Alcohol and Drug Use in the Disability Process

Alcohol and Drug Use in the Disability Process

 

Despite the fact that alcoholism is recognized by the medical community as a legitimate disease with both physical and mental components, Social Security uses its own rules to evaluate alcohol and drug use.  In 1996, the Social Security Act was amended by Congress to deny benefits if drug and/or alcohol addiction or abuse is a "material factor" causing the disability.  Because of this change in the law, SSA may use drinking or illegal drug use as reasons to deny your claim for disability benefits.  Whether or not substance abuse will lead to denial of your claim depends largely on how it affects your medical conditions. Either way, you can be sure these issues will arise in the disability process if you've had drug and alcohol abuse (DAA) issues in the past.

Typically, SSA evaluates drug and alcohol issues by asking two questions.   First, is the medical condition for which the claimant alleges disability caused, or made worse by alcohol and/or drug use?  Second, would the medical condition improve to the point of non-disability if the claimant stopped using drugs or alcohol?

For example, if you are alleging disability due to a mental impairment and SSA finds that your condition improves during periods of sobriety, the agency may find that drinking is material to the condition, and deny the claim.  However, materiality is also affected by potential improvement of the underlying condition.  For example, if a person drank heavily for most of his life and was later diagnosed with alcoholic liver disease, it's possible that his condition might not improve even if he stopped drinking alcohol.  In that case, alcohol might be found not material to the current claim, and benefits could be paid.  In that case, it doesn't matter whether past alcohol abuse caused the medical condition, if the condition would continue in the absence of alcohol abuse. Finally, there may be some conditions that are not affected by DAA issues at all.  If a person is alleging disability due to a severe back impairment or physical injury on the job, those conditions may be disabling even if there is ongoing drug and alcohol abuse.

If your claim for disability benefits is approved but alcohol or drugs are still an issue, the SSA may require you to have a representative payee.  Representative payees are people designated by SSA to handle your disability funds on your behalf, and spend those funds in your best interest. Representative payees are used in a variety of situations, including disability payments to minor children, and situations where claimants are found unable to manage their own funds. 


www.ForsytheDisability.com

Honesty: Still the Best Policy

Most disability claims that are not approved initially will end up being adjudicated in a disability hearing held by an administrative law judge, or ALJ.   At the hearing level, ALJs have broad discretion to rule on the evidence in your case.  If they decide that the opinion of a physician is not well supported by the evidence in your medical record, they can effectively ignore that doctor's opinion.  Similarly, the ALJ will make a judgement about the credibility of the disability applicant. 

At the hearing, it is not uncommon for judges to ask questions about the applicant's past.  Judges have access to a variety of background information, including information about past jobs, medical records, and even criminal history.  If the applicant served in the military, the judge may want to know if he or she was honorably discharged. 

As an applicant giving testimony under oath, you have a responsibility to answer the judge's questions honestly.   From a practical standpoint, it is in your best interests to do so anyway.  Judges often know the answers to questions before they ask.  A history of personal or legal problems that people might find embarrassing frequently appear in medical records or other records available to the ALJ.  If there is anything embarrassing in your background, there's a high probability that the judge is aware of it.  Answering the ALJ's questions honestly is your best option.  If the judge suspects you are being dishonest about your past, he or she may decide you are also being dishonest about your medical conditions or ability to work.  It is far better to admit to a past mistake than to attempt to mislead the judge because of embarrassment. 

If you need help preparing for an upcoming hearing, give us a call today.  We would be happy to talk with you about your case.

(615) 732-6159
Franklin, TN (Nashville) office 

(256) 799-0297    
Huntsville, AL office      

www.ForsytheDisability.com

The Problem with Unemployment Benefits

I recently appeared in a Social Security disability hearing where the client had what should have been a clear cut disability case. He had a severe medical condition that had lasted for many months. His condition did not respond to treatment and was expected to last indefinitely. Finally, he had seen his family doctor in Murfreesboro several times per month and his medical file showed unmistakable evidence of the extent and severity of his condition.  For several months, the client had been receiving unemployment benefits after leaving his previous job.

Applying for unemployment benefits is something most people do automatically after losing a job, almost without thinking about it.  Unfortunately, filing for unemployment insurance can have serious consequences if you are also filing for Social Security disability. Why? Because of the weekly certification requirements. Each week when you file for unemployment benefits, you certify to the state that you are physically able to work, you are looking for work, and you are available to accept work if it is offered. Social Security knows this, so when the judge looks at your records, it can produce a very awkward conversation. In this case, the judge wanted to know why the applicant told the state of Tennessee that he could work, and then told Social Security that he could not. This contradiction can damage a claimant's credibility in the eyes of the court, and the judge may choose not to believe other parts of his or her testimony.

In the end, we were able to explain the discrepancy to the judge's satisfaction and our client was approved for benefits. Still, receiving unemployment benefits often raises questions that need to be handled appropriately for a case to be approved. It's one more reason that applicants need an advocate who understands the system and will work to protect their rights.

(615) 732-6159
Franklin, TN (Nashville) office

(256) 799-0297
Huntsville, AL office


www.ForsytheDisability.com

Is Your Eligibility for Disability About to Expire?

While there are many ways an application for Social Security disability can be denied, one of the most common can be easily avoided. About 4 years after you stop working, your disability insurance coverage will expire. Social Security calls this expiration date your "date last insured." When this date rolls around, you can no longer file a new claim. It doesn't matter how sick you are, or how unable to work. You no longer have insurance.

