Social Security Disability Consultative Exam: What is it?

Some Social Security Disability applicants are sent for a consultative examination while others are not.  What is a consultative examination?

SSD Benefits

Mooney & Associates representing social security clients – 717-200-HELP – http://www.mooney4law.com

 

Essentially, it is a medical examination scheduled by Social Security with a physician they choose.  It can range from a general internal medicine (family) doctor, to a specialist, such as an Orthopedic, to a pain management doctor to a Psychiatrist.  It really depends on the medical conditions you are alleging to cause you to be disabled.  If Social Security feels the need for a consultative examination for determination of your application, you will receive written notification from social security. Continue reading

Social Security Disability Hearings Tips

Here we provide social security disability hearing tips and advice.  Many of my clients express anxiety, stress, fear, and nervousness toward their upcoming hearing for Social Security Disability benefits.  Unlike Workers Compensation, where an injured worker may testify twice, with social security disability hearings, there is one hearing.  Claimants have one shot to convince an otherwise skeptical administrative law judge that they are indeed disabled and unable to work full time.

Here are some tips we provide to our clients as they prepare for their disability hearing.

  1. Relax.  The ALJ’s at the Harrisburg Office of Disability and Adjudication Review (ODAR) hearings office are nice individuals.  They are not going to attack you personally, attack your credibility, or make you feel uncomfortable.  They are going to ask you questions that you can answer.  There is no need to be nervous that you will be treated poorly.  It will not happen nor should your counsel allow it to happen.  Just relax.
  2. Answer the Question that is Asked.  Listen to the question that you are asked, then provide a direct answer.  Seems simple.  Often times though, a claimant may not fully understand the question, but yet, they try an answer what they think the question really was that was asked.   Other times, claimants may be quite nervous, and not really hear or listen to the full question.  If you do not understand a question, simply ask the ALJ or your attorney to repeat the question.  Asking to have a question repeated is much better than providing an inappropriate answer that doe snot addressed the question that was asked.  If you think taking notes on the questions being asked by the ALJ or your attorney would be helpful, then do so.  You may be asked some tough questions about your condition, about what is in your medical records, about your past employment, etc . . . Avoiding to answer a question is a sure way to sink your case.  ALJ’s will pick up on the fact you are trying to avoid giving an answer.  Don’t do it.  Just answer the question.
  3. Be clear and concise.  Do not ramble on, go off subject, or try and give a long winded answer that you think will be impressive.  Straying a way from the actual question asked will likely bore the ALJ, which will not be good for your case.  You should prepare yourself to answer questions.  We meet with our clients to prepare for hearings and review the types of questions that you could be expected to have to answer. Being nervous can cause a person to ramble on.  Practice with a friend, family member, or your attorney.  We prepare our clients.
  4. Be clear on symptoms and limitations.  It’s critical to specify your pain levels, symptoms, limitations, and functional deficits in your testimony.  Vague answers will sink your case.  Let’s use an example.  When an ALJ asks you to describe your pain, a response like, ‘it hurts’, isn’t acceptable.  Be descriptive.  Specify where it hurts.  Is the pain centered in your low back only?  Does it run into either or both legs?  Does it cause any other problems?  On a scale of 1 to 10, with 10 being the most severe, describe your daily pain.  Saying your daily pain level is a 10, everyday, is likely not going to be persuasive to an ALJ.  Answering questions with details will help draw a more clear picture of you and your struggles for the ALJ.  Use detail for questions about your functional limitations.  As an example, if an ALJ asks you how long you can sit for a period of time, a bad response would be “not long’.  That tells the ALJ absolutely nothing.  Be specific.  Can you only sit for 15 minutes at a time?  If so, then what happens?  Do you have to then stand up?  Do you have to walk around?  If so, for how long before you can sit again?  The way I describe testimony to my client is for them to think of themselves as an artist.  The testimony of the claimant paints a detailed picture of the claimant’s disability and its impact on their daily life.  In order for another, such as the ALJ, to know what picture is suppose to be, the picture must have detail.  In other words, good details to explain what the picture is and what it is not.  It is your painting of your disability.  Generalized answers like ‘it hurts’ or I can’t lift much” or I can’t sit long” do nothing to full in the details.
  5. Be ready for to explain medical records.  Let me explain.  I do not mean that it is your responsibility to explain your medical records in detail.  You likely do not even understand medical records.  However, if there has been a significant gap in medical treatment, be ready to explain it.  Perhaps you had no health insurance, no money, no transportation, and therefore could not treat.  Be honest. Giving untruthful answers is the quickest way to sink your claim.  Always remember, the ALJ has reviewed all your medical records.  So making things up, like facts and symptoms, just isn’t a wise thing to do.  If there is a period of time you were telling your doctor you were feeling better, then explain it.  Perhaps you had a brief time where your symptoms were a bit better.   Perhaps you just had an injection that provided temporary relief.  There isn’t anything wrong with that.  However, lying about it is a sure way to get your claim denied.  If your doctor has talked to you about pain medication abuse or has denied you pain medicine, you need to be prepared to address that issue.  You need to speak with your attorney about that.
  6. You will be asked about an average day.  Nearly in every case, since claimants are not working, the question will be asked, ‘tell me about your average day’.  You need to think about this question.  Don’t be afraid to write down notes to refresh your memory on things you may want to say in response to this question. You will be asked to describe what you do around the house.  Do you cook, do laundry, clean?  To say NO to all of these types things generally won’t be believable.  Describe hobbies you used to be able to do, but your disabilities have caused you to cease those type of activities.  Does someone help you on a daily or weekly basis to perform certain tasks, like laundry and groceries?   These questions are important because it helps to fill in that detail of your picture of your disability.
  7. Do not exaggerate.  This is important.  ALJs have heard hundreds, if not thousands, of cases.  Do not make your symptoms sound worse than what they are.  Your medical records, history you provided, physical examination results, and diagnostic tests are well documented in medical records the ALJ has reviewed.  Exaggerations beyond findings will undermine your credibility.  ALJs are well-trained to determine whether an individual is magnifying or exaggerating their symptoms.  Just be honest with your answers.  Additionally, avoid answers that indicate you are in pain ‘all the time’, ‘everyday’ ‘always’, ‘my pain is a 10 all the time’.  ALJs just won’t believe that testimony.  Additionally, do no exaggerate your limitations of what you can and can’t do.

