What is the Appeals Council?

When a disability claimant goes before an Administrative Law Judge (ALJ) at a hearing and subsequently receives an unfavorable decision, this does not necessarily mean this is the end of the claim. If a disability claimant and/or his representative feel the ALJ made any errors in his judgment, that unfavorable decision can actually be appealed to the Appeals Council.

Located in Falls Church, Virginia, the Appeals Council (AC) consists of approximately 70 Administrative Appeals Judges, 56 Appeals Officers, and hundreds of support staff. There are also offices in Crystal City, Virginia, and Baltimore, Maryland. The original AC, created on March 1^st, 1940, consisted of a three member staff. Since then, the number of requests for review and the complexity of cases increased dramatically over time. The AC reviewed over 173,000 cases in 2011 alone.

The main responsibility of the AC is to review unfavorable decisions and partially favorable decisions to determine whether an ALJ was correct in his ruling. Other responsibilities of the AC include quality review, policy interpretations, and court-related functions.

How is an appeal filed with the AC? As with any other denial from SSA, you have 60 days from the date if the Appeals Council’s decision, plus five days mailing time, to appeal.  If you miss this deadline because your mail was lost, you were hospitalized, you moved, or a similar reason, good cause for late filing may be pursued.

You must request this review in writing by using form HA-520-U5, along with any additional evidence you may have to submit that was not originally considered by the ALJ. Once received, the AC will review the decision in order to determine whether or not they agree with the ALJ’s ruling. However, the AC can also deny requests for review if they believe a hearing decision was correct.

If the AC does decide to review your case, which takes approximately 9 months to one year, it will either decide your case itself or it will return the case to the ALJ for further review. When it is returned to the ALJ, it is referred to as a remand, and a new hearing is scheduled.

During review, the AC looks at the same issues the ALJ did originally, including issues that were decided in your favor. Once the AC is finished with the review, a decision is issued in writing to the claimant and his representative (if the claimant has representation). They will either issue a fully favorable decision, remand the case back to the ALJ for further review, or they may agree with the ALJ and deny your claim.

If the AC does agree with the ALJ’s decision, the claim can still continue. The next step in the appeals process would be to file a complaint with Federal Court. This step in the appeals process is one that not many disability claimants know about, and not very many disability attorneys deal with Federal Court. This is another reason why Paulette F. Balin & Associates is exceptional. In our next blog entry, we will explore appeals to Federal Court and how we can help you in this aspect of your disability claim.

In the meantime, if you have received an unfavorable or partially favorable decision from an ALJ in the last 60 days, please contact us as soon as possible. We represent claimants every step of the way in the appeals process, and if the AC does deny your claim, we will be right by your side to appeal to Federal Court right away so you get the justice you deserve.

 Written by Anna Westfall & edited by Paulette F. Balin

Contact us today about your Appeals Council decision by clicking here!  We would be happy to meet with you in Akron, Canton, Youngstown, Toledo, Lorain, Ashtabula, Cleveland or Mentor to discuss your case!

Social Security Field Offices Change Their Hours

Beginning November 19^th, 2012, SSA field offices have changed their public hours from 9am-3:30pm to 9am-3:00pm. However, this doesn’t mean SSA employees get to go home a half-hour early! Rather, it is an attempt to help them catch up with other work such as conducting application interviews and processing paperwork.

Due to the impact of Hurricane Sandy, these new office hours will be delayed in being implemented for the following areas: New Jersey, New York City, and Long Island, NY.

Beginning January 2^nd, 2013, SSA field offices will also be closed to the public at noon each Wednesday. This will also aid SSA employees in catching up on necessary work.

In light of this, SSA encourages the public to use either their nation-wide, toll-free number or their website (www.ssa.gov) to utilize their services, such as filing for retirement or disability, signing up for direct deposit, getting a replacement Medicare card, etc. While it is great that SSA is trying to make their services more available, there are still several issues with this.

While it is already difficult to call SSA for information due to the reduced amount of workers and high volume of calls, the fact that the window to obtain information is much smaller makes it more difficult for someone to do business with SSA. Many times disability applicants have transportation issues and must rely on using the telephone.

The national, toll-free number may be helpful for general information or routine tasks such a changing your address, but some questions can only be answered by field office staff, such as if a requested document had been received.

Another issue with using the toll-free number is if you do not have a land line or limited minutes on your phone. Often the hold times can be extraordinary, using up a disability claimant’s precious pay-per-use minutes.

Many disability applicants do not own computers, and many also may not know how to use one. SSA often reminds us that many of their forms and publications are available online, but that is useless to someone who does not have a computer.

This is another reason why having representation on your claim is helpful. Attorneys’ offices have staff that can make these phone calls for you, research information on ssa.gov, and stay on top of your claim. Many attorneys’ offices also have good rapport with the local SSA field office representatives, making it easier to get questions answered in a timely manner.

Are failed attempts at contacting SSA causing a road block in your claim? If so, contact us today and make an appointment for the office closest to you. We are happy to serve the Mentor, Cleveland, Ashtabula, Akron, Canton, Lorain, Youngstown and Toledo areas for your convenience. Learn more by visiting our website, www.balinlaw.com. We look forward to helping you!

 Written by Anna Westfall & edited by Paulette F. Balin

Honesty, Compliance, and Side Effects: How Medical Records Tell Your Story

In past blog entries, we touched upon the importance of continuous medical treatment as well as the importance of being honest with SSA. Today we will look at the importance of being honest with your doctor, your relationship with your doctor, how this affects your medical records and subsequently, your disability claim.

1.       Honesty: When a doctor asks you how you are, tell him!  Don’t give him/her the “canned” answer of fine, good, etc.  Most people with mental or physical disabilities do have good days and bad days, but be honest!  Examples:  Have you been in pain?  Maybe you aren’t today, because today’s a “good” day, but what about yesterday or over the weekend?  Are you depressed (due to pain, inability to work, etc.)?  Do you have a new symptom?  This is part of your written medical record.

2.       Compliance: This matters greatly in the eyes of SSA, as well as your doctor!  Examples: take meds as prescribed.  Go to physical therapy if referred.  Don’t miss counseling appointments.  Judges frown upon non-compliance issues and may deny you partially because you were not following your doctor’s advice to help improve your health.  This is part of your written medical record.

