About Disability Appeals
All we do are Social Security Disability law matters and Employee Retirement Income Security Act (ERISA) disability claims.
Whether your claim is with the Social Security Administration or with a private disability insurance company, you should not simply accept their refusal to acknowledge your disability. Unfortunately, half the people who are denied disability benefits lack the emotional strength, physical energy or supportive help to persist with their claim. Claimants need to recognize that a denial of a legitimate claim does not mean that your situation is hopeless. With knowledgeable representation you can dramatically change the odds in your favor.
Social Security Disability and SSI Claims
The Social Security disability benefits system is perhaps the most confusing of all of the federal bureaucracies. The statistics are not good. About 3,000,000 people apply for Social Security Disability Insurance or for SSI benefits a year. Over 70% are turned down. When SSA denies meritorious claims they do not provide adequate explanations of their action, and do not give any guidance about how the applicant can change the result on appeal. As a result, fewer than half of the applicants who receive these unfavorable decisions decide to appeal. If an applicant persists through SSA’s “reconsideration” appeal and to a hearing, about 50% of those who have a hearing will eventually get a favorable decision and receive the benefits for which they have paid. Having a knowledgeable representative increases these odds dramatically.
Social Security/SSI applicants are not required to have an attorney represent them. However, the statistics against unrepresented applicants are quite high because of the complexity of the application process. Unrepresented individuals are generally unaware of SSA’s definition of disability, of SSA’s process for reviewing disability claims, and of the various approaches to establishing that the applicant’s impairments meet SSA’s disability requirements. These applicants don’t have access to the court decisions, laws, regulations, and rules that SSA’s staff and administrative law judges are supposed to comply with when they make decisions. The importance of complete and current medical records pertaining to the disabling conditions is not understood. They do not have the experience to obtain useful supportive statements from treating doctors. While doctors often are quite willing to help by providing a brief statement about a patient’s disability, these statements have to be crafted in a way that increases the chances that Social Security will adopt the doctor’s opinion. This means that key words and phrases addressing SSA’s requirements must be included. An experienced representative is aware of these requirements and more.
When you have us serve as your representative you can devote your energy to taking care of yourself. We will take care of dealing with Social Security.
Your disability claim is critical to you and to us. We will handle your claim personally. While we cannot guarantee a favorable result, between us, we have over 40 years experience with these matters.
You and your employer may have paid for disability insurance benefits that are supposed to provide you with economic security if you become disabled during the time you are employed. Unfortunately, while the insurance companies that issue these policies like to collect the premiums they are not happy about paying legitimate claims.
An insurance policy is a contract. Enforcement of your rights requires understanding of the contract governing your policy – including the definition of disability, applicable deadlines for submitting claims and supporting evidence, and appeals procedures.
Too often, private insurers base decisions on incomplete medical information, relying on opinions from doctors in their employ who briefly review your application and records and then dismiss the evidence of your disabling impairment.
Many ERISA claims end up in court because of the insurance company’s stubbornness. It is important to you to be aware of the time within which claims, appeals, and (if necessary) lawsuits against the insurer must be filed. A missed deadline will be crucial. Equally important is the need to present all available medical evidence, treating physician opinion, and other relevant information to the insurance company while it is considering your claim. Failure to do this can result in the evidence not being considered by the court. Judges are limited to deciding whether the insurer made a proper decision given the evidence it had to review. The burden is on the applicant to be certain that the insurance company has all of the medical evidence.
On ERISA claims we work with applicants to improve the chances of a favorable decision without the need to sue the insurance company – and to increase the chances that if your claim is denied by the company after all internal appeals are exhausted, that a court has before it sufficient evidence to decide that the insurer failed to issue a reasonable decision.
Your job is to take care of yourself – ours is to deal with the insurer. Those large insurance company buildings and the generous salaries are paid for with policyholders’ premiums. The company would much rather collect your payments than to pay you. They have a large staff dedicated to denying ERISA claims. You should have competent help on your side.