Thursday, November 16, 2017

Debunking Disability Fraud Myths

Debunking Disability Fraud Myths

A set of recent articles in the New York Times set astir notions of fraud being rampant for disability benefits under the Social Security Disability Fund.   In one of the articles, comment was interpreted that current legislation pointed to the belief by some that the fund was not work protecting until the perceived abuses could be better governed.

There is an excellent policy brief from the Center on Budget and Policy Priorities that explains the disability system in good detail.

While there is a perception, there are facts that override the perceptions, some are:

  • Getting on disability is difficult. There is a myriad of requirements just to qualify, and nearly 60% get turned away.  Some of the requirements are work force participation of 25% of the applicant’s life and the ability to demonstrate work in 5 of the past 10 years.
  • Some are rejected for a technical reason or simply haven’t worked long enough and to qualify the disability, whether physical or mental, must be severe.
  • Of the mere 40 percent of applicants who are accepted, it is common for the applicant to have been rejected on the initial request and have been subjected to additional scrutiny.
  • While physical disorders, which constitute the majority of claims, are easier to identify, some raise concern that others are less obvious such as back issue or depression or other mental disorders.  However, these mental disorders can be diagnosed and can be extremely debilitating for those who suffer from them.  There are real issues for those who suffer from injury or disease of the brain and conditions such as bipolar disorder or schizophrenia.
  • If there was rampant fraud, the death rate wouldn’t be as high as it is with disability recipients up to 6 times more likely to pass away as compared to others in an equivalent age group who aren’t on disability.
  • Claims are going up but not at a disproportionate rate to the population most likely to require this assistance.  The age group, starting with 50-year olds is larger with baby-boomers coming of age and there are more women that are eligible as since the post-World War II generations produced more working women.

disability fraudThe problem is not solved just by raising the bar of difficulty for persons to participate in the disability system as too many are shut out today and while there is certainly some fraud, it isn’t rampant. As it sits, the US has a very restrictive and limit benefit offering compared to many other similar economies per the Organization for Economic Cooperation and Development.

It does seem that the solution requires a legislative cure.  The cure would include financial support to the Social Security Administration that would allow it to develop and deploy a system to prevent and detect fraud.  To this point, there has been no such legislative remedy.  It is also important to note that in the last 20 years, resources available to the Social Security Administration have declined even as claims have increased as the largest component of the population is aging into the sweet spot.

If you would like to find out more information about a disability claim, please contact Edelstein Martin and Nelson.  To arrange a free consultation with one of our experienced disability attorneys in Philadelphia, call 215-858-8440, or toll-free 866-532-2504 or contact us online.  

The post Debunking Disability Fraud Myths appeared first on Philadelphia Disability Insurance Lawyer.

Wednesday, November 1, 2017

Important facts regarding traumatic brain injuries

According to the U.S. National Library of Medicine, millions of people suffer traumatic brain injuries (TBIs) in America each year.  The majority of these are severe enough to require immediate medical attention.  In the worst cases, permanent brain damage or death can result.  About fifty percent of all such injuries result from motor vehicle accidents.  Half of the more serious TBIs result in ruptured blood vessels (hematomas) or contusions (bruised brain tissue).  These have to be surgically removed when present.

Victims of TBIs may not always experience symptoms right away.  Sometimes it can take days or weeks before a person feels the full effects of the injury.  This is why its imperative that you seek medical attention immediately following an accident, whether you feel you were hurt or not.

Mild traumatic brain injuries: concussions

brain injuries in phillyThe mildest kind of traumatic brain injury is known as a concussion. Concussions can be caused by an impact to the head or any jolting movement of the head or body that caused the brain to move rapidly back and forth inside the skull.  Such sudden movement and shock and brain and damage brain cells.  Concussions do not always result in unconsciousness.  If they do, it is only for a matter of seconds or minutes.  While concussions are mild in terms of TBIs, they are still serious injuries.

