The Law Offices of Steven GaechterNew Jersey Social Security Disability Attorney | Hasbrouck Heights SSDI Lawyer | Bergen County ERISA Law Firm2024-03-12T16:08:44Zhttps://www.gaechterlaw.com/feed/atom/WordPress/wp-content/uploads/sites/1504021/2020/02/cropped-favicon-32x32.pngOn Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506892024-03-07T18:14:36Z2024-03-07T18:14:36Z
Reconsideration: Here, you ask that your claim be re-evaluated by someone who wasn’t involved in the initial decision on your claim. You can even submit additional evidence to support your claim.
Reconsideration appeal: If your claim is still denied after reconsideration, then you can request an official hearing in front of an administrative judge to appeal the reconsideration outcome. Again, this individual will not have been a part of the initial evaluation and determination of your claim. At this hearing, you can present additional evidence and clarify any points that may be in controversy. You can even have witnesses there to testify on your behalf.
Social Security Appeals Council review: If you still don’t have a favorable decision, then you can ask to have your case reviewed by the full Appeals Council. This is a discretionary review, though, meaning that they may not take up your case. If they do, though, then the record you presented will be re-evaluated and an ultimate decision will be issued.
You might also be able to appeal your case to a federal court. So, don’t lose hope just because you’ve suffered an initial denial.
How you approach your disability claim appeal can make all the difference in your ultimate outcome. That’s why it’s critical that you devote the time and attention needed to building a robust case. Hopefully then you can recover the financial assistance needed to focus on your recovery and secure stability.]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506882024-02-21T13:55:21Z2024-02-21T13:55:21ZSocial Security disability benefits.
How to qualify for SSD benefits
Before being awarded disability benefits, you’ll have to prove to the government that you meet certain eligibility requirements. This includes showing that you suffer from three identified symptoms of bipolar disorder, which may include:
Distractibility
Pressured speech
Decreased need for sleep
Failure to recognize that participation in certain activities have a high probability of resulting in pain
Inflated self-esteem
There are other characteristics that you can show, so be sure to consult with the disability bluebook for more information.
In addition to showing at least three symptoms of bipolar disorder, you’ll also have to demonstrate your condition has extremely impaired your ability to do things like remember and understand information, interact with other people, concentrate, and take care of yourself. Again, there’s a catch-all provision of sorts that you might be able to utilize, so familiarize yourself with the requirements for that category, too.
Competently pursue the disability benefits you deserve
If you need financial support while you cope with your disabling mental health condition, then you need to diligently work to build your disability claim. This means understanding the law and knowing how to present evidence that speaks to the required elements.
If that has you stressed out, don’t worry. Help is available to assist you in navigating whatever challenges you may be facing. So, don’t be afraid to seek out the support that you need to get through this difficult time so that you can secure the resources necessary to allow you to focus on yourself and your health.
]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506872024-02-20T07:31:15Z2024-02-20T07:31:15Zrecovering the benefits you deserve isn’t as easy as it may seem. Even if your disability is obvious and you think it’s clear that you should be paid the benefits you seek, your claim could end up being reduced or denied. That’s why as you proceed with your claim, you need to be careful with what you say to insurance representatives.
What you shouldn’t say
There are certain this you shouldn't say to an insurance representative when seeking long-term disability benefits. Your own words may work against you. They might give an indication that you’re not really disabled, which will drive the insurance company to deny your claim. That’s why you should avoid discussing the following with insurance representatives:
Your job dissatisfaction: As they assess your claim, an insurance adjuster is going to ask you questions about your job and the duties you perform there. These questions are aimed at gauging your ability to work. If you start talking about how much you hate your job or your co-workers, then you’re going to open the door for the insurance company to argue that you’re only saying you’re disabled so that you don’t have to return to a job that you don’t like.
