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Enforcing Guiding Principles in The Face of Changing Regulation

Sometimes the Social Security Administration seeks to change the rules to reduce the number of cases for which it must pay benefits. For example, the Administration has questioned the need for a doctor’s opinion when determining whether or not one can do work. This question arises especially in cases where the claimant is young or has a condition that a lay person finds difficult to understand (or even to accept as real). However, even with changing regulations, a claimant’s lawyer will hold the Administration to the timeless principle that diagnoses and determination of the impairing effects of those diagnoses are best handled by physicians—specifically, physicians that examine you and know your medical history.

The process of applying for disability begins with the initial level, where the Administration reviews your application and evidence, and it makes an initial decision (and sometimes a second opinion called a reconsideration decision). Next there is the hearing stage, during which an Administrative Law Judge (ALJ) will determine whether or not you are disabled based upon: i) your application, ii) the opinions of the Administration at the initial level, iii) your medical record and professional opinions, and iv) your testimony. Also, there is often testimony from a vocational expert that discusses what jobs might be available based on the limitations the ALJ finds after considering the evidence. However, sometimes (actually quite often) the ALJ will overstep his or her bounds and try to make a decision against the advice of medical professionals. This is an error that is often rubber-stamped by the Appeals Council after the hearing decision.

When this happens, it is time to consider taking the Administration to federal court. If the attorneys at Olinsky Law Group find that the ALJ has made an error in applying the law and regulations, we can sue the Social Security Administration. This means that a United States District Court will consider your case, and, if appropriate, the Court will order the Social Security Administration to rehear your case and to follow the District Court’s instructions when doing so.

Recently, the Administration has sought to repeal the regulations requiring ALJ’s to afford more weight to the physicians who treat you on a regular basis, instead allowing the ALJ to rely on the opinions of doctors who review your record on paper or who conduct a single consultation exam. However, despite this repeal of regulations, the District Courts understand that the principles behind the old regulations favoring treating doctors are as applicable today as they were years ago. The Administration must defend their decision by doing more than merely stating that they do not have to follow the old regulations.

Now, does this mean that if your doctor says you are sick or injured that the Administration must provide benefits? No. However, your doctor’s opinion is important, and it must not be taken lightly. A suit in federal court is meant to compel the Administration to afford your case the consideration that the law demands it be shown. In addition to providing professional service in helping claimants at the initial and hearing levels, Olinsky Law Group has a team of attorneys and staff dedicated solely to bringing cases to the District Court so that you can be sure that your case has been given as much consideration as the laws demand. Note by Andrew Flemming.


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I Lost My Disability Case, What Now?

If your application for disability benefits has been denied, you may be wondering what you should do next. Your next steps will depend on what kind of disability benefits they are and what step of the process you are at. The good news is that usually there are several levels of the process and if you are denied at one level, you can appeal to the next level to hopefully get a favorable decision there.

There are different kinds of programs that may be considered “disability,” including worker’s compensation, Disability Insurance benefits (SSDI), and Supplemental Security Income (SSI). The programs differ in many ways and depending on which program you are applying for, the steps you may take will differ.

For example, with SSI and SSDI, you first apply directly to the Social Security Administration. If they deny your claim (which they will likely do), you may be able to ask for reconsideration. If your claim is denied at that point you can then ask for a hearing with an administrative law judge. The hearings can be held in person or over videoconference. (However, if those options don’t work for you your representative may be able to help you figure something else out.) If you are denied by the Administrative Law Judge, then you can ask the appeals council to look at your case. If the Appeals Council still denies your case, you may even be able to appeal to the Federal Court in your area!

In other words, don’t give up!

One thing that all of the programs have in common is that they have a lot of complicated rules and regulations, and if you want to be approved it is important that you have the necessary evidence, and present your case in the way most likely to be approved. There are also specific timelines for applications or for appeals, so you should contact an attorney or someone who specializes in this kind of law as soon as possible if you have been denied.

All cases are different and sometimes instead of appealing at a certain level it may be better to reapply. In the end, the circumstances of your case, the benefits you are applying for, and other factors will influence the best course of action.

Our experienced disability lawyers at Olinsky Law Group represent people from all over the country who are applying for disability. Contact us today to help you figure out your next steps!