Get Answers to Your Legal Questions in Our FAQ

Dealing with a legal issue whether it be applying for and receiving disability benefits, fighting for a personal injury claim, or navigating through a divorce, can be a challenge, and many people are left with questions about what they can do to get the help they need.  At the law offices of Loyd J. Bourgeois, we understand how hard it can be to get the answers you need. That’s why we’ve put together the following list of Frequently Asked Questions (FAQs) and answers dealing with family law, personal injury, disability benefits, claims, and appeals and the related law in Louisiana.

The following are some FAQs that I receive as a Louisiana attorney. They may answer some of the questions you have regarding your Social Security Disability appeal, your long-term disability insurance denial, your personal injury claim, or your Louisiana divorce. If you have a question that is not answered here, please call the legal team of Loyd J Bourgeois, LLC at 985-240-9773.

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  • Who decides if I am disabled?

    Unfortunately, the long-term disability insurance company makes the decision on whether or not you are disabled. They have this power because the United States Supreme Court has ruled that the insurance company can reserve to itself the discretion to make such decisions. After the ruling, all long-term disability insurance companies reserved the power to themselves.

    Thus, even though you may have a favorable doctor’s opinion, or several, and other supporting documentation, do not be surprised to receive a denial. Why? In the face of such documentation, the long-term disability insurer will often have their internal company doctors, or their own consulting doctors, render an opinion on whether or not you can work with your ailment or whether or not you are truly suffering from your ailment. In the insurer’s discretion, they can decide to rely on this one opinion from a doctor who never treated or examined you and deny your claim. 

     

  • What is an elimination period for disability?

    An elimination period is the amount of time you must be disabled under a disability insurance policy after filing the claim and prior to receiving benefits.

    It is the length of time between the date of the beginning of a disabling injury or illness (also known as the onset date) and the day you can begin receiving benefit payments from an insurer.

    It can also be known as the waiting period or deductible period.

    Elimination Period for SSDI

    The elimination period for Social Security Disability is 5 months.

    Elimination Period for Short-Term Disability

    For a short-term disability policy, the elimination period is generally 0-14 days.

    Elimination Period for Long-Term Disability

    Many long-term disability policies have a 90-day elimination period, but other periods do exist. Some are 180 days, and others can be much more. 

    Generally, a long-term disability policy with a longer elimination period will cost less.  However, if you should become disabled, you will have to go a longer period before payment can begin.

    The length of your elimination period can be found in your policy.

    Remember, you will not get any benefits for the duration of the elimination period, even though you are disabled.

  • What is a substantial and material duty?

    These are the duties required for the performance of your regular occupation that cannot be reasonably omitted or modified. For example, if you are a truck driver and we removed sitting for long periods from your job description, your occupation would no longer be considered a truck driver.

    • Material duties are subjective tasks specific to a particular occupation. For example, a salesperson must have the ability to communicate with a prospective client. If this subjective task (“communicate”) is removed from the job description, the description would no longer describe a salesperson.
    • Substantial duties are objective tasks required for the completion of a specific occupation in the course of an 8-hour day. For example, if you are a process operator, substantial duties may include sitting for 40% of the time and standing for 60% of the time.

    A rule of thumb in determining whether you are unable to perform the material and substantial duties of your occupation is to determine whether or not you are able to do those things that comprise at least 20% of your workday. For example, if you are a computer programmer but can only type for 15 minutes out of every hour, then you cannot perform your occupation.  It is incredibly important to know your job description before filing a long-term disability claim.

    If you have a question about the material and substantial duties for your job and how they may affect your long-term disability claim, give us a call at 985-240-9773.

  • Can I get Social Security Disability for Spinal Stenosis?

    WHAT IS SPINAL STENOSIS?

    Spinal stenosis is a condition that causes an abnormal narrowing of the spinal canal and compression of the spinal cord and nerves. Spinal stenosis is most often the result of degenerative arthritis or a result of the aging process, but sometimes a bulging or ruptured disc may be the cause. Spinal stenosis usually occurs in the neck or lower bank.

    The most common types of spinal stenosis are lumbar stenosis and cervical stenosis. While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord whereas the lumbar spinal stenosis involves compression of the cauda equina.

