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.

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’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.”

 

Tools of the Trade for Disability Representatives

With so much technology now on-hand for so many different aspects of our daily lives, it should come as no surprise that it plays a heavy roll in the work of Social Security disability representatives. SSA has made several tools available online that help them closely monitor and develop your disability claim.

Electronic Records Express (“ERE”)

This program can be used by anyone who is going through, or helping someone go through, a disability claim. If you have a computer and a scanner, you can submit medical records and other correspondence directly to SSA through this designated website.

The ERE website accepts medical records, representative correspondence, claimant correspondence, school records, representative briefs, requests for hearing postponement or change in location, address changes, and forms SSA sends to claimants for completion, which often include their own barcode that must be used.

During all stages of claim adjudication, a disability claimant is issued a paper barcode. This is placed on top of whatever document you are scanning to submit. On the barcode itself are codes you would type where prompted on the website. Once you submit the information, it is received by SSA immediately and exhibited in your exhibit file. You also get a confirmation you can print out and keep with your submission.

Electronic Folders

In the past, attorneys relied on paper exhibit files that must be copied from a claimant’s master file kept by Social Security. Your exhibit file contains your entire procedural history, notes made by SSA employees regarding your claim, your correspondence with SSA, and your medical records. Paper files were time-consuming (and paper-consuming!) to obtain, and if there was a problem with SSA’s copy machine, you were out of luck until it was repaired.

Later, SSA began sending representatives exhibit files on CD’s that could be opened on a computer. These were troublesome, however. If the SSA employee who made the disc did not do it correctly, it will not open and a new disc would have to be requested. Sometimes SSA would mail the discs and the representative would never receive it – very troublesome when you are dealing with an impending hearing.

Today, your exhibit file can be obtained by your representative through another dedicated website, Appointed Representative Services. Once requested, the file is ready for viewing within 48 hours. It can be downloaded for easy viewing into PDF form, so your representative can view your entire file on a computer or tablet. If your representative has Adobe Pro, he or she can also make electronic notes on the exhibit file. Now instead of lugging a big paper file to court (which can sometimes be over 1,000 pages), your representative can bring up particular exhibits with ease in the courtroom.

Hearing Office and Appeals Council Status Reports

Instead of calling the hearing offices or the Appeals Council of Social Security to check the status of your claim, your representative can now download a report that tells him or her exactly what is going on with your claim.

Hearing office reports can tell the representative what Administrative Law Judge (ALJ) is assigned to your case, if a hearing has been scheduled yet, where it will take place, and how close the ALJ is to issuing a decision after a hearing is held.

Since the Appeals Council can take anywhere from 15 to 18 months to review an ALJ’s decision, the Appeals Council Status Reports are particularly helpful. These can tell a representative is an analyst has been assigned, if the case is being worked up, or if a decision has been made. 

The great thing about these tools is, by making the more mundane tasks of developing a disability claim easier, your representative can dedicate greater time to the real meat of your case. Our office staff in particular is well-versed in these tools that SSA offers, and we look forward to continuing to serve our clients in the most efficient capacity possible!

Written by Anna Westfall

Help is just right around the corner! We are conveniently located in Mentor, Cleveland, Akron, Canton, Lorain Youngstown, Toledo and Ashtabula. Click HERE for more information!

No Insurance? No Problem!

In order to prove disability, SSA must have access to your medical records. However, many claimants find themselves in a position where, due to the loss of employment, they do not have sufficient insurance coverage and/or funds to see their doctors and generate those much-needed medical records. 

There are other options, however. It may take some persistence, but when it comes to proving disability, finding some type of medical treatment is critical if a claimant wants to prevail and obtain the benefits they need to survive.

Hospital Rating Systems

In the Cleveland area, hospitals like MetroHealth Medical Center have a rating system for patients who cannot afford care. MetroHealth’s website states that they will provide certain basic medically necessary hospital services, as long as the patient is a resident of the state of Ohio, is not currently receiving Medicaid, and meets Federal Poverty Guidelines in regards to income. The hospital also covers other services for Ohioans who are at or below 400 percent of the Federal Poverty Level.

Many major hospitals have similar programs for low income families and adults. Contact your local hospital and ask to speak with the financial assistance department to find out if they offer this type of help.

Free Clinics

Most major cities also have area free clinics that offer many basic services for free or very low cost. Free clinics are typically funded by local donations and are often staffed by student doctors. Most free clinics offer acute, non-emergent care. Some offer on-going preventative care and even dental care. Free clinics are open to anyone who lacks insurance, and/or do not qualify for Medicare or Medicaid.

If you are unsure if there is a free clinic in your area, visit http://www.needymeds.org/free_clinics.taf , which lists free clinics by state.

The Health Department

Similar to free clinics, your local health department may offer either basic low-cost or free medical care. Here in Cleveland, the health department boasts three wellness clinics that offer access to free vaccinations for children, free lead screenings, pregnancy tests, TB tests, family planning and HIV testing. 

The phone number to your local health department can usually be found in the phone book, and most government agencies have websites online explaining the services they provide as well as their contact information.

The Drug Store

It has become a recent trend for drug stores, such as Walgreens and CVS, to start offering some basic services right within their store. Most of these mini-clinics can diagnose, treat, and write prescriptions for common family illnesses, provide routine vaccinations and lab tests, as well as treat minor wounds, abrasions and sprains (minuteclinic.com). 

Most services for people without insurance cost under $100.00, and the clinics are staffed by certified nurse practitioners. Check out the costs and services CVS offers here. See what Walgreens has to offer by clicking here.

No matter where you decide to treat, it is a great favor you do for yourself to have the conditions that disable you not only properly treated, but well-documented by a healthcare professional. This is how SSA sees what’s really going on in your disability claim. If you require further assistance seeking treatment in relation to your disability claim, contact us today to find out how we can help.

 Written by Anna Westfall

We do whatever it takes to win your case!! If you live near Akron, Canton, Youngstown, Lorain, Toledo, Cleveland, Ashtabula or Mentor (or even if you don't!), contact us today to find out how we can help you!