The point here is to relax, answer the questions clearly, and be honest.  Those are the keys to painting a much clearer picture of your disability and limitations because of your disability.

Going to your social security disability hearing without legal counsel is not a smart idea.  We understand the process, we know your ALJs, and we [are[pare our clients for their one shot hearings.  If you have applied for and been denied social security disability benefits, we can help.  We handle social security cases in both Pennsylvania and Maryland.  Call Mooney & Associates today for a FREE CONSULTATION at 717-200-HELP or 1-877-632-4656.  Additionally, if you have not applied for disability benefits yet, call us.  We handle the application process for you.

Injury Description is important in Workers Compensation

Pennsylvania Workers CompOne of the more important, and often overlooked, aspects of a workers compensation claim in Pennsylvania is the description of injury.  More times than not, if you get hurt at work and your employer accepts your work injury, the description of your injury provided is nothing more than a ‘strain/sprain’ or ‘contusion’, whether it be to your neck, back, shoulder, etc. . .  Often times, it is simply not accurate.

So why is that the description provided on the PA Department of Labor & Industry forms that you get?  Could be a few reasons.  First, many insurance carries only accept sprain/strains and contusions.  Second, your actual injury may have just happened and the actual medical diagnosis is unclear.  Third, it may actually be accurate.

More than likely, the first two reasons are applicable.  Many insurance carriers do not accept anything outside those generalized descriptions.  There is a reason for that.  By accepting only generalized descriptions of injury like a strain/sprain, it provides the insurance carrier leeway in denying future medical treatment.  For example, if you have an accepted left shoulder strain, but you recently had a left shoulder MRI that indicated a rotator cuff tear, the insurance carrier may deny surgery.  They will deny surgery based on the fact that they only ever accepted a left shoulder strain/sprain, not a rotator cuff tear.    Another frequent example is a head injury.  Often times, the accepted injury for a head injury is a ‘head contusion’.  That provides leeway for the insurance carrier to deny treatment for concussion and post concussion syndrome.  They often do as well.    Continue reading

Amazon employee killed in accident at Amazon Warehouse in Carlisle

An Amazon Warehouse employee was killed in a work accident recently.