3.       Side Effects: All meds have side effects, some worse than others.  Fatigue, dizziness, nausea, diarrhea, etc. Tell your doctor!  In addition, when asked, list them on any SSA forms. Reports of side effects are just as important as the conditions the medications are treating, as they can also interfere with your ability to work.  This is part of your written medical record.

Doctors, nurses and other medical staff notate everything you tell them at your doctor visits. They also make observations regarding your presentation, such as if you are walking with a limp or you seem particularly depressed. Doctors and nurses can usually tell if someone is lying or exaggerating. This is also made part of your written medical record, and if SSA sees these kinds of notes, it ruins your credibility and may harm your claim.

If your current doctor does not seem sympathetic to your situation, or you feel you are not getting the proper care, it is OK to find a new doctor. It is a wide misconception that you must stay with the same doctor throughout the life of your disability claim. This is helpful if you have a good relationship with your doctor, but pointless if you do not. If you cannot clearly communicate your medical issues and consequently cannot get the treatment you need, it is important to start looking for a “second opinion.” Since the basis of your disability claim relies heavily on your medical records, it is vital to have treating providers who you feel comfortable with and have your best interests in mind.

It is vital to remember that YOU are the most important factor in your disability claim. Attorney representation can paint a vivid picture and submit compelling arguments for a finding of disability, but only if the underlying facts are there as found in the written medical records. The medical treatment record and the limitations opined by the treating doctors provide a strong foundation, and with this, we can help you build the Taj Mahal!

Written by Anna Westfall & Anita Feldkamp, edited by Paulette F. Balin & Andrew November

Need help with your claim? Learn more about us by clicking here! We have offices in Mentor, Cleveland, Akron, Canton, Youngstown, Toledo, Ashtabula and Lorain to serve you better!

What is COLA?

COLA stands for Cost of Living Adjustment. This is utilized by SSA in order for retirement, disability and SSI benefits to keep up with inflation. As the cost of living rises, so must the benefits of retirement, disability and SSI recipients so they can still afford their food, medical care and rent.

COLA was enacted in 1973. It consists of a formula that is used to calculate what the COLA adjustment for the year should be. It is based on increases in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). The CPI-W is calculated by the Bureau of Labor Statistics each month.

SSA must use the average CPI-W for the third quarter of the last COLA year to calculate the next year’s COLA. The last year a COLA was issued was 2011. Therefore, SSA used CPI-W from the third quarter of 2011, which was 223.233. Since it is lower than the CPI-W from the third quarter of 2012, which was 226.936, there is a 1.7% difference between the two numbers. This is the COLA for 2013. If there is an increase, it must be rounded to the nearest tenth of one percent. If there is no increase, or if the rounded increase is zero, there is no COLA.

COLA’s become active in December because those benefits are payable in January of the following year.

COLA has also been scrutinized over the years as members of Congress and others have tried to devise a better system for beneficiaries to keep pace with the cost of living. Instead of using the CPI-W as the base for figuring COLA, the CPI for All Urban Consumers (C-CPI-U) has been proposed to be used.

The C-CPI-U, which has been measured monthly by the Bureau of Labor Statistics since 2002, measures the price of a basket of goods that changes in response to the relative price shifts of various goods. For example, if a raise in the cost of beef causes people to buy more chicken, then the C-CPI-U would have a higher weight on its chicken component and a lower weight on its beef component.

Dean Baker, a co-director of the Center for Economic and Policy Research, stated:

“If it (the C-CPI-U) were adopted as the basis for indexation, then benefits would fall by 0.3 percentage points each year compared to the current law. This lower adjustment would accumulate through time so that after 10 years, beneficiaries would be seeing Social Security checks that are 3 percent smaller, after 20 years 6 percent, and after 30 years would be 9 percent smaller.”

Baker goes on to say that because Social Security beneficiaries have substantially different consumption patterns compared to other Americans, an Elderly Index (CPI-E) has been considered for use instead of the CPI-W. Healthcare and housing make up the greatest part of a Social Security beneficiary’s consumption, and elderly people in particular have fewer opportunities for substituting across items to take advantage of changes in relative prices. They are also less mobile which also causes problems as far as being able to substitute.

Baker concludes his statement by saying an “honest discussion” would be necessary to determine the best route for calculating future COLA. If the C-CPI-U would be used, it would be a dishonest way to cut benefits as those who would be hit the hardest are the oldest beneficiaries. They also tend to be the poorest. Overall, the ability for every American to be able to afford their food, housing and medical care is a critical need that must be handled carefully, so no one is left out in the cold.

Written by Anna Westfall


Need help with your claim? Contact us by clicking here! We have offices in Cleveland, Akron, Canton, Ashtabula, Mentor, Youngstown, Lorain and Toledo for your convenience!

The Advantages of Local Representation

If you have seen any amount of daytime television, chances are you have seen many ads for disability attorneys. Some are local attorneys with offices in your area, but many of them are large, national firms that are usually located in a different state.

Typically, the mindset of most individuals is that “bigger is better,” however, this is not necessarily the case when it comes to representation in a legal matter.

By hiring a smaller, more local firm, you will receive much more personalized attention in the following ways:

1.       Familiarity with local field offices and courts. This is another advantage over a national firm because a local representative deals with the area Social Security offices and courts on a daily basis. A local representative will be familiar with the staff in these offices and therefore has more ease obtaining information or getting questions answered because they have an established rapport. A local representative can also give you good directions to the court and parking tips that someone from many states away would not know!

2.       Relationships with local medical providers. Since Social Security disability representatives are constantly requesting medical records in support of their clients’ claims, over time relationships are established between the providers and the representatives. A local representative may be aware of a doctor retiring in the near-future and can make sure all the pertinent records are secured from that doctor ahead of time. A representative of a national firm, on the other hand, must rely on the information provided by their clients to find out such things.

3.       Face-to-face appointments. Unless you are willing to purchase a plane ticket, chances are you will never see your representative in-person until it is time for the hearing. Face-to-face appointments are critical when it comes to understanding a person’s disability claim. If the representative is able to physically see how you function, such as difficulty rising from a chair or the panic you experience when you speak with someone for the first time, he is able to get a better idea as far as what your claim is all about. It is also much easier to ask questions when you are face-to-face with someone, and establish that all-important rapport.