    Symptoms, if they occur, include pain, numbness, tingling, muscle weakness, loss of motor control, loss of balance, and impaired bladder or bowel control. Treatment options for spinal stenosis can be surgical or non-surgical.


    CAN I GET SOCIAL SECURITY DISABILITY FOR SPINAL STENOSIS?

    Spinal Stenosis pain and associated symptoms can impact your ability to work. Social Security Disability benefits may be available to you.

    Can I get Social Security Disability for Spinal Stenosis

    If you are not engaging in gainful activity due to Spinal Stenosis, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)

    Generally, to establish Spinal Stenosis as a medically determinable severe impairment, you must show:

    • Objective medical imaging such as MRIs or CT Scans establishing spinal stenosis;
    • Consistent complaints of pain or other symptoms for a period of time and which is not controlled through conservative treatment modalities

    At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. For Lumbar Spinal Stenosis, SSA will determine if your condition meets Listing 1.04C – Disorders of the Spine – Lumbar Spinal Stenosis. 

    • 1.04C can be met if your condition
      • Causes lumbar spinal stenosis resulting in pseudoclaudiction established by findings on appropriate medically acceptable imaging,
      • Is manifested by chronic nonradicular pain and weakness,
      • Results in inability to ambulate effectively, which is defined as
        • The inability to walk without the use of a walker, two crutches or two canes,
        • The inability to walk a block at a reasonable pace on rough or uneven surfaces,
        • The inability to use standard public transportation,
        • The inability to carry out routine ambulatory activities, such as shopping and banking, and
        • The inability to climb a few steps at a reasonable pace with the use of a single handrail.

    The key to meeting the listing is to have the appropriate objective medical testing including MRIs or CT Scans which show lumbar spinal stenosis.  In most cases, in my experience, the medical listing will not be met, but having a good knowledge of what you have to prove can help you discuss your case with your doctor.

    If your condition and/or related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your stenosis and pain), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.


    TIPS FOR SSDI APPLICATION FOR SPINAL STENOSIS

    1. Make sure an imaging report (MRI, CT, X-ray) diagnosing Spinal Stenosis is in your medical records. It is important that you “know your medical records.”
    2. Make sure your medical records document ALL of your symptoms and limitations including, but not limited to, numbness, tingling, muscle weakness, loss of motor control, loss of balance, and impaired bladder or bowel control. Your medical records should not just document your pain. Let your doctor how often you feel the symptoms, how severe each symptom is, and how long each episode lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
    3. See a specialist. Treatment of spinal stenosis by an orthopedist or neurologist or a chronic pain specialist will carry more weight than the same diagnosis from a family physician or internist professional.
    4. Comply with your doctor’s orders and try various modes of conservative or less invasive treatment, if recommended.
    5. See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic pain and inability to participate in life, see a mental health professional to diagnose, treat, and document these conditions. Pain is often accompanied by or is the cause of mental health conditions. Treatment of the depression can help with the pain.
    6. See your doctor regularly and keep your appointments.
    7. If you can, provide evidence of a long work history.
    8. Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
    9. Include information from nonmedical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time.  These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
    10. Keep a journal. Make regular notes about your impairment, level of function, and treatments.
    11. If you need assistance with your claim, contact an attorney who is knowledgeable in obtaining Social Security Disability benefits for spinal stenosis.

     

  • Can I receive Social Security Disability benefits for Lupus?

    WHAT IS LUPUS?

    Lupus is a chronic, autoimmune, inflammatory disease caused when the immune system attacks its own tissues. It can damage any part of the body (skin, joints, and/or organs inside the body). Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. There are many kinds of lupus. The most common type, systemic lupus erythematosus (SLE), affects many parts of the body.
     

    CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR LUPUS?

