How does the Social Security Administration evaluate mental illness with regard to disability cases?

Many applications for Social Security disability cite mental illness as the primary cause of disability.  In addition, physical ailments can come with unseen psychological consequences.  Painful chronic conditions can take a toll on an individual both emotionally and psychologically.  Many of these cases get denied and wind up going to a hearing.  

There are three basic things needed by the Social Security Administration in order to proceed with evaluating your mental disorder.  First, they require documentation of a severe and lasting mental illness.  Then they must be able to consider whether or not your mental illness impairs your capacity to work, and to what extent.  Finally, they must also consider whether or not that limitation has lasted for at least twelve months.

Mental conditions considered by the SSA

SSI mental conditions What kinds of mental illnesses does the Social Security Administration consider in disability cases?

There are nine general diagnostic categories set forth by the Social Security Administration.  They include:

  • 12.02 Organic mental disorders.  This category includes a disabling mental state that can be directly linked to a specific biological (organic) abnormality in the brain that leads to impaired functioning.  For example, a severe head injury that caused permanent brain damage.
  • 12.03 Psychotic disorders.  The most well known psychotic disorder is schizophrenia.  Psychotic disorders involve a decrease in functioning from previous levels.  
  • 12.04 Mood disorders.  Mood disorders are just as they sound – disturbances of mood.  The most common mood disorders include severe depression and bipolar disorder.  A mood, in this case, is considered to be a long-lasting emotion that overshadows the entire psychic life of an individual.
  • 12.05 Retardation.  Retardation involves less than average intellectual capacity.  Deficits in adapting to normal functioning that usually first occur during early development.  Specifically, evidence must exist to support the fact that the impairment began before twenty-two years of age.
  • 12.06 Anxiety disorders. Anxiety disorders can involve either generalized anxiety or a manifestation of anxiety when an individual tries to mask other symptoms.  Confronting the object of a phobia or attempting to resist compulsions related to obsessive-compulsive disorders are two examples.
  • 12.07 Somatoform disorders.  Somatoform disorders are those in which physical symptoms arise from no known or perceivable biological mechanism.
  • 12.08 Personality disorders. When maladaptive personality traits become inflexible and result in decreased occupational or social functioning, the individual is said to have a personality disorder.  Maladaptive personality features must be sustained over a long period and not be limited to isolated instances.
  • 12.09 Substance abuse disorders. Physical or behavioral changes the arise as a result of consistent use of substances that impact the nervous system.
  • 12.10 Autism Spectrum Disorder and other developmental disorders. These disorders involve deficits in social interaction, delayed development of communication skills and imaginative activity.  Limited activities and interests, often of a repetitive nature, are also common hallmarks of these disorders.

There are several other conditions that must be met in addition to having one of these disorders.  If you need disability benefits stemming from mental illness or any other condition, contact us today.

Sources:

https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm

http://www.philadelphiadisabilityinsurancelawyer.com/contact/

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Applying for SSDI Benefits

Coping with disabilities presents many challenges.  If you have been disabled to the point of not being able to work or function on a daily basis, then of course you must find a way to get by.  The Social Security Administration (SSA) allows those who have been disabled to seek benefits through the Social Security Disability (SSD) benefits system.

The most common type of benefits awarded by the SSA is Social Security Disability Insurance (SSDI) benefits.  Such benefits disburse a pre-determined amount to qualified claimants on a monthly basis.  Unfortunately, even those who are qualified can have their applications rejected and not receive the SSDI benefits they are entitled to because of mistakes made during the long and complex Social Security claims process.  Even the minutest mistakes can result in benefits being denied.

Therefore, it’s best to consult with a disability lawyer from the beginning in order to maximize your odds of success.  In the event your application has been denied in the past, an attorney can appeal for you.  

Practice Areas in SSDI

social Security Disability laywerIf you cannot work due to a debilitating mental or physical disability, you may be eligible for social security disability benefits.  No matter if you are applying for benefits for the first time or have had an application denied in the past and need to file an appeal, our lawyers can help you.  Our Pennsylvania disability lawyers are experienced in helping clients with claims such as:

  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)
  • Long-term Disability Benefits

Do not be denied your right to benefits due to the fact that your initial application has been rejected.  Most social security disability applications are denied the first time around and require an appeal before a person receives their benefits.  Our well-versed Pennsylvania disability lawyers comprehend the importance of these benefits to disabled individuals and families.  We’re ready to assist you with filing your claim or appeal.  We will make sure that all information needed for a successful claim or appeal will be included in your claim.  We can address every issue pertaining to your filing with diligence to make sure that your case is supported with the most compelling evidence possible.

