Disbaility Lawyer/Advice needed

[sewell94]

Is anyone here a disability lawyer?? or Know a good one??

My wife and i were in major accident about year and a half ago, she still goes to therapy 3 days a week, and is not able to work, some days shes barely able to walk to the bathroom and i'm pretty sure has a mild case of depression. She applied for disability but got denied, at this point we need a lawyer, i'm in florida, shes in NE Ohio staying with her parents. Where do we need to get a lawyer at??

Some background she has a bachelors in history, and her teaching certificate. She wants to work, so its not a matter of her not wanting to work or wanting to milk the system, she physically can't work. More details can be provided if needed.

[MRM]

You're talking about Social Security Disability, right? It's different if you're talking about a private disability insurance policy.

[Noah930]

Laws will also vary (quite considerably) from state to state. So, if she's in Ohio, you're in Florida (and the accident was where?), I'm not even sure where you'd establish jurisdiction.

[tcar]

Automobile accident, or???

Where was the accident?

[MRM]

If it's SSDI the law will be the same everywhere. If it is a private disability policy the policy will be interpreted wherever it was issued, usually where you lived when it was purchased. If you were both in an auto accident in Florida one or both of you have several avenues of relief. Up until recently Florida was a no fault state, although the no fault coverage was pretty low.

The answer to the direct question of how to chose a lawyer is that you should ask people you know to refer you to a lawyer they have used before and had a good experience with. You as a consumer of legal services cannot tell a good lawyer from a bad one until after your case is over. The ABA has done studies and the best way to select a high quality attorney is to get personal referrals to a lawyer who specializes in your field. Wait here a bit and someone from Florida will chime in with a couple of good referrals. If you need, I can use a listserve network I belong to to get some referrals for you.

SSDI lawyers are a subspecialty of personal injury lawyers. Some do both, but the better SSDA firms do mostly Social Security work. It really is a specialty. You want someone who does SSDI and nothing else. If you find an office like that they will certainly have someone in the office that does traditional personal injury litigation. More lawyers do general PI than to SSDI work.

If you're looking for help with a private disability insurancy policy you'll need someone who does ERISA work. That's another subspecialty. It's probably not as complex as SSDI work, but not many people do it. SSDI work is mostly forms, but it's like filling out your taxes on a form that tries to be confusing. Private disability policies are more like traditional insurance coverage work. Some people do it, others don't but either way you'll want someone who specializes in that area.

[sewell94]

I'm looking for S.S disability lawyer. We had short term disability insurance, but thats over, we didn't have long term

Accident was in florida, she's now in Ohio, her grandparents, live next to her parent, her other granparents live a block a away, her sister lives 2 block away, so it was much easier for her to go back to her parents house. When she left i was also in very bad shape due to the accident so i couldn't take care of her.

[Dueller]

SS disability is an unusual animal...I know as I worked for the bastages for 11 years. Do you know what level they denied her? I.e., initial claim, reconsideration, hearing? If she only has been denied at the initial claims level I would recommend immediately filing the reconsideration and make sure medical is up to date...to the extent I would submit all new medical with (or subsequent to) the filing of the recon.

SS disability is based not only on the persons medical impairment but also their age, education, work experience etc. It must be totally disabling for a period of 1 year (or expected to last more than a year) or expected to result in death. She must be unable to perform any substantial gainful activity in any occupation available in the national economy (essentially defined as working and making more than about $800/month. She has to have worked 5 out of the last 10 years under SS covered employment. Thus two people with different injuries could receive different out comes. E.g., a 60 y.o. ditchdigger with a third grade education will be approved for a sli[pped disc whereas a 35 y.o. CPA would not.

Hope this helps. You really only need a lawyer at the hearings level IMO. I.e., once the reconsideration is denied. Which it likely will be barring any new medical evidence.

[targa911S]

They turn 90% of apps down the first time. Took my wife 3 tries. Keep at it.

[sewell94]

This was her inital claim, SS never had her check out by a dr, her medical records are up to date, her medical records from this are almost 200 pages, shes had 5 surgerys, with the lastest being 2 months ago.