    Can I receive Social Security Disability benefits for Lupus

    Lupus health problems, pain, and fatigue can impact your ability to work. Social Security Disability benefits may be available to you.
    If you are not engaging in gainful activity due to Lupus, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)

    At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. Systemic lupus erythematosus is listed under SSA Medical Listing 14.02, the category of impairments known as the Immune System Disorders – Adult(14.00). To qualify as disabled under this listing, your medical records must show that you meet the following requirements:

    A. Involvement of two or more organs/body systems (such as kidneys and brain or heart and lungs), with:

    1. One of the organs/body systems involved to at least a moderate level of severity
    2. At least two of the constitutional symptoms or signs (severe fatigue or exhaustion, fever, malaise, or involuntary weight loss)

    OR

    B. Repeated manifestations of SLE, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:

    1. Limitation of activities of daily living.
    2. Limitation in maintaining social functioning.
    3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

    To determine if an individual has been correctly diagnosed with SLE and that the listing has been “met,” Social Security follows the guidelines set out in the current Criteria for the Classification of Systemic Lupus Erythematosus, by the American College of Rheumatology. An individual must meet four criteria of the established eleven to be diagnosed with lupus. The criteria include:

    • Malar Rash
    • Discoid rash
    • Photosensitivity
    • Oral ulcers
    • Nonerosive Arthritis
    • Pleuritis or Pericarditis
    • Renal Disorder
    • Neurologic Disorder
    • Hematologic disorder
    • Immunologic disorder
    • Positive Antinuclear Antibody

    Medical evidence proving these symptoms may include doctor observations, electrocardiography, and blood tests, but is also dependent on the type of maladies suffered.

    If your diagnosis does not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your lupus), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.

    TIPS FOR SSDI APPLICATION FOR LUPUS

    1. Make sure a lupus diagnosis is in your medical records. We’ve mentioned this before for long-term disability, but it is also true for SSDI, “know your medical records.”
    2. Make sure your medical records document ALL of your constitutional symptoms and limitations. Let your doctor how often you feel the symptoms, how severe each symptom is, and what limitations they cause. Lupus may cause you to have fatigue, chest pain, shortness of breath, vision problems, headaches, and abnormal heart rhythms. These symptoms could make it difficult to stand or walk. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
    3. See a specialist. A lupus diagnosis from a rheumatologist will carry more weight than the same diagnosis from a family physician or internist professional.
    4. See a mental health professional. If you are suffering from depression or anxiety, see a mental health professional to diagnose, treat, and document these conditions. SLE is often accompanied by or is the cause of mental health conditions. However, it is important that the actual lupus diagnosis comes from a specialist and not your counselor, therapist, or psychiatrist. (see above)
    5. See your doctor regularly and keep your appointments.
    6. If you can, provide evidence of a long work history.
    7. Do not exaggerate your symptoms or limitations.  Keep all of your statements consistent and truthful.
    8. Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
    9. Include information from nonmedical sources to support your medical claims. Gather information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
    10. Keep a journal. Make regular notes about your impairment, level of function, and treatments.
    11. If you need assistance, contact an attorney with experience in Social Security Disability.  Give us a call at 985-240-9773 or take our quick disability eligibility quiz.

  • Can I receive Social Security disability payments for bladder cancer?

    July 17 is Bladder Cancer Awareness Day. Social Security offers expedited disability case processing for over 225 qualified conditions under their Compassionate Allowances program – bladder cancer is one of them.

    Compassionate Allowances are a way for the Social Security Administration to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards. Individuals with bladder cancer may receive a decision on their claim in a matter of weeks instead of months or years. Being diagnosed with a Compassionate Allowance condition does not provide additional money above what an individual is eligible for under the Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) disability programs. The Compassionate Allowance program simply speeds up the receipt of a decision on the claim. 

    There is no special application or form. Individuals with bladder cancer or any other Compassionate Allowance condition apply for benefits using the standard process. SSA will expedite the applications of those with a qualifying condition.

    To qualify for Social Security Disability with bladder cancer, SSA will determine if your condition meets Listing 13.22 for Urinary bladder – carcinoma. To meet this listing, you must show in your medical records that you have carcinoma of the urinary bladder that meets one of the following conditions:

    • With infiltration beyond the bladder wall.
    • Recurrent after total cystectomy.
    • Inoperable or unresectable.
    • With metastases to or beyond the regional lymph nodes.

    If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your bladder cancer), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.

