the 65-day deadline, the SSA will schedule an Administrative Law Judge hearing. Usually, it takes between 6 months to 18 months to schedule your hearing date.

The Administrative Law Judge who conducts your hearing will evaluate the following factors, to decide if you should get benefits:

• Whether or not you accumulated enough Social Security earnings, or “work credits,” to qualify for benefits.
• If not, whether or not your income and other financial resources are so limited that you may qualify for Supplemental Security Income (SSI)
• Whether or not you have an impairment that has lasted, or is expected to last, for at least 12 months, or is expected to result in death.
• The nature and extent of your impairment.
• Your ability to engage in substantial gainful activity since your impairment began.
• The date that your disability began.

If the Social Security Administration just denied your application for benefits, or if you already filed an appeal and are waiting for your hearing, take the time to contact an experienced Michigan Social Security lawyer immediately. Our Michigan Social Security law firm represents individuals at this level of appeal. We want to help you get the Social Security Disability benefits you deserve.

Question: I filed for Social Security Disability benefits and the Social Security Administration denied my claim. What do I do now?
Answer: It is not uncommon for the Social Security Administration to deny an initial application for benefits. If you get denied, you need to act immediately. You only have 65 days from the date stamped on the Social Security Administration’s letter denying your application to file an appeal and preserve your Social Security Disability claim.

Question: If the Social Security Administration approves my application for Social Security Disability benefits, what will I get?
Answer: Social Security Disability benefits may include Medicare health care insurance, individual benefits, and family benefits. Your monthly financial benefits will be based on the formula in the Social Security Act, as well as the amount that the federal government counts as your Social Security earnings from employment before you became disabled.

Question: How do I know if I am disabled for purposes of receiving Social Security Disability benefits?
Answer: According to the Social Security law, an eligible "disability" means the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months or result in death."  If you are not sure if you qualify, you should check with both your family doctor and our Michigan Social Security lawyers about a potential claim for Social Security Disability benefits.

Question: I have not worked in recent years. Could I still qualify for Social Security Disability benefits?
Answer: The Social Security Administration requires a specific amount of Social Security earnings, or "work credits," to qualify for Social Security Disability benefits. As a general rule, if you worked for 5 out of the last 10 years, you probably have enough "work credits." You certainly should contact the Social Security Administration or consult with an experienced Michigan Social Security Disability lawyer to find out whether or not you qualify.

Question: I have a serious mental or psychological condition that prevents me from working. Can I still receive Social Security Disability benefits?
Answer: According to the Social Security Act, a "disability" can be either physical or emotional, or a combination of both. The key is that a doctor finds "objective medical evidence" that you your condition prevents you from working for at least 12 months.

Question: Can I apply for Social Security Disability benefits on my own?
Answer: Yes. You can file your own application for Social Security Disability benefits, and represent yourself in all legal proceedings. However, statistics show that people with legal representation, especially on appeals, win their Social Security Disability claims much more often than those who try to represent themselves.

Question: I cannot afford to pay an attorney fee now. Can I still get legal help with an appeal of the Social Security Administration’s decision to deny my application for Social Security Disability benefits?
Answer: Yes. If you retain our law firm, there is no attorney fee, unless we convince the Social Security Administration to approve your claim for Social Security Disability benefits. If we win, our fee is defined by the Social Security Act and kept very reasonable. 

Question: I was denied Social Security Disability benefits last year, but my medical condition has gotten worse. Can I try again to get Social Security Disability benefits?
Answer: Yes. There is no limit to the number of times you may apply for Social Security Disability benefits. If you feel that you now qualify for Social Security Disability benefits, you should file another application with the Social Security Administration.

Question: If the Social Security Administration approves my Social Security Disability claim, how long will these benefits last?
Answer: You can get Social Security Disability benefits for as long as you remain disabled from employment and meet all other Social Security Administration requirements. From time to time, the Social Security Administration may review the level of your disability by sending you for a medical evaluation.

Question: My disability was brought on by alcoholism or drug addiction. Can I still qualify for Social Security Disability benefits?
Answer: Maybe. To determine whether you still have a potential Social Security Disability claim, you should consult an experienced Social Security Disability attorney. The Social Security law states that you cannot get Social Security Disability benefits, if alcoholism and/or drug addiction is a contributing factor that is material to the determination that you are disabled. However, people who used to abuse alcohol or drugs can qualify for Social Security Disability benefits, based on other unrelated and disabling health problems.

Social Security Disability Insurance Benefits (DIB) are available to disabled workers who paid enough earnings into the Social Security system. The Social Security Administration (SSA) determines if you are eligible for DIB, based on your work history during the years before you became totally disabled. As a general rule, you probably have enough work credits to qualify, if you worked for 5 out of the last 10 years.

The following factors determine eligibility for DIB:

• Whether or not you have enough work credits to qualify for disability benefits.
• Whether or not you have an impairment that has lasted, or is expected to last, for at least 12 months, or is expected to result in death.
• The nature and extent of your impairment.
• Your ability to engage in substantial gainful activity since your impairment began.
• The date your disability began.

Do I Qualify for Social Security Disability Benefits?

You must be totally disabled from employment and meet the Social Security Administration requirements for prior earnings.

As defined by the Social Security Act, a disability means:

Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months or result in death.

