Using the “Grids” to win a Social Security Disability claim

Using the Medical-Vocational Guidelines, or “Grids” to which they are commonly referred, in the appropriate Social Security disability claims can often mean a guaranteed victory for your clients. There is a section of the law tucked quietly away in the appendices of the Social Security Act that is used for determining whether a person is automatically entitled to Social Security disability benefits based on their age, education, prior work experience and maximum exertional capacity. See, If a claimant meets certain criteria listed in these Grids based upon the medical evidence in the claim file, a favorable determination must be made by Social Security. To illustrate how this works, let me generally present the facts of a hearing I had today: A 61 year old individual with a high school education and prior work experience in construction and as a process server has undergone two (2) total knee replacements and has a torn rotator cuff in his dominant right shoulder documented by an MRI. We have an opinion from his orthopedic surgeon that states he is capable of sedentary work, but no more than that. Many inexperienced attorneys would look at that opinion as adverse to a claim for Social Security disability benefits. They would think that any opinion stating an individual has the ability to work in a full time job, sedentary or otherwise, means the individual is sure to be denied because they are not “totally disabled from gainful employment” as required. This is far from the truth. That opinion of a maximum sedentary capacity guarantees my client a victory, and it’s all because of the Grids. Looking at the Medical-Vocational Guidelines we see several categories itemized in a chart format. Rule 201.06 is the important rule for this example. We have an individual of Advanced Age (55 years or older) with a high school education who has past relevant work as a laborer (heavy/unskilled) and process server (light/semiskilled) and a maximum exertional level of sedentary as documented by the doctor’s opinion obtained by our firm. In the final column labeled “Decision” it states “Disabled”. This is the decision that the Social Security Administration is REQUIRED to render for any individual who meets each of these categories AND has never performed sedentary work in the past. These Grids are Social Security’s way of acknowledging that once you hit a certain age, retraining for some lighter duty job is often not possible in our economy. As often happens, Social Security did not initially issue the correct decision in our client’s claim at the outset of the process, and we had to get involved to protect his interests. But by obtaining the appropriate medical opinions and presenting our argument based …Read More

Personal Injury through Another Driver’s Negligence

Q: I was involved in a serious motor vehicle accident in which I broke my leg due to another driver’s negligence. I have been in touch with the other driver’s insurance company who has indicated that he has the minimum 20/40 coverage available to cover my injuries and medical bills. They offered me the policy limit, but I’m not happy. I have had two surgeries and incurred almost $60,000 in medical bills. What can I do? A: First, do not settle with the other driver’s insurance company until we get more information. The other driver is carrying a 20/40 policy, meaning they have $20,000 per person / $40,000 per accident (no matter how many people were injured) to cover your personal injuries and medical bills above the $8,000 in Personal Injury Protection (PIP) available through your car insurance.  $20,000 is not going to cover the damage that this person has caused. However, you may have additional coverage under your own car insurance called “underinsured” motorist coverage. Let’s say you carry a 100/300 optional bodily injury provision on your car insurance policy. You then would have an additional $80,000 of coverage available to you above the other person’s $20,000 policy limit ($100,000 – $20,000 from the other car = $80,000 underinsured coverage). Additionally, you may have Medical Payments coverage under your car insurance to cover your medical bills. These are benefits that you pay for through your premiums in the event of this type of accident, and recovery under these provisions will not increase your rates because the accident is not your fault. I have advised you not to settle with the other car’s insurance company, even though they are offering you the most money they can, because you must first get permission from your car insurance company to settle with them if you are pursuing “underinsured” benefits. If you do not get this required authorization in writing before settling, you are precluded from collecting under the underinsured provision of your policy. As always, an experienced attorney should be consulted to navigate these issues so you do not lose benefits.

Supreme Court’s Ruling Has Positive Impact For Workers Receiving Social Security Disability Benefits

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Personal Injury Protection (PIP)

Q: I was in a car accident in which I was injured. I thought that in Massachusetts insurance companies are required to offer Personal Injury Protection (PIP) coverage up to $8,000 for lost wages, medical bills and out-of-pocket expenses, but my insurance company is saying that they aren’t paying because I have a deductable. Is this legal? A: You are correct that in Massachusetts automobile insurance companies must offer Personal Injury Protection (PIP) on your insurance policy, but you as the insured can opt out of that coverage, often without even realizing it. Unfortunately automobile insurance companies are beginning to entice customers with lower rates, but at the expense of valuable benefits that they write out of the policy. One way they do this is to give you a deductable on the PIP coverage, and you may not even be aware of it unless you review the policy in detail. This means that you will be personally responsible for the medical bills from your accident if you have a full $8,000.00 deductable, even if you were not at fault. Ideally, either your private health insurance must cover the payments, or you will need to pay the outstanding medical bills out of any bodily injury settlement you receive. Always be sure to review the terms of your insurance policy. If the rate seems too good to be true, it probably is!

Social Security Disability (SSDI) benefits

Q: I recently tried to apply for Social Security Disability (SSDI) benefits.  My local Social Security office told me that I am not insured for SSDI benefits and denied my application, but I worked all of my life and paid taxes until 7 years ago when I suffered a head injury on a construction site.  I don’t understand why I wouldn’t be eligible if I paid into Social Security for all those years. Is there something I can do? A: Yes.  Social Security Disability (SSDI) works like any other type of insurance you can buy. As long as you have paid enough into the system through taxes from working, you are “insured” for SSDI benefits if you become unable to work due to a disability. However, just like if you stopped paying premiums for health insurance, that eligibility will run out eventually if you stop paying into the system. The general rule is that your eligibility or “insured status” runs out after five years once you stop paying Social Security taxes. What often happens in cases like yours is that the worker at your local Social Security office looks you up in the computer and sees that you are not currently insured for benefits and sends you on your way without asking the important follow up questions. It is more important for them to ask when you became disabled for the following reasons. In your situation, I can assume that you went out of work in 2006, and that you were last insured for benefits at some point in 2011 (5 years later), leaving you currently uninsured for SSDI. However, you are still eligible for SSDI benefits if you can prove that you became disabled while you were still insured for benefits. So, if we can prove that you were totally disabled before your insured status ran out in 2011, then you absolutely have a claim for SSDI. This shouldn’t be an issue since a traumatic injury put you out of work in 2006. We would gather all of the medical evidence from that accident to support your claim.  It is because of these obscure legal issues and misinformation given by Social Security that it is always important to consult an attorney in the filing of these claims.