Now You Can Check Social Security Judge Approval Rates

In Portland, Oregon, the local newspaper called The Oregonian has done a great service to Social Security claimants and the public. For what I believe is the first time, Social Security has released statistics about how often Social Security Administrative Law Judges approve disability cases. The Oregonian did a Freedom of Information Act request and obtained the information. Now, you can go to their website and type in a Judge's name and search their approval rates for 2006, 2007, and 2008. Here is the link: http://www.oregonlive.com/special/index.ssf/2008/12/social_security_database.html?app


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

In Florida - Creditors Cannot Seize Disability Income Payments or Disability Benefits

In these touch economic times, more and more people find they cannot pay their debts.....credit cards, car loans, rent, etc. As creditors start suing people, those on disability can be hit very hard. However, there is some protection. Florida has a law that prohibits creditors from taking disability insurance payments. That's right. It's Florida Statute Section 222.18, and it reads:

"Disability income benefits under any policy or contract of life, health, accident or other insurance of any form, shall not in any case be liable to attachment, garnishment or legal process in the state, in favor of any creditors or creditors of the recipient of such disability income payments unless such policy or contract of insurance was effected for the benefits of such creditor or creditors."

This means that your creditors cannot sue you, get a judgment and then seize your disability insurance payments...UNLESS your disability insurance was taken out to help pay a specific debt to that creditor if you became disabled, such as credit disability insurance on a credit card or car loan. Any other creditor cannot take your disability payments.

So, there is some protection in the law for the disabled after all.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

Some Startling Disability Insurance Facts

The website, protectyourincome.com, states the following facts about disability insurance and disability benefits:

1. Someone who is 35 years old has a 50 percent chance of disability for 90 days or more before they turn 65.
2. Most people in the U.S. are better prepared financially in case of death (usually with life insurance) than if they get disabled, even though the chances are at least three to five times greater (depending on age) that a disability will occur.
3. Upwards of 375,000 Americans become totally disabled every year.
4. Approximately one out of seven people who are between the ages 35–65 can expect to become disabled for five years or longer.
5. Almost 30 percent of the people who are between the ages 35 and 65 will experience a disability that lasts at least 90 days during their working careers.
6. About 110 million Americans do not have long term disability insurance.
7. About 8 million adults have some disability that limits or prevents them from working.
8. 46 percent of all foreclosures on conventional mortgages are brought about by a disability. Approximately 2 percent are caused by the death of the homeowner.
9. Benefits from an employer plan are taxable. Individual policies, purchased as an individual pay benefits free of income tax.
10. Most people, no matter their income, spend 65 percent to 75 percent of their cash flow. In thinking about this, this means a person should aim toward securing as much disability income insurance they can toward the goal of replacing such income.
11. If you put away 10 percent of your income each year, then simple arithmetic says that one year of being totally disabled could wipe out the 10 years of principal that you put into your savings.
12. How good is social security disability income? Anyone at any income level can apply for Social Security Disability Insurance but one requirement is that you have to have worked at least 10 years before becoming disabled.
13. The Social Security disability Insurance program pays $722 per month on average. The requirements to receive disability benefits are so strict that only about 35 percent of the individuals that apply for benefits actually qualify and wind up receiving benefits.
14. The most common chronic conditions listed for limitation on working are back disorders (21 percent), followed by heart disease and arthritis.

Source: www.soundfinancialplan.com, from the MDRT

Having disability insurance is a key component to anyone's financial plan. The key is to buy good coverage. If you have a claim, hiring a disability benefit attorney will help you document your claim well and avoid a coverage denial.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

DISABILITY BENEFIT TIP OF THE WEEK: Long Term Disability Claims....Deadlines - Do NOT Miss Them

While every Long Term Disability policy and plan is different, they all impose deadlines that a claimant has to meet to file for disability benefits, to appeal a denial of those benefits, and to file a lawsuit once you have gone through the pre-suit claim process (what insurance companies call "exhausting administrative remedies").

When you first stops working because of a disability, you must apply for disability benefits and provide proof of your disability (i.e., medical records, vocational records, performance reviews that comment on your inability to do the job, "buddy letters" from friends or co-workers that know you and have observed your limitations, etc.). The deadline that applies to filing for benefits and providing proof of that disability can usually be found under the heading "Proof of Loss" in you policy or company's disability benefit plan. Policies and plans will require that you submit you application and proof of disability anywhere from within 30 days to up to a year after the date you stopped working. If you do not notify your insurance company within that deadline, the insurance company could deny your claim.

If your benefits are denied, or paid and then terminated, you will be provided a chance to appeal that decision. Again, different policies and plans have different deadlines, as well as a different number of times you may appeal before filing a lawsuit. Most employer benefit plans allow 180 days from the date of the denial/termination letter to file an appeal. Individual disability insurance policies may not offer an appeal or may offer a very short appeal window of 30 or 60 days. Read your policy or plan to find our your deadline.

NOTE: If you did not receive your denial letter until much later than the date on the letter, look at the date on the envelope to determine if the letter was sent on the same day that the letter was written. If not, keep the envelope as proof that the insurance company delayed mailing this letter, as this may give you more time to gather the evidence you would like to submit for an appeal.

It is important to understand that your policy or plan may require one or more appeals before you file a lawsuit, so do not think you can skip that process. Missing the appeal deadline may cause you to lose your claim forever.

Once you have gone through the pre-suit appeals, you may file a lawsuit. Your plan or policy may state how long you have to appeal. If it does not, your state law will determine the statute of limitations to file a lawsuit. If you miss this deadline, you will lose your right to file a lawsuit to recovery your benefits forever.

REMEMBER: Read your policy or plan thoroughly to determine what deadlines apply to your particular claim. Failure to meet those deadlines could result in the denial of your claim. If you are not sure what deadlines you must meet, consult with an attorney who specializes in disability cases. We recommend consulting with a disability benefit attorney from the beginning of your claim, but you should certainly contact an attorney if your claim has been denied before you file an appeal.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For a free consultation about your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker Toll Free at (866) 282-5260.

Multiple Sclerosis Patients With Relapsing-Remitting MS May Get Relief From New Drug

The National MS Society is reporting a study on its research page that may of interest to those with Relapsing-Remitting Multiple Sclerosis. The study, titled Oral FTY720 (Fingolimod) Reduced Relapse Rate More Effectively Than Avonex in Initial Results of One-Year Study on relpasing-remitting Multiple Sclerosis, addresses the impact of an experimental drug called FTY720 on relapsing-remitting Multiple Sclerosis. The drug is a Novartis product which is also referred to by its tradename, Fingolimod. It is still in clinical trials. Novartis hopes to begin the FDA approval process for Fingolimod in 2009 according to the article.

With any luck, this new medication may reduce the impact of MS on people with relapsing-remitting MS, as well as reduce the incidence of disability due to MS.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260. Disability benefit attorney John Tucker is a member of the Board of Trustees of the Mid-Florida Chapter of the National Mutliple Sclerosis Society, and has represented many individuals with MS in disability insurance and disability benefit claims.

Florida Social Security Hearing Offices Continue to Face Huge Scheduling Delays For Disability Hearings

Social Security Administration Statistics released on October 30, 2008 reflect that Social Security's Florida hearing offices continue to have large delays before Social Security Disability hearings are scheduled with Administrative Law Judges.

Out of 148 Offices of Disability Adjudication and Review ("ODARs") in the U.S. and its territories, the Tampa hearing office ranked in the bottom fifth at 120th with a 593 day waiting time for the average disability hearing to be scheduled after a hearing request is filed. The Miami ODAR fared similarly, ranked 118th with a 592 day wait.

The Jacksonville hearing office was ranked 87th with a 477 day wait. The Orlando ODAR ranked 38th with a 393 day wait.

At the other end of the scale, the Ft. Lauderdale ODAR was one of the nation's best, ranked 5th out of 148, but still had a 264 day wait for hearings. Comparatively, the best ODAR in the nation, Mayaguez had a 146 day wait.