Your travel plans: Unable to work, you’re going to find yourself with a lot of extra time. You might plan to take a vacation or travel to visit family and friends, but you’re better off keeping that information from your insurance company. After all, if you’re able to travel in a cramped airplane or survive a multi-hour drive in a car, then the insurance company might wonder whether your injuries are less severe than you claim them to be.
Your sick relatives: If you have a parent, spouse, or child who is dealing with a serious medical condition, you might feel compelled to discuss it with those around you, including your insurance adjuster. But doing so might make the insurance company think that you’re only seeking disability benefits so that you can take time off to care for your loved one. This will drive them to find evidence to support their opinion, thereby putting your claim at risk of being denied.
How long you’ve been dealing with pain and discomfort: A lot of workers push through a certain amount of pain and discomfort so that they can avoid taking time off work and can continue to earn a wage. But if you talk about how long you’ve been dealing with pain and discomfort, then you raise the possibility that the insurance company will argue that your disability is a pre-existing condition and therefore not covered by your policy.
What you do on a daily basis: The insurance company might try to gauge the severity of your condition by assessing the daily activities you conduct. Even though there are things that you can do when you’re disabled, the insurance company might view them as evidence that you’re capable of working. That’s why it’s best to forego discussions about what you do on a daily basis.
Advocate for the disability benefits you need
There’s a lot that can go wrong when seeking benefits from your private long-term disability or ERISA policy. That’s why it’s a good idea to educate yourself on the process and what you can do to position yourself for success. We hope you’ll find our blog and our website a good resource in that regard.
]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506862024-02-19T20:56:08Z2024-02-19T20:56:08Zbefore an Administrative Law Judge (ALJ). The idea of attending a hearing and presenting your case can be overwhelming and intimidating. You may have no idea what to expect or how to present your evidence.
Fortunately, properly preparing your evidence for your hearing can ease your anxiety and increase your chance of prevailing.
You will receive a notice giving the date and time of your appeal hearing
Review this notice carefully, as well as all documents in your case file. This should include your application and all communications you have had with the Social Security Administration (SSA).
While you know how your disability impacts your life better than anyone else, it is still helpful to know what is in your case file.
Gather your medical records to use as evidence at your hearing. The hearing is an opportunity for you to present new information to the ALJ that can change their decision on your benefits.
Contact your doctors and other healthcare providers immediately after you receive the notice of your appeal hearing and request your medical documentation.
Request all your medical records, not just records that pertain to your disability
To get a complete picture of your disability, the SSA should have all your medical records.
For example, if you have a major back problem that causes you anxiety, the ALJ should see evidence that is related to both conditions. This helps them see how both conditions could prevent you from working.
This is one of the most important steps to take when preparing for your hearing because there is a rule that requires you to send all written evidence to the ALJ five business days before your appeal hearing.
When you review your appeal notice, learn where and how to send your evidence. If you do not submit your written evidence within five business days, the rules state that the ALJ can decline to consider the evidence.
Your medical documentation could be the key to you securing your benefits. Therefore, you do not want to lose your case because you missed a deadline.
The purpose of the five-day rule is to prevent delays in the process and allow the ALJ time to review your records before the hearing. This works in your favor since the ALJ having an appropriate amount of time to consider your evidence allows you to have a fair hearing.
Additional evidence that can help
Expert testimony or written statements from family or friends about your disability are other strong pieces of evidence. This written evidence must also be submitted to the ALJ within five business days of your hearing.
Your primary care physician is typically your best choice for a medical expert, especially if you have been seeing them for a long time. If they cannot testify for you at the hearing, ask them to write a statement detailing your disability and how it impacts your ability to work.
]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506852024-02-06T06:14:49Z2024-02-06T06:14:49ZEvidence required to prove a claim
The SSDI regulations require objective medical evidence from an acceptable medical source verifying the applicant’s need for SSDI benefits. The SSA will consider all relevant medical evidence from appropriate sources, including physicians, physicians’ assistants, psychiatric nurse practitioners, licensed clinical social workers, and clinical mental health counselors.
