Monthly Archives: January 2015

Social Security Disability Benefits to be reduced by 20% in 2016

Why does Congress want to reduce Social Security Disability Insurance benefits for millions of Americans in 2016? The answer lies in the nature of the specific benefits, and where the funding for disability benefits originate.

Title II of the Social Security Act provides insurance benefits in three separate categories: Old-Age, Survivors, and Disability Insurance (OASDI), each of which maintains its own separate trust fund. In order to sustain these funds, Congress has set up a system where, based upon an actuarial formula, FICA contributions from employers and employees are distributed to the three separate trust funds.

Currently there is an imbalance in the disability fund. Unless Congress acts by mid-2016, Social Security will only be able to pay about 80% of disability benefits to which beneficiaries are entitled under the law.

A recent email from the National Organization of Social Security Claimants’ Representatives (NOSSCR) notes as follows:

Even though the disability fund shortfall largely occurred because of changes in America’s population and retirement age, a new House Of Representatives rule prevents “clean reallocation”, a solution Congress has used 11 times in the past to shift money from one trust fund to the other when shortfalls arise. The reallocations have occurred in both directions.

Why is this happening? Some in Congress have raised concerns that too many individuals are being approved for disability benefits by “liberal” judges. Interestingly, current Social Security statistics reflect that it is getting more difficult to obtain Social Security disability benefits, possibly because administrative law judges (ALJs) are feeling pressure to deny more cases.

As noted above, the “clean reallocation” solution has been used 11 times, with virtually no opposition between 1957 and 1994. In fact, the Reagan administration used “clean reallocation” 4 times during his presidency.

Rules for Determining Disability – The ALJ Hearing continued

The rules that for determining disability apply most directly to impairments that limit your physical ability to stand, sit, walk, lift, bend or work with your hands. Mental impairments are a bit more complicated.

If you are unable to do certain kinds of manual labor, whether because of a back problem or a heart condition or breathing problem or some other medical problem, your lawyer will be able to look at the rules and figure out what you’ve got to prove to win your case. Here are some examples:
•If you are under age 50, the general rule is that you’ve got to prove that you can’t do an easy sit-down job or even a job where you’re allowed to alternate sitting and standing during the workday. You’ve got to prove this even though you might not be hired for such a job.
•If you are age 50 through 54, the general rule is that you have to prove that you cannot do light work, that is, work involving being on your feet most of the day and lifting up to about 20 pounds. Thus, even though you might still be able to do a sit-down job, a desk job, you can still be found disabled.
•If you are age 55 or older, it gets even easier. The general rule is that you have to prove that you cannot do “medium” work, that is, work involving being on your feet for most of the day, frequently lifting 25 pounds, occasionally up to 50 pounds. Thus, you can even be capable of doing light work and still be found disabled.

As you can see, your representative will not only prove what you can’t do, but also what you can do. In most cases, the judges just won’t accept any sort of “I can’t do anything” explanation for why you’re disabled.

These issues can get complicated when you’ve had jobs in the past where you’ve learned a lot of skills. The judge is going to want to know about your work skills, and you are going to have to be able to explain them to the judge.

How does your repersentative go about proving all of this? He or she does it through your testimony in response to questions from the judge and your representative at the hearing. Although your representative will remind you if you forget something, it’s best if you can answer all questions thoroughly yourself. Otherwise, it could look like your representative is prodding you or putting words in your mouth.

How the Judge Determines Disability

It is important that you understand some basic points about how the Administrative Law Judge goes about determining whether someone is disabled. This process is complicated and technical, and it doesn’t necessarily involve common sense. For example, most people think that if they cannot get a job because of their medical problems, this must prove that they are disabled. But inability to get a job proves nothing.

A disability determination is a “hypothetical” determination. That is, it has very little to do with the real world. It has nothing to do with the fact that employers won’t hire you because of your medical problems. The Social Security Administration looks only at whether you are capable of doing jobs, not whether you’d be hired. Thus, you may have to prove that you are unable to do jobs that you would never be hired for in a million years.

In some cases, the medical findings about your condition alone will cause the judge to find you disabled. However, in the majority of cases your attorney will have to prove two things: First, that your medical impairments prevent you from performing any job you’ve done in the past 15 years; and second, that there aren’t many other jobs you are capable of doing considering your age, education and work experience.

Think about all the jobs you’ve had in the past 15 years, and pick out the easiest one. You have to prove that you cannot do that easiest job—you have to prove this even if you’re dead certain you’d never be hired for that job again, and even if the company where you worked no longer exists or if the job is not available for some other reason.