The SSD process in Philadelphia

The application process for Social Security disability is, for the most part, identical in Philadelphia as anywhere else in America.  Most individuals go through two parts of this process.  They include the paper application along with the administrative hearing.

Physical application

  • The first part of the process involves completing the application.  Almost two-thirds of people get denied the first time they apply.
  • Your odds of approval are improved by making sure your application has been completed in the proper way.  This involves having adequate evidence and physician testimony explaining your disability.
  • After the initial application, you can expect a response in about three to six months.
  • Our Philadelphia disability lawyers will ensure that your application has been completed properly.

If you are disabled and need benefits, don’t delay.  For more information on the Social Security Disability application process in Philadelphia, contact our office today.

Sources:

https://www.ssa.gov/disability/

http://www.philadelphiadisabilityinsurancelawyer.com/contact/

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Cuomo Signs NY’s New Auto Insurance Law

Last night, New York’s Gov. Andrew Cuomo signed legislation that alters New York’s auto insurance law, and it’s a win-win deal for everybody.

While the law sounds uber-wonky, it’s quite important due to a fundamental misunderstanding of how auto insurance works by the general public.

Most folks think that the insurance coverage they choose  — let’s say a 250K limit — will protect them if they’re involved in a collision. But it doesn’t. That insurance only covers other people.

You, the injured driver, must pursue the guy that plowed into you at the intersection because he was checking his texts, through the limits of his insurance policy. And if his insurance policy is only, let’s say, the bare minimum 25K because his job is flipping burgers and he doesn’t really have a pot to piss in, then you with your fractured pelvis are, as we say in the law, shit out of luck.

But wait! There is one small hope for you, and that hope lies in your own policy provisions for getting involved in a collision with an uninsured or underinsured driver. That provision is known here in New York as Supplementary Uninsured/Underinsured Motorist (SUM) insurance.

The problem? The default on your policy was the state minimum, just 25K. And you can’t even collect that if have received the 25K from the guy that plowed into you.

Only a savvy person — or one with a conscientious insurance broker that informed him — would know that you could elect more SUM coverage. Most don’t, because most don’t know. My own legislator wasn’t aware of this whenI discussed this bill with her a few years ago, and found out only when her daughter was injured in a collision and got caught in this trap.

That law is the one that has now changed. Now the default choice is your SUM insurance matches the underlying coverage that you picked. So if you have a 250K policy you will have 250K SUM, and get as much protection for yourself as you are giving to others.

The cost is minimal and people can easily opt out. The thing is, those that are picking more than the minimum amount of coverage are the ones who understand that they likely have the most to lose. That’s why they bought the higher coverage in the first place.

When a bill becomes a law that has no losers attached to it, it’s a win-win all the way around.

I wrote about this back in June when it passed in the closing hours of the legislative session. The vote was 62-1 in the Senate and 104-6 in the Assembly.

People complain often about dysfunctional governments.  But when they get it right we should take notice with a little golf clap in their direction.


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It Only Affects 14,000 Doctors. And Their Patients.

New York’s largest medical malpractice insurance company is owned by its doctors. But pretty soon, it will be sold to Warren Buffet’s profit-hungry Berkshire Hathaway. And that’s gonna be a problem.

That company is Medical Liability Mutual Insurance Company, which insures over 14,000 New York doctors and is one of the largest such companies in the nation.

And when its doctors are sued for negligence they hire some of the most competent trial lawyers in the city. Doctors, after all, are not shy about demanding the best.

Many of the current gaggle of defense firms were created from the mid-90s dissolution of Bower and Gardner, one of the largest — if not literally the largest — medical malpractice defense firms in the nation.

Unlike BigLaw firms that do “litigation” these folks actually go out and try cases, and know how to do it well. While every large firm has its bad apples, and this biz is no exception, their reputation is, on the whole, excellent.

So what are the ramifications of this sale to a publicly traded company? For doctors? For patient/litigants? For lawyers?

For doctors, I think this is a losing proposition, regardless of the dollars involved when they get bought out, and my reasoning is simple. Currently, MLMIC owes its allegiance to the doctors that own it and run it. But once sold to Berkshire Hathaway, company loyalty shifts to the shareholders. Warren Buffet, after all, is buying this business for the profits it will make for its shareholders. In fact, the very essence of a publicly traded corporation is that fiduciary duty to the shareholders.

