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When Insurance Companies Don’t Play Fair

One of the ways we at OBL ensure that we are offering excellent representation to folks whose claim for long-term disability benefits has been denied is to continuously watch federal court decisions being issued in appeals of insurance companies’ denials of these cases. This helps in two ways: (1) to guide us in making sure that our clients’ cases are being developed in the best possible way in light of current court decisions, and (2) to give us insight into the kinds of mistakes (and, frankly, bad behavior) committed by certain insurance companies. Sometimes, we see a trend, and unfortunately, we are definitely spotting one with respect to The Hartford and Aetna’s mismanagement of long-term disability cases, resulting in unsupported and unfair denials.

Read the full article HERE.

Osterhout Berger assists Amazon Employee in her Claim for Benefits from The Hartford

The Hartford denied our client’s claim for Long Term disability benefits due to a lack of medical documentation.  Our client suffered from significant mental impairments, to include a persistent mood disorder and anxiety disorder.  After being retained by the client, who worked for Amazon, Attorney Berger obtained all of the medical evidence, along with a detailed statement from our client’s treating physician and a comprehensive vocational report.  This evidence was enough to persuade The Hartford to overturn its previous decision and award our client her much-needed Long Term disability benefits.

If your Short Term or Long Term benefits have been denied or terminated, please contact Attorney Berger for a free consultation.

Osterhout Berger Helps a Financial Executive Get His Benefits Reinstated from The Hartford

Our client had been receiving Long Term disability benefits from The Hartford for difficulties stemming from a sleep disorder for approximately 10 years before The Hartford terminated the benefits after finding he could return to work.  Our client immediately contacted Attorney Berger and after extensive development of his claim file, to include obtaining multiple statements from our client’s treating physicians, an Independent Medical Examination and a comprehensive vocational evaluation, The Hartford reversed its decision and reinstated our client’s Long Term Disability benefits.

If your application for Long Term disability benefits or your appeal of a decision denying or terminating has been denied do not hesitate to contact Osterhout Berger Disability Law for a free consultation.

We Are Still Working!

As we mentioned in a previous post, most of our employees had the capacity to work remotely when the quarantine began, so we have been able to continue working on cases, including going to many hearings. I am delighted to say that as of 10 minutes ago, ALL our employees now have the ability to work from home, which only increases our ability to work for you.

As of right now, neither Social Security nor the federal courts have closed (although they have limited their services). This means that any deadlines in your case continue to run, even though you are stuck at home. We can help you! If you have a new Social Security application, a pending claim with Social Security, or if you have received an unfavorable decision from a Social Security judge which needs to be appealed, we can help you. Now.

Life is tough right now. We want to be a part of making at least some of it easier if we can. Please contact us if you have any concerns about your pending claim, or if you have a new Social Security application that needs to be filed or a denial of benefits that needs to be appealed.

Covid-19

Covid-19 (coronavirus) is changing life as we know it; at least temporarily. The virus has the potential to be deadly and overburden the nation’s healthcare system. Large gatherings are being canceled, universities are canceling in-person classes, sports leagues are suspending seasons; all with the goal of slowing the spread of the contagion.

So far, the Social Security Administration has not announced any closings or special protocols related to the outbreak. SSA field offices and hearing offices are open and continuing as they normally do.  

Many of our clients have compromised immune systems and all of us rely on our healthcare facilities. We encourage everyone to follow the CDC’s guidance for slowing the spread of the virus:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces.

We will post updates as we learn more about the virus in relation to SSA procedures.

 

Social Security Disability Can Be the First Step in Achieving Medical Stability

Many individuals who are unable to work also lack the means to receive regular medical treatment. Obtaining Social Security Disability (SSD) or Supplemental Security Income (SSI) can help secure monthly cash benefits and medical insurance through Medicare or Medicaid to cover medical costs.

OBL Partner, Lindsay Osterhout, was recently featured in a video produced by ACHIEVA about one of their clients, “D-Man” who needed SSD to establish regular medical treatment and get on his feet. Lindsay was able to win his case and help him achieve stability. This is what we mean when we say “Winning Your Life Back”!

We enjoy partnering with local agencies like ACHIEVA to help case managers secure benefits for their consumers and are happy to be a resource for community partners. If you are a case manager and want information on how OBL can help your organization, contact us today!