The sad part is that these waiting times reflect the wait that disability claimants have after they request a hearing. It does not include the time that the system eats up during their Initial applications for disability benefits and their first appeal, called Reconsideration. These 2 early stages can often take 6 to 10 months. When added to the hearing delay, many of our clients are waiting more than 3 years from the day that they apply for Social Security Disability benefits to get a decision from a Judge.



Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

Social Security Announces COLA for 2009

The Social Security Administration announced a 5.9% Cost of Living Adjustment ("COLA") for the coming year. This increase is the largest COLA since 1982. This is contrasted with the 2.8% increase Social Security adopted last year.

Other changes include the following:

• It will take $1,090 in earnings to earn one Quarter of Coverage in the Social Security System;
• If a non-blind person claiming disability earns $980 per month in 2009, they will be presumed to be engaging in Substantial Gainful Activity (i.e. earning too much to qualify for disability that month). A blind person may earn up to $1,640 per month.
• Trial work period caps are being raised to $700 per month.
  

SSI monthly benefits will increase from $637 per month to $674 per month for an individual.

The full list of changes can be found at ssa.gov or at 73 Fed.Reg. 64651 (Oct. 30, 2008).



Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

DISABILITY BENEFIT TIP OF THE WEEK: Pre-existing Conditions

When you file for Short and Long Term Disability, your insurance company will try to determine whether your disabling condition is a pre-existing condition. Depending on the provisions of your plan or policy, the period during which a condition would be considered pre-existing varies. Many plans/policies state that if you become disabled within the first 12 months of coverage, they will review your records for the year before you became eligible in order to determine if you treated for the same disabling condition. If so, they will consider it a pre-existing condition and deny benefits. For example:

Example A:

You begin working on January 1, 2006. You are eligible for Short and Long Term Disability coverage on April 1, 2006. You become disabled because of a car accident on October 1, 2006. Your plan/policy states that if you become disabled within the first 12 months of coverage that your insurance company will look back to your records for the 12 months before you were eligible for coverage - in other words back to April 1, 2005. Because you are disabled as a result of an accident after you became eligible for coverage, your insurance company will determine that your disablity is not the result of a pre-existing condition.

Example B:

You have a car accident on September 1, 2005, hurt your low back, and visit your doctor because of the pain. You begin working on January 1, 2006. You are eligible for Short and Long Term Disability coverage on April 1, 2006. On October 1, 2006, you stop working because your low back pain has increased to the point that you can no longer work. Your plan/policy states that if you become disabled within the first 12 months of coverage that your insurance company will look back to your records for the 12 months before you were eligible for coverage - in other words back to April 1, 2005. Because you went to the doctor for your low back pain during the 12 month period before you became eligible for coverage, your insurance company will determine that your disability is a result of a pre-existing condition.

Example C:

You have a car accident on September 1, 2005, hurt your low back, and visit your doctor because of the pain. You begin working on January 1, 2006. You are eligible for Short and Long Term Disability coverage on April 1, 2006. On March 1, 2008, you stop working because your low back pain has increased to the point that you can no longer work. Your plan/policy states that if you become disabled within the first 12 months of coverage that your insurance company will look back to your records for the 12 months before you were eligible for coverage - in other words back to April 1, 2005. Because you did not stop working until you were past the initial 12 months of coverage (i.e. April 2007), your insurance company will not look back to determine if you are suffering from a pre-existing condition.

Even if you have not been officially diagnosed with what your doctor concludes is the underlying cause of your disability, if you treated for the symptoms of the disability during the "look back" period, your condition will be considered pre-existing. For example:

You visit your doctor on December 1, 2005 because of numbness and tingling in your arms and your doctor diagnoses you with carpal tunnel syndrome. You begin working on January 1, 2006. You are eligible for Short and Long Term Disability coverage on April 1, 2006. Your symptoms worsen and you stop working on October 1, 2006. On November 1, 2006, your doctor discovers that you actually are suffering from Lupus, not carpal tunnel syndrome. Your plan/policy states that if you become disabled within the first 12 months of coverage that your insurance company will look back to your records for the 12 months before you were eligible for coverage - in other words back to April 1, 2005. Even though you did not have the same diagnosis during the "look back" period, you still treated for the same symptoms, and your insurance company will consider your condition to be pre-existing.

REMEMBER: It is extremely important to read your plan or policy to find out when you are eligible for benefits and when you are out of the "look back" period. If you suffered from any of the same symptoms during the period in question, your condition will be considered pre-existing. If you are not sure when you will be out of the pre-existing condition/"look back" period, consult with an attorney before stopping work.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

DISABILITY BENEFIT TIP OF THE WEEK: Applying for Social Security Disability After Age 62

If you are close to or over the age of 62 and become disabled and unable to work, you may be tempted to simply forget about applying for Social Security Disability ("SSD") benefits and instead just take early Social Security Retirement benefits. However, you can maximize your benefits later on if you successfully pursue the SSD benefit.

SSD benefits are calculated to approximate the amount of money you would receive as your full retirement benefit. Your full retirement benefits are usually much higher than the amount of your early retirement benefit - often by 30% or more. If you are approved for SSD benefits, you will become "fully insured" for retirement benefits and be paid your entire benefit (the extra 30%) when you reach full retirement age. Over many years, the money can really add up if you pursue SSD benefits instead of early retirement.

Even if you are currently receiving early retirement benefits, you can still file for SSD benefits if you are under the age of 65. If your claim is approved, you will receive back pay for the amount of the difference between the two benefits.

REMEMBER: EVEN AFTER THE AGE OF 62, CONSIDER APPLYING FOR SSD BENEFITS IF YOU ARE NO LONGER ABLE TO WORK. A SUCCESSFUL CLAIM COULD MEAN EXTRA BENEFITS FOR YOU IN THE FUTURE.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

Check out SSAConnect - a good bulletin board for Social Security Disability Q&A

From time to time, I recommend another law firm's site or blog simply because it is very useful for people going through the disability benefit claim process. One site that I suggest you read is SSAConnect. It is a good site with a fantastic bulletin board. You may find some answers to your questions about Social Security Disability there or you may want to add a post and see what you answers you get.

As always, feel free to contact The Disability Law Firm if you have any questions about applying for any type of disability benefits.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

Disability Benefit Tip of the Week: How to Talk to Claims Administrators and Insurance Adjusters

In last week's Disability Benefit Tip of the Week, we suggested that every time you talk to someone about your disability claim, you should keep notes about who you speak with, including their name, phone number and extension, the date, and the time, as well as what you discussed. Here are some additional tips for speaking with claims administrators.

It is important to remember that when dealing with adjusters that they are paid by the insurance company (or an ERISA plan's third party administrator). They have a vested interest in denying your claim. The insurance companies are running a business, and they only make money when they collect more money in premiums than they pay out in benefits. That means they are looking for reasons to deny your claim.

When you speak with someone from the insurance company, they are taking notes on what you say and how you sound. These notes are kept in their computer with other information on our claim and can be used as evidence against you from your initial application all the way to a lawsuit. Even if you are "on claim" (being paid benefits on a monthly basis), the claim administrator will examine your statements. If you say something that indicates that you might have the capacity to work or something they might think is inconsistent with what you have said in the past, they will use that as a reason to deny your claim or cut off your benefits or to step up their investigation of your claim.

Simple statements about what you do during the day are recorded in the insurance company's logs. For example, if you mention that you enjoy sewing, your insurance company may allege that you are capable of sedentary (sitting) work. Another example would be that you mention you are looking into taking online classes. Even if you have not started the actual classes, the insurance company may try to use this to deny the claim, saying that you are capable of work activity.

Therefore, when speaking with your claim adjuster or adjudicator, do not speak with them as if they are a friend, no matter how nice or sympathetic they may be. You should be polite and respectful, but you should also be aware of what information you are providing. Be careful, because everything you say is on the record, even if you think it does not pertain to your claim.

REMEMBER: THE CLAIM ADMINISTRATORS AND INSURANCE ADJUSTERS ARE NOT YOUR FRIEND. AN INSURANCE COMPANY IS ALWAYS LOOKING FOR REASONS TO DENY YOUR CLAIM.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

TODAY WE HONOR OUR VETERANS

In recognition of Veteran's Day, we want to honor our nation's veterans.