    Tips for SSDI Application for Bladder Cancer

    1. Know your medical records.
    2. Make sure your medical records document ALL of your symptoms and limitations and the residual effects you experience. Your medical records should not just document your bladder cancer, they should include notes on your symptoms like how often you feel symptoms, how severe each symptom is and how long each symptom lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms. Make sure any and all side effects of treatment and/or medication are noted in your records.
    3. Have someone assist you with your claim if your memory, concentration, etc. prevent you from completing the forms yourself.
    4. See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic problems and inability to participate fully in life, see a mental health professional to diagnose, treat, and document these conditions.
    5. See your doctor regularly and keep your appointments.
    6. If you can, provide evidence of a long work history.
    7. Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity, if applicable.
    8. Include information from nonmedical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time.  These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
    9. Keep a journal. Make regular notes about your impairment, level of function, and treatments.
    10. If you need assistance with your claim, contact an attorney who specializes in Social Security Disability

  • How long do I have to wait for a SSDI hearing after I appeal my denial?

    wait times for SSDI hearing in LouisianaA question I am often asked is “How long will I have to wait for my Social Security Disability hearing?

    The wait time can vary greatly from one Office of Disability Adjudication and Review (ODAR) to another.

    The national average for February 2014 was 11.7 months between the request for an appeal hearing and the hearing date.

    The good news for Louisiana claimants is that all Louisiana ODARs have wait times below the national average.

    The wait times for Louisiana offices in February 2014 were:

    Metairie   7 months
    New Orleans   11 months
    Shreveport   6 months
    Alexandria   8 months

    Shreveport actually had the shortest wait time out of all offices in the nation at 6 months.

    Data on all ODAR offices can be found at ssa.gov

    If you have questions about your Social Security disability appeal or hearing, call New Orleans area disability lawyer, Loyd Bourgeois at 985-240-9773 or submit an online case evaluation.

     

  • How can I qualify for SSDI benefits with Multiple Sclerosis?

    Multiple sclerosis (MS) is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). Between attacks, symptoms may go away completely; however, permanent neurological problems often occur, especially as the disease advances.

    While the cause is not clear, the underlying mechanism is thought to be either destruction by the immune system or failure of the myelin-producing cells. Proposed causes for this include genetics and environmental factors such as infections. MS is usually diagnosed based on the presenting signs and symptoms and the results of supporting medical tests.

    There is no known cure for multiple sclerosis. Treatments attempt to improve function after an attack and prevent new attacks. Medications used to treat MS while modestly effective can have adverse effects and be poorly tolerated. Many people pursue alternative treatments, despite a lack of evidence. The long-term outcome is difficult to predict, with good outcomes more often seen in women; those who develop the disease early in life; those with a relapsing course; and those who initially experienced few attacks. Life expectancy is 5 to 10 years lower than that of an unaffected population.

    Some common symptoms of MS include almost any neurological symptom or sign; with autonomic, visual, motor, and sensory problems being the most common. The specific symptoms are determined by the locations of the lesions within the nervous system, and may include loss of sensitivity or changes in sensation such as tingling, pins and needles or numbness, muscle weakness, very pronounced reflexes, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems with speech or swallowing, visual problems (nystagmus, optic neuritis or double vision), feeling tired, acute or chronic pain, and bladder and bowel difficulties, among others. Difficulties thinking and emotional problems such as depression or unstable mood are also common. Uhthoff’s phenomenon, a worsening of symptoms due to exposure to higher than usual temperatures, and Lhermitte’s sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS.

    Can I receive Social Security Disability benefits for Multiple Sclerosis?

    Multiple Sclerosis can cause symptoms, limitations, and restrictions that can impact your ability to work. Social Security Disability benefits may be available to you if you suffer from MS.

    If you are not engaging in gainful activity due to MS and its symptoms or limitations, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)

    Generally, to establish MS as a medically determinable severe impairment, you should provide:

    At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. For multiple sclerosis, SSA will determine if your condition meets Listing 11.09.  To meet this listing, you must show:

    The key to meeting the listing is to have the appropriate objective medical testing and a longitudinal medical history that addresses each of the requirements.  A knowledgeable social security attorney can help you determine if your MS meet the listing.

    If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your multiple sclerosis), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.

    • Objective medical testing establishing MS (i.e., MRI results, etc.); and/or
    • Evidence of consistent and repeated symptoms despite treatment.
      1. Disorganization of motor function as described in 11.04B; or
      2. Visual or mental impairment as described under the criteria in 2.02, 2.03, 2.04, or 12.02; or
      3. Significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, demonstrated on physical examination, resulting from neurological dysfunction in areas of the central nervous system known to be pathologically involved by the multiple sclerosis process.

