Saturday, July 20, 2013

Earnings Record

EARNINGS RECORD


Preparing a case requires a look at the claimant's earning record. The record is full of acronyms, abbreviations, messages that look like they are written in code. So what does it all mean? Here is some of the answers!

Consider the following:

NH NAME JOSEPH LOST SN PG001
INPUT 02/02/13 MINNEAPOLIS, MN
RUN DATE 02/02/13 V: 01/12/11 CO: 01/15
CONTROL CC:R BLK:3
EVENT EARNINGS RECORD – PIA DETERMINATION
TID DISABILITY CLAIM



DATES AP: 12/15/12 DO: 06/06/11 DENT: 12/11
(date claimant applied (claimant's alleged (the first day of the month
for benefits) disability on-set is the date the claimant becomes
date) entitled to benefits—5 months
from disability on-set date)

************************************************************

NH NAME JOSEPH LOST.....



INS STAT DISABILITY: EXCL QU:24 EXCL: HAS: 40
…...................................................DID DLI: 01/01/14
DISABILITY TEST: 20/40 MET...................................



COMPUTATIONAL YEARLY EARNINGS
MAX AMT YR REGULAR U INDEXED
70 NNNC 115.00 L $575 (examples only)
71 CCCC** 175.00 L $875
( Year) (quarters*) (actual earnings) (present value of earnings-- used to calculate
primary insurance amount (PIA))


*The amount of earnings required for a quarter of coverage (QC) in 2013 is $1,160. A QC is the basic unit for determining whether you are insured under Social Security.
**No matter how high your earnings may be, you can not earn more than 4 QC's in one year.

**You have disability-insured status if you:
  1. have earned at least 20 QCs during the last 10 years (a way to estimate, worked full time 5 of the past ten years), and
  2. are fully insured.










Disclaimer: Blogs posted herein are intended neither as legal advice, nor do they create nor attempt to create an attorney-client relationship. The person viewing my blogs is admonished that an attorney-client relationship may only be created with the express consent to the parties to it.






Sunday, July 14, 2013

Thoughts on the Working Claimant





The following are thoughts by the author and not intended to be taken as representation of the law. It is comment, and comment only. There is no attempt in posting this blog to establish an attorney client relationship with any reader.
A big reason why you have private attorneys working in the area of social security disability is the same reason many claimants find it necessary to work pending a hearing; that reason being delay! The law allows attorney's fees to be paid out of past due benefits awarded to the claimant. There is an ability to earn a good fee, if the past due benefits are large, i.e. if the delay from requesting a hearing to the actual hearing date is lengthy. After a denial on a request for reconsideration, it can take 12 to 18 months to eventually appear before an ALJ. Claimants who are desperate for income to maintain a bare life style, sometimes feel forced to take a part time job. Most admit working was very hard and painful but they feel they had no choice, especially if they have a family depending on them.
The big problem with the delay is the financial hardship. The claimant has to wait without money for a hearing, this can be very, very difficult. Most hope to win benefits so that they will have some small token of their life back.
What happens in the system to these people is the subject of the blog.
Compare what an ALJ sees at every hearing, and literature put out by social security. A judge sees people unable to work with claims of disability. Some disabilities reach the level the ALJ deems subject to benefits, many others do not. The majority of claimants at this stage are suffering the impact of some disability. The majority of claimants are unemployed, down on their luck, and begging for financial assistance. Given this, in walks a claimant claiming to be totally disabled and unable to work at any job within his or her functional capacity, yet the claimant is working a part time job.
There is nothing illegal in a claimant working a part time job and claiming benefits. In some cases, where the claimant has tried several and failed at each, (an unsuccessful work attempt is work at a job that generally lasts less than 3 months) it might even assist them in a win. In the normal case, part time work by the claimant sets up a bad situation...let's say that the claimant is working 20 or 30 hours a week, but all the prior claimants that week before this ALJ were unable to work at all and benefits have been denied to some of the non-working claimants. It is hard to believe that claimant's ability to work part time does not affect the ALJ's thought process.
On the other hand, if you look at the literature put out by social security you will see that it tells you that you can work while you apply for disability benefits (and while you receive benefits), as long as your earnings do not exceed a certain amount set by the SSA each year, called the SGA limit. SGA stands for "substantial gainful activity." In 2013, the SGA limit is $1,040 per month (or $1,740 for blind claimants).
 