It doesn’t matter if you call that profit motive a bug or a feature of capitalism, that’s the way it is. It’s a plain fact that publicly owned companies and privately owned companies owe their loyalty to different constituencies. Wall Street demands profits, and they don’t care too much whose hide it comes from.

How will this manifest itself? First, by trying to trim costs, of course. And part of that will likely mean trying to trim legal fees.

I fully expect to see a new raft of medical malpractice defense firms, who will pitch their business to Berkshire by undercutting the rates of those that currently lead the defense bar. They will try to trim their prices by focusing more on volume, less on quality. And these firms will hire less experienced (cheaper) attorneys to do the work, so that they can give that lower legal rate to their new masters at Berkshire.

And that will be very bad for the docs.

One of the great advantages that small firms have over large ones is that the small firm lawyer generally knows everything there is no to know about a case — every nuance. But when firms do volume, that nuance is lost. The experienced small firm lawyer that sees a constantly shifting parade of big firms come in on a case with inexperienced lawyers has an advantage.

How does this affect the patients, who are now litigants? Well, if the case is part of a volume practice for the defense firm, it is less likely that a savvy defense lawyer or adjuster will recognize the dangers ahead and move to settle the case. The matter gets prolonged.

Now a case being prolonged isn’t always bad for an insurance company, as they make money by investing the float — those premiums that they have taken in but not yet paid out in claims. The insurance business model is, of course, to take in as much as you can in premiums, pay out as little as possible, and invest the money in the interim.

In my younger days, no medical malpractice case ever settled until jury selection, even if a sponge or clamp was errantly left behind. In recent years, however, the insurance carriers have become more savvy and recognized they could get a discount with an early settlement on clear liability cases, and that this discount (along with savings on the legal fees) might well exceed the interest on the float that they might make by stalling. (If interest rates go up, of course, that could change.)

On the one hand, this delay could be very bad for desperate plaintiffs who might not be able to work anymore. The reality, however, is that this scenario is already exploited when possible.  Desperate plaintiffs don’t do as well, in general, as “tell ’em to go pound sand” plaintiffs. The delay tool is used in some cases, but not all.

But once they get to trial, plaintiffs will magically have the driver’s seat. Now there’s  a jury to be reckoned with. The discount factor for early settlement has evaporated, and settlement demands may become more firm, or even rise (as I’ve done on multiple occasions).

My opinions stem, in part, from the fact that Berkshire owns other insurance companies, one of which is Geico. Geico doesn’t exactly enjoy the best of reputations in New York, and on many occasions I think it has put its own insured at risk of excess verdicts due to a refusal to make early good faith settlement offers.

And one would naturally expect the new MLMIC to follow in those footsteps as they will now answer to the same masters. The problem, however, is that an excess verdict means a hell of a lot more to a doctor than it does to a minimum wage worker with a minimal auto policy.

Will the Gecko treat doctors the way it now treats others that it insures? The best guess from my little corner of cyberspace, is yes. I don’t think that selling itself to Berkshire will end well for the doctors.

I would not be surprised at all if, within 5 years, a new medical malpractice insurance company is born in New York, once again owned by doctors, with the interests of doctors as its priority, instead of a bunch of Wall Street traders.

The deal is expected to close in the first quarter of 2018. It was first announced last year.


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How we hold insurance companies accountable

The law stipulates that insurance companies must deal with their policyholders in good faith and act in a fair manner, not depriving the insured of the benefits that the policy brings.  Unfortunately, many insurance companies do not live up to this standard.  They have been known to deny claims before even conducting a thorough investigation in addition to fighting medical diagnoses and challenging each and every loss claimed.  They do all this as they attempt to negotiate a settlement that lets them off easy, leaving you with less than you deserve or were entitled to.  Our firm holds insurance companies accountable and makes them abide by relevant laws and statues.

Our firm will fight for you

Disability Cases Lawyer PAWe bring claims against all major insurers and review major disabling medical conditions.  Sometimes this involves the insurer admitting an injury while disputing its severity.  Other times it may involve a disease the insurance company would rather deny their policyholder has, such as Crohn’s Disease or Multiple Sclerosis.