Evidence of a mental disorder may include the patient’s reported symptoms, the patient’s medical history, the results of psychological testing and imaging results, a provider’s diagnosis, the type, dosage, and beneficial effects of any medications taken by the applicant.
Generally speaking, the SSA will accept and consider any evidence provided by a reputable source. If the applicant is participating in any work-related vocational training, the SSA will ask for any reports or evaluations prepared by the persons leading such training.
Need for longitudinal evidence
The SSA relies heavily on longitudinal evidence, that is, evidence collected over time, to evaluate the severity of the illness and its effect on the applicant’s ability to function. Even if the applicant cannot provide significant longitudinal evidence, the SSA will look to other sources for evidence that can help in evaluating the applicant’s mental disorder.
Need for professional assistance
The SSDI regulations are lengthy and very detailed. An applicant will benefit from seeking professional assistance in completing an application. The professional assistance can be provided by a psychiatric health care provider or an attorney with experience in understanding the SSDI regulations and the SSA’s approval process.
]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506842024-01-26T15:47:52Z2024-01-24T15:36:16Zphysical or mental impairment that is expected to last at least 12 months or result in death.
Impairments and benefit denial
Your eligibility for benefits will depend on your individual circumstances, however there are examples of impairments that may qualify for SSDI. These include back injuries, joint problems, amputations and heart failure or chronic heart disease.
You may qualify if you have chronic obstructive pulmonary disease, also known as COPD, neurological disorders, certain mental health conditions, cancer and immune system issues.
If you apply for SSDI and your claim is denied, you can request a reconsideration by a different examiner. If your reconsideration is denied, an Administrative Law Judge (ALJ) may hear your case.
ALJ and hearing process
An ALJ is an impartial decision-maker, meaning they are tasked with evaluating cases fairly and without bias. They operate independently from the Social Security Administration.
Before you attend the ALJ hearing, it’s important to gather all medical records, documents or other evidence to support your claim. At the hearing, the ALJ will review your case and you may be allowed to present witnesses or experts.
The ALJ will issue a written decision that is based on the facts, legal conclusions and the reasoning behind your eligibility for benefits.
If the ALJ denies the benefits, you may have additional appeal options available.]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506822024-01-16T16:25:50Z2024-01-19T15:37:40ZEmployee Retirement Income Security Act, or ERISA, is a federal law that aims to give workers this kind of security by placing certain requirements on privately-managed employee retirement plans. However, the system doesn't always work smoothly. ERISA doesn't cover every kind of plan, nor every kind of employee.
Complex lawsuit
An ongoing court case illustrates how complicated the issues can become. According to a recent news story, a group of former financial advisors who once worked for the financial giant Morgan Stanley filed suit against their former employer, alleging that Morgan Stanley had refused to pay them retirement benefits worth hundreds of thousands of dollars.
Before they could even get to the issue of whether their former employer had to pay them, or how much, the plaintiffs in this case had to prove that their benefits were covered by ERISA. After years of litigation, a judge in the case ruled that the benefits, which were part of a deferred compensation plan, were in fact covered by ERISA. The case is now headed toward arbitration.
Defined benefit plans: These plans promise retired workers a specified amount as a monthly payment. The amount may be designated by a certain dollar amount, or it may be arrived at through a formula based on the worker's pre-retirement wages, their years of service and other factors.
Defined contribution plans: These plans do not promise a specified amount at retirement. Instead, they work by having the employee, the employer (or both) contribute a designated amount to a retirement account with every paycheck. A typical example is an employer-provided 401(k) plan in which an employer matches an employee's contributions with every paycheck.
These are relatively broad categories that encompass a wide variety of retirement plans. However, ERISA doesn't cover everything.
Generally, ERISA does not cover retirement plans from government agency employers or churches, nor does it cover many retirement plans that are managed through workers' compensation or disability programs.