For those that have sacrificed in service to the United States, we thank you. We particularly want to recognize those whose service led to a disability. We have the honor of representing many of you, and we know the price you have paid.

And for those who lost a loved one in service to our country, our prayers are with you as we remember our fallen heroes.

We are humbled to recognize these men and women. Our thanks will never be enough for your service.

Disability Benefit Tip of the Week: Documenting Your Correspondence

In order to ensure that your insurance company and Social Security received any letters, forms, or records that you sent, it is a good idea to use the following guidelines:

• Send everything via certified mail, return receipt requested
• If you do fax something, save the confirmation page
• Keep copies of everything you send to the insurance company or Social Security, including reports and forms you fill out
• Keep notes about who you speak with, including their name, phone number and extension, the date, and the time, as well as what you discussed
• Use some kind of organizational system, such as folders or a three-ring binder, to store and sort any correspondence. Keeping paperwork in order according to date is also a good idea. If you need to hire an attorney in the future, it will help him or her quickly understand the progress of your claim.

Keeping copies of any forms that you fill out will help you stay consistent when the insurance company or Social Security asks you to fill out similar forms in the future.

REMEMBER: You cannot be too thorough in documenting and tracking your claim. It is better to have too much information than not enough.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

What is ERISA and How Does It Apply to Your Disability Claim?

What is ERISA? It is shorthand for the Employee Retirement Income Security Act, a federal law passed in 1974 that regulates employee benefits for all private employers (those which are not the government or a church).

What does ERISA have to do with your Short Term Disability ("STD") or Long Term Disability ("LTD") claim? If you have STD or LTD insurance through work, then ERISA applies to your coverage. If you have become disabled and have to file a claim, your claim is going to subject to ERISA. That means that you lose a lot of rights that people who buy individual STD or LTD coverage have under state law. The federal ERISA law allows federal courts, not state courts, to hear ERISA disability claims. ERISA also prohibits jury trials like you might get in state court. Finally, many states require insurance companies that lose disability cases in court to pay your attorney fees, but under ERISA, it is an option that the federal judge may require, but often does not.

Finally, the most important thing to understand about ERISA claims is what is called the "standard of review." This is the method a judge uses to review your claim if it goes to court. Under ERISA, most STD and LTD cases are reviewed under an abuse of discretion standard of review on motions submitted by both parties. There is no trial, and the judge has an obligation to uphold a denial if there is any reasonable basis for the insurance company's decision to deny the claim. Compare that to state court where a jury would get to hear from you and your doctors in a real trial if you have bought your own insurance from a local insurance agent outside of work. In fact, all of the evidence in an ERISA case gets created before a case is finally denied. If you have an ERISA claim, be sure to get all of your doctors records, opinion letters, forms and other information in support of your claim in to the administrator BEFORE you get the last denial letter. If you wait, you will not be able to get it into evidence in court.

In many ways, ERISA works in favor of plan administrators - usually an insurance company. You should hire an experienced ERISA attorney if you become disabled and have STD or LTD coverage through work.



Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.

Veterans Administration Shredding Documents By Mistake!

You may have heard of the problems the Veterans Administration ("VA") has had with document shredding. If not, check out these articles from the St. Petersburg Times about horrible problems at the VA's Florida Regional Office at Bay Pines here in Pinellas County:

http://www.tampabay.com/news/military/veterans/article867002.ece
http://www.tampabay.com/news/military/veterans/article868654.ece
http://www.tampabay.com/news/military/veterans/article870556.ece
http://www.tampabay.com/news/military/veterans/article860293.ece
http://www.tampabay.com/news/military/veterans/article867002.ece
http://www.tampabay.com/news/military/veterans/article868654.ece
http://www.tampabay.com/news/military/veterans/article870556.ece

To say that this is disgraceful is an understatement. We are advising our clients that they only send things to the VA by certified mail or some other means that offers proof of delivery (like FedEx or UPS or courier). If you hand deliver something, write up a receipt and have someone sign it, print there name and write the date you delivered it on the receipt.

Here are some tips to prove to the VA that you submitted materials in support of your application for VA service-connected compensation or VA pension disability:

1. Use certified mail. Whatever you do, get proof that it was received.
2. If you have deliver anything, have the person that takes it sign a receipt.
3. When you go to a VA Medical Center, get copies of your records.
4. If you deliver or send anything to the VA, KEEP A COPY FOR YOUR RECORDS.
5. If you speak to anyone at the VA about your claim file ("C-File"), get their name, and write it down with the date and time you spoke to them.
6. When you send things to the VA, send a cover letter explaining why you are submitting materials, and list the documents you are sending them as enclosures.

You do not want to be one of the vets who is wondering if the VA shredded your documents. But if you have the misfortune of the VA doing that to you, you need to be able to proof what you sent and when they got it.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved.

Tucker & Ludin - The Disability Law Firm - Opens Tampa Office

John Tucker and Tucker & Ludin, P.A. announce the opening of a new location in Tampa. Located in Westchase, a suburb in West Tampa, the office will service the firm's many Hillsborough County residents. Individuals living in Tampa, Lutz, Oldsmar, southern Pasco County and north along the Veterans Expressway/Sunshine Parkway corridor will find it more convenient to meet with the firm's attorneys at this new office.

The Tampa office is located at 12027 Whitmarsh Lane, Tampa, FL 33626, just off the corner of W. Linebaugh Avenue and Countryway Blvd. (in the office park next to the 7-Eleven store).

Phone numbers: Tampa: (813) 594-5000 or Toll Free at (866) 282-5260.

Se Habla Espanol. Office hours by appointment.

Tucker & Ludin, P.A. is The Disability Law Firm handling all types of disability benefit claims, including Long Term Disability insurance, ERISA, Social Security Disability & VA Disability claims.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved.

Disability Tip of the Week: Taking Medication

When prescribed medications by your doctor, it is important to be compliant. If you do not take your prescribed medications, the Social Security judge or the Long Term Disability insurance company may view your claim unfavorably because you did not follow your doctor's orders and take the medication you were supposed to. They may claim that your condition is not as serious as you report it to be since you do not take your medications.

If you are not able to take the prescribed medication, ask your doctor to write clearly in his or her notes why this is the case. For example, if you find out that you are allergic or have unpleasant side effects, this should be clearly written in your medical records.

Likewise, if you do not have the money to fill a prescription, you should make every effort to seek help from social service organizations for assistance. Again, if you are unsuccessful and still cannot obtain the medication, make sure your doctor is writing this information down.

REMEMBER: Take your prescribed medications. There are many organizations that can help you afford your prescriptions.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Social Security Announces "Compassionate Allowances Program"

The Social Security Administration Press Release Reads:

Process Will Fast Track Applications For People with Cancers and Rare Diseases

Michael J. Astrue, Commissioner of Social Security, today announced the national rollout of the agency’s Compassionate Allowances initiative, a way to expedite the processing of disability claims for applicants whose medical conditions are so severe that their conditions obviously meet Social Security’s standards.

“Getting benefits quickly to people with the most severe medical conditions is both the right and the compassionate thing to do,” Commissioner Astrue said. “This initiative will allow us to make decisions on these cases in a matter of days, rather than months or years.”

Social Security is launching this expedited decision process with a total of 50 conditions. Over time, more diseases and conditions will be added. A list of the first 50 impairments -- 25 rare diseases and 25 cancers -- can be found at www.socialsecurity.gov/compassionateallowances.

Before announcing this initiative, Social Security held public hearings to receive information from experts on rare diseases and cancers. The agency also enlisted the assistance of the National Institutes of Health.

Compassionate Allowances is the second piece of the agency’s two-track, fast-track system for certain disability claims. When combined with the agency’s Quick Disability Determination process, and once fully implemented, this two-track system could result in six to nine percent of disability claims, the cases for as much as a quarter million people, being decided in an average of six to eight days.