Caveat! Remember that "past relevant work" (PRW) -- that is, jobs the claimant has done in the past 15 years.  If that work included part time employment and at the part time employment qualified as "substantially gainful" work, i.e. claimant was earning more $1,040.00 a month, and  SSA decides you can do your part-time PRW, you will be denied benefits.
Social Security disability is based upon a claimant's inability to work any full time job within his/her functional capacity (except as noted above). Social Security defines disability in terms of a claimant's ability/inability to work. To win, you need to prove that at the lightest job category that the claimant has the ability (his/her functional capacity) to work, the impairment(s) makes competitive employment impossible, i.e. even at a simple, unskilled job, claimant could not perform the duties to the quality demanded by an employer, i. e. show up to work consistently, be at your job site, work for 8 hours a day, 5 days a week and continue to do that for the term of employment. If you return to work before a hearing on your disability claim, the judge may have trouble dealing with part time work, and a finding of disability, i.e. “Isn't it possible with a little more effort, full time work could be handled?”
Testimony from the claimant, who is working a part time job, that “I am working at my capacity. I could not work longer hours or more days, or at a more difficult job, and I don't know how much longer I can do the little I am doing.”
Unfortunately, a judge may conclude that claimant's testimony is not credible. Claimant admits working 3 to 4 hours a day, maybe at a different job or with a little more effort, you could work 7 to 8 hours a day. What if you have consistently shown up to work your part time job, done a good job working at it for the past year, three months or whatever time period? What if you worked a part time job that required heavy lifting, medium lifting etc? There is no other way to look at it, but that part time work damages a claimant's chances of winning!
I explain this to my clients when the issue arises and let them make the decision. I understand that to some it is necessary to bring in some money to meet living expenses, and that it will take a long time to get to a hearing.
They need to understand that if their case is not cut and dry (as it would be if the client had had a liver transplant, say, which automatically qualifies for benefits for 12 months), they may want to think twice about working when you apply for benefits. It is a very difficult issue for many clients who are faced with the difficulty of attempting to win benefits.

Sunday, July 7, 2013

FAILURE TO FOLLOW TREATMENT


Every now and then a client appears who, upon review of medical reports, appears not to follow one or more of his/her treating physician's recommendations on treatment. What is the effect of such conduct?

As a general rule, Social Security can use information on whether your client has been following his/her doctor's recommended treatment, taken prescribed medication, been using prescribed devices such as a cane or brace, and keeping medical appointments. If the client has failed to follow recommended treatment, the ALJ could use that failure to conclude that your client's condition is not as severe as alleged.

It is always of concern when the Administrative Law Judge questioning your client –making specific comment on the fact that the client failed to appear for doctor appointments; or, seems to have difficulty following prescribed treatment; etc.

This is of such a concern because if it appears that claimant's impairment can be remedied by treatment, to the point he/she could return to some type of work, the claimant must follow the treatment prescribed by claimant's physician. 20. C.F.R. §§ 404.1530(a)

If claimant fails to follow prescribed treatment, absent a good excuse, he/she cannot be found disabled. Ostronski v. Chater, 94 F3d 413 , (8th Cir. 1996). Claimant failed to take prescribed pain medication or seek regular medical treatment, claimant rejected doctor's recommendations of surgery...all were sufficient to up-hold the ALJ denial of benefits.