4.       Knowledge of local hospital rating programs and other care. There are instances when a claimant does not have insurance. Since medical records are imperative to a disability claim, it is important to find either free or low cost care for these claimants. A local representative is knowledgeable about area hospitals that offer sliding scale fees and free clinics. Local representatives may also have good relationships with social workers that can help coordinate care for claimants.

5.       Familiarity with your area. When you hire representation that is local to you, they, too, understand the local issues that may be important to you, such as the closing of an area hospital or an election where community mental health funding is at stake.  Because issues such as these affect everyone in an area, it helps to establish rapport between client and representative. You may even root for the same sports teams, which creates a nice feeling of camaraderie between the client and the representative.

Representation is a personal choice and sometimes a quite difficult one. With so many representatives with TV commercials and other types of ads, it is hard to know who would be right for you. However, based on the reasons outlined above, choosing someone in your local area is a step in the right direction.

Written by Anna Westfall & edited by Paulette F. Balin

If you need help with your Social Security disability claim, we are right close by if you need us! We are proud to offer office locations in Cleveland, Akron, Canton, Mentor, Ashtabula, Youngstown, Lorain and Toledo! Call us today for more information and to set up your appointment.

What Will SSA Do About Direct Deposit Fraud?

While SSA is pushing for more disability and retirement benefit recipients to sign up for electronic payment in lieu of a paper check, scammers are working harder than ever to put those benefits in their own bank accounts.

For example, some Social Security benefit recipients – senior citizens in particular – have been victimized by a scam that asks them for their bank information in order to claim a big cash prize. Instead of a prize, their monthly benefits are stolen.

According to a CNN Money article published on September 26^th , all an identity thief needs is a name and a bank account number in order to have the benefits re-routed to their own accounts. Given all the security measures SSA requires to disclose information about a particular person or their claim (name, date of birth, mother’s maiden name, city of birth, etc.), this is incredibly shocking.

The Office of the Inspector General (OIG) reported that as of August 31^st, 2012, their office received over 19,000 reports of “questionable” changes or attempts to change beneficiary’s direct deposit information. In response, SSA spokesman Mark Hinkle stated that these reports represent only a “tiny fraction” of the 711 million electronic payments SSA has made to benefit recipients up until August 31^st, 2012.

SSA stated they cannot comment on particular cases. However, Hinkle stated that not all cases of wrong payments are due to fraud.  

The inspector general said that SSA needs to make vast improvements as far as correctly identifying benefit recipients that want to change their direct deposit information. Recommendations include sending letters, emails or text messages to the benefit recipient whenever direct deposit information is changed, or develop unique routing numbers for the pre-paid cards, since these are of particular interest to identity thieves because they are harder to track.

Currently, SSA has a system in place that allows a benefit recipient to completely block access to his or her Social Security account. This also includes the benefit recipient. This way, no changes can be made whatsoever unless the benefit recipient visits their local field office and presents a photo I.D., and requests the block to be removed. Electronic access to make changes can be blocked as well. This can be accomplished online by visiting www.socialsecurity.gov/blockaccess.

However, in light of these findings by the OIG, is this enough? With so many Americans depending on disability or retirement payments to get by, a typing error is just as unacceptable as lax security. What will be done about it?

If someone contacts you via email or phone asking for personal information, never give it out. If it has been a few days since you expected your benefit to be deposited into your account, contact SSA as soon as possible. If you hired an attorney to obtain your benefits, contact their office for assistance immediately. Your attorney will protect your rights and make sure SSA does everything properly for you.

 Written by Anna Westfall & edited by Attorney Andrew November

Need help with your disability claim? Chances are we have an office located in your neighborhood! We are proud ot offer meeting locations in Mentor, Cleveland, Ashtabula, Akron, Canton, Youngstown, Lorain and Toledo for your convenience! Find out more by clicking here!

SSA Now Accepting Electronic Signatures for Disability Applications and Appeals

The Social Security Administration is continuing to make more and more of their services available online. After what seemed to be a test-run over the last several months, claimants can now electronically sign their SSA-827 form for disability applications and appeals.

The purpose of the form is to request medical and educational information from the claimant’s providers. In the past, claimants were required to print and either mail or bring a signed paper SSA-827 to their local SSA office in order to complete an application or an appeal.

According to SSA, by allowing claimants to electronically sign the SSA-827, it decreases the application process by approximately 9 days. It streamlines the process and allows SSA to start working on a claim or an appeal sooner.

How does SSA verify the identity of the signer? SSA will take the answers the claimant provides on either the application or appeal and compares them to information they already have on file about the claimant, including name, date of birth, Social Security number, place of birth, work history and mother’s maiden name. If some information does not match up, it raises a red flag for SSA to investigate further.

Will this affect how quickly SSA gets a claimant’s medical records? SSA will still send the releases to medical and educational providers the same way they have in the past, and the form will look essentially the same. SSA says there is no change to the HIPAA compliance of the form. Instead of a “wet” signature, the form will state that it was electronically signed by the claimant. Medical and educational providers would submit their information to SSA the same way.

While it is progressive for SSA to streamline their processes and essentially make the process quicker, is it truly helpful for claimants, or more so for SSA? With identity theft becoming more and more of a problem every day, is this another piece of personal information hackers could potentially get their hands on? SSA touts that this change will help get claimants their benefits faster. If the disability adjudication process still takes approximately 2 years, is 9 days going to make that much more of a difference?

This change is still new and time will tell whether or not it is going to be helpful to claimants. The biggest help right now is that claimants will save money on printing and postage, but at what potential cost?

Written by Anna Westfall

If we can help you, contact us by clicking here! We are located in Mentor, Ashtabula, Cleveland, Akron, Canton, Youngstown, Lorain and Toledo for your convenience!

Should I Be On Disability?

Recently Senator Tom Colburn lead an investigation into the Social Security Disability claims that were awarded between 2006 and 2010. According to Senator Colburn’s report, it is believed that approximately a quarter of 300 randomly selected cases were awarded “without properly addressing insufficient, contradictory and incomplete evidence.” This is concerning claims that were approved by ALJs only and not lower-level awards.

Could this be true? After such a long road in an attempt to obtain benefits and getting denied time and again, it seems to be a disservice to not only taxpayers, but the disabled claimant as well. Even if the decision is a favorable one, it must be properly adjudicated within the limits of the law.