The is the second death at the Middletown/Carlisle facility since 2014.  If you recall, an employee was killed in 2014 in a pallet jack accident.

The Occupational Safety and Health Administration is investigating a death at an area Amazon facility.

Devan Michael Shoemaker, 28, of Millerstown, died Tuesday of multiple traumatic injuries at the Amazon warehouse on Allen Road in South Middleton Township.

Cumberland County Coroner Charles Hall confirmed Shoemaker died after the 5:15 p.m. accident in which he was run over while helping the driver of a truck tractor hook up a trailer.

Amazon had already been warned and fined by OSHA in 2016 at it’s New Jersey facility for failure to address workplace safety concerns.  I’ve written in this issue time and time again.  Big conglomerates like Amazon consistently skirt safety issues for lower operating costs, while the employees are the ones to suffer, often from devastating work injuries, and in this case, even death.

I have represented many injured workers at Amazon in Carlisle.  With Central Pennsylvania’s warehouse growth in full swing, more and more warehouse type injuries are occurring.  Check out my previous article on common warehouse injuries.

If you work at one of the many warehouse or distribution center in Central Pennsylvania and have sustained a work injury, don’t hesitate to call Mooney & Associates to protect your right and benefits you may be entitled to under the Workers Compensation Act.  Places of employment like this often try and intimidate injured employees, downplay injuries, deny injuries, terminate employment when injured, or have injured workers sign forms quickly.   Get represented!  Call Mooney & Associates for a FREE CONSULTATION AT 717-200-HELP or 1-877-632-4656.

In Pennsylvania, do I have to work light duty when hurt at work?

Under Pennsylvania law, do I have to return to light duty when I am hurt on the job.  Why would an injured worker ask that?  Well, it isn’t that these clients are lazy, not at all.  Many times, an injured worker simply wants appropriate time to recover and heal from the work injury.

Legal ramifications for turning down light duty

Turning down available light duty is not a wise decision and can put workers compensation benefits at risk.  In Pennsylvania, your employer has the right to offer you modified duty employment.  Many employers in Central Pennsylvania do offer light-duty work assignments or alternate work programs. The critical thing to remember is that both the employer and the injured employee must act in good faith in offering and responding to an offer of light-duty work.  Failure to do so can result in a suspension or reduction in you wage loss benefits. Continue reading

Pennsylvania Workers Compensation and travel expenses to doctor

Either way you look at it, a work injury can be financially disturbing for many.  Many injured workers have their injury denied, meaning they are receiving no income while they litigate their claim.  Others have an accepted claim, but for medical benefits only, which again means, no wage loss benefits while the claim is being litigated.  Others may be receiving benefits, but at a reduced rate from their regular, average weekly wages.  Often, it causes financial hardship.

Regardless, work injuries often times require significant medical treatment.  That means trips back and forth to the doctors, to pain management, to physical therapy, and to the pharmacy.  Unfortunately, there is a misperception out there that an injured worker is entitled to reimbursement of travel expenses back and forth for their treatment.    The injury isn’t my fault, why should I have to pay for my own gas to and from treatment.  Great argument.  And I agree wholeheartedly.  However, in Pennsylvania, it is not a reality.  Continue reading

How long does Workers Compensation litigation take in Pennsylvania

An obvious question asked by many clients is just how long does Workers Compensation litigation take in Pennsylvania. It is a concerning issue for many injured workers because they are either off work with a denied injury or off work and the insurance carrier has accepted the injury, but only for medical purposes, not wage loss. That means that the injured worker is out of work, often times with no alternative sources of income.

In Pennsylvania, a typical time line for workers compensation litigation extend from 8 months to 12 months. Let’s walk through the time line to illustrate why the lengthy time line exists.