"This is an outstanding achievement for the Social Security Administration," said Peter Saltonstall, President of the National Organization for Rare Disorders. "It has taken Social Security less than a year to develop this much-needed program that will benefit those whose claims merit expedited consideration based on the nature of their disease. Disability backlogs cause a hardship for patients and their families. Commissioner Astrue and his staff deserve our thanks for a job well done.”

“Unfortunately, many hardworking people with cancer may not only face intensive treatment to save their lives, but they may also find themselves truly unable to perform their daily work-related activities and as result, may face serious financial concerns, such as the loss of income and the cost of treatment,” said Daniel E. Smith, president of the American Cancer Society Cancer Action Network. “The Social Security Administration’s Compassionate Allowances program will help streamline the disability benefits application process so that benefits are quickly provided to those who need them most.”

“This is America, and it simply is not acceptable for people to wait years for a final decision on a disability claim,” Commissioner Astrue said. “I am committed to a process that is as fair and speedy as possible. The launch of Compassionate Allowances is another step to ensuring Americans with disabilities, especially those with certain cancers and rare diseases, get the benefits they need quickly.”

Good Chronic Fatigue Site

Anyone with Myalgic Encephalomyelitis (M.E.), Chronic Fatigue Syndrome (CFS) or Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) ought to check out the The ME and CFS Information Page written by someone named Mary M. Schweitzer, Ph.D.. I don't know Dr. Schweitzer, but her page is chock full of good information for anyone dealing with this problem.

DISABILITY TIP OF THE WEEK: Statute of Limitations for Disability Insurance and ERISA Disability Claims

Generally, if an insurance company or an ERISA plan administrator denies a claim, you have deadlines to file a lawsuit or you lose your right to pursue the claim in court. It is important to understand what the deadline may be, but most people do not know where to look to find that.

In Florida for example, in order to file a lawsuit against an insurance company for disability benefits (after you have exhausted your administrative remedies), you must do so within a certain time frame. Florida Statute Section 627.616 states that no legal action may be brought before 60 days after written proof of loss has been given, nor can a legal action be brought after the expiration of the applicable statute of limitations from the time written proof of loss is required to be given. According to Florida Statute Section 95.11, you must file your lawsuit within 5 years. Other states have different statutes.

However, many plans/policies shorten that amount of time to three years or even less. Some ERISA plans have deadlines as short as 60 days after the last denial letter! Even if your state's statute of limitations is 3, 4, or 5 years, courts typically enforce the shorter deadlines in the plan/policy.

Therefore, you should request a copy of your plan document/policy from your insurance company and/or your former employer so that you can find out what the statute of limitations is to file a lawsuit.

REMEMBER: It is important to read your plan/policy carefully for language that states what the deadline is to file a lawsuit. If the plan/policy does not specify what the statute of limitations is, then your state's statute of limitation applies.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

DISABILITY TIP OF THE WEEK: Unemployment Payments

If you file for unemployment when you leave your job due to a disability, you damage your chances of receiving Long Term Disability benefits from your insurance company and from the Social Security Administration. When you file for unemployment, you are certifying that you are capable of working. This, obviously, undermines your credibility because if you certify that you are capable of working, your insurance company and the Social Security Administration will think that you are, in fact, capable of working.

If you receive unemployment benefits and you file for Social Security Disability ("SSD"), your SSD benefits may be reduced by the amount you received for unemployment.

REMEMBER: Even though it is tempting to apply for unemployment in order to have income while you are waiting for your disability benefits, this could ruin your claims for those disability benefits. If you have filed for unemployment, make sure you let your attorney know.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Social Security Cost of Living Increases to Be Announced on October 16th

On October 16, 2008, the Social Security Administration is expected to announce cost of living increases for Social Security Disability and other Social Security benefits. Some estimates have the COLA ("cost of living adjustment") coming in around 5%, a very high figure compared to past increases. Stay tuned for the announcement.



Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

DISABILITY BENEFIT TIP OF THE WEEK: When should I apply for Social Security Benefits?

In general, you should apply for Social Security Benefits as soon as possible. First, you want to get the process started as soon as possible. The initial decision can take anywhere from 3-6 months. If you are denied and must appeal, it can take another 3-6 months for the reconsideration. If you are again denied, it can take 12-24 months to get a hearing, depending on where you live. This means that the entire process can take up to 3 years! The sooner you apply, the sooner you can get the process started and the faster you can get your benefits.

By applying sooner rather than later, you can also maximize the amount of your benefit. Under the Supplemental Security Income ("SSI") program, your benefits are only payable from the first full month after the date you apply. For example, if you apply on September 30, 2008, your benefits would start as of October 2008, but if you wait until October 2, 2008, your benefits would not start for another month (November 2008). Just a few days of waiting can mean losing a month's worth of benefits.

Under the Social Security Disability program, your benefits are only payable for up to a year before you apply, depending on the date of the onset of your disability. Again, the longer you wait, the less money you are eligible to receive.

REMEMBER: Waiting to apply can cost you money! After getting your paperwork together and making sure your doctor is on board, you should submit your application to Social Security and get the process started.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

DISABILITY BENEFIT TIP OF THE WEEK: How often should I see my doctor?

One of the things that both insurance companies and the Social Security Administration use to determine if you are disabled is the frequency with which you visit your doctors. Here are a few pointers.


Long Term Disability

• Most insurance companies would like to see you treating once a month to once every two months.
• Most insurance companies have a provision that requires you to be under the "regular care of a physician." You can find out what the definition of regular care is by reading your plan document.

Social Security Disability

• Social Security generally weighs the opinion of a "treating physician" more heavily than a one-time evaluating physician. A treating doctor is one that has seen you at least three times.
• Social Security also values the opinions of specialists (i.e., rheumatologists, oncologists, orthopedists) more than general practitioners (i.e., internists and family medicine doctors).
• Most of the time, it is better to see a doctor with an M.D. or D.O. degree than a doctor of eastern medicine, a chiropractor (D.C.), physical therapist, or nurse.
• In general, you should be seeing a doctor at a minimum of once every 2-3 months, though more is better.

REMEMBER: The more frequently you treat, the more credibility you have and the more documentation you will have of your disability. In order to make sure you have proper documentation, please click here and here for additional tips.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Americans with Disabilities Act Amended

President Bush signed the ADA Amendments Act (the "ADA-AA") of 2008 into law today. The new law will be effective on January 1, 2009. This law was Congress' fix in response to a recent Supreme Court case which construed the terms "disability" and "significantly limits a major life activity" in a way that have drastically limited the group of Americans that truly can benefit from the ADA.

The ADA-AA significantly changes court interpretations of the ADA as follows:

• It explicitly removing the Supreme Court's requirement that mitigating measures (like taking medication) be considered when evaluating whether an individual has a disability within the meaning of the ADA;

• It included language in the findings and purposes section to clarify that the courts' previous interpretations of the term "substantially limits" [in the phrase "substantially limits a major life activity"] was wrong;

• It defines the phrase "major life activity" to include "operation of a major bodily function" such as the neurological, circulatory, and reproductive systems, though other bodily functions may also be included as well;

• It clarified that a physical or mental limitation that is episodic or in remission is a disability if it would substantially limit a major life activity when active;

• It ordered the courts to interpret the ADA liberally, not restrictively;
  

• It aligned the definition of "disability" under other federal laws, such as the federal Rehabilitation Act, which covers federal, state, and local government employees, to the ADA-AA. However, it did not include ERISA plans - employee benefit plans that offer disability benefits - or insurance policies in this new definition, so ERISA plan sponsors are still free to define disability however they like (so you must read an employer's disability plan or an insurance policy to see what conditions are needed to get paid disability benefits.
  

It will be interesting to see what impact this new law will have on the meanings of these terms in other disability contexts. It will also be interesting to see if the Long Term Disability insurance carriers and ERISA plan administrators change their attitude toward work accommodations, as many have long said that a disability that could be accommodated under the ADA meant that a person could work, despite language in disability insurance plans and policies that seem to say exactly the opposite.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved.

DISABILITY TIP OF THE WEEK: Surveillance

"Surveillance" is video taken of you in secret when you do not expect it.