The Social Security Administration has already responded to Senator Colburn’s report by saying they are aware of the issue regarding ALJs, and have already taken steps to address same. “We share the subcommittee’s concern that a small number of judges have failed our expectations with regard to a balanced application of the law, proper documentation, proper hearings and proper judicial conduct,” Agency  spokesperson Mark Hinkle said.

This may be true, but it is good enough to protect the rights of disability claimants? The issue raises several questions that are of concern to people not only applying for benefits but also people who are already receiving them.

For instance: Is it going to be tougher to win benefits in the future? Probably. SSA is going to have to become more vigilant about how the ALJs are coming to decisions. According to SSA’s response to the subcommittee’s report, SSA has undertaken a “vigorous set” of initiatives and say they have made “substantial progress” over the last five years. What this means exactly, however, is unclear.

Will I lose my benefits if my claim was improperly adjudicated? That is hard to say right now, but very worrisome nonetheless. If a claim was awarded erroneously due to improper adjudication, will the claimant have to pay the price even though it was not the claimant’s fault?

In light of this investigation, it is more important than ever to obtain knowledgeable representation if you chose to pursue a disability claim. A disability attorney can help assure your claim is given proper attention and that everything is done according to the law. Your attorney can’t control what SSA does, of course, but they can react to whatever injustice SSA may have inflicted. Social Security law is very complex, so it is hard to find the right answers when you have a problem. Sometimes a claimant may not even know there is a problem because they do not have the expertise to recognize it. A disability attorney will answer all your questions and protect your rights through every step of adjudication.

Written by Anna Westfall

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What To Expect at a Disability Hearing

For most people, the most nerve-wracking part of a disability claim is going to a hearing in front of an Administrative Law Judge (ALJ). It is a wide misconception that the hearing will proceed as seen on TV, with a crowd of people watching and a jury of your peers to decide your fate. Surprisingly, disability hearings are much more casual than this, but still very important!

In Cleveland, hearings take place at the Office of Disability Adjudication & Review (ODAR), located in the Skylight Office Tower building downtown. Traveling into a big city can be daunting for people not accustomed to all of the crowds, traffic and noise, so driving with someone who is familiar with the city is a big help. It also eases some of the fear associated with the whole experience of going to the hearing. We always recommend someone drop you off before parking the car to make sure you get to court on time, as getting lost or not finding parking easily is frequently raised by our clients.

Upon entering the reception area of the office, which is a rather large room, you must let security check you and make sure you are not bringing in weapons or any other illegal items. Always bring a picture I.D. because you won’t be let in through security otherwise. Once you are cleared, you proceed to the waiting area until you are called into the courtroom. If you have representation, typically this is where you will meet up with him or her. It is always good practice to arrive at the office at least a half-hour prior to the hearing to go over any last minute items with your attorney and make sure you are as prepared as possible.

The hearing monitor will call you when the ALJ is ready. The rooms in which the hearings are held are about the size of large living rooms. The far side of the room is raised for the ALJ’s desk. In front of him are tables or desks fit together so that the people sitting at them are facing each other or the ALJ. You and your attorney sit directly across from the ALJ.

Besides the person recording the hearing using a special computer program, other people you may expect to see are experts. You may have a vocational expert (VE), a medical expert (ME), both or none, depending on the facts of your case and what the ALJ feels is necessary to help him/her make a decision. A medical expert would testify to your medical impairments and how they adversely impact work-related activities and whether the complaints of pain are reasonably related to the objective medical evidence or the underlying conditions. The vocational expert will testify to past work; specifically work performed in the past 15 years and whether the profile set forth in a hypothetical question submitted by the ALJ can perform that type of work or other jobs with the same functional limitations.

Typically, the hearing starts with the ALJ briefly summarizing the claimant’s case. He or she then requires the claimant and any experts to take the oath to be truthful with their testimony. Then, if the claimant has representation, the representative will give an opening statement in support of the claim for disability. The ALJ then gives the representative the opportunity to question the claimant. Sometimes the ALJ asks the questions of the claimant, and allows the representative attorney to ask follow-up questions.

The questions posed to the claimant by the ALJ or the representative will vary based on the facts of your case, but typically include activities of daily living; how much you can lift, carry, push, pull, stand, walk, any manipulative limitations involving reaching, handling, gripping, grasping, fingering; any postural limitations including stooping, bending, kneeling, crouching; any environmental limitations including inability to be around gases, fumes, perfumes, machinery, etc; any communicative limitations including inability to see, hear or speak well;  it addresses any mental impairments including problems with social functioning, limitations regarding concentration, persistence and pace and any side-effects of medication and any need for assistive devices . The ALJ will then turn to the experts and direct questions to them. The claimant’s representative also gets an opportunity to question the experts (this is called cross-examination).

After all the pertinent questions have been asked, and the ALJ is satisfied with the amount of information that was provided, the representative is usually given the opportunity to give a closing statement. This typically summarizes the important facts of your case and addresses what the ALJ should note in particular. After all is said and done, the hearing is over, usually in an hour or less, but sometimes two hours depending on the facts of your case and the particular ALJ.

Many claimants ask if the ALJ renders the decision right then and there after the hearing. Occasionally this does happen, and that is referred to as a Bench Decision. Usually, however, the ALJ will take approximately 30 to 90 days to mail the decision to you, sometimes longer, depending on your case. You must wait for the written decision to be sent to you; neither SSA nor ODAR will tell you the result of the ALJ’s decision over the phone.

If you receive a Fully Favorable decision from the ALJ, congratulations! Your long road to obtaining benefits has finally come to an end. If you receive a Partially Favorable decision, meaning the ALJ found you disabled on a different date than you had claimed, or an Unfavorable decision, meaning the ALJ did not find you disabled at all, not to worry. If you disagree with the ALJ’s decision in part or in full, you can appeal both Partially Favorable and Unfavorable decisions to the Appeals Council.

This blog article is a brief summary of what to expect at a disability hearing. Since the facts of your case may be much more complicated, it is advisable to obtain representation well before you go to court. Then you will have someone knowledgeable right by your side, every step of the way, to guide you through the disability process with much more ease and likelihood of success.

 Written by Anna Westfall & edited by Paulette F. Balin & Attorney Andrew November

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Paulette Balin & Associates Continues to go High-Tech!

