Obtaining Representation and How It Affects Your Claim

Often times when claimants represent themselves in court, the Administrative Law Judge will postpone the hearing in order for the claimant to obtain legal representation.

The Social Security Administration’s policy on claimant representation states:

     Although SSA neither encourages nor discourages representation (see GN 03910.010B.), SSA is required to inform claimants of their right to be represented, if they choose, by an attorney or non-attorney at each step of the administrative review process. SSA also provides more detailed information to claimants who inquire about representation, or who are not represented when SSA makes an unfavorable determination or decision.

Why Choose Attorney Representation?

First, you must remember that each and every one of our clients has specific factual and legal circumstances.  This blog is not intended to create an expectation of success for prospective clients. Rather, this blog is intended to highlight some of the things an attorney can do in a case.

Typically, a doctor’s office and hospitals will charge $20 or more to provide copies of medical records. Usually, representatives are able to obtain your medical records at no charge, as long as they are facilities inside the state of Ohio (some other states have analogous rules).

Another reason why having attorney representation is helpful is that attorneys and their assistants deal directly with the Social Security Administration (SSA), the Bureau of Disability Determinations (BDD), and the Office of Disability Adjudication and Review (ODAR) on your behalf. Often times it is difficult to get through to a representative at SSA to have a question answered or to get information. Your representative will make every effort to get your questions or concerns addressed with SSA, BDD or ODAR in a timely and professional manner, and communicate the results to you quickly and in a way you can understand.

Along those same lines, having an attorney representative means having a professional on your side that can help you better understand what is happening with your claim. With knowledge of the law as well as an understanding of your disabling condition(s), an attorney can create a “game plan” to assist  your claim as well as explain the  terms and law you will hear.  Without a professional such as an attorney, you would have to depend on whatever information you are able to obtain from Social Security, the internet, or the public library.

Of course, every person’s case is different, and each requires different amounts of attention and care. Deciding whether or not to obtain attorney representation, or representation of any kind, is a personal choice that must be made carefully. For more information, please visit http://policy.ssa.gov/poms.nsf/lnx/0203910030 which was also referenced in this blog.


Written by Anna Westfall and Attorney Andrew November

DISCLAIMER: The information contained in this blog is for information purposes only, and may not apply to your situation. This blog is an informative piece and is not intended to make any representations regarding future outcomes.

Read What Some of Our Clients Are Saying About Balin Law...

To Paulette F Balin & Associates,

Just a short note of thanks for your great help in helping me to help myself in these trying times. God bless you all for what you do!

-          Martin A., Cleveland, OH

Dear Ms. Balin,

Thank you for all the work you did on my disability claim. After 17 months of waiting and two denials, I was completely surprised when, on April 15^th, to receive an award letter. I am deeply grateful and appreciative for the time you and your staff put on my claim.

-          Barbara T., Bedford, OH

To Paulette F. Balin & Associates, LLC,

First off, I want to let you know I’m not a very good writer. Second I want to thank you for your help, kindness, putting up with me calling so much, standing up for me, and all your hard work. How I came to have you represent me was from another client you had, and said you did a wonderful job, so she referred you. That’s why I would like to recommend your office to others. I’ve been treated good from your office, whether I was on the phone, letters, or in person. I’m not sure what else I can write except thanks again so much for the great job you are doing on my behalf.

-          Peggy K., Louisville, OH

DISCLAIMER: Each and every one of our clients has specific factual and legal circumstances.  The above statements are testimonials of gratitude from former clients that are not intended to create an expectation of success for prospective clients.

“Why doesn’t anyone believe me?” How Social Security Views Your Allegations of Pain and Other Symptoms

When someone suffers from a physical or mental impairment, they often experience day-to-day symptoms that can result in the need to file a claim for disability. Because symptoms vary so much from person to person, it is important that Social Security has a policy in place to evaluate a claimant’s symptoms to verify whether or not the symptoms are severe enough to interfere with basic work activity.

Allegations of symptoms alone are not enough to find someone disabled. A few things must be taken into account in order to find out whether or not someone is disabled.

Medically Determinable Physical and/or Mental Impairment

First, a Social Security claim adjudicator must consider whether or not the physical and/or mental impairment(s) alleged could reasonably be expected to produce the symptoms a claimant alleges. If a medically determinable physical and/or mental impairment cannot be established, the symptoms can not be considered to interfere with basic work activity.