OBL Remembers Judge Emmanuel “Manny” Smith

 

Judge Smith passed away on February 6, 2020.

The Osterhout Berger Disability office is saddened to hear of the passing of Judge Manny Smith, who had a long career with the Social Security Administration. According to his obituary, he graduated from the University of Texas, Phi Beta Kappa and Harvard Law School. He worked in Washington, DC beginning with the Interstate Commerce Commission and elected to work with the Social Security Administration in Maryland and Virginia as well. He moved to Pittsburgh in 1991 to be an administrative law judge for the Social Security Administration and retired with over forty-five years of service to the federal government. Karl Osterhout has a great amount of respect for the work that Judge Smith did behind the bench and shares his thoughts:

 

Judge Smith was one of the good guys, a real Mensch, someone who was a straight shooter, and who told you upfront what the problems were with your case, as he saw it. He also graciously agreed to attend my wedding (imagine that happening these days).

He ended up retiring in response to pressure to what was viewed as his supposedly “too high“ award rate (in a local newspaper article, and by the agency, who try to send him back for “retraining“). He is the only ALJ I’ve ever met in 35 years of doing this who spoke frequently about the actual burden of proof in Social Security cases, “preponderance of the evidence.“ This was clearly the guiding principle of his decision making, whether you agreed with him or not. We extend our condolences and best wishes to his family.

 

Tenacious Representation Leads to Incredible Success Story Out of Minnesota

Disability appeals have, unfortunately, become standard practice for many claimants. Judges frequently make errors in hearing decisions. OBL partners with many firms who are fierce advocates for their clients, yet come to us with unfavorable decisions due to legal error. Disability Specialists of Minnesota is one company we work with on a regular basis. They recently delivered incredible news related to an appeal Karl Osterhout handled, all because they refused to give up on their client’s case! “This case really demonstrates the value of working with a group like mine, who offers all services related to appeals. In fact, the reality is that we never made a dime on this case, since we offer free of cost Appeals Council briefing to our regular referral sources, among many other services” explains Karl. Our partnerships with groups like Disability Specialists are special to us and we always try to help when I can, but this case really stands out!

Amy Pearson, President of Disability Specialists, describes the history of the case:

We filed her application for benefits in 2014, with an alleged onset date in 1/13, when she stopped working due to her conditions. A hearing was held in April of 2016, with the judge awarding her a partially favorable decision with an onset date of October of 2015- the date her neurologist completed a supportive medical source statement. I sought out the advice of an appeals attorney who reviewed her decision and strongly recommended appealing. After a discussion of the risks/benefit of appeal, the claimant decided to move forward with an appeal. There were several inconsistencies in the judge’s decision and little rationale for why he chose the date of a supportive opinion vs. her longitudinal treatment records supporting the opinion. It was appealed to the Appeals Council.

The AC remanded her case. Instead of being scheduled with the same judge from her prior decision, it was scheduled with a new judge (the prior judge was on military leave). The new judge denied her claim altogether and this resulted in the loss of her monthly benefits as well as an overpayment.  We were crushed.  I had never had this happen before, and we never imagined that this would happen.  I can’t count how many hours of sleep I lost agonizing about the outcome of her case.  My disappointment was nothing compared to the effect it had on her life.  She could no longer afford her apartment, so she and her daughter had to move into subsidized housing.  She went from receiving a substantial check every month to relying on county assistance.  

Clearly, this claimant went through a lot over the course of several years. Disability Specialists reached out to the original attorney who assisted with her federal court appeal but they declined to provide any additional help or guidance in this case. Disability Specialist then turned to Karl who accepted the case after hearing the case and the emotional turmoil it had caused the client. Amy adds, “I didn’t want to give up on this for her. I strongly felt that the judge made the wrong decision and that we could prove it. She was relieved that Karl agreed to appeal the decision to the Appeals Council. The denial was extremely upsetting for her, and she was glad to know that we were not going to give up on the claim- and that we would have Karl on our side.” After reviewing Karl’s appeal, the Appeals Council made a favorable decision and sent the case to an Administrative Law Judge who had never reviewed her case before.