Shes worked 8 1/2 out of last 10 years(with the last 1 1/2 not being worked due to the accident). She literally graduated the week before our accident, She was a waitress for the previous 4 years. She did order entry for about a year before that but she can't do that because she can't use the computer for long peroids of time, due a fractued wrist in the accident. And to be frank, i think there is some mental issues present(drepression, etc etc)

On her right leg her broke her femur, and a very bad external fracture of her ankle, the drs at the trama hospital said it was the worst ankle they have ever seen. They removed a bunch of bones and tendons, they actually transplanted some of her ankle bones in her calf for storage, then retrasnplanted them back to her ankle about a week later. It had gotten infected so they had a to take a bunch of tendons/bones from her ankle.

So should i file the reconsidration or would i be better off getting a lawyer to handle it for me??

[targa911S]

Get a lawyer. At the very least, from a "respect" perspective, it will get better attention.

[MRM]

I would recommend interviewing local SSDI lawyers to do it all for you. Make sure you know what fee they're charging. It may be worth it to you to not have to do the paperwork and make sure it's done right.

What were the facts of the accident? If both of you were injured then one of you had to be a passenger, even if the other was the at-fault driver. You/she have the right to seek Florida's no fault benefits for medical bills (I think that covers $5,000) plus seek insurance coverage against the at-fault driver. If you were driving she would look to the insurance you both had. There is no reason she shouldn't do this. A good lawyer can explain it to you. The insurer won't bat an eye at it. That's why you bought insurance - to cover any injuries you might have caused and for your family to br protected.

[sewell94]

I guess i need to find a good lawyer anyone know one in the NE ohio area??

All of our insurances' have been max'd out/used up.

[MRM]

If no one chimes in here I'll try my list serve and get you lined up with one.

[sewell94]

I would really appericiate it.

[BLEW911]

I've also been thru this with my wife. I believe almost everyone gets turned down initially. We were given a list of local SSDI attorneys when we were first denied. The appeal and hearing went smoothly and we were approved. There are laws or regs governing the attorney fees
and they appear to be watched closely.
Hang in there, it's just our government at work.
Try asking the SS office for a list of referrals. Good Luck.

Don

P.S. We never paid a cent until the check came.

[Dueller]

Let me try to clear up a few questions:

Fees: Lawyer is limited to a fee of 25% of back pay subject to a cap of c. $5300 if you sign a fee agreement. Can charge hourly but must petition judge for amounts in excess of that. 99.9% of lawyers do contingency fee agreements since petitioning on an hourly basis requires documenting billable hours and is time consuming to get fee approved. SSA will pay the lawyer directly out of her back pay.

At the recon level the case is sent back to the state agency (DDS) who made the initial claim decision for a review and most denials are affirmed unless there is new evidence of if the evidence was not complete on the initial claim. The recon decision usually is decided in 3 months or less. There is very little a lawyer can do at this level beyond making sure every thing is properly documented. That is a pro. The con is that if she has to file a hearing some areas have backlogs for scheduling the hearing uo to 3 YEARS!!!!

Writing your congresssman to complain usually delays the case as it has to be pulled out of ther work flow and pi$$e$ off the bureaucrats that they have to deal with responding to the congressional inquiry.

At the recon level DDS could care less if you have a lawyer or not. So much for respect. More respect at the hearings level. definitely get a lawyer at the hearings level.

They did not send her to an SSA doctor likely because in their eyes her treating physicians records were sufficient for them to make a decision. Very few doctors are willing to do independent medical exams for the chump change SSA pays them. I had one client who was sent to a neurologist, examined client for less than 2 minutes and spent the next 10 minutes trying to convince her to get derma-abrasion at her sattelite clinic. She also discussed how much she liked my client's shoes and where she got them. That doctor has now been removed from SSA's approved list of SSA consulting physicans thanks to that stunt and my outrage.

By all means have your wife seen by a psychiatrist for emotional trauma, PTSD, depression etc. SSA has arbitrary "listings" that spell out how serious a condition must be to be considered totally disabling. However, the most effective way I get a person approved is to show a combination of impairments, none of which are disabling by themselves, in fact renders the person TOTALLY diasabled.

Why did your wife get turned down? They likely said that while her condition was severe initially and temporarily totally disabling, based on her progress (and doctors are notorious about optimistic progress reports in theircharts) it was not so severe to prevent her from performing sedentary work readily available in the national economy within 1 year of traumatic onset. They see that she is a college graduate and likely contend that that coupled with the fact that she is a young worker she could be trained or has the training to do some job somewhere given her physical limitations. See my example re: the ditchdigger and the CPA. I have seen a case where a person had an above the knee amputation that was turned down because of his age and education. Ditto educated parapalegics.

Any questions? Class? Class?