Secondly, the adjudicator must determine the limiting effects the alleged symptoms have on basic work activities. In order to do so, the adjudicator must establish credibility of the claimant’s allegations.  This requires consideration of the entire case record, including the medical evidence of record.

Establishing Credibility

The statements made by the claimant as recorded in the medical evidence of record, as well as through interactions with Social Security employees, must be consistent in order for an adjudicator to find a claimant’s allegations as credible. Other sources an adjudicator can turn to in order to assess credibility may also be statements by third parties and reports completed by the claimant that state medications taken, treatments tried, and factors that either precipitate or relieve pain. Another important factor an adjudicator must keep in mind is that symptoms vary from person to person. What is excruciating pain for one person may be simply a nuisance to another.

Once credibility is established, the adjudicator must have an explanation to back up the allegation of credibility. He or she must cite specific reasons that must also be supported by the evidence in the record.

Medical Evidence of Record and other Sources of Information

As mentioned in the previous section, statements made by the claimant in the medical evidence of record should match up to other records and findings in the claimant’s file. Another reason why medical evidence is important in this aspect is because there may be clinical observations of the symptoms in the records. However, even if the clinical observations are absent from the medical evidence of record, the allegation of symptoms still cannot be totally discounted. An adjudicator must take all of the allegations into consideration in the context of all of the evidence of record.

Longitudinal history established in medical records is also helpful when determining credibility. If an adjudicator can see that a claimant has been persistent in his or her attempts to find relief of his or her symptoms, this can give weight to that person’s allegations of symptoms. However, this is a double-edged sword. If a person, in their attempts to find relief from alleged symptoms, does not follow through with treatment with no good reason, credibility may be damaged. On the other hand, there may be good reasons why a claimant did not follow through with treatment (lack of income, transportation, etc.) that may not be readily apparent in the medical evidence of record and must be investigated further by the adjudicator.

Exams conducted by a state agency of the Social Security Administration must also be taken into account when determining the credibility of a claimant and his or her allegations of symptoms. However, the adjudicator is not bound by these findings. They must explain whether or not they give weight to the state examiner’s findings and why.

Overall, there is a great deal of investigation and research a claim adjudicator must perform in order for the Social Security Administration to make the right decision on a disability claim. This is important for a person to keep in mind when they are applying for benefits. To put it simply, “Honesty is the best policy.” If a claimant is truthful in their allegations of pain or other symptoms, the adjudication process is easier and more clear-cut for all parties involved.

For more information, please visit http://www.ssa.gov/OP_Home/rulings/di/01/SSR96-07-di-01.html

- written by Anna Westfall and Attorney Andrew November

Working While Your Claim is Pending: A Delicate Balance

As we already know, Social Security Disability benefits are for people who are unable to work. However, because claimants still need to eat and have a roof over their heads, stopping work entirely isn’t always realistic. A person may not be able to go back to their past job, but they need to make ends meet somehow.

Fortunately, the Social Security Administration understands this, and has guidelines in place so that people can still take care of themselves while their claim is pending. The following needs to be kept in mind by anyone who is even considering working while their claim for SSD or SSI is pending:

-          Your gross earnings must stay below the limit set by Social Security, called Substantial Gainful Activity (SGA). SGA is raised each year to accommodate the cost of living. Currently the SGA for 2011 is $1,000. In order to still qualify for disability benefits, you must keep your gross earnings well-below that figure.

-          Keep in mind that the type of work you chose to do may also affect your claim. While earning more than SGA is complete bar to receiving benefits, work under SGA is evidence for the Social Security Administration  of what you can and can't do. So while you're still able to receive benefits for the months you worked under SGA, you're also creating evidence that may support or hurt your case.

-          Do not think you can hide your work history from Social Security. Because they look a your earnings, they will always be able to tell when you worked and how much you earned in any given year, as long as they are jobs in which you paid taxes. They even receive information simply of your hiring.

-          If you are being represented, always discuss the possibility of returning to work with your attorney/representative before taking the job. He or she will want to advise you as to whether  it is a wise move in regards to your claim. This is especially important if you are considering self-employment, because the rules are different than discussed above.

The Social Security Administration can even help you go back to work if you are disabled and have been receiving benefits. That information can be found here: http://www.socialsecurity.gov/pubs/10095.html

No one wants to lose their home or be buried further in debt. By keeping these guidelines in mind, a person can still potentially succeed in proving their claim without jeopardizing their basic needs.

- written by Anna Westfall and Attorney Andrew November