Team mentality dominates Balin Law's case strategy in recent victories

It’s often said winning cases is a team effort, but that “team” includes more than attorneys.

“One thing we tend to focus on very heavily is the treating physician rule,” said Matt Shupe, associate attorney at Balin Law. This treating physician is often relied on to provide expert medical opinions and a detailed patient history for the disability claimant.

In order to award disability benefits to the claimant, judges are required to give deference to that claimant’s doctors, provided the opinions given are supported by objective medical findings and not inconsistent with other “substantial evidence” in the record.

The Social Security Administration (SSA) also employs its own physicians to provide medical opinions on a claimant, though these physicians may not have treated that claimant for nearly as long or as extensively as a primary care provider.

“Administrative Law Judges (ALJs) will give more weight to the opinions of SSA’s physicians to deny an individual,” Shupe said. “In doing so, the ALJ’s decision often doesn’t include all the limitations a claimant faces as opined by SSA’s physician’s report.” This discrepancy in an ALJ’s ruling can be frustrating for clients, treating physicians, and attorneys alike.

“That’s why Balin Law brings suit against the government in federal court, when appropriate,” Shupe said.“ In these instances, we have a district court judge entirely separate from the SSA that rule on whether an ALJ adequately followed the law. If we prevail, the case goes back to the SSA instructing them to apply the law properly.”

Recently, Balin Law has succeeded in litigating this very issue in three recently published decisions: Moretti v. Colvin, Matejka v. Commissioner of Social Security, and Hovater v. Colvin.

The claimant is then entitled to a new hearing, this time with the law applied properly. “More often than not, the ruling is to the tune of a different result,” Shupe said.

Balin attorneys use "congressional interest" to aid clients

While the federal government offers multiple programs for disability compensation, bureaucracy can be a challenging obstacle to overcome when awaiting a decision on a case. In these situations, any time a constituent feels like they’re getting a raw deal, they can contact their congressperson and have a pending case marked as one of “congressional interest.”

When a case is flagged with “congressional interest,” three things happen:

1.       The Social Security Administration (SSA) must give high priority to inquiries received from members of Congress and their staff.

2.       The SSA must respond to congressional inquiries promptly, accurately and courteously.

3.       The SSA must communicate any concern about a particular congressional inquiry to the congressperson.

“The local SSA field offices have to report to their bosses every 60 days to show how the inquiry is being addressed,” said Matt Shupe, associate attorney at Balin Law. “If such reports aren’t made or if they have a surplus of these inquiries from a certain region, the SSA is able to follow up with those regions to ensure proper care is provided for applicants.”

Balin has had positive experiences in the past with congressional interest, noting that the SSA has responded promptly to the requests they filed.

“I just had a case we won at the federal court level,” said Shupe, who was waiting between four and six months for even a single document to change hands between the court and the SSA. “We contacted Representative Jim Renacci and asked the case be looked into to make sure it gets remanded as expediently as possible, which it did.”

Balin litigation attorney Andrew November remembers a case that was pending for four years since the filing date.

“That wasn’t unheard of,” November said of the four-year time frame. “But by flagging that case as one of congressional interest, it was nice just to get someone involved. Congresspeople represent a pool of constituents, but most people don’t ever contact their representative. It’s an option for someone to get their representative involved.”

The House of Representatives website offers a handy tool to find your congressperson by ZIP code, but we've compiled a list below for all our office locations.

Mentor/Ashtabula
Dave Joyce - 440.352.3939 (Painesville Office)

Lorain
Jim Jordan - 419.999.6455 (Lima Office)

Canton
Jim Renacci - 440.882.6779 (Parma Office)

Toledo
Marcy Kaptur - 419.259.7500 (Lorain Office)

Cleveland/Akron
Marcia Fudge - 216.522.4900 (Cleveland Office)

Youngstown
Tim Ryan - 330.740.0193 (Youngstown Office)


 

Ohio Medicaid expansion aids Balin Law clients

Earlier this year, Ohio Governor John Kasich expanded Medicaid eligibility for all state residents, adding to several existing financial assistance programs Balin Law clients can apply for while waiting for a ruling on their case.

Prior to the Medicaid expansion, Medicaid eligibility was provided to those with minor children or those found “disabled” by the Ohio Department of Job and Family Services. With the expansion Medicaid is now provided to individuals with income below 140% of the federal poverty guidelines. In signing up for the expanded Medicaid program, applicants have to mark whether or not they are “disabled.” If they mark no, a determination is made strictly upon financial eligibility. And if they mark yes, their application is processed through the existing Department of Job and Family Services program.