Therefore, you may be eligible for Social Security Disability benefits if you can answer yes to one or more of the following questions:

1. Do you have a severe physical or mental impairment that prevents you from participating in any type of gainful employment?
2. Do you have a disability that prevents you from working at any job, rather than just your previous employment? Has your disability lasted, or is it expected to last, for at least one year?
3. Is your disability life threatening?

The Social Security Disability Application Process
The Social Security Administration requires evidence of the extent of a disabling condition before awarding benefits. To succeed in obtaining benefits, you must have a severe impairment that is shown by “medically acceptable clinical and laboratory findings.” Unfortunately, many illnesses may completely disable an individual, but remain difficult to diagnose. In these cases, an attorney can analyze your medical records to try to find the evidence necessary to prove that you have a serious disability.

Can I apply for Social Security Benefits on my own?
Yes, you can file your own application for Social Security Disability Benefits or SSI, and represent yourself in seeking benefits. However, statistics indicate that claimants who have legal representation, especially on appeals, win their benefits much more often than those who represent themselves.

The Initial Application
You can apply for SSA benefits at a local Social Security Branch Office. To obtain the address and telephone number of your nearest Branch Office, call the SSA Hotline telephone number at 1-800-772-1213. (Deaf and hard of hearing individuals can reach SSA on its TTY number at 1-800-325-0778.)

The SSA application form requests a lot of information. In addition, the claim review process can take a long time. Some people simply give up and go away, even if they are genuinely entitled to their benefits. Often, SSA takes several weeks or months to review your initial application. Many individuals are denied at this stage, even though they meet all the requirements for benefits.

Do not be intimidated by the application process. If you are disabled, you have the right to seek benefits.

If SSA denies your application for Social Security Disability Benefits at the initial stage, you only have 65 days from the date stamped on the denial letter to appeal the decision and ask for a hearing to present your claim to an Administrative Law Judge.

The Social Security Hearing
An individual who files a proper appeal before the 65-day deadline will be scheduled for an Administrative Law Judge hearing. Usually, SSA takes between 6 months to 18 months to schedule your hearing date.

The Administrative Law Judge who conducts your hearing will evaluate the following factors, to decide if you should get benefits:

• Whether or not you accumulated enough SSA earnings (work credits) to be insured for disability benefits.
• If not, whether or not you qualify under the SSI income limits.
• Whether or not you have an impairment that has lasted, or is expected to last, for at least 12 months, or is expected to result in death.
• The nature and extent of your impairment.
• Your ability to engage in substantial gainful activity since your impairment began.
• The date that your disability began.

Appeal of a Denial at the Hearing Level
If you are denied benefits at a hearing before an Administration Law Judge (ALJ), you have a right to appeal your decision further, to the Appeals Council. However, you only have 65 days from the date of the ALJ denial to file for that appeal.

Therefore we recommend that you contact a lawyer immediately, if an ALJ denied your claim. A lot is at stake when you are unable to work and wrongfully denied Social Security Disability Benefits or Supplemental Security Income (SSI). Families often depend on the income that was denied. A professional, experienced Social Security lawyer will work hard to obtain all relevant medical and employment records, review all documentation, and aggressively pursue a claim on your behalf.

It’s just not right.

Today, 745,000 Americans are waiting an average of 17 months for the Social Security Administration to review their Social Security Disability claims. Of these individuals, almost 50,000 are Michigan residents.

These Social Security claimants had been working and supporting themselves, until they were disabled by serious illness or injury.

The long delay at the Social Security Administration puts many Social Security Disability claimants in desperate circumstances, because they have no other source of income and no health insurance. Due to the Social Security Administration backlog, some claimants may have to use up their savings, borrow money from family and friends, run up staggering credit card debts, lose homes to foreclosure, declare bankruptcy, or end up homeless.

If that were not bad enough, some people die from terminal illness while waiting for the Social Security Administration to look at their applications for Social Security Disability benefits.

According to the National Council of Social Security Management Associations, which represents local Social Security Office administrators, there are two reasons for the long delay in processing for Social Security Disability claims.

First, the aging of “baby boomers” has significantly increased the number of people applying for Social Security Disability benefits. Claims rose 62% in just four years between 2000 and 2004.

Second, the federal government has ignored this trend. Rather than increasing Social Security Administration staffing to handle additional Social Security Disability claims, the federal government cut funding. Now four-fifths of local Social Security Offices cannot keep up with current workloads, and nearly two-thirds of the office cannot even provide prompt telephone service.

Clearly, this is not how America should treat disabled workers or their families.

If you agree, take the time to contact your U.S. Senators and your U.S. Congressperson, and ask them to make sure that the Social Security Administration has the staffing and resources to start giving every Social Security Disability claim fair - and timely - consideration.

I want to welcome you to our Michigan Social Security Legal Help Center Blog on the important issues related to claims for Social Security Disability benefits.

After many years of representing individuals seeking Social Security Disability, we know the impact that a disabling condition or illness can have on an individual’s life. It not only limits the ability to work or handle normal activities of daily living, but also can result in huge medical expenses.

For Michigan families already living on the financial edge, a serious disability can push them past the tipping point, into bankruptcy and foreclosure. Needless to say, these extraordinary financial pressures only add to the emotional pressures of trying to cope with disability.

In short, we understand that people seeking Social Security Disability benefits need all the help that they can get.

Our Michigan Social Security law firm is dedicated to protecting your legal rights and getting you all the Social Security Disability benefits you deserve.

This Michigan Social Security Legal Help Center Blog is another way for us to help share our point of view on Social Security related issues. We hope you find it thoughtful and helpful.