The Social Security Administration is continuing its foray into the electronic era by making more tools and materials available online for appointed representatives. Starting August 25^th, 2012, appointed representatives now have the option of downloading the audio recordings of their client’s hearing through Appointed Representatives Services (ARS).

Over the past several months, ARS has become a helpful tool for representatives. It allows them to access electronic copies of their client’s file at any time, as well as appeal decisions. ARS can be accessed through the Business Services section of ssa.gov.

When a claim is denied by an Administrative Law Judge (ALJ), obtaining a recording of the hearing is vital. Usually by the time an ALJ decision is rendered, many months have passed and it is hard to remember all the details, especially if the representative has many clients and is in court several times per month. By listening to the recording of the hearing, it can help the representative make a decision as to whether to appeal. Or, if the decision was already appealed, listening to the recording can assist greatly in writing a supplemental brief to the Appeals Council.

In the past, the Appeals Council would always supply CD recordings of hearings to appointed representatives for their review. This was not a good method, however, as sometimes a CD would not be sent out, get lost in the mail, become damaged, etc.

This feature is only available for cases at the Hearings and Appeals levels that are pending, reactivated, or closed within the past 90 days. Representatives must be enrolled in ARS to gain access to this valuable tool.

As usual, Paulette Balin & Associates, LLC is staying on top of the latest innovations as SSA is introducing them. Thanks to electronic files, our office has gone practically paperless. Our attorneys use laptops and iPads in court instead of bulky paper files. We are already in the process of getting our attorneys set up to receive the audio recordings of the hearings, so our ALJ appeal process will be even more streamlined than ever. We do all this (and more) to serve our clients to the best of our ability.

As always, we stand by our motto: We do whatever it takes to win your case!

Written by Anna Westfall & edited by Attorney Andrew November

We have offices in Cleveland, Mentor, Toledo, Youngstown, Lorain, Akron, Canton and Ashtabula to serve you better! Click here to contact us for an appointment.

Meet Paulette Balin & Associates' Latest Asset

Our office is proud to announce the latest addition to our team, Matt Shupe. Matt is a recent graduate of the Case Western Reserve University School of Law and is currently awaiting the summer 2012 Bar Exam Results.

Matt is a person who has advocated for the disabled his entire life. After seeing his uncle struggle to obtain disability benefits back in the 1990’s, and how an attorney helped him get the benefits to stabilize his household, Matt knew what he wanted to do when he grew up.

In 2008, Matt graduated magna cum laude from Slippery Rock University with degrees in history and anthropology. During his time at Slippery Rock, Matt acted as vice president of Phi Alpha Theta and won the National Best Chapter Award in 2008. He also held the title of treasurer for two years on the Student Advisory Board as well as worked as a peer tutor.

After graduation, Matt began his foray into the disability law field with an internship at Paulette Balin & Associates as a case manager in 2009. Here Matt helped develop over 450 active disability and SSI claims. He communicated frequently with health care professionals and Social Security representatives, as well as prepared cases for court hearings.

In 2009, Matt also began attending Case Western Reserve University School of Law. During this time he continued to work as a legal intern for Paulette Balin & Associates, writing legal briefs for Appeals Council and federal court cases. During this time he also worked for the Milton A. Kramer Law Clinic Center as a Supreme Court of Ohio Certified Legal Intern. Here Matt provided transactional and corporate counsel legal services for education and arts-based non-profit organizations. Matt also assisted physically and mentally impaired clients that were discriminated against under state and federal Fair Housing laws.

Also during this time, Matt spearheaded a community project in Cleveland Heights, Ohio, to build a handicap-accessible garden for low-income adults. Matt organized the project, as well as helped build the garden himself, which is enjoyed by many in the Cleveland Heights community to this day.

Now that we are lucky to have Matt back in our office, he will be actively representing clients in court, conducting prospective client interviews, as well as continuing to write compelling legal briefs. We are proud to have Matt as part of our team and wish him the best success as our newest associate attorney once he passes the Ohio Bar Exam!

 Written by Anna Westfall, edited by Attorney Andrew November & Attorney Matt Shupe

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Need Help Applying for Disability Online? Paulette Balin & Associates Can Help!

As many people know, you can now file for Social Security disability online. While the process is relatively user-friendly, it can still be confusing to some and requires a great deal of homework for the applicant. We are proud to announce that our office now offers the service of helping people apply online.

There are three parts to the online disability application process. The first part is the actual application, which takes approximately 20 minutes to complete. Here you are asked basic information to identify you, as well as for information such as marriages, past and present, and any children you have. In this stage of the application it is important to have your tax returns from the past two years, as you will also be asked about your income. If you served in the military, you will be asked for your discharge information and all periods of active duty.

If you are applying for yourself, you may electronically sign the application online when finished. If you are helping someone else apply, they are sent a copy of the application in the mail to review and sign. In this case, your application is not recognized by SSA until they receive the signed copy back from you.

The second part of the application process is the Adult Disability Report. This is the lengthiest part of the process that may be quite discouraging to some. Depending on how much information you have to provide (and SSA asks that you provide as much as possible), this part of the application can take an hour to two hours to complete. Here you are asked specific questions about your disabilities, medications, doctors, and past work. You must list the last five jobs from the last fifteen years and the dates you worked. When you start the report you are given a re-entry number, in case you need to stop and finish the report later.

Third, SSA needs a release form from you in order to request your medical records. Once you complete the Adult Disability Report, the website gives you the option to print out a SSA-827, along with a cover sheet that lists the local office you would take the form to. At this point, the claimant can apply for Supplemental Security Income (SSI) at the local office if they qualify. You cannot file for SSI online.

 Your claim will not be active until SSA receives these three items from you – the application, the Adult Disability Report, and the SSA-827. For a more complete list of the items needs to file online, please visit: http://www.socialsecurity.gov/info/isba/disability/firstpartydib.htm .

Because applying online is time-consuming and potentially confusing, it is a good idea to consult an attorney who practices in this field before getting started. He or she can help you understand the questions asked on the application, as well as help you understand what disability programs you qualify for. An attorney may also advise you in regards to other matters pertaining to your disability claim, such as if you are also collecting worker’s compensation or unemployment benefits, and how this would affect your claim.