Most insurance companies hire private investigators to perform surveillance on their Long Term Disability claimants. They will film you, and often use the footage they obtain to prove that you are capable of more than you claim on the various forms they require you to complete. This is particularly common on the days surrounding an examination they have scheduled for you with one of their doctors (the so-called "independent medical exam").

Most investigators will spend a period of two to three days obtaining video footage of you around your home and running errands. They will not be filming inside your home, but will find an inconspicuous place near your home from which to film. They may also interview your neighbors for additional information.

Some things to keep in mind:

• If you and/or your doctor say that you cannot bend at the waist, the investigator will attempt to get footage of you bending over to do something simple like check your mailbox.

• If you and/or your doctor say that you cannot lift over 10 pounds, they will try to get footage of you lifting heavy groceries.

• If you and/or your doctor say that you cannot sit for more than 20 minutes, the investigator will try to get footage of you driving for long periods.

If you do something out of the ordinary, like take a long road trip, be sure to stop frequently, keep receipts from those stops, and document the trip and any physical consequences you experience as a result (for example, increased back pain, etc.). Be sure to tell those around you of any of the extra pain or other consequences you experience so that they can attest to it later. Do not "gut it out" just to save time or avoid being a bother to others you are traveling with.

If your insurance company gets surveillance footage that it considers incriminating, they will often send a field representative to your house to interview you. They will ask about your daily activities in hopes that you will use absolutes like, "I NEVER drive long distances," or "I CANNOT bend over." They will record your responses on a computer (not necessarily in your own words), print it out, and ask you to sign the record. Once they have your written statement, they will use that to question your credibility (if they have video footage of you driving long distances or bending, etc.). If your insurance company sends someone to interview you, be sure to avoid absolutes like those stated above. If you have an attorney, do not speak to the field representative without your attorney present. Do not sign any statement if it does not accurately represent the whole truth. Do not be afraid to tell the field representative to change anything on the written statement that you do not agree with.

REMEMBER: The insurance company can request surveillance of you at any time throughout your claim. Just because you have been approved does not mean that they will not try to obtain evidence that you are not disabled.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved.

DISABILITY TIP OF THE WEEK: How long do I have to appeal?

ERISA PLANS
Every disability insurance plan is different, but those that are governed by the Employee Retirement Income Security Act ("ERISA") must allow you an opportunity to appeal if your claim is denied. The letter denying your benefits must tell you how long you have to appeal. Usually you will have 180 days from the date of the denial letter to appeal. Once your plan administrator has received your appeal, it will have 45 days to render a decision. If necessary, your plan administrator can take an additional 45 days. If they take longer than 90 days, your attorney can advise you whether filing a lawsuit is advisable. In some instances, your insurance provider will pay you a lump sum "by exception" while they continue to review your claim beyond the 90 day deadline.

Most plans have a provision that requires a second appeal before filing a lawsuit. The deadline to appeal varies, but is often another 180 days. Again, the plan administrator can take 45 to 90 days to render a decision.

INDIVIDUAL POLICIES
Every individual policy has different deadlines. The letter denying your claim should tell you how long you have to appeal. Your policy will also have a provision that explains the appeal process and any deadlines.

SOCIAL SECURITY
If your claim for Social Security Disability benefits is denied, you are allowed 60 days to file an appeal from the date of the denial, plus 5 days for mailing. If you miss the deadline, you will be required to start the process over from the beginning. At the initial application phase, as well as after you have filed a Request for Reconsideration, the Social Security Administration can take anywhere from 3 to 6 months to make a decision. If your claim is denied after your Request for Reconsideration you again have 60 days plus 5 days for mailing to appeal.

REMEMBER: Every plan is different, whether governed by ERISA or not, so be sure to request a copy from your insurance carrier or employer. Pay close attention to the deadlines stated, or you could lose your chance to appeal or file a lawsuit.



Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Disability Benefit Tip of the Week: Social Networking and Personal Websites

With the growing use of computers, many claimants have social networking and personal websites (such as Myspace.com and Facebook.com). These webpages can be viewed by anyone, including your insurance company and the Social Security Administration, even if you designate them to be private. If you have one of these sites, be aware that anything you put on it could be used against you - including pictures, videos, blogs, and even comments from your friends. For example, if you are claiming total disability due to back injuries but there is a picture of you hiking a mountain, this could ruin your case. Also be conscious of how frequently you update your site. If you are spending a lot of time working on the computer, your insurance company may claim you are capable of doing sedentary or desk work.

REMEMBER: When in doubt, leave it out! Even if you delete content from a site, insurance companies can use technology to view old versions of the page. While social networking sites are a great way to stay in touch with friends and family, err on the side of caution.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Radio Story on the Wait for Social Security Disability Benefits

Click here to hear or read a story from American Public Media's Marketplace program, aired on 9/4/08, about the wait for Social Security Disability benefits.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

DISABILITY BENEFIT TIP OF THE WEEK: Buddy Letters

While building your disability case, it is often helpful to have input from friends, co-workers, or relatives. These “buddy letters” help to paint a picture of your life before and after the onset of your disability and can be submitted to the insurance company or the Social Security Administration. You can give the following guidelines to whomever is writing the letter on your behalf.

While writing your buddy letter, be sure to follow the guidelines provided below. These guidelines were designed to help you write the most effective letter. When possible, describe concrete examples of experiences which are pertinent to your friend/relative's disability. Once you have completed your letter, his/her attorney should review the information

• Talk only about things you have witnessed.
• Do not rely on something your friend/relative may have said as material for your letter.
• Describe your relationship with your friend/relative. Include activities that your friend/relative was able to do prior to the disability, and how he/she is limited in those activities presently – Going to the park, driving a car, playing any kind of sports, or participating in hobbies. If he/she can no longer do such an activity, say so.
• Explain any lifestyle changes that you have seen in your friend/relative since the disability – Has their personal hygiene changed, are they wearing different clothing to accommodate for the disability, has their overall appearance changed at all?
• Talk about his/her ability to socialize – are their conversation skills affected by the disability, can they remember words, does their disability cause them to be easily irritable when dealing with other people?
• Describe any changes to his/her organization since the disability – Are their personal belongings still kept in order, can he/she keep track of obligations such as paying bills, meeting with people, or doctors appointments?
• Describe any changes in routine activities – Can he/she still go grocery shopping, complete household chores, care for pets?
• While completing this letter be as specific as possible. Instead of saying, “his/her head hurt,” say, for example, “she/he was wincing in pain because of a headache, she had to take 2 Advil and rest on the coach for 2 hours.”
• While writing this letter, try not to exaggerate in an effort to help your friend/relative. It has to be a truthful account of your experiences with him/her.
• Make sure to cite to particular examples throughout the letter. If he/she used to participate in a hobby, describe that hobby, how he/she participated, and how he/she is no longer able to participate. Giving dates of incidents and lengths of time are also helpful. If it took him/her 45 minutes to do an activity that normally would take 15 minutes, include that in your letter.
• Do not give a medical opinion. If you accompanied your friend/relative to the doctor, you can describe the events, however, do not say, “he/she is no longer able to work.”
• Stay within the bounds of your personal knowledge and experience with your friend/relative.

REMEMBER: To write an effective buddy letter, be specific with examples of what you have personally witnessed and do not rely on what you have heard from other people. Your letter does not need to be long to be helpful, but it MUST be truthful.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

DISABILITY BENEFIT TIP OF THE WEEK: Offsets for Social Security

Like Long Term Disability, Social Security benefits can also be reduced ("offset") based on income and eligibility for other government benefits, which include:

• Worker's Compensation
• Government Pension Offset
• Windfall Elimination Provision

Worker's Compensation

• If you receive worker's compensation payments, your payments will offset your Social Security Disability and SSI benefits.
• Your worker's compensation settlement can be structured as a lifetime payout, thereby reducing or eliminating the offset. You should advise both your Social Security and worker's compensation lawyers that you would like your settlement to be structured this way.

