Proving you are disabled is not always as easy at is should be. even when your treating physician agrees you cannot work due to your disability. The reason it’s often such a challenges is it is not your doctor, but an administrative law judge (ALJ) has the power to decide. The ALJ can overrule the opinion of treating physician based upon other evidence. While they are able to do this, they are technically only able to do this when the evidence on record fully supports the decision. In some cases, an ALJ may fail to establish there was sufficient evidence detailed in the record of benefits to justify denial. In these cases, an appeal is often necessary. The first appeal can be made the SSA Appeals Commission. However, that appeal is discretionary, so commissioners can decide not to hear it.
If this happens or a commissioner hears claimant’s appeal and affirms the denial of benefits, the claimant can either submit a new application (starting the process all over again) or appeal to the U.S District Court. In cases that originate in Massachusetts, the proper court is the U.S. District Court for the District of Massachusetts, which is located on Boston’s waterfront. This will be a hearing before a federal magistrate. If that does not go in the claimant’s favor, the next appeal would but the U.S Court of Appeals for the First Circuit.Social Security Disability Insurance, also known as SSDI, is the most common type of disability benefits applied for by claimants who are disabled and can no longer work. This is a disability benefits program administered by the U.S. Social Security Administration (SSA) and is designed for people who had worked their whole life and can no longer work due to a disability.
While working their whole life, they paid taxes, and a portion of those federal withholdings went to fund the SSA Disability Fund. This is known as paying into the system. This program is also for people who generally become disabled for reasons other than an on-the-job accident as that would typically involve a claim for workers’ compensation benefits. SSDI might also be an option for a claimant who injured on the job, but was self-employed and was not covered under a workers’ compensation insurance plan as the self-employed are not generally required to purchase workers’ compensation insurance for themselves.
All that should be necessary is to prove the claimant has enough quarterly credits from working and paying taxes and that he or she is disabled. As our Boston SSDI attorneys can explain, it is systematically very difficult for claimants to obtain a disability rating. This is especially true in cases where claimant is not represented by an experienced attorney. Many claimants shy away from hiring an attorney, fearing the cost as they face already mounting debt. However, claimants should know in SSDI cases, there are no legal fees unless they are successful in obtaining SSDI or Supplemental Security Income (SSI), as these cases are handled on a contingency fee basis.
Gerstner v. Berryhill
In Gerstner v. Berryhill, a case from the U.S. Court of Appeals for the Seventh Circuit, a 27-year-old claimant applied for both SSDI and SSI benefits and was her initial application was denied. SSI benefits are generally for disabled children and adults who have never been able to work, or the elderly or blind individuals. These benefits are available for those who do not have the quarterly credits to qualify for SSDI benefits. Normally, disability benefits are not available for the elderly because they are entitled to the Old Age and Retirements benefits when they reach the age of retirement as set by the federal government, but this program also requires you to have worked and paid into the system to qualify. This is why you get a statement of Social Security payment history from time to time so you have proof you have paid into the system as you are working and having taxes and other monies withheld from each paycheck.
In this case, claimant asserted she was disabled due to being diagnosed with several physical and mental disorders including fibromyalgia, bipolar disorder, clinical anxiety disorder with panic attacks, and clinical depression. While the ALJ determined she did in fact suffer from all of these medical conditions, no single condition or the combination of all conditions made her disabled. This means ALJ determined she was able to engage in substantial gainful activity. This is the legal way of saying she could work and earn more than approximately $1,120 each month. This is not a very large sum of money, but that is about the federal cutoff for begin disabled at the time of this article.
This determination by ALJ was found to be in error by the appellate judges of the Seventh Circuit who heard the case in that it was not supported by adequate evidence necessary to overrule the opinion of claimant’s treating physicians. In the appellate opinion, the court noted the denial was based primarily on a selective review of the treating physicians’ notes. In other words, the ALJ used some portions of the doctors’ notes that help support his decision to deny the claimant a disability rating and overlooked or dismissed portions of the notes that supported the fact that claimant was disabled.
There are several problems with this. One is that is legally incongruent and logically incongruent to afford veracity to one portion of a document and discredit the rest. Either the doctor formed a competent and well-supported opinion, or he did not. Moreover, even if the ALJ was going to discredit all of the notes, he would have to show by a sufficient showing of evidence to the contrary and the court found that this was not the case here. The court also found that ALJ did not understand what fibromyalgia is and who it affects those who suffer from this serious and debilitating medical condition. There was a time when many were skeptical of the existence of this medical condition, but times have changed and now fibromyalgia is a fully-recognized severe medical condition.
If you have a medical condition or injury that has rendered you unable to work, we may be able to help you secure SSDI.
If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.
Gerstner v. Berryhill, January, 5 2018, U.S. Court of Appeals for the Seventh Circuit
More Blog Entries:
SSDI Appeal Results in Affirmation of Denial, Feb. 15, 2017, Boston SSDI Attorney Blog