Paulette F Balin & Associates, LLC is now helping people apply online! If you have lots of questions, are not sure which direction to take, or simply do not have access to a computer, we are here to help you. Call us today, toll-free, (866) 49BALIN and ask for Anna to set up your appointment. After we meet with you and get your basic information, we will file your application online for you and begin working on your claim immediately. We will help you every step of the way!

Written by Anna Westfall & edited by Attorney Andrew November 

Visit us online by clicking here! We are located in Mentor, Cleveland, Asthabula, Akron, Canton, Youngstown, Toledo and Lorain for your convenience!

Can I Apply for Disability and Early Retirement at the Same Time?

It is a common misconception many people have that an individual must choose between filing for either early retirement at age 62 or for disability benefits, when in reality a person can pursue both types of benefits at the same time.

When an individual chooses to start collecting early retirement, they are accepting a 25% reduction of their full retirement benefit. This reduction is permanent and cannot be reversed. The only way an individual can increase their early retirement benefit is by also receiving disability benefits.

If the retired individual is found disabled after the age of 62, they are paid the difference between the reduced retirement amount and the full Social Security benefit amount for each month the individual was already paid early retirement. They will then receive their full benefit amount for each month moving forward.

For example, Mary stopped working on January 1^st, 2010 because of her health condition. After her 62^nd birthday on June 1^st, 2011, Mary filed for early retirement. Because she already had stopped working due to her health condition, Mary also applied for disability, alleging that she could not work as of January 1^st, 2010.  In November, 2011, SSA found Mary disabled as she had alleged as of January 1^st, 2010. She is entitled to disability benefits as of July, 2010.

By this time, Mary had been collecting early retirement since June, 2011. SSA will retroactively pay Mary the difference between her early retirement benefit amount and her disability benefit amount for June, 2011 through November, 2011, then continue to pay her the full monthly benefit amount as long as she remains disabled through the age of 66.

However, there are some possible issues that could arise should an individual choose to file for early retirement and disability benefits at the same time. These possibilities must be kept in mind for anyone who is considering this route.

The first thing to remember is if you are denied disability, you will receive your retirement benefits at the reduced rate for the rest of your life. If you wish to avoid this scenario, it is more advisable to file for disability benefits between the ages of 62 and 65, rather than early retirement.

The second important point to remember is that it is possible for SSA to find you disabled on a date different than the one you claimed. In our example, Mary claimed she became unable to work on January 1^st, 2010. Instead, SSA finds her disabled as of December 1^st, 2011. Because Mary started collecting early retirement in June, 2011, this results in a 6 month reduction of benefits. She will not be paid any retroactive disability benefits for those months and, when she does turn 66, she will continue to suffer a 6 month penalty on her benefits as if she had retired at age 65 and 6 months.

SSA figures the penalty amount based on the year you are born. Please visit http://www.socialsecurity.gov/retire2/agereduction.htm for more information regarding reduction of benefits.

Because this interaction between the disability and retirement programs can be very confusing, it is a good idea to first talk to an attorney who can help you decide what is best for you. Knowing what your options are, as well as all possible outcomes, is vital in this very important decision. 

Written by Anna Westfall & edited by Paulette F. Balin

Please visit us online by clicking here! We are located in Mentor, Cleveland, Ashtabula, Akron, Canton, Youngstown, Lorain and Toledo for your convenience.

What is the Five Step Sequential Evaluation Process?

For every adult disability, SSI, child disability, widow’s or widower’s benefit claim, the five step sequential evaluation process must be followed to determine whether or not the claimant is disabled. The steps must be followed in a set order. If SSA finds that a claimant is or is not disabled at a step, the evaluation process ends. If they cannot find the claimant either disabled or not disabled at a step, the process then proceeds to the next step. Before SSA can go from step three to step four, however, the claimant’s residual functional capacity must be assessed. This assessment is then used at both steps four and five.

Step 1: Are You Engaged in Substantial Gainful Activity?

Just because a person is working does not automatically disqualify them from pursuing disability. However, the work activity must fall below Substantial Gainful Activity (SGA). Engaging in SGA basically means you are making reasonably enough income to live based on the cost of living, therefore you cannot be considered disabled and in need of the financial help disability benefits provide. The current SGA amount for 2012 is $1,010. If your earnings fall below SGA, or you have no income at all, your claim proceeds to step two.

Step 2: Are Your Impairments Severe?

A severe medical impairment significantly interferes with an individuals either physical or mental ability to do basic work activities. If your impairment is found to only mildly interfere with basic work activity, you will not be found disabled. This can be a single, severe impairment or a combination of impairments that is severe, and is expected to last at least twelve consecutive months. If your impairment or combination of same is found to be severe by SSA, proceed to step three.

Step 3: Do Your Impairments Meet or Equal a Listing?

At this step, the severity of your impairment or combination of same is also considered. If they meet or equal one of SSA’s listings, you will be found disabled. The complete list can be found here: http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm. Once this is determined, proceed to step four.

Step 4: Are You Able to Return to Your Past Relevant Work?

At this step, your residual functional capacity (RFC) is assessed to determine whether or not you are able to return to your past relevant work (PRW). Past relevant work is the work you did within the last fifteen years, that was SGA, and that you performed long enough to learn how to do it. Ideally, your doctor would test your abilities (such as how much you can crouch, stoop, handle objects, walk, sit, etc.) and complete a RFC form that outlines your limitations. One of the benefits of hiring an experienced disability representative is that he or she will work with your doctor to get this information for SSA. If your limitations are as such that you cannot perform your past work duties, proceed to step five.

 Step 5: Can you Adjust to Other Work?

If you cannot go back to your past relevant work, SSA then considers your age, education and work experience to determine whether you can perform other work. If you previously performed work that was considered “heavy,” you may be able to adjust to other work that is considered “medium” or “light.” If you can perform other work, you will not be found disabled. SSA utilizes the Medical-Vocational Guidelines, also known as the “grids,” to help make this determination. The guidelines take into account your impairment(s), age, education and work experience. However, the grids only address exertional limitations.

Because individuals are not always found disabled by the grids alone, other factors are considered by SSA, such as mental impairments, postural, manipulative, communicative and environmental limitations, as well as side effects from medication, pain, and fatigue levels. In cases such as these, vocational testimony is vital in order to determine whether someone can adjust to other work. If you cannot adjust to other work, you will be found disabled by SSA and the process ends.