]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506812024-01-16T21:58:49Z2024-01-16T21:58:49ZFollowing a work-related injury or illness, many workers turn to disability benefits to help them on their path to recovery. The Social Security Administration (SSA) is often the main source of this crucial support. However, it's not always smooth sailing, and there are instances where the SSA may deny a claim outright.
It's important to note that this initial denial is not the end of the road. As a worker, you can challenge this decision and appeal for reconsideration.
Denial due to medical reasons
When the SSA denies your Social Security Disability Insurance (SSDI) claim for medical reasons, they don't consider your condition disabling by their standards. They might believe your disability isn't severe or long-lasting enough or that there isn't enough medical evidence to support your claim. But a denial doesn't mean you're out of options - you can still file an appeal.Before you appeal, though, providing the SSA with any new, relevant information about your medical condition is crucial. This could include information about any recent medical treatments, diagnostic tests or doctor consultations that have occurred since your initial application.
Denial for nonmedical reasons
The SSA may also deny your SSDI claim for nonmedical reasons. Generally, this occurs if the administration determines you are not insured, such as not having accrued enough work credits over your years of working. If such a denial occurs, you can seek a review from your local Social Security office. This review allows you to clarify any possible misunderstandings about your employment record, earnings, or any other nonmedical factors that could have led to the rejection of your claim.
Filing an appeal
Once you decide to appeal, it's essential to act quickly. Ideally, you should file your appeal within 60 days of receiving the denial letter. After filing, be prepared to wait several months for a resolution. Even if the SSA initially denied your claim, that 'no' isn't the final word. Workers can contest this decision and ask the SSA to reconsider. This process can be challenging to navigate on your own. So, it may be beneficial to seek the assistance of a legal professional experienced in social security benefits to help get your SSDI coverage back on track.]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506802024-01-04T04:37:07Z2024-01-04T04:37:07ZMental health parity
The president of Sun Life U.S., which is of one of the nation’s largest providers of employee benefits, released a statement supporting the ERISA Advisory Council’s position just hours after the advisory body submitted its recommendations. Mental health issues can leave people unable to work and earn a living, but they are only covered for two years by most ERISA disability plans. If the ERISA Advisory Council’s recommendations are acted upon, ERISA disability plans will treat mental health conditions in the same way that health insurance plans do. The American Council of Life Insurers has released a statement that opposes the ERISA Advisory Council’s position.
Government action needed
The statement released by Sun Life U.S. says that mental health parity will only be achieved if the government takes action. If insurers act without a government mandate, their plans would become uncompetitive according to the statement. The ACLI says that mandating mental health parity would make all ERISA disability plans more expensive.
Costs and benefits
ERISA disability plans provide benefits to employees who are unable to work because of illness or injury, but mental health conditions are only covered for two years. The ERISA Advisory Council has urged lawmakers to establish mental health parity in ERISA disability plans, and their position is supported by one of the country’s largest employee benefits providers. However, a group that lobbies on behalf of the insurance industry opposes the ERISA Advisory Council’s position on mental health parity.]]>On Behalf of The Law Offices of Steven Gaechterhttps://www.gaechterlaw.com/?p=506782024-01-03T19:22:04Z2024-01-02T18:05:42ZSubstantial gainful activity
SSDI benefits are for people whose disabilities make them unable to work to earn a living. Therefore, there is a limit on how much income a person can earn before they become ineligible for SSDI benefits.
Many SSDI benefits recipients are permanently disabled, but others recover and begin working again. Sometimes this means taking a part time job, or working at a less demanding job than they had before they became disabled, and sometimes it means returning to full-time work. However, in the Social Security Administration's view, if a person is well enough to engage in substantial gainful activity, the SSA considers them no longer eligible for SSDI benefits.
The SSA sets an income limit for substantial gainful activity and changes it every year in order to keep up with the cost of living. In 2024, the limit for most people is now $1,550 a month, up from 2023's limit of $1,470 per month.
The limit is higher for those who are legally blind. A blind person can earn up to $2,590 per month in 2024 without losing eligibility.]]>