The Government Pension Offset (GPO)

• Some individuals work for employers, such as the goverment, that do not withhold Social Security taxes and instead provide a pension for their work.
• "Individuals who qualify for noth a government pension based on non-Social Security-covered employment and a Social Security spousal benefit are subject to the Government Pension Offset (GPO) provision. The GPO provision reduces Social Security benefits that a person receives as a spouse if he or she also has a federal, state or local government pension based on work that was not covered by Social Security. The GPO reduction in Social Security spousal benefits is equal to two-thirds of the government pension." (CRS Report for Congress, 7/6/04).

The Windfall Elimination Provision

• If you work in a job where you did not pay Social Security taxes and you also work in another job long enough to qualify for a retirement or disability benefit, you will be subject to the Windfall Elimination provision.
• If you receive a pension from work where Social Security taxes were not taken out of your pay, a formula is used to calculate a lower Social Security benefit.
• For more information, see the Social Security Windfall Elimination Provision Electronic Fact Sheet.

REMEMBER: There are exceptions to these rules. If you have questions, call your local Social Security Administration office.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

John Tucker Receives "AV Rating" from Martindale-Hubbell...Highest Rating a Lawyer Can Receive

John Tucker, Managing Shareholder of Tucker & Ludin, P.A. - The Disability Law Firm - has received an "AV" Rating from Martindale-Hubbell. This rating is based upon confidential peer review surveys completed by members of the legal community that know about the skills and honesty of a particular lawyer.

The AV Rating is the highest a lawyer can receive. Martindale-Hubbell states that the AV Rating "identifies a lawyer with very high to preeminent legal ability," and reflects a lawyer's "expertise, experience, integrity and overall professional excellence."


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

What is ERISA?

ERISA stands for the Employee Retirement Income Security Act, a federal law passed by Congress in 1974. President Nixon signed ERISA into law after 10 years of study designed to reform the nation's pension system.

Congress ultimately included employer-provided insurance benefits as part of the law. That is why most Short Term Disability, Long Term Disability, and other insurance benefits that are offered by private employers are covered by ERISA. Keep in mind that ERISA applies only to employee benefits provided by private employers. If you work for a government entity or a church, ERISA will not apply to your claim. However, any private employer (even a small company with only one employee other than the owner) that provides employee benefits will be subject to ERISA.

With certain exceptions, ERISA creates one uniform system to administer these group benefit programs sponsored by employers. However, this “uniform system” is far from uniform. The law actually allows employers to establish nearly any type of benefit plan they wish, as long as they provide certain documents to employees and allow for an appeal when benefits are denied.

There are many differences between group benefit cases covered by ERISA and individual insurance claims regulated by state laws. If you or your lawyer do not know those differences and how to handle them, it can hurt your case. ERISA is much less consumer-friendly than state insurance laws, and the insurance companies that administer ERISA plans hide behind its protections to deny many group disability benefit claims that would not be denied if they were individual insurance claims.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

DISABILITY BENEFIT TIP OF THE WEEK: Offsets

Offsets for Long Term Disability Benefits
Depending on your Long Term Disability ("LTD") insurance plan, your LTD benefits may be adjusted to reflect other income benefits from various sources. These sources can include but are not limited to:

• Social Security Disability ("SSD") or retirement benefits
• Worker's Compensation
• Veterans Service-Connected Disability or Pension ("VA") benefits
• No-fault auto insurance settlements
• Other employer income
• Any payments from the Railroad Retirement Act
• Any state compulsory benefit act or law

For example, assume Bob is entitled to receive $1000 in LTD benefits and $800 in SSD benefits. Bob's LTD insurance carrier will deduct the $800 from his LTD benefit, leaving him with a $200 net LTD benefit.

In some instances, you may be entitled to a minimum benefit if your LTD is less than your other source of income. For example, if Bob was also entitled to a VA disability benefit of $300 a month, his net LTD benefits would be $0. However, some plans will still give him a minimum monthly payment. This amount will vary according to the plan.

If you are receiving an LTD benefit and have not been approved for SSD yet, your insurance company may estimate your SSD benefit and deduct it from your monthly payment. If they do not, be aware that if you are later approved for SSD and receive a lump sum payment, you will have to pay back the lump sum to the insurance carrier. Your insurance company will then begin deducting your monthly SSD benefit from their payment.

REMEMBER: If you are receiving LTD benefits, READ YOUR INSURANCE POLICY OR EMPLOYER'S BENEFIT PLAN. Know what sources of income the administrator or insurance company may use to offset your benefit. If you receive payments from any of these sources, make sure to tell your insurance carrier. If you do not, they will find out later, and you will have to pay them back!


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

DISABILITY BENEFIT TIP OF THE WEEK: Filling out Forms

During the initial application process and throughout the life of your claim, your insurance company, the Social Security Administration, and even the Veteran's Administration may require you to fill out various forms. One of the most common forms they will request from you is an Activities of Daily Living form. This type of form has various names, including things like "Claimant Statement," but the common elements are questions about what you can and can't do (i.e., your limitations). Whatever it is called, these kinds of forms are VERY important. Here are some tips for filling them out:

- Be thorough in your responses. Do not give one word answers. For example, if the forms asks, "Do you need help preparing meals?" Do not write simply write "yes." Tell them why you need help. For example: "It hurts to stand long enough to make a meal, so my wife usually prepares them for me."

- Be specific. Do not say, "I cannot sit for a long time." Instead, say something like, "When I sit for more than 20 minutes, my lower back starts to really hurt and I have to stand up and move around." Quantify your answers. "A long time" means different things to different people.

- Give examples of ways your disability has limited your activities. For example, "I only take a shower if I know somebody else is home, because I am afraid I will lose consciousness and fall and no one will be there to help me," or "I went to the grocery store last week but could not finish my shopping because my legs started to hurt too much to continue."

- Avoid absolute statements unless they are always true. Do not say something like, "I cannot sit for more than 20 minutes." Instead say, "It usually hurts when I sit for more than 20 minutes." Insurance companies often get surveillance footage of people making claims. If an investigator gets footage of you driving for 30 minutes without interruption and they have your written statement saying that you cannot sit for more than 20 minutes, they will deny your claim because they think you are lying. Another example might be if you say that you cannot bend at the waist, they might catch you leaning over to check your mailbox.

- List all of your limitations. Most forms do not include a section to list your limitations that are not physical. If you experience fatigue, difficulty concentrating, memory problems and/or irritability, etc., be sure to list those limitations.

-Do not be afraid to attach additional paper if the space provided for your answers is not sufficient.

In general, remember that you are trying to give the person that is deciding your claim a complete picture of your condition. Do not limit your answers simply because there is not much space provided for them. Always be truthful and thorough and it will help build your case from the very beginning.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Financial Help While You Wait for Disability Benefits

We often find that our clients are in need of financial assistance while waiting for their disability benefits to be approved. The following is a list of links that may be helpful.

General Resources
http://www.211.org/
http://www.ssa.gov/ – Go to “Find Local Office,” enter in the zip code, then go to “Local Agencies”
Department Children and Families – Medicaid, Discount Drug Card, other services

Prescription Help
RX Outreach

Brevard County
Health Department
Social Services

Citrus County
Health Department
Social Services

Hernando County
Health Department and Social Services

Hillsborough County
Health Department
Social Services

Manatee County
Health Department
Social Services

Orange County
Health Department
Social Services

Pasco County
Health Department
Social Services

Pinellas County
Health Department
Social Services

Polk County
Health Department
Social Services



Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

How Much Social Security Will Pay You?

You can visit Social Security's website and use the Social Security Benefit Calculator to estimate your benefits from Social Security.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Disability Benefit Tip of the Week: How to Apply for Social Security Disability

There are three ways you can apply for Social Security Disability benefits:

• Online: At the Social Security Administration's website (http://ssa.gov/applyfordisability/). By submitting an online application, you can complete both Social Security's Application and Social Security's Adult Disability and Work History Report online.
• By Phone: Call Social Security at their toll-free phone number 1-800-772-1213, and they will schedule an appointment to call you back.
• In-Person: You can also go into your local Social Security office and tell them you want to apply for Social Security Disability or SSI benefits. To find the closest Social Security office to your home, use Social Security's zip code office locater on their website.