This is a brief summary of how the five step sequential evaluation process works. Because there are exceptions to this process, as well as slightly different rules for individuals already receiving benefits, it is advisable to consult an attorney who specializes in disability to help you understand this process better.

Written by Anna Westfall & edited by Paulette F. Balin

Visit us online by clicking here! We are located in Mentor, Cleveland, Ashtabula, Akron, Canton, Lorain Youngstown and Toledo for your convenience!

What is Ticket to Work?

Most people who are receiving disability benefits do not wish to be in the situation they are in. Many disability and SSI recipients like to work and want to go back to work for a number of reasons, such as not receiving enough benefits to cover the rent, utility bills, food costs, etc. SSA’s program, Ticket to Work, can help those individuals do just that.

Introduced in 2001, and improved upon in 2008, the Ticket to Work Program allows disability and SSI recipients to re-enter the work force to obtain a good job, and possibly a new career, without jeopardizing their benefits. The program is free and voluntary for any disability and SSI recipients who wish to return to work, ages 18 to 64. So how does it work? SSA connects the disability recipient with either the Employment Network (EN) or his or her local Bureau of Vocational Rehabilitation (BVR).

EN agencies are under contract with SSA to work closely with individuals interested in going back to work. They will help the disability beneficiary identify their career goals and form a plan that highlights these goals, as well as what the agency will do to help that person achieve them. They provide career counseling, job placement, and ongoing support services. There are usually several different agencies for the beneficiary to choose from, and they have the right to talk to as many EN agencies as they wish before deciding to assign their ticket to the agency they want to work with. The beneficiary may also change his ticket to a different agency at any time. The agency MAXIMUS is currently contracted to serve as the Operations Support Manager of EN. For more information, call (866)968-7842.

The Bureau of Vocational Rehabilitation (BVR) is a state agency. If accepted into the program, the beneficiary works with BVR to form a plan which helps that person get ready to go back to work. Once the plan’s goals are met, the individual is then referred to EN or a similar agency for job placement and continued support. Most major cities have a BVR agency. To find the BVR agency nearest to you, visit http://www.chooseworkttw.net/resource/jsp/searchByState.jsp .

 Once the beneficiary has completed a program either through EN or BVR and achieves work and earnings goals set forth in their plan, SSA pays the provider for their services. Rather than being fees for services, however, these payments are compensation for assisting the beneficiaries in obtaining their goals.

While participating in Ticket to Work, the disability recipient is not subject to any medical reviews during that time to determine whether or not the recipient is still disabled. They continue to receive their benefits until their employment income is above the applicable earnings limit for the Supplemental Security Income or Social Security Disability Insurance program. However, this also varies from individual to individual. This is partially because it is possible to subtract certain amounts from your gross earnings by taking advantage of Social Security Work Incentives. For more information regarding work incentives, please visit www.ssa.gov/redbook.

Medicare and Medicaid are also not affected while a beneficiary is participating in Ticket to Work, as long as they are still receiving their cash benefits. Even after the beneficiary returns to work, it is possible to keep their insurance benefits. For Medicare, an individual may remain covered for up to 93 months after the Trial Work Period has ended. It is also possible to keep Medicare through Work Incentives. Medicaid can also be maintained through Work Incentives. An individual may also have the option of participating in a Medicaid Buy-In Program, depending on whether state in which the individual lives offers the program. This allows the individual to keep Medicaid by paying a monthly premium, provided that other requirements set by the state are met.

Sometimes after people go back to work, they find their disabilities are still getting in the way and they have to stop work again. Instead of filing a new application, these individuals can request the reinstatement of benefits up to five years after going back to work. In the Work Incentives program, this is called Expedited Reinstatement. SSA will then pay the individual provisional benefits for up to six months while they determine whether or not that individual can get benefits again.

The decision to go back to work can be tough for a disabled person. The pro’s and con’s must be weighed carefully and, if possible, discussed with an attorney who is well-versed in Social Security rules and regulations to determine whether it is the right choice.

 Written by Anna Westfall

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What is Substitution of Party?

When a claimant dies while waiting to go to a hearing in front of an Administrative Law Judge (ALJ) regarding his disability claim, that does not necessarily mean the claim ends. If the claimant has an estate, surviving spouse, family member or dependent, they can be substituted on the deceased claimant’s behalf.

The first step is to make sure SSA is aware that the claimant has passed away. This can be done by either calling the national toll-free number (800)772-1213, or by calling or visiting the local SSA office that is handling the claim. A Claims Representative will also discuss any potential survivor’s benefits and/or death benefits due on the claimant’s record with the informer.

Once the surviving beneficiary is identified, Form HA-529 must be completed and submitted to SSA (please click here to see what the form looks like). The substituted party is usually a family member, but this varies depending on the type of benefit the claimant was applying for (SSI, SSD or both). A copy of the deceased claimant’s death certificate must accompany the form when it is submitted to SSA.

The substitute may also elect whether he or she wishes to appear before the ALJ. The decision may also be made “on the record,” meaning that the ALJ reviews the claim and issues a decision without a hearing. If the ALJ issues a favorable decision, benefits are then paid to the substituted party from the alleged onset date (AOD) of disability until the date of death.

The substitute may also be eligible for a continuing dependents benefit. For example, if you are the older parent of an insured worker who has died, and you were dependent on that person, you may collect the monthly benefit if:

-         You are at least 62 years old

-         You have not remarried since your child’s death

-         You are not entitled to your own, higher Social Security benefit, and

-         You were receiving at least one-half of your financial support from your child at the time of his or her death (proof of this must be submitted to SSA within two years of your child’s death)

When a person dies it can be a very difficult time for the surviving family members, especially when important choices such as these must be made. Because of this, it is advisable to seek the advice of a qualified Social Security attorney to help best decide who the Substituted Party can be, and guide that person through the remainder of the disability determination process.

Written by Anna Westfall & edited by Attorney Andrew November

Visit us online by clicking here! We are located in Mentor, Cleveland, Ashtabula, Akron, Canton, Youngstown, Lorain and Toledo for your convenience!