I often speak to people who say, "I worked for 23 years, then stopped working in 2003. I went back to work in 2007 and had to quit again in 2010." (or some version of that). When we check their record, we find that their coverage has expired. Just last week, I had to tell a man from Antioch that he had missed the deadline to file his claim by just a couple months. When you or someone you love is unable to work and needs help, it is heartbreaking to miss that deadline.

If you believe you are disabled, file your disability claim as soon as possible. Once you file your application, the application date is locked in and the claim can still go through the process even if insurance expires later. Getting in the initial application on time is critical.

If you have questions about filing dates or have other concerns about filing your claim, myself and our experienced representatives are always here to help.

(615) 732-6159 Franklin, TN (Nashville) office

(256) 799-0297 Huntsville, AL office

www.ForsytheDisability.com

Types of Disability Insurance Available to Tennessee Residents

Social Security offers a number of disability benefits.  I want to talk about two of the basic Social Security benefits, SSDI and SSI, and explain how they are different.

SSDI - Title 2 Disability.   When most people talk about Social Security disability, they are referring to Title 2.  Title 2 disability coverage is based on your employment history.  When you work, both you and your employer pay FICA taxes which entitles you to disability coverage once you have worked long enough.  You qualify for Title 2 by paying into the system, and you can receive these benefits regardless of your income or your assets.

SSI or Supplemental Security Income is also referred to as Title 16.  SSI is a program for needy individuals with limited assets and income.  Because SSI is based on need, no previous work history is needed to qualify.  The monthly benefit for Title 16 is usually less than for Title 2 benefits.  In some cases, a person may receive both Title 2 and SSI.

Both these programs have the same basic requirement.  To qualify for either one, you must be disabled or blind or have a condition that is expected to end in death.  A "disabling impairment" is one that has lasted or is expected to last for at least 12 consecutive months. You do not have to be sick for 12 months before you apply, however.

The process to get either Title 2 or SSI benefits can be lengthy and may require professional legal assistance.  The Forsythe Firm handles both Title 2 and Title 16 claims, and can help you determine which programs you qualify for.

Besides these basic plans, Social Security offers other types of benefits, such as Widow or Widower benefits and dependent benefits for children.

If you have questions about applying for disability, you should seek the advice of a qualified legal representative.  At the Forsythe Firm, we are always happy to give advice or help you get started.   If we can be of assistance to you, don't hesitate to give us a call.

(615) 732-6159
Franklin, TN (Nashville) office

(256) 799-0297  
Huntsville, AL office

www.ForsytheDisability.com

What is Reconsideration?

I sometimes get calls from people who have been denied for benefits, but were given the option to go through a process that SSA calls "reconsideration".   Simply put, if your first application is denied, reconsideration is the next step.  Essentially, SSA will assign a different claims examiner to review your file.  The second examiner will follow exactly the same process as the first.  He or she will look at the same documentation and apply the same rules.  

Not surprisingly, the second examiner usually reaches the same decision.  About 85% of denied applications are denied again in reconsideration.   If your claim is denied for a second time, you can file for a hearing before an Administrative Law Judge (ALJ).   Often, your best chance of being approved comes at this hearing.  A qualified representative can prepare your case for hearing, let you know what to expect, and appear with you.  It is a representative's job to present your best case and tip the odds in your favor. 

Oddly, there are ten states that SSA has exempted from the reconsideration process.  Alabama is one of those ten states.  In those ten states, if your claim is denied, you can go directly to hearing and skip reconsideration altogether.  Unfortunately, in Tennessee, this step is still required.

(615) 732-6159
Franklin, TN (Nashville) office 

(256) 799-0297    
Huntsville, AL office      

www.ForsytheDisability.com

I've Filed for Disability. How Do I Improve my Chances of Winning?

If you've recently filed for disability, you've probably heard that the next step is to prepare for a long wait.  Still, there are things you can do right now to help your case.

First, be cooperative with the Social Security examiner.  If you speak to the examiner, be polite and try to answer all questions accurately.   Be sure to respond promptly to requests for medical records or documentation.  If you have a representative, he will handle most of this work for you.  If you receive a letter from SSA, it's a good idea to make sure your representative is aware of it.  Being proactive helps to make sure Social Security gets all the information they need to decide your case.

Perhaps the single most important thing you can do for your claim is to continue getting medical treatment on a regular basis.  SSA rules require that you have a condition that has lasted 12 months, or will last 12 months into the future.  A doctor's visit showing a severe medical condition is helpful, but two visits that are at least 12 months apart are much more helpful to your case.   It is very common for truly disabled people to have their claims denied because they have not had recent medical treatment.  If you cannot afford treatment, try to find a free or reduced-fee clinic in your area.  It is almost impossible to be approved for disability without good medical documentation. 

Keep a weekly journal of your medical progress.  Document your symptoms and the limitations you experience with everyday life.  If you have to take frequent breaks while doing housework, document that.  Experience a side effect from medication?  Write it down.  Be sure to record problems with mental impairments as well as physical problems.  Problems remembering things or having feelings of anxiety or depression can be important to your case.  This information will be very helpful as you go forward with your claim.

Talk to your doctor.  SSA is required to consider your doctor's opinion when deciding your case.  Although many other factors also come into play, your physician's expert medical opinion can help your case.  If your doctor supports your decision to seek disability benefits, be sure to inform your legal  representative.

Finally, get experienced representation immediately if you are unsure how to proceed or if your claim is denied.  Social Security rules are complex, and a having experience with the system can greatly improve your chances of being approved. 

(615) 732-6159
Franklin, TN (Nashville) office

(256) 799-0297   
Huntsville, AL office     

www.ForsytheDisability.com