Before starting the application, you will want to have the following information handy:

• The name, address, phone number, and dates of treatment for any doctors or hospitals that have treated your for your condition
• The name, prescribing doctor, and side effects of any prescription medication
• Your work history for the past 15 years, including the dates of employment and the type of work that you did.

If you do not provide Social Security with this information, your case may be decided with less than a full set of facts. This may result in an unfavorable determination simply because Social Security could not get the information they needed to make a decision.

REMEMBER: BEFORE APPLYING, MAKE SURE TO HAVE A COMPLETE LIST OF YOUR MEDICAL TREATMENT, MEDICATION, AND WORK HISTORY AVAILABLE


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

VA Finally Accepts ALS (also called Lou Gehrig's Disease) as Service-Connected Disability

The Baltimore Sun is reporting that the Department of Veterans Affairs ("VA") has decided to designate ALS, the disease also known as Lou Gehrig's Disease, as a service-connected disability for all veterans, regardless of their time in service. VA previously offered a presumption related to ALS only for veterans of the First Persian Gulf War. Vets from the first Gulf War have contracted ALS at an alarming rate. However, all veterans are more likely than the rest of the population to contract ALS.

ALS is a horrible disease which causes paralysis, but leaves a person's mind fully intact. Our research has shown that it often results in death in 3 to 5 years from the time a person starts showing symptoms and is diagnosed.

This was the right thing to do, and we applaud VA for making this decision. Of course, the devil is in the details, so we are waiting to see the final regulations which VA issues, but this is a step in the right direction.

Here is the full story in the Sun: http://www.baltimoresun.com/news/health/bal-te.als25jul25,0,5102561.story?track=rss


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

McCains Backs Law That Would Give the ADA Some Teeth Again

The Associated Press is reporting that Republican Presidential Candidate Sen. John McCain is backing proposed legislation that would extend the protections of the American With Disabilities Act to people people who take medicine to control epilepsy, diabetes or cancer, or use prosthetic limbs. The law has been largely made ineffective by the courts since it was enacted under the first President Bush. Democratic Presidential hopeful Sen. Barak Obama also supports the bill.

Here is a link to the full article: http://news.yahoo.com/s/ap/20080727/ap_on_el_pr/mccain_disabilities


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Senate Asks Disability Insurers to Turn Over Information About How They Handle LTD Claims

The New York Times is reporting today that Sen. Charles Grassley (R-IA), the senior Republican on the Senate Finance Committee, has sent information requests to 9 Disability Insurance companies requesting information about how they handle Long Term Disability ("LTD") Insurance claims. The 9 companies are Aetna, Cigna, Hartford, Lincoln (who recently bought Jefferson Pilot), MetLife, Prudential, Reliance Standard, Standard Insurance Company, and UNUM. The Senate is apparently investigating the common practice of having all LTD insurance applicants apply for Social Security, even though many do not qualify for Social Security Disability benefits.

Often, LTD insurance policies pay disability benefits when people cannot perform their own occupation, even if they can work in another type of job. This is commonly called "own occupation" coverage. However, Social Security requires that a person show they cannot work in other jobs too. Their system is based upon age, education and work experience, and for many that apply for Social Security Disability, they must prove there is no job they can perform. LTD insurance companies make people apply for Social Security Disability because their insurance policies usually allow they to deduct the amount Social Security pays from the LTD benefit they pay to their insured.

In my experience, each of the insurers which Senator Grassley is investigating have made people apply for Social Security, many of whom would never qualify. The Senator's investigation is geared toward determining whether these insurers are helping to create the huge backlog of cases at Social Security. What is worse, many people get Social Security Disability, and the insurance companies still deny their claims!


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Your Earnings - Being "Insured" for Social Security Disability and Why You Don't Want to Work Under the Table

Yesterday, a man called me to discuss his denial from Social Security. He had applied for Disability Benefits, but was turned down because he was not "insured." That means that he had no paid enough into the Social Security system to be covered. Unfortunately, he had too much in assets to qualify for Supplement Security Income ("SSI" - Social Security's indigent program). It turns out that he had worked "under the table" for several years, and never reported his earnings by filing taxes. I had to explain that I could not help him.

Social Security Disability ("SSD") payments are based on what you have paid in taxes. The government gives you credits when you work. Each year, you can earn up to 4 credits (one for each quarter of the year). You earn credits based upon how much money you earn. For example, in 2008, a worker will earn one credit for every $1,050 they earn and report as wages on their taxes. To get 4 credits for 2008, you will have to report $4,200 in earnings for the year. You can earn all of that money in just 1 or 2 months of the year, and still get all 4 credits; you do not have to actually work in each quarter.

The government views SSD as a form of disability insurance. To be eligible to apply for and receive SSD payments, you have to be "fully insured." There is no partially insured status. You either are or you are not. To get fully insured, you must have reported earnings on your taxes to the IRS and have earned at least 20 credits within the last ten years, i.e. the last 40 quarters. Young people in their late teens and twenties may be able to qualify with less than 20 quarters. Essentially, you have to have earned credits for half of the last 10 years to be insured today. Another way to say that is that you are "insured for disability purposes" if you earned 20 credits during the 10 years before you stop working due to your disability.

That means that a person who works 5 years in a row (earning all 4 credits in each of those years) will be insured for 5 more years, even if they stop working. They would have earned 20 quarters and could not work for 20 more quarters, but still be insured.

Here is a chart of explaining how much money you need to report in taxes each year to earn credits for this year and the previous 10 years:

2008 - To earn 1 quarter = $1,050; To earn all 4 quarters = $4,200
2007 - To earn 1 quarter =$1,000; To earn all 4 quarters = $4,000
2006 - To earn 1 quarter =$970; To earn all 4 quarters = $3,880
2005 - To earn 1 quarter =$920; To earn all 4 quarters = $3,860
2004 - To earn 1 quarter =$900; To earn all 4 quarters = $3,600
2003 - To earn 1 quarter =$890; To earn all 4 quarters = $3,560
2002 - To earn 1 quarter =$870; To earn all 4 quarters = $3,480
2001 - To earn 1 quarter =$830; To earn all 4 quarters = $3,320
2000 - To earn 1 quarter =$780; To earn all 4 quarters = $3,120
1999 - To earn 1 quarter = $740; To earn all 4 quarters = $2,960
1998 - To earn 1 quarter =$700; To earn all 4 quarters = $2,800
1997 - To earn 1 quarter =$670; To earn all 4 quarters = $2,680

I mentioned above that you have to report your earnings by paying taxes. That is how the Social Security Administration gets your eanings information. Each person has a Social Security account under their Social Security number, and the IRS shares your tax data with Social Security. You get credits as you work and pay taxes. People that earn more money get higher disability payments. Similarly, higher wage earners get a higher retirement benefit if they never become disabled, because Social Security uses your earnings over your lifetime to determine how much you get when you retire. However, people that "work under the table" who do not report their earnings on taxes, never get any credits.

You may think you are fooling Uncle Sam by not reporting your earnings, but in the end you are just fooling yourself. Bad things can happen to good people. If you become sick or injured to the point where you cannot work, all those years of working under the table may leave you destitute with no income. Along with Social Security Disability comes Medicare after a period of time. Those that don't pay taxes lose not only Disability Benefits, but also Medicare insurance.


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Apply for Social Security Disability....Online!

Did you know that you can apply for Social Security Disability benefits online? Yes, you can. It's easy. Simply go to the Social Security Website at http://ssa.gov/applyfordisability/, and follow the steps from there. It may take you some time to complete, but you can stop and start the application up to 3 times before you have to start over.

Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.

Insurers Faulted as Overloading Social Security

The following is a story quoted From the New York Times:
By MARY WILLIAMS WALSH

Published: April 1, 2008

The Social Security system is choking on paperwork and spending millions of dollars a year screening dubious applications for disability benefits, according to lawsuits filed by whistle-blowers.

Jessica Ortiz of San Diego said her disability insurer called more than 10 times after she was hurt in a car crash, insisting that she apply for Social Security. She was denied, as she had expected.