Disability and Unemployment

When a person files for disability benefits, that means he or she either has not worked or expects not to work in at least a 12 month period. When that same person files for unemployment benefits, that means he or she is willing and able to work at any time, should a job arise that fits their skills and abilities. As you can see, this could potentially create a conflict of claims in the eyes of a disability adjudicator or Administrative Law Judge (ALJ).

Filing for unemployment benefits alone does not mean a disability applicant will automatically be turned down, however. SSA looks at the “whole picture” of a person filing for disability, and because every case is different, there are circumstances that would explain why a person has filed for both types of benefits. On August 9^th, 2010, Chief ALJ Frank A. Cristaudo sent a memorandum to ALJs across the nation regarding this issue. In part, ALJ Cristaudo stated:

…the Supreme Court held, in a unanimous decision, that a claim for Social Security disability benefits is often consistent with a claim for relief under the Americans With Disabilities Act (ADA) even though there must be an ability to work in order to obtain relief under ADA. The Court noted that, under the presumptions embodied in our five-step sequential evaluation process, a person can qualify for Social Security disability benefits even though he or she remains capable of performing some work. Similar logic applies to applications for unemployment benefits.

In addition, it is often uncertain as to whether we will find a person who applies for unemployment benefits ultimately to be disabled under our rules, and our decision-making process can be quite lengthy. Therefore, it is SSA’s position that individuals need not choose between applying for unemployment insurance and Social Security disability benefits.

Sometimes disability benefits are granted to people who are not only still able to work, but are in fact still working. For example, an older claimant is reduced to being able to perform only sedentary work. However, due to his age, skill set and education, he is not expected to be able to obtain such a job; therefore the granting of benefits is warranted.

Theoretically, the claimant could actually collect disability benefits and still work a sedentary job, as long as his earnings stay well below Substantial Gainful Activity (SGA) limits and it is not full-time (40 hours per week or more). He would also have to make sure his earnings don’t interfere with any SSI payments due to him. SSI recipients are allowed no more than $2,000 in their collective bank accounts, one vehicle and one residence.

Along those same lines, that same claimant could apply for unemployment benefits, while collecting disability benefits, if he says he is willing and able to work a sedentary job. He can potentially collect unemployment benefits until he finds a part-time, sedentary job, which he must actively seek in order to receive the benefits.

However, filing for unemployment can also potentially be used against you. As mentioned previously, filing for unemployment benefits alone does not prevent someone from receiving disability benefits, but SSA can count the unemployment filing as one of the factors in considering whether or not the claimant is disabled. For example, if a claimant applies for jobs that are physically demanding, but tells SSA he cannot do these types of jobs due to his disability, SSA can take that into account and may view the claimant’s statements as less credible.

The rules for unemployment are different for each state. Some states will even make an applicant pay the benefits back if it is discovered that he was ineligible for them at the time of receipt. Since it can be a difficult decision to make, talking the situation over with a disability attorney can help a claimant decide the best course of action, as well as the timing of both filings, if necessary.

Written by Anna Westfall & edited by Attorney Andrew November


We are located in Mentor, Cleveland, Ashtabula, Akron, Canton, Lorain, Toledo and Youngstown for easy access to justice! Visit us online by clicking here!

To Exam or Not to Exam...

A consultative exam (CE) is an appointment set for a disability claimant by SSA for the purpose of having that claimant undergo a medical evaluation.  The doctor, referred to by SSA as the “examiner," tests and observes either physical or mental/emotional disabilities, depending on the nature of the disability claim. The examiner then summarizes his or her findings in a report that is submitted to SSA. These tests are paid for by SSA and the examiners involved are physicians with their own practices contracted to do this work for SSA.

There are a few different reasons why SSA orders these exams, but it may not always be necessary and may even damage a disability claim. When a disability claimant has a representative, he or she can best determine as to whether the CE is necessary and can object to it if need be.  To the contrary, sometimes a representative may encourage SSA to order a CE when the medical evidence is incomplete or a representative believes there is an undiagnosed impairment.  This is often the case with mental limitations where remote school records suggest possible mental retardation.  In that case, SSA would have the ability to request IQ testing.

The foremost reason why CEs are ordered is when a claimant’s medical evidence of record (MER) is “thin,” meaning there is not enough information from the claimant’s treating sources to make a determination. Another reason is if the MER in the file is old and updated information on the claimant’s current condition is needed. There are also reasons beyond the claimant’s control, such as lack of cooperation from the treating source to release the records or pertinent, objective information such as diagnostic imaging or lab results are not included in the treating source’s records.

While this information could potentially help SSA find a claimant disabled, there is the possibility that it could also do the exact opposite. Because the examiner sees the claimant only one time, from a few minutes to possibly up to one hour, it is difficult to see the “whole picture” of a person’s disability and create an accurate report.

For example, a claimant suffering from back pain may be asked by the examiner to stoop, bend, crouch, etc. The examiner then records how well the claimant can do these things as well as for how long. If the claimant happens to do “well” on the exam (i.e: able to stoop, bend and crouch with little to no difficulty), the examiner will, of course, report same to SSA.

However, if the MER from the claimant’s treating providers shows that the claimant has been complaining to his doctor that he can no longer weed his garden or pick up his grandson due to back pain, this creates a conflict of information in the claimant’s file that SSA must sort out. Disability examiners must decide how much “weight” they can place on the examiner’s report compared to the MER already in the file. Typically, more weight is usually given to the treating providers’ opinions over that of the CE examiner, but it is a conflict of information nonetheless. If the claimant has a representative, he or she can object to a CE if it is felt that this sort of conflict would be created by the CE examiner’s findings.

Generally, people do not like to attend consultative exams and that is understandable. SSA tries to schedule the exam as close to where the claimant lives as possible, but sometimes that can still be quite a drive depending on where the claimant lives. Claimants are usually given a little under a month’s notice to make arrangements to attend the exam. Attending is vital, because if a claimant does not show, it is considered failure to cooperate by SSA and the claim can be turned down for that reason alone (unless the CE is objected to).

Because the issue of “to exam or not to exam” can be complicated, it is advisable for a disability claimant to obtain representation so he or she can determine whether or not a consultative exam would help or hurt the claim.

Written by Anna Westfall & edited by Attorney Andrew November


Visit us online by clicking here! We are located in Mentor, Cleveland, Ashtabula, Akron, Canton, Lorain, Youngstown and Toledo for your convenience!