Balin Law associate attorney Matt Shupe called the expansion a positive, one that's brought a lot of Balin’s clients off the streets – with a catch. “The definition of ‘disabled’ is wide ranging to say the least,” Shupe said. “The Social Security Administration, Americans with Disabilities Act, and Bureau of Workers Compensation all have different definitions of ‘disabled.’ What ‘disabled’ means under the Ohio Medicaid expansion remains unclear and this lack of clarity makes it difficult to advise clients as to what Medicaid program to apply for.”

Even though so many programs share the same or similar requirements, qualifying for both state and federal programs isn't always easy. A lot of times, judges don't give deference to other agency findings. “They'll rule the findings of other government agencies are not controlling on their court,” said Balin litigation attorney Andrew November. “So many of these programs don't allow a basic narrative to articulate how an individual met the Social Security disability definition and how that was applied to the medical and objective findings.”

Shupe, November and the entire Balin team have extensive experience navigating these cross-court deliberations, serving as staunch advocates for their clients. 

SSI candidates turn to Balin Law, MetroHealth for help

We understand people sometimes find themselves in difficult situations – financially, physically, emotionally or otherwise. It’s our privilege to advocate for them. People who are disabled and have limited resources but not enough of a work history to qualify for Social Security Disability Insurance (SSDI) may qualify for Supplemental Security Income (SSI). The Social Security Administration site is a great resource for SSI information, like this SSI overview page and this page on resources the administration considers when applying for SSI.

 “If you have too much in assets, you don’t qualify for this program which is an additional hurdle,” said Andrew November, associate attorney at Balin Law. “With SSDI, you just have to be disabled.” Some assets, like the home you live in or the land it’s on, grants, and personal effects aren’t counted as a resource, but items like cash, stocks, or “deemed resources” are taken into account during the approval process. “There’s a ‘deeming chart’ that’s used,” said November. “The SSA uses mathematical formulas based on the size of the house and the source of the income for children and from spouse-to-spouse.”

Separate from the assets portion of a case is a client’s access to medical care. “It’s always a large concern,” associate attorney Matthew Shupe said of Balin’s clients. “That involves a lot of education from our staff and attorneys regarding what our clients’ options are for subsidized or free physical and mental healthcare in their area, be that through Medicaid or a financial means-based charity program through various hospital systems in the area.”

With the expansion of Medicaid in Ohio only occurring in January 2013, many of Balin’s clients have turned to the MetroHealth System for health care. “This is the only treatment option for a lot of people,” November said. MetroHealth’s financial assistance program helps patients pay for health care costs, while their shuttle service allows patients to be transported to and from various MetroHealth locations.“ Having limited resources means limited access to medical care,” November said. It doesn’t mean you have limited access to us. Balin Law is here to help – click here for our contact information and call today.

MetroHealth Phone Numbers

Transportation Service - 216-778-5258
Financial Assistance - 216-957-2325
Switchboard - 216-778-7800

For a complete list of MetroHealth contact information, click here.

Partnerships with VA, healthcare providers and veteran facilities critical to Balin's success

Over the past several years, Balin Law owner Paulette Balin presented at various healthcare providers and veteran facilities, ensuring the firm works closely with nurse practitioners, case workers and veterans themselves to build critical relationships that better serve clients and their cases.

“It’s so satisfying to see these health care providers that treat our clients so engaged and interested in what we do in the same way we’re so indebted to veterans and their services,” said Matt Shupe, associate attorney at Balin. “It’s crystal clear how committed they are to their patients.”

Shupe and his team share the same commitment to clients, using every tool at their disposal and exhausting every resource to hopefully earn a win on their clients’ behalf.

“Over-prepare for everything,” Shupe said of Balin’s winning strategy. “Spend more time than it takes. You need to know the case better than the client, the judge and, any experts combined. If you can convey that that is your level of knowledge, it builds confidence in yourself and in the client, too.”

With veteran disability cases, Balin’s attorneys also seek out narrative statements from an individuals’ treating physician citing any physical limitations that support the clients’ claim and the physicians’ own treatment notes.”

Even with all those tools, representation for disabled veterans is newer territory.

When Andrew November, a litigation attorney at Balin, started at the firm in 2009 he found very few attorneys in the state of Ohio even represented veterans.

“The backlog and volume for these veterans to get representation was incredibly frustrating,” November said. “Using our experience as disability attorneys, we thought it would be a natural transition to start representing veterans.”

The VA hasn’t had the high level of development that programs like Social Security have, making partnerships between firms and the VA challenging. This is largely attributed to most employees’ inexperience working with attorneys and the sheer amount of cases they're asked to address daily.

“The VA regional office in Cleveland Ohio handles all claims for the state of Ohio,” November said.“Compare that to the abundance of Social Security offices that are used to breaking up the case load, working with attorneys and supplying documents to us.”

Still, Balin hasn’t let the challenges in working with the VA dissuade them from working to build a meaningful and collaborative partnership.