Amy explains the procedural and emotional aspect of the new hearing:

I have been doing hearings for over 8 years, and I don’t think I have ever been as nervous about the outcome of a hearing as I was for hers. There was so much riding on this!  Another denial would be catastrophic for her well-being.  We just HAD to win. Her testimony was very compelling and she was extremely credible. The judge posed a hypothetical to the vocational expert for absenteeism at a rate of one day per week, including the need to leave work early or arrive late, and the expert said she would not be employable with this limitation. She further clarified that employer tolerance for absenteeism was 8-9 days per year. The judge stated that he felt this hypothetical was a true reflection of her limitations, and he would be awarding benefits! My client was relieved beyond measure.  This will improve her quality of life, allowing her to move into better housing and provide financial stability for herself and her child.

“I was really happy to hear from Amy; I ask all my referral sources to let me know how things turned out, and most probably get busy and forget, but it’s really awesome to hear that a case like this ultimately came out right. This is especially true when the claimant’s representative is someone I respect as much as Amy and her group at Disability Specialist. They are so committed to the best outcome for their clients, and consistently develop incredibly good records on their behalf. This makes the job of someone like me, coming along later and trying to demonstrate error in the judge’s decision, so much easier,” explains Karl. Amy adds, “I am extremely grateful for Karl’s assistance in this claim. I don’t know if we would have secured a second AC remand without his help. He knew exactly what issues to present to the AC to strengthen our appeal. I have helped thousands of clients in my 17 years working for Disability Specialists. This case is definitely one that I will carry with me for the rest of my career. I am glad she didn’t give up faith and trusted us to keep fighting for her.”

We commend Disability Specialists and representative Amy Pearson for truly advocating for their clients and we are happy to be a part of this success story!

Nobody Knows Me When I’m Down and Out

Looking back on 2019, one of our favorite moments was the 412 Food Rescue Benefit Concert featuring independent folk singer-songwriter Peter Mulvey. OBL Managing Partner, Karl Osterhout, organized the event to support the organization and opened for Mulvey. One of the songs he performed was “Nobody Knows Me When I’m Down and Out”. Karl describes the song:

I don’t play out often enough to have a setlist, so every time I do I end up kinda working a theme. And this setlist was easy: a list of love songs for this organization I love and admire so much…

This song talks about forgotten people, people who 412 Food Rescue refuse to forget about and in their insistent, but loving, way, refuse to let us forget about too. There aren’t enough words to express my personal gratitude for the leadership and seemingly tireless and endless volunteer energy of 412FR. 200 cities by 2030!

(BTW the very beginning of the first line is clipped; it goes “Once upon a time I was a millionaire…”)

The Problem with the SSI Program

Supplemental Security Income (SSI) benefits are paid to disabled persons who do not qualify for Social Security disability insurance (SSDI) program because they have not paid sufficient Social Security taxes or do not have enough work credits.  The definition of disability and claims process is the same for both SSI and SSDI and in fact, many people are able to apply for both at the same time. The SSI program was designed to provide cash for food, clothing, and shelter it has kept many Americans from becoming homeless. SSI benefits total approximately $771 per month in 2019 (can be more with state supplements) and recipients usually continue to receive Food Stamps and retain their state Medical Assistance card.

When filing an SSI claim, the applicant must show that he or she meets a “needs test” by virtue of low income and resources. This test is similar to the one used to determine whether a person is entitled to Public Assistance.  There are two components to the needs test; income and resources.

 

The problem with SSI is that most of the SSI eligibility rules have not been updated since the program was signed into law by President Nixon over 40 years ago.  The economy has changed since then. The cost of living today is more than 5.5 times what it was in 1972. In addition, the asset (resource) limit for the program–$2,000/$3,000–has not been updated since 1989. Many Americans are finding themselves unable to qualify for SSDI because they lack work credits, and unable to qualify for SSI because they are over the income and resource limits.

The Supplemental Security Income Restoration Act of 2019 has recently been introduced and would update these income and asset limits to better reflect reasonable assistance in today’s dollars. The National Association of Disability Representatives has made it easy for you to support this legislation. Simply text “ssirestoration” to 52286 or click here to send a message of support to your representatives.

Osterhout Berger Disability Law handles both SSDI and SSI claims. If you or someone you love is unable to work due to a physical or mental impairment, call us for a free consultation: 1-866-438-8773