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.

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.

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.”