“What our firm decided to do was learn as much as we can about the law now,” November said. “If we continue to make ourselves known to the VA, we can be better known for representing our country’s veterans on a larger scale."

Balin meets challenges facing disabled veterans head-on

Following the May resignation of Erik Shinseki, former head of the Department of Veterans Affairs, some wondered how such a broken health care system that left thousands of veterans in the dust could even be repaired.

Answers may take time to find, but the flaws in the VA are more apparent than ever.

“We see delays at every point of the appeals process right now for veterans applying for service-connected disability,” said Matt Shupe, associate attorney at Balin Law. This compensation program provides a tax free monetary benefit paid to veterans with disabilities that are the result of a disease or injury incurred or aggravated during active military service.

Compensation may also be paid for post-service disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service.

The primary difficulty representing veterans for Balin is the backlog of cases before the Department of Veterans Affairs. With already longstanding delays faced by veterans claiming service-connected disabilities, the culmination of two major and recent conflicts is only adding to the wait time every veteran and their representative must face.

“There’s an enormous backlog,” Shupe said. “It’s very overwhelming to them as it is to all our clients.”

When a veteran approaches Balin Law for assistance, they have already waited for a determination on their claim and have been denied. This is because attorneys are prohibited from receiving a fee for representing veterans in service-disconnected disability compensation cases until the veteran has been denied at least once. As a result, veterans must often navigate an extremely complex field of law without the assistance of a licensed attorney for months or years.

Balin Law uses every tool at its disposal and exhausts every resource to ensure the veteran is in the best position possible when the time comes to have their case adjudicated.

“The key is to over-prepare for everything,” Shupe said of Balin’s winning strategy. “Spend more time than it takes. You need to know the case better than the client, the judge and, any expert combined. If you can convey that that is your level of knowledge, it builds confidence in yourself and in the client, too.”

Balin’s winning strategy pays off

Disability in America
The increased prevalence of disability in the U.S. today cannot be overstated. According to the Social Security Administration, disability claims in 2013 totaled 2,640,100 – nearly twice as many as in 2000.

“We’re faced with a time when the baby boomer generation has been aging out,” said Matt Shupe, associate attorney at Balin Law. “Those who have performed manual labor in particular, their bodies tend to start wearing out from 54 onwards. They have a great deal of pride in their work, but also a great deal of fear with what they can do in their fifties until they meet the qualifications for SSDI.”

Complicating that fear is the constant attack on federal disability programs, which are often – mistakenly – listed as entitlements.

“The SSDI program is just an insurance policy,” he said. “These individuals are paying a premium on this policy, which comes in the form of FICA taxes taken out of paychecks.”

With SSDI claims, Balin provides clients with a questionnaire to fill out then files the application online. This saves valuable time and gives relief to clients knowing the application process is seamless.

Even after an application is filed, there can be a lengthy approval process due to the increase in baby boomers, the recent fiscal crisis and the diminished number of hours federal employees have to process these claims.

“We’re talking a year or two – or more – in particular cases, especially when issues are more mental than physical,” Shupe said. “It's easy to look at an injury and say, ‘This femur has been rebuilt.’ It’s a very different evaluation process for mental disabilities.”

Thankfully, Balin’s standard of excellence and history of winning cases sets the bar for ensuring this process goes as smoothly and painlessly as possible.

Balin’s winning strategy

“We take the hard cases,” Shupe said. “A lot of firms would look at a client and say, ‘This person’s in their thirties, sporadic work history, criminal record, or issues with alcohol or substance abuse – no way we can take this on.’ We would be an advocate for that client if we thought we could develop the facts and if the claimant was compliant with medical treatment.”

Balin’s focus on a cohesive, team-oriented approach helps clients not only win cases, but educates them about subsidized medical care programs like Medicaid for the disabled, disability cash assistance, and hospital financial aid programs.

This approach extends to clients with mental disabilities, too.

“There needs to be great communication between our staff, our attorneys and the mental health care providers,” Shupe said. “A lot of times this involves getting opinions from the treating psychologists and psychiatrists and nurses who see this person to rebut the opinion of one-time  SSA consultants who see the client and evaluate them for maybe twenty minutes, at most an hour.”

Balin also takes time to sit down with case managers and case workers to make sure a client understands an appeal is due and that new case notes and progress notes from physicians are in their file.

Additionally, clients are assigned a member of Balin’s staff to help put their mind at ease throughout the entire process, and the firm’s tireless attitude certainly accomplishes that.

“It's about managing expectations,” Shupe said. “You hire an attorney not necessarily to speed the process up but to make sure everything gets done right. Most places, five o'clock comes around and you're clocked out,” Shupe said. “Then there are people like us, where work is always on our mind. We do whatever it takes to properly win the case for our clients as early as we can.”