Concussions can cause nausea, headaches, ear ringing, dizziness, and fatigue.  People with more severe TBIs may have the aforementioned symptoms in combination with other symptoms such as:

  • A persistent or worsening headache
  • Nausea or vomiting
  • Difficulty waking up from sleep
  • Slurring of words
  • Numbness or weakness in limbs
  • Dilated pupils

Severe traumatic brain injuries

The most severe form of TBI is that of a coma.  When a person is said to be in a coma, they remain unconscious for an extended length of time.  People who find themselves in a coma often suffer the most brain damage.

TBIs can also be associated with more complex, long-lasting symptoms, depending upon the severity of the injury along with the age and general health of the victim.  These include changes to cognition, emotional and mental health, sensory processing, or communication.  Examples include difficulty with thinking and memory, increased aggression or other personality changes, new or worsening depression or anxiety, or changes in the interpretation of smell, touch, scent, sight, and taste.

Severe injuries of this nature often require rehabilitation.  Medical personnel cannot do much in order to reverse the initial damage done by this kind of trauma.  Their main concern when dealing with TBI patients lies in preventing further damage.  They will ensure proper blood flow and oxygen supply to the brain.  Imaging tests can show details of the extent of the injury and assist with diagnosis and prognosis.  Patients may also receive X-rays of the neck and skull to see if fractures were sustained in addition to the brain injury.

At Edelstein Martin & Nelson, we specialize in personal injury law.  If you’ve sustained a traumatic brain injury or any injury caused by the negligence of another person and need to file a personal injury claim, don’t hesitate to contact us today.




The post Important facts regarding traumatic brain injuries appeared first on Philadelphia Disability Insurance Lawyer.

Wednesday, October 25, 2017

Americans with Disabilities Act (ADA) at-a-glance

In July 2009, the U.S. Department of Justice, Civil Rights Division, Disability Rights Section published a document entitled “A Guide to Disability Rights Laws”.

This document describes, among other things, the Americans with Disabilities Act (ADA).  While many Americans have heard of the ADA, few are aware of its details.  The ADA aims to stop discrimination due to disability in employment, government, Congress, and other areas.  It stipulates a number of regulations to this end.  The regulations are organized into different “titles”, each covering a general area.

In order to be protected under the ADA, you must be disabled or be associated with someone who is disabled.  A disabled person in this context is defined as a person who suffers limitations in a major area of life due to a physical or mental impairment.  Not all impairments that might be covered are listed, presumably because they would be too numerous.  




Americans with Disabilities Act


Under the first title of the ADA, businesses that employ fifteen or more individuals are required to provide equal opportunities to those with disabilities.  It prohibits discrimination in all areas relating to employment, including hiring and recruitment, training and promotions, pay, and more.  It requires employers to make reasonable accommodations to the limitations of disabled persons to the extent that it is feasible.  Title I includes religious institutions that employ fifteen or more people.

State and local government

This part of the ADA says that State and local governments must give equal opportunities to people with disabilities, including all of their programs and services.

Title II also includes an interesting tidbit of information regarding the construction of government buildings.  It stipulates that State and local governments must follow specific architectural designs when they construct new buildings or alter existing ones.  This is why you may have noticed your local city hall, government welfare office, public healthcare provider, or other government buildings being designed with features to accommodate those with disabilities.  For example, wheelchair ramps and door-opening buttons serve to assist those who cannot walk.

Public transportation

Title II also includes public transportation such as subways and Amtrak.  The rules that must be followed here mirror closely those of State and local government.  The authorities who manage public transportation must not discriminate against disabled people.  They have to comply with certain rules regarding the accessibility of their vehicles, both new and used.  They are also required to offer something called paratransit in the event they provide a fixed route transportation service such as buses or rails.  The term “paratransit” refers to a parallel service that takes individuals along the same route as the original service but provides accommodations that could not otherwise be implemented upon the main transportation method.

Public Accommodations

Title III covers public accommodations.  This includes a number of nonprofit organizations, commercial facilities, and select portions of the private sector.  The private sector services covered under public accommodations are quite broad.  They must abide by the same general rules set forth in Titles I & II.

For questions regarding the ADA or any disability-related concerns, please contact our office today.