When a client presents such facts, it is necessary to talk with them and review the medical records to determine if there was a 'good excuse' for not following prescribed treatment, or, if no 'good excuse', would compliance have made a difference in being capable to being competitively employed,-- “ doctor, would Mr/Ms X ability to work be restored if prescribed treatment were followed?” Obviously, if the treatment had been followed and it still would not restore claimant's ability to work, whether or not treatment was followed is irrelevant.

What if the doctor believes that it could have sufficiently improved the client's health? Then it is important to determine if there is a “good excuse” for the failure to follow the doctor's orders.

If it is a failure to take medication, why? Sometimes the side effects of the medication is worse than the symptoms of the impairment. Sometimes the claimant is afraid of addiction. The claimant may be offered surgery that did not work in the past. Surgery in general presents a conflict among the circuit courts.  Is it proper to force an invasion on the body when the client has in his or her mind a justifiable reason to say “no”?  i.e.  Is it proper to demand that a claimant under-go surgery, when the claimant has a heart felt fear of surgery and the problems that can be associated with surgery? Consider Ostronski, supra.

It is the commissioner's burden to show that claimant's refusal of treatment was not justified. Consider,
Walker v. Callahan, 990 F. Supp 1283 (D Kan 1997) Before the ALJ may rely on claimant's use of low-cost clinic or failure to pursue treatment or take medication as support for determination that testimony lacks credibility, the ALJ should consider whether 1. treatment was prescribed; 2. treatment was refused; 3. would restore the claimant's ability to return to work; and if so, refusal was based on a “good excuse”.

What if claimant is willing to accept treatment, but cannot afford it and there is no community agency providing such treatment within claimant's resources? Consider: SSR 82-59 – “4. The individual is unable to afford prescribed treatment which he or she is willing to accept, but for which free community resources are unavailable. Although a free or subsidized source of treatment is often available, the claim may be allowed where such treatment is not reasonably available in the local community. All possible resources (e.g., clinics, charitable and public assistance agencies, etc.), must be explored. Contacts with such resources and the claimant's financial circumstances must be documented. Where treatment is not available, the case will be referred to VR.”

Religious beliefs that run contra to the recommended treatment always raises an issue of allowance. Again consider SSR 82-59 – “1. Acceptance of prescribed treatment would be contrary to the teachings and tenets of the claimant's or beneficiary's religion. A finding of disability would be in order where the evidence establishes that the disabled individual rejects prescribed treatment on the grounds that he or she is a member of a church which teaches that healing may be accomplished only through faith or prayer. In such a case the claimant will have to identify his church, prove he is a member, and the church's position on medical treatment must be documented (there is an exception for Christian Science—you need not develop the church philosophy on medical treatment).”

If this is an issue in a case, a good place to start is SSR 82-59, it sets forth the commissioner's position on a number of these issues, in addition case law can flesh out the issues.

Of particular difficulty in this area is conditions which appear to be the result of 'bad habits'. The lay thought would be remove the 'bad habit” and the condition is remediable and as such refusal to 'act normal' should bar recovery.

When you ask a 'man on the street' - “Should obese people be granted disability benefits?” Most would argue that an obese person should not be allowed benefits, --”Go on a diet”. “Watch what you eat” etc.

Drugs and alcohol have their own provisions in the law that restricts benefits. Which is a shame. In many cases the drug user or alcoholic cannot stop, they have an addiction and try as they will, even with professional intervention, they continue to relapse. Congress in its questionable wisdom, has proscribed both outside the realm of benefits.

Smoking is another issue that pops up in the cases, i.e. Kisling v. Chater, 105 F.3d 1255 (8th Cir. 1997) Medical evaluation of the claimant showed that her respiratory problems were related to smoking, failure to follow prescribed course of remedial treatment without good cause was grounds to deny benefits.

Disclaimer: Blogs posted herein are intended neither as legal advice, nor do they create nor attempt to create an attorney-client relationship. The person viewing my blogs is admonished that an attorney-client relationship may only be created with the express consent to the parties to it.