First, we will gather all the necessary evidence for your claim.  This can include W-2s, medical records and bills, and other important documents that can show the totality of your economic losses.  This way the insurance company cannot claim they were unaware of your injuries and associated losses.  Then we will consult with the appropriate medical professionals to make sure you get the care that you need.  And finally, we will interpret insurance policies in your favor.  We won’t let the insurance company do the interpreting in a way the benefits only their own interests.

“Bad faith” in disability cases

Most lawsuits filed by individuals against insurance companies involve the legal claims known as breach of contract and bad faith.

Breach of contract refers to an insurance company not paying a claim they should have paid.  This constitutes a breach of the agreements that were established when the policyholder purchased a policy from the insurer and means the insurance company still has a responsibility to pay the claim in full.

Bad faith is defined as a breach of duty towards an individual for one’s own personal gain.  In this context, that would take the form of an insurance company denying a claim without a good reason for the simple fact that they would benefit by not having to pay a settlement.

Pennsylvania law allows for a claimant to recover additional damages on top of what they are owed, such as punitive damages and attorney’s fees, in the event they are able to prove “bad faith” by the insurance company.  There are many different means by which one may show unreasonable claims handling.  It can be done by closely examining every part of the insurance claims file, by deposing the insurance claims adjusters or those who manage them, or even by serving a subpoena for the internal policies of the company.  Using this information, it can then be shown how the insurance company violated basic requirements for its policies.

If you have a disability case and need quality representation, contact our law office today.

Sources:

http://www.dli.pa.gov/Individuals/Disability-Services/bdd/Pages/default.aspx

http://www.philadelphiadisabilityinsurancelawyer.com/disability-insurance-overview/

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Have you been disabled due to an asbestos exposure at work?

Asbestos is a naturally occurring mineral that is toxic to us humans.  Believe it or not, you may be inhaling small quantities right now as it can be found soil and rock and in small doses, it isn’t harmful.  The minerals the put off asbestos are in demand due to their properties in a wide array of manufacturing and construction applications.  

Asbestos disability lawyerUntil regulations on the use of asbestos came into play in the 1970’s, asbestos was widely used in everything from floors and ceilings in buildings and ships to brake pads and heating systems in vehicles.  The military also used asbestos in its bombers and fighter planes adding additional risk to our fighting forces and putting the long-term health of our warriors at risk.

When handled, asbestos effective sheds fibers into the air which end up getting inhaled by nearby workers.  Over time, these fibers built up and lead to serious illnesses.  People who worked in the industrial sector (Mining, Shipbuilding, Construction and some Manufacturing) have been at higher risk to asbestos exposure and the ailments it causes.

Unfortunately, even though regulations put a stop to the use of asbestos in the 70’s there are still installations and older building that may have this toxic material present.  Also unfortunate, the impact of asbestos exposure may not be evident for decades as these small inhaled fibers slowly damage the soft tissue of the lungs and do not necessarily show up as symptoms until much time has passed.  Symptoms can include difficulty breathing, chest pain and coughing.  Some of the serious and debilitating diseases that asbestos can cause are:

Mesothelioma – You’ve almost seen commercials on the television about this form of cancer that impact the cardio-pulmonary system.  Mesothelioma is aggressive and ultimately impacts the core of the human body with difficulty breathing, fatigue, and constipation.

Asbestosis – This is less known about than mesothelioma and is a chronic condition that can mean permanent lung damage with coughing and shortness of breath as leading symptoms.  In some cases, the impacted person’s finger or toenails may look extra wide or round.

Pleural Plaques – This is a thickening of the lining of the lung fiber and often can exist without symptoms.

Lung Cancer Is cancer or growth of malignant cells in the lungs that come with chest pain and shortness of breath.  Sufferers may first notice respiratory infections before cancer is found.

If you worked in the industrial sector or served in the military and feel you may be disabled due to asbestos exposure, get us on your team to protect you and your family.

Disability is a serious issue that can substantively impact your life.  Insurance policies don’t make this any easier and they often require a lawyer just to make sense of them.  The disability lawyers of Edelstein Martin & Nelson, LLP represent clients who have become disabled and need a partner in their fight against insurance providers.  Our practice is exclusively focused on this critical area and we are the trusted subject matter experts in disability insurance law. We will study your policy and situation so that we can advise you on your best options. We are located in Philadelphia and serve clients, throughout the state of Pennsylvania and across the United States.

To arrange a free initial consultation with an experienced disability attorney in Philadelphia, PA, call 215-858-8440, toll free 866-532-2504 or contact our Philadelphia disability insurance law firm online.

 

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