The post Americans with Disabilities Act (ADA) at-a-glance appeared first on Philadelphia Disability Insurance Lawyer.

Wednesday, October 18, 2017

Common Disability Questions

Disability Questions

The initial question that often comes up with regard to disability benefits is: will I be eligible for social security benefits? People want to know if they ought to even go through the trouble of applying in the first place. Of course, the most basic requirement is to meet the definition of having a debilitating disability.

The Social Security Administration has a specific definition of disability. In order to be eligible for benefits, individuals must meet the definition as follows:

disability questions“For all individuals applying for disability benefits under title II, and for adults applying under title XVI, the definition of disability is the same. The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

There are several additional conditions you must meet as well. For example, you must not a) have a job that pays over $1,000 a month, b) be able to do work you have done in the past 15 years or c) be able to adjust to other work that might suit your age and experience. You must also be “insured”, meaning you have paid enough Social Security taxes over a certain timeframe and paid them in the recent past. Sometime after stopping working and paying these taxes, you will lose your insured status. If you meet all the above conditions and have paid adequate Social Security taxes, there is a significant chance that you will be approved for Social Security benefits.

How a lawyer can help

It is possible to apply for disability benefits on your own. However, few people who go this route end up receiving benefits. This is due to the fact that filing for these benefits can be a long, complex, frustrating process. The Social Security Administration even acknowledges the fact that claimants possessing representation have much better chances of success. Working with a lawyer who knows the ins and outs of the system can have tremendous benefits and will ensure you the best possible chance of being deemed eligible.

Your lawyer will deal with the specific tasks required to help you with your case. If you have applied in the past, your lawyer can request that your previous request is reopened. Time limits can also be waived if necessary.

A lawyer can help you with obtaining the required medical documentation as well. This is of the utmost importance when applying for Social Security disability benefits. Certain documents are more valuable than others. The Social Security Administration requires a large amount of such documentation. We can help you determine what is needed and assist you in obtaining it.

Here at Edelstein Martin & Nelson, disability law is our prime specialty. Our lawyers will be sure to gather all of the critical evidence needed to win your case and get you the benefits you deserve. Contact us today to schedule a consultation.


The post Common Disability Questions appeared first on Philadelphia Disability Insurance Lawyer.

Sunday, June 18, 2017

Better Insurance Options from Employers a Major Draw for Millennials

According to a new study, Millennials are more realistic and financially savvy than many give them credit for. The survey conducted by Anthem found that a full 35% of Millennials between 18 and 34 have turned down a job offer at least partially due to dissatisfaction with the insurance options from the employer. This compares to just 27% of respondents of all ages in the workforce.

Millennials are also far more likely than the previous generation to engage in long-term financial planning at 29% among Millennials compared to 19% of 35- to 54-year-olds.

While employers are all increasing their financial wellness offerings, Anthem says that they’re missing an opportunity by failing to improve their insurance offerings as well. A particular form of insurance that Anthem suggests for employers is disability insurance as these policies can benefit employers as well as employees. By integrating disability and medical benefits, Anthem says it can reduce benefits administration costs while helping employees return to work sooner.

Disability insurance offers the greatest benefit to employees, especially those who aren’t paid well and live paycheck to paycheck.

Among survey respondents who didn’t have disability insurance, more than half said it was because it wasn’t offered by their employer and 32% said it was just too expensive.

The post Better Insurance Options from Employers a Major Draw for Millennials appeared first on Philadelphia Disability Insurance Lawyer.

Thursday, June 8, 2017

Study: Only 20% of Americans Have Disability Insurance

According to a new study commissioned by the Million Dollar Round Table (MDRT), even families who appear financially stable are not always protected against risk. Nearly half of Americans say they could only maintain their existing lifestyle for 3 months or less if they were to lose their primary source of income and even fewer have insurance products like life insurance and long-term disability insurance to protect against risks.

The study found 61% of families would need to assume debt if they lost the primary wage earner in their family while 38% would have at least $10,000 in debt. Just half of Americans have life insurance. Among adults with dependents, 47% say their families would run out of money without their income in less than two years if they were to die.