    Tips for SSDI Application for Multiple SclerosisTips for your Social Security Disability application for Multiple Sclerosis from Louisiana SSDI attorney Loyd Bourgeois

    1. Make sure that the medical records diagnosing the Multiple Sclerosis and its progression are included. This is usually done by MRI results but may include other appropriate testing. It is important that you “know your medical records.” 
    2. Make sure your medical records document ALL of your symptoms and limitations and the residual effects you experience. Your medical records should not just document your MS, they should include notes on your symptoms like how often you feel symptoms, how severe each symptom is and how long each symptom lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms. Make sure any side effects of medication are noted in your records.
    3. Have someone assist you with your claim if your memory, concentration, etc. prevent you from completing the forms yourself.
    4. See a specialist. Treatment of MS by a neurologist is important.
    5. Comply with your doctor’s orders and try what is recommended like physical therapy, cognitive training, diet and exercise, smoking cessation, weight loss, etc.  The key is that you want your records to show that you are concerned about your health and are working with your doctor to improve.
    6. See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic problems and inability to participate fully in life, see a mental health professional to diagnose, treat, and document these conditions.
    7. See your doctor regularly and keep your appointments.
    8. If you can, provide evidence of a long work history.
    9. Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity, if applicable.
    10. Include information from nonmedical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time.  These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
    11. Keep a journal. Make regular notes about your impairment, level of function, and treatments.
    12. If you need assistance with your claim, contact an attorney who specializes in Social Security Disability. At Louisiana Disability Law, we have extensive experience with obtaining Social Security Disability benefits and have successfully obtained benefits for clients with Multiple Sclerosis.

  • How common is SSDI fraud?

    Reports of Social Security Disability fraud seem to come almost weekly these days.

    These reports have increased attention to the disability program and led to claims that the Social Security Administration’s program is rampant with fraudulent claims.

    A recent story about New York firefighters making fraudulent claims has helped fuel the debate over SSDI fraud and claims that fraud is the only reason why disability claims have increased in the U.S.

    Despite the media’s claims that the disability program is rampant with fraud, that is simply not the case according to a recent report by the executive director of the Consortium for Citizens with Disabilities and a vice president of Easter Seals.

    The report points out the exacting requirements necessary to prove that a person is disabled under SSA.

    To win an SSDI claim, a person must first have worked enough to qualify for benefits, have a severe medical condition that limits their ability to function proven by extensive medical records and reports, and must be so limited that they cannot perform their past work or other available work.

    To say that obtaining Social Security disability benefits is hard would be an understatement.

    According to the report, less than four in 10 (or 40%) SSDI claims are approved.

    And, those that do receive SSDI benefits receive only a modest monthly benefit which averages only $1,130.

    These funds must be used to pay for living expenses, medical care, food, and other basic necessities of life.

    While the overall number of Social Security disability applications has increased over time, according to the report, the reasons for the increase are many and varied but mostly result from three things:

    1. Overall population growth
    2. Baby-boomers reaching the age where disability is more likely
    3. Entry of a greater number of women into the workplace in the 70s and 80s.

    That is why the claim and reporting that the disability program is full of fraudulent claims is so disheartening.

    I see sick and disabled individuals every day that need the benefits that they paid for throughout their working life.

    Having these individuals cast into the same light by the public and the media as fraudsters only serve to further marginalize and stigmatize people at their lowest point.

    Does fraud exist in the SSDI program?

    Yes, that cannot be denied and they should be rooted out and face the consequences of their actions.

    But, fraud is not as widespread or endemic as some would have you believe.

    A few outliers that receive all the attention does not make the entire program a sham.

    The small number of fraudulent claims should not be used to justify wholesale changes or further limit access to the necessary and vital benefits.

    How Social Security Disability Fraud Hurts Everyone

    A recent news article about an ex-postal worker sentenced for worker’s compensation fraud caught my attention and bears mentioning in this blog.