First, from the time you file a claim, it may be 15-45 days before a hearing is scheduled.  Depending upon what Judge is assigned to your case, you may or may not testify at the first hearing. I advise my clients on that issue immediately (So there is at minimum 1 month) Continue reading

Pennsylvania Supreme Court strikes down IRE provisions in Workers Compensation Act

Attorneys across the Commonwealth of Pennsylvania have been waiting for the Pennsylvania Supreme Court to clarify the status of the Impairment Rating Evaluation section of the Act, since the Commonwealth Court struck down provisions and remanded the case back to a Workers Compensation Judge.   The PA Supreme Court issued it’s decision as I sat in a workers compensation hearing around 11:30 AM this morning.   In Protz v. WCAB (Derry Area School District), No. 6 WAP 2016, the Court struck down the IRE provisions of the Act as unconstitutional in it’s entirety.

To help you understand, let me first explain the IRE process.  First, and foremost, it is a process used to limit injured worker wage loss benefits.  The injured worker is examined by a doctor chosen by the Commonwealth for what is called an impairment rating evaluation.  The IRE exam is solely used to establish a whole body impairment.  If the IRE examination finds an injured worker to have 50% or less whole body impairment from the work-related diagnoses, then wage loss benefits are capped to 500 weeks (about 9 1/2 years).   A request for an IRE examination by the insurance carrier cannot occur until an injured worker has received at least 104 weeks (2 years) of total disability compensation. Don’t confuse this examination with an IME  (defense) examination.  They are entirely different.  IRE examinations are nothing more than a tool for an insurance carrier to limit wage loss benefits of the injured worker.  Additionally, the provision is also unfair because it is nearly impossible to get a 50% or more whole impairment rating evaluation, outside completely catastrophic injuries. Continue reading

In Pennsylvania, what happens to Medicare Set Aside Funds

You may have heard about Medicare Set Aside agreements when it comes to Workers Compensation lump sum settlements.  They are complex and confusing too many.  Let me try and help explain a little about this complex area of law.

First, when is a Medicare Set Aside agreement required as part of a structured workers compensation settlement?  Generally, with a worker’s compensation settlement, federal law prohibits Medicare from paying for injury-related medical expenses or medications that an employer is responsible to pay.  In essence, other insurance coverage exists for those medical expenses.  To achieve that purpose, Federal government regulations require that a portion of settlement funds be “set-aside” in an account to pay for future medical expenses related to the work injury. So what specifically triggers this process?  Here are the general criteria when a settlement should be submitted for CMS review.

CMS will only review new WCMSA proposals that meet the following criteria:

  • The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or

  • The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00

So, what is the important words in here — “is” and reasonable Continue reading

New Opioid policy for Injured Federal Employees

The US Department of Labor’s Division of Federal Employee Compensation has issued new guidelines for the use of opioids to treat injured federal employees.  There has been significant nationwide concern over the growing opioid addiction epidemic across America and we should expect more changes to come, at the state levels as well.

Here is the gist of the new opioid guidelines.

  • Implementation is set for August 2017
  • Opioids can be prescribed for an initial 60 days.  However, the prescription must be broken down to  two 30 prescriptions each.
  • After the initial 60 day prescription, then to extend opioids, the treating physician must complete a Letter of Medical Neccessity (LMN). A LMN must be completed for any subsequent prescriptions.
  • Compound medications containing opioids must alway be prescribed with a LMN.  This guidelines goes into effect as of June 26, 2017.

The use of narcotic painkillers has been steadily increasing, and with that rise in use has come addiction, abuse and resulting deaths.  Many estimates put opioid use three times  higher this decade than previous decades.  Unfortunately, patients with long-term injuries are readily prescribed narcotic pain medications and that use has created significant dependency issues for many users, especially those suffering from arthritis and back injury. In many instances, insurance companies simply find it much cheaper to pay for opioid prescriptions than other treatments, including surgical procedures, that could provide much more effective long-term relief.

I suspect we will start to see similar measures rolled out in state Workers’ Compensation programs.

If you are an injured Federal Government employee, or you have suffered any work injury in the private sector and live in Pennsylvania or Maryland, contact Mooney & Associates today for a FREE consultation.  Don’t risk it going alone.  You have too much to lose.  You can call us at 717-200-HURT.