One key area of financial planning that is overwhelmingly overlooked is the risk of disability or illness. 1 out of every 20 Americans are unable to work due to an illness or disability, but just 20% of Americans have short-term or long-term disability insurance. Only 39% of those who do have coverage think it would be enough to cover their care and medical expenses if they are seriously hurt, disabled, or sick.

Many Americans with long-term disability (LTD) insurance receive it through their employer, although LTD insurance can also be purchased as a private policy. An individual policy may have looser definitions of “disabled,” greater coverage, and flexibility, although these policies are usually more expensive than group coverage.

The post Study: Only 20% of Americans Have Disability Insurance appeared first on Philadelphia Disability Insurance Lawyer.

Monday, May 1, 2017

Long Term Disability & Mental Health Issues

mental illness ltdIt can be very challenging to get long term disability benefits for mental disorders, even though you may still be eligible. The reason is mental illness typically doesn’t show up on diagnostic tests and the severity of the condition can be difficult to measure objectively.

LTD claims processors are not licensed psychologists and often fail to understand the true limitations of a mental illness. They are typically quick to deny disability claims for mental illness because the disease does not show up on a blood test. Many disability insurance adjusters also fail to understand that many mental illnesses have a cyclical nature, including schizophrenia and bipolar disorder. An insurance agent may assume someone is “cured” because they are not displaying symptoms when this really just means that symptoms have abated temporarily and are almost sure to return.

There is also a strong bias against mental illness in popular culture. This bias extends to some disability insurance agents who do not consider mental disease a real illness.

Mental Illnesses Eligible for Long Term Disability (LTD) Benefits
Many forms of mental illness and impairments can qualify for LTD benefits if the condition prevents you from working and a residual functional capacity test shows functional, social, or intellectual limitations. Qualifying conditions include:
— Bipolar disorder
— Schizophrenia and other psychotic disorders
— Affective disorders like schizoaffective disorder
— Anxiety
— Personality disorders
— Substance abuse disorders
— Organic mental disorders

LTD Limitations on Mental Illness
It’s becoming more common for LTD insurance companies to limit payments for nervous and mental conditions to just two years. This provision is found in almost all employer-provided ERISA LTD plans and many individual LTD policies. With individual policies, it may be possible to buy a rider to remove this limitation in exchange for a higher premium.

Most policies have a limitation that states that disabilities based primarily on self-reported symptoms and disabilities caused by mental illness, drug abuse, and alcohol abuse are limited to 24 months of benefits. This provision defines self-reported symptoms as manifestations you report to your doctor, such as fatigue or pain, that can’t be verified by objective tests and clinical exams. Depression is almost always included in the list of conditions for which benefits are limited to 24 months.

Some mental illnesses are exempt from this limitation in many cases. Commonly exempted disorders include dementia, schizophrenia, Alzheimer’s disease, organic brain disease, and sometimes bipolar disorder. If your policy exempts these disorders from the limitation, you can collect LTD benefits indefinitely as long as you remain disabled.

Documenting Your LTD Claim
To improve the chances of having your claim approved, it’s vital that you properly document your claim and receive consistent treatment from a mental health professional. Your treating doctor should write an explanation about your condition and limitations rather than using the form provided by the insurance company which is designed to elicit responses that allow the insurer to deny your claim. Be sure your doctor explains any limitations you have with:
— Stay on-task all day
— Maintaining concentration and focus
— Avoiding excessive absences
— Responding appropriately to criticism
— Interacting appropriately with the public and co-workers
— Remembering, understanding, and performing simple actions

If you are attempting to file an LTD claim for a mental disorder or your claim has been denied, it’s important to work with an experienced Philadelphia LTD attorney to help document your condition and avoid common mistakes that can get your claim denied. Contact Edelstein Martin & Nelson for a free consultation with a disability lawyer in Philadelphia to get help with your claim.

The post Long Term Disability & Mental Health Issues appeared first on Philadelphia Disability Insurance Lawyer.