    First, let’s talk about the ex-postal worker. She was a Florida resident and reportedly injured her back during the annual Letter Carrier’s Food Drive in 2009. Due to her injuries, she alleged that she could no longer deliver mail. She was relieved of her mail carrying duties and placed on “light duty” work. During this time, she collected worker’s compensation benefits since her pay was reduced due to the lessened responsibilities.

    However, evidence—including videos and photographs—showed that this allegedly injured worker competed in 80 long-distance races including marathons and triathlons following her injury. According to news reports, her times improved after her injury. A federal jury convicted the allegedly injured ex-postal worker of health care fraud and making false statements to collect benefits. She faces up to 15 years in prison and will be sentenced on July 25.

    While this case was a worker’s compensation case, its message and repercussions will be felt throughout many other programs.

    As a Social Security disability attorney, cases like these are disheartening to me for a number of reasons.

    Mostly because I know that most benefit recipients (whether worker’s compensation or disability) are truly in need of the benefits.

    They are not stealing from the system, but relying on the system.

    But cases like these are used by those in power to make it much more difficult for truly injured or disabled people to get benefits.

    Can you Turn Someone in for Social Security Disability Fraud?

    I know that in every system there will be those who abuse and steal from it for their own personal gain, and I am in full favor of rooting out such fraud and punishing those who abuse these much-needed systems.

    To report suspected fraud, you can fill out an online form here.

  • Can I Get Social Security Disability After A Stroke?

    A stroke recently struck 53-year-old U.S. Senator Mark Kirk (R.–Ill.). Many have mentioned that strokes do not usually occur in people as young as Kirk.

    According to a recent Associated Press article on strokes, up to 25% of strokes nationally occur in people younger than 65 years old. However, in Louisiana and other southeastern states, the figure is much worse. For example, in North Carolina, the article reports one facility measured 45% of strokes in young and middle-aged individuals.

    While strokes are devastating at any age, when a younger or middle-aged person is affected with a stroke there is more chance of survival according to the article. But the recovery may take a long time. And you may experience loss of certain functionality.

    As a result, you may need to apply for Social Security disability benefits for stroke. The residual effects of stroke often involve memory difficulties and problems with motor coordination and function, and for this reason, a stroke victim may have difficulty performing an occupation.

    There are a few things to note when applying for disability benefits related to a stroke. Initial claims for disability benefits usually take several months before a decision is reached. However, stroke cases can take even longer because the evaluation is often delayed over a longer period of time to see if there is any improvement. The residual effects of a stroke can be nearly impossible to measure in the short time following a stroke. Doctors simply do not know enough to allow for a reliable projection as to how a stroke victim may recover from a stroke.

    Your recovery can be influenced by factors such as age and the existence of other medical conditions and risk factors. Also, not all individuals will recover at the same rate. The Social Security Administration (SSA) needs to see how your recovery progresses before making a determination on your claim.

    WHAT IS A STROKE? 

    A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen.

    A stroke can be caused by an obstruction in the blood flow or the rupture of an artery that feeds the brain. You may suddenly lose the ability to speak, or have memory problems, or one side of your body can become paralyzed.

    The two main types of stroke are ischemic stroke and hemorrhagic stroke. Both types of stroke result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.

    Ischemic stroke – Ischemic stroke is the most common type of stroke and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.

    Hemorrhagic stroke – A hemorrhagic stroke occurs when a blood vessel on the brain’s surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).

    The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Major strokes may lead to paralysis or death. Many patients are left with weakness on one side of the body, difficulty speaking, incontinence, and bladder problems.

    WHAT ARE THE SYMPTOMS OF STROKE?

    Can you get disability benefits after a stroke?

    Within a few minutes of having a stroke brain cells begin to die and symptoms emerge. Recognition of the symptoms is important, as prompt treatment is crucial to recovery.

    Common symptoms include:

    • Trouble walking, loss of balance and coordination.
    • Speech problems.
    • Dizziness.
    • Numbness, weakness, or paralysis.
    • Blurred, blackened, or double vision.
    • Sudden severe headache.
    • Confusion.

    Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.

    A transient ischemic attack (TIA) may be a sign of an impending stroke – TIA is a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to those of strokes but last for a shorter period and do not leave noticeable permanent damage.

    WHAT ARE THE EFFECTS OF STROKE?