Good luck. Hope she gets approved.




Sidenote: MRM...if you read this, where do you want me to send your CLE credit

[sewell94]

First, let me say, thanks for the help everyone.

Ok so let me get this straight, do the reconsideration, and make sure her medical redords are up to date. If/when she gets denied, then get a lawyer.

I hope she will get better eventually, we don't plan for her to be permanantly disabled for the rest of her life, but its going to be another year or 2(min)before shes really mobile again(if ever), is there anywhere/anyway for us to get some help until she better(as good as she can get)??

I'm 27, shes 28, we had about 100k in savings before out accident. We sold our house 6 months prior to the accident, we were planning on moving, she had a teaching job lined up, and i was going to go finish my degree. We had car insurance, health insurance etc etc, just not enough. Savings has been spent.

Makes me very angry that if i had a bunch of kids and had nothing to our name we'd get help.

[Dueller]

If I were you, I'd go to the SSA office and ask for a copy of her entire file...medical and non-medical. I would review it thoroughly looking particularly at med records to see if doctors assessment is consisitent with her condition. Also to make sure that records are complete. Pay particular attentioon to the disability evaluation by SSA...it will have checklists that assess (in their view) how much she can lift, how long she can stand etc etc . This gives her RFC (residual functional capacity). Challenge their assessment if possible.

Make sure when you file the recon you list EVERY medical problem she has whether it was related to the accident or not. Even if she hasn't been treated for it. If she's experiencing depression, anger, ptsd, etc say so...if there is no record of treatment they will likely send her to a psychologist for a consultative exam. But don't expect much of an evaluation.

Get a statement from her doctor regarding future surgeries and the length of recovery. Talk specifically about pain and how it distracts her from concentrating yadadadada. (Recent court ruling indicates pain can be a disabling condition for SSA purposes).

If she was going to be a teacher, explain in your recon why she can't perform that job due to her physical and emotional injuries. Let's face it...teachers have lost limbs, become parapalegics and were back teaching within a year. In SSA's eyes she's just had a really badly broken leg. To give you an idea of how SSA looks at it a person is presumtively totally disabled and are automatically approved if they've had an amputation at the hip and have only worked in unskilled heavy labor and have less than a sixth grade education. Give you an idea of how stringent the standards are? No question she can't go back to being a waitress, but you've got to show why she can't do sedentary labor that someone with a college dgree would be qualified for., even if its not teaching.

You talk about a year or two before she's mobile..people in wheelchairs are considered mobile.

I don't mean to minimize the severity of your wife's injury...I'm trying to explain the law.
To that end, I'm going to let your comment go about having a bunch of kids to get help as your anger and frustration with your wife's predicament. But you must understand SS disability is intended for TOTAL disability for a period of one year or longer or if it is expected to result in death.

Armed with the information I've provided you might want to contact a few SS lawyers and interview them to see specifically how they approach the recon. Most think that you can only get approved at the hearings level. If they tell you that find someone else or prepare the recon yourself. Ask them how many cases they've won at the recon level etc.

On a side note..how did the accident occur? Who was at fault? Do you have a lawsuit on that?

Good luck.

[Jims5543]

Totally off topic but its driving my nuts. What kind of car was that and WTF happened?

I want to say FC with a 3 rotor but I am not sure, <--- wrong engine intake is wrong. what a mess!!

[ramonesfreak]

sewell94, i didnt read all the responses so maybe i am repeating.. im a SSD lawyer. if your wife has been disabled for 1 year, she maybe entitled to ongoing SSD benefits. If she is out 1 year and returns to work, she may be awarded a closed period of benefits. there are also rules concerning trial work periods and unsuccessful work attempts, and, she may be entitled to SSD ongoing, even if she works if she is below what is called substantial gainful employment. You need to file a request for hearing ASAP. I recommend you get a lawyer. nothing comes out of pocket - except expenses. the rules are the same from state to state as this is Federal law. The legal fee is 25% of the retroactive benefit lump sum, if any, but capped at $5,300.

SSA's website has some decent information. I do not know any SSD lawyers in Florida but I am sure you wont have trouble finding one. Once you request a hearing, expect to wait a MINIMUM of 24 months to get the hearing because of the backlog

Good luck
PM me if you have any questions

p.s. regarding winning prior to a hearing now that you have been denied...if it has been more than 1 year, or the disability will clearly last one year and her injuries are extremely severe, its possible to get an "on the record" decision but very unlikely.