Proving the second thing—that considering your age, education and work experience you’re unable to do many other jobs—is even more complicated and opposed to common sense. In many cases you have to prove that you’re incapable of doing jobs that you know you’d never actually be hired for.

A lot of people have heard the language “totally and permanently disabled.” This phrase, which comes from workers’ compensation cases, does not apply in Social Security disability and SSI disability cases. For Social Security, you don’t have to be “permanently” disabled; you only have to be disabled for 12 months. Although you have to be totally disabled in the sense that you are unable to perform jobs existing in significant numbers in the economy, this doesn’t mean that you have to be unable to do anything. In fact, very few people who go in front of an Administrative Law Judge are unable to do anything at all.

What your Representative does at a hearing

Your hearing will be over in about an hour, maybe less. Hearings seldom take longer than an hour and one-half.

If you’re well prepared because of this website and your meeting with your representative before your hearing, your representative may not have to ask many questions at the hearing. In hearings with judges who like to ask most of the questions, the only time your representative needs to ask you anything is if your represemtative thinks that your testimony wasn’t clear enough or there are issues that were not developed. In fact, it’s better that way. The more information you give in answer to the judge’s questions, the better it is for your case. Your case will be presented naturally and your testimony will flow freely. The judge will get to know you and your situation as you and the judge talk; and the judge won’t think that it’s your representative testifying rather than you.

Your representative will, however, ask questions of any witnesses you bring along to the hearing; and it is the representative’s job to question any expert witnesses called by the judge.

The most important part of what your representative does usually takes place outside the hearing. That is, your representative gathers medical evidence, gets reports from doctors, does legal and medical research, and prepares witnesses to testify.

Your representative may make a closing argument either in writing or at the hearing. However, the best-developed cases don’t need a closing argument. If a case is well developed with medical evidence and with the claimant’s testimony, a closing argument is often not necessary.

There is one thing that representatives cannot do: they are powerless to speed up the system. There may be a delay in getting the written decision. The written decision will be mailed to you with a copy to your representative. If you’re lucky enough to have the judge issue a bench decision at the hearing, the short written bench decision summary usually comes within a week. Otherwise, don’t expect a decision from the judge for at least a month — two months is more common. Sometimes it takes even longer for a hearing decision to be mailed to you. Some judges are very slow.

There is seldom any way to speed up getting a decision out. So, as hard as it is, you must grit your teeth and wait. If more than three months pass, it’s a good idea to make sure that your file hasn’t been lost; and your representative can do that. But your representative can’t do much more to speed things up.

The Order in Which Things Happen at the Hearing

Many judges begin Social Security disability hearings by reciting the “case history” of your disability claim and stating the issues to be decided. Judges often state what you have to prove in your case — but they seldom give a clear and simple explanation. They usually say that in order to be found disabled for purposes of Social Security disability benefits you must be “unable to perform substantial gainful activity which exists in significant numbers
in the economy, considering your age, education and work experience.” When they say this, it almost sounds like you’ve got to be bedridden to get disability benefits – but this isn’t true.

The judge may question you first. Then the judge will give your representative a chance to ask you some questions. Occasionally, if a claimant is well prepared to testify, the representative doesn’t have to ask any questions at all.

On the other hand, some judges expect representatives to handle most of the questioning. If so, answer questions asked by your representative as if a stranger were the one asking them. Sometimes a claimant gives incomplete answers when his or her lawyer asks questions, because the representative already knows a lot about the case. But it is important to keep in mind that the judge, who will decide your case, doesn’t know the answers until you say them. Although the judge probably will read your file before the hearing, when you’re testifying, it is best to assume that the judge knows nothing about your case. Plan on explaining everything.

When you’re done testifying, your representative will be allowed to question any witnesses you’ve brought to the hearing. It is important to bring at least one witness to your hearing to testify in support of what you say, to give the judge details about your disabilities and how they affect you, or to offer a different perspective on your medical problems.

After your witness’s testimony, any doctor or vocational expert called by the judge will testify.

At the end of the hearing, some judges will ask you if you have anything more to say. It’s best if you don’t try to argue your case at this point — let your lawyer do that. Most judges will give a representative the opportunity to make a closing argument either at the end of the hearing or to be submitted in writing.

Most judges won’t tell you if you’ve won, although a few will. A few judges issue what is called a “bench decision” (a decision stated right at the hearing). Even if the judge issues a bench decision, the judge still must issue a short written decision, which will be mailed to you with a copy to your representative. The good thing about the written part of the bench decision is that it comes only a few days after the hearing. When the judge issues a regular decision, sometimes it takes quite a while for the decision to come out.