    Strokes can range in degree of severity, and the type of damage done depends on where in the brain they occur and how long they last. Strokes can cause death immediately, or cause little limitation. Some of the common and lasting effects caused by strokes include:

    • Weakness, paralysis, numbness. This refers to limitations in movement or motor ability, such as weakness and paralysis in an arm and leg on the same side of the body as a result of the blockage.
    • Speech and language problems. Strokes sometimes produce some degree of loss of ability to understand or express certain aspects of written or spoken language in various combinations (known as aphasia).
    • Personality changes. Strokes may produce personality changes if it is large enough and in the right area of the brain.
    • Vision problems. Usually to one eye only and can affect depth perception, peripheral vision, and cause other vision issues.
    • Balance problems. Strokes can affect balance and ability to walk without producing any actual weakness. Strokes may also cause unilateral neglect, or where the brain does not recognize one of the limbs, which makes it functionally useless.

    CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR STROKE?

    A stroke can cause symptoms, limitations and restrictions that can impact your ability to work. Social Security Disability benefits may be available to you if you have suffered a stroke and have residual symptoms.

    If you are not engaging in gainful activity due to a stroke and the effect of residual symptoms, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)

    Generally, to establish a stroke as a medically determinable severe impairment, you should provide:

    • Objective medical testing establishing the CVA (i.e., MRI or CT); and
    • Treatment records detailing your initial hospitalization and ongoing therapy or residual effects.

    At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing.

    The SSA does have a listing for strokes. It is Listing 11.04, vascular insult to the brain. The listing for stroke is fairly short and requires the following:

    • Stroke residuals will be evaluated at least 3 months following a stroke (meaning a case may be deferred).
    • To be approved on the basis of the stroke listing, a claimant must demonstrate:
      • 11.04A. Ineffective speech or communication that results from sensory or motor aphasia (the loss of ability to speak or comprehend due to brain illness or injury) OR
      • 11.04B. Persistent, significant motor function disorganization in two extremities (this could be two legs, two arms, or an arm and a leg) that results in a sustained disturbance of gross and dexterous movements, or in gait and station.

    These effects, if present, should be described in your medical records by your treating provider. It is important to note, that they must exist at least three months following the stroke and be expected to last at least 12 months total.

    A knowledgeable social security attorney can help you determine if your residual effects meet the listing.

    Even if your condition does not rise to the listing level, you may still be found disabled if the limitations resulting from the stroke prevent you from performing your past relevant work and other work available in the national economy. In such cases, you should consult with a disability attorney for help with proving your limitations.

    As with any impairment, your level of impairment (or residual functionalality/RFC) will be determined by a review of your medical records, including treatment notes, admission and discharge summaries, lab and imaging studies, and also supporting statements from one’s treating physician(s). It is important to get these records into SSA as soon as possible for a complete evaluation of your disability claim.

    The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.

    TIPS FOR SSDI APPLICATION FOR STROKE

    1. Make sure that the medical records diagnosing the stroke are included. This may be an MRI, CT Scan, or other appropriate testing. It is important that you “know your medical records.”
    2. Make sure your medical records document ALL of your symptoms and limitations and the residual effects you experience. Your medical records should not just document your stroke, they should include your physical therapy, speech therapy or other therapy you have undergone. You need to let your doctor how often you feel symptoms, how severe each symptom is and how long each symptom lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms. Make sure any side effects of medication are noted in your records.
    3. Have someone assist you with your claim if your memory, concentration, etc. prevent you from completing the forms yourself.
    4. See a specialist. Treatment of stroke and recovery by a neurologist will carry more weight than the same diagnosis from a family physician or internist professional.
    5. Comply with your doctor’s orders and try what is recommended.
    6. See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic problems and inability to participate in life, see a mental health professional to diagnose, treat, and document these conditions.
    7. See your doctor regularly and keep your appointments.
    8. If you can, provide evidence of a long work history.
    9. Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity, if applicable.
    10. Include information from non-medical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time.  These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
    11. Keep a journal. Make regular notes about your impairment, level of function, and treatments.
    12. If you need assistance with your claim, contact an attorney who specializes in Social Security Disability.  For a free case evaluation, call Loyd Bourgeois at 985-240-9773