Insurance companies are the source of the problem, the lawsuits say. The insurers are forcing many people who file disability claims with them to also apply to Social Security — even people who clearly do not qualify for the government program.

The Social Security Administration defines “disabled” much more stringently than the insurers generally do, so it rejects most of the applications, at least initially. Often, the insurers then tell their claimants to appeal, the lawsuits say, raising the cost.

The insurers say that requiring a Social Security assessment is a standard practice and that there is nothing wrong with it.

The policies they sell allow them to coordinate their benefit payments with others to make sure no one is paid twice. Thus, if a disabled person can get benefits from somewhere else — like workers’ compensation, a disability pension or Social Security — the insurance company can reduce the benefit check by that amount.

The flood of referrals, however, is making it hard for Social Security to respond to people who are truly disabled, said Kenneth D. Nibali, the former top administrator of the Social Security disability program.

“Anybody who is forced to come into this system, and who doesn’t need to be there, is affecting someone else,” said Mr. Nibali, who retired in 2002 and is serving as an expert witness for the plaintiffs. “They’re holding up cases for the people who have been waiting for months and years, who in many cases are much worse off.”

Already, the disability program is in much worse shape financially than the old-age portion of Social Security. It is projected to run out of money in 2026, 16 years ahead of the old-age trust fund.

The disability caseload is also expected to grow as the work force ages, since recovery time increases with age. The number of people waiting for hearings on their claims by an administrative law judge has more than doubled since 2000, and the average wait has grown to 512 days in that time, from 258 days.

The Social Security Administration is not an active participant in the lawsuits and declined to comment on them. A spokesman, Mark Lassiter, said Social Security does not keep track of how many of its roughly 2.5 million annual applicants for disability are referred by insurance companies. But he cited academic research showing that 18 percent acknowledged privately that they were unqualified, because they could still work. “It is probable that many of these claimants were required to apply,” Mr. Lassiter said.

Jessica Ortiz, a 27-year-old gas station attendant in San Diego, said that was what happened to her. Her disability insurer, the Unum Group, called more than 10 times after she was hurt in a car crash, insisting that she apply for Social Security and asking repeatedly where her application stood. Unum was paying her only $50 a month under her policy, she said, which seemed a small amount to merit so much attention.

She did not need or want money from Social Security, and did not think she was entitled to it. Her doctors had told her she would recover, and Social Security is limited to people whose disabilities are total and permanent. But she applied because Unum insisted, she said.

Ten months after her accident, Ms. Ortiz returned to work. Social Security turned her down, as she had expected. People who can work are by definition unqualified for disability pay from the government. But when she told the Unum representative what had happened, he told her she could still appeal.

“If I were the government, I’d be pretty upset,” she said. “No wonder the pot could run out of money.”

When the circumstances of Ms. Ortiz’s case were described, a spokesman for Unum said he could not comment without reviewing her case file. The spokesman, Jim Sabourin, said the company believed that it always had valid reasons for telling people to apply for Social Security.

Forcing people who are injured to apply for Social Security before paying their claims appears to bolster insurers’ profits in several ways. If claimants refuse to apply, the insurers can simply stop paying their benefits, said Dawn Barrett, an employee of the Cigna Corporation, who grew frustrated sending people to Social Security and who is now a plaintiff in one of the lawsuits. More typically, she said, people apply for Social Security when an insurer tells them to. That allows the insurer to reduce its claim reserves, money that is kept in conservative investments for benefit payments. And in the insurance industry, smaller reserves mean bigger profits.

“It’s all about the numbers,” Ms. Barrett said.

Finally, disability insurers tell many of their claimants to appeal Social Security’s rejections again and again, until some are finally accepted. Then the insurers can take those people off their rolls, shifting the cost to the government.

Whistle-blowers have filed lawsuits against the Unum Group, America’s largest disability insurer, and Cigna, another large one, though there is no dispute that the Social Security requirement is an industrywide practice. Unum, with revenue of $10.5 billion, paid disability claims of $4 billion last year.

Both companies said their claims practices were fair, legal and consumer-friendly.

“Our goal is to ensure that each member receives all of the benefits to which he or she is entitled,” said Jill Roman, a spokeswoman for Cigna.

The lawsuits do not fault the idea of coordinating benefits with Social Security and workers’ compensation. Instead, they contend that insurers are recklessly dumping people on Social Security’s doorstep, without properly screening them to make sure they have a chance of qualifying.

The typical long-term disability policy says workers can collect when they are unable to do their own jobs for some period, usually more than five months. Social Security, by contrast, will pay only those people who are so badly disabled they cannot do any job at all. The disability must be one that will last more than 12 months or that will lead to death within that time.

Mr. Sabourin, the spokesman for Unum, denies the suits’ accusations and says that his company does screen people. He said Unum considered it in the best interests of its claimants to try for Social Security, because the federal program offers advantages over private insurance. Even though the federal requirements are tough, he said, Social Security has certain exceptions and trial programs that Unum’s claimants might qualify for.

Unum is also concerned that the lawsuits might lead to changes in federal rules that require Social Security to vet all applications thoroughly. Any changes might drive up the cost of disability insurance premiums, Mr. Sabourin added. Unum plans to file a motion for a summary judgment in its lawsuit, which is in Federal District Court in Boston. The case is to be heard this fall.

Both whistle-blower lawsuits cite the federal False Claims Act, a law that allows affected government programs to recover triple damages. The lawsuits were brought by people contending that the insurers were knowingly committing fraud.

Mr. Nibali, the retired Social Security administrator, says the disability program has “an open-door policy” and is required to seriously consider all applications, even those that might seem improbable. While deciding whether a 65-year-old should get retirement benefits is relatively quick and easy; deciding whether someone should get disability benefits is not. The Social Security Administration compiles detailed medical records, sends applicants to doctors for examinations and tests, reviews their work histories and sometimes interviews their friends and relatives.

Rejections can be appealed again and again.

“A person can come in and file a disability claim with us as many times as they want to,” Mr. Nibali said.

Linda Simmond, a 41-year-old mother in Atlanta, has been at it for four years. She worked as the supervisor of 10 Little Caesars pizza shops in Detroit but had to stop when she was found to have carpal tunnel syndrome, a wrist injury, from rolling out pizza dough. Surgery did not help.

Little Caesar Enterprises was insured through Unum, which started paying Ms. Simmond disability benefits of about $1,780 a month, but told her she had to apply for Social Security. She did so, and was rejected. Ms. Simmond thought that was correct.

“I’m not totally disabled,” she said. “I’ve seen people with one hand, no legs, working, so I know I can do something.”

Unum told her to appeal. She refused. Unum stopped sending her checks. After several months with no income, Ms. Simmond relented and filed the appeal. Unum then resumed her payments — but before long, Social Security rejected her again, and the whole cycle began anew.

Unum is now paying Ms. Simmond her benefits, but warning her that if she does not apply for Social Security again, it will stop her checks a third time, she said. “I need my benefits,” she said. “I have two children. I have a lot of debts. I’m going to have to do it, but I don’t believe in it.”

When Ms. Simmond’s situation was described to him, Mr. Sabourin said he could not comment on it without reviewing her case file.

Mr. Nibali has calculated that it costs $1,180, on average, to process a single Social Security disability application to the first decision, usually a rejection. If the applicant persists through the first three levels — the initial review, a reconsideration and a hearing by an administrative law judge — the case will cost the system an average of $4,759, he found. It is possible to appeal even higher, adding further to the cost. Lawyers from the firm Phillips & Cohen, in Washington, who are representing the plaintiffs, have been working with statistical samples. Their numbers suggest that the industry has been sending tens of thousands of dubious claims to Social Security, costing the system hundreds of millions of dollars over the last decade.

Mr. Nibali said he believed that Cigna, Unum and other disability insurers had enough data on their claimants to weed out many meritless applications before sending so many people to Social Security. That would help the program’s finances, he said. “We’re not here to give money away.”

Quoted from http://www.nytimes.com/2008/04/01/business/01disabled.html?_r=1&hp=&oref=slogin&pagewanted=all