Lessons From NY Disability Fraud Case

Another round of disability fraud in New York City has made national headlines and it’s an excellent example of how disability claims can be abused. There were already 100 retired firefighters, police officers, jail guards and others accused of scamming the Social Security disability system and most recently 32 more people were charged.

An interesting aspect of this round of allegations is that some of the newly accused happen to be the sons of some of the men from the first round of accusations. These fathers are thought to be the ringleaders of this whole operation. The early numbers of the amount of the people and money from this scam were revised and now prosecutors believe there could be hundreds of people involved in cheating the Social Security disability system out of $400 million.

One of the key points of this scheme is that half of those accused are charged with faking the symptoms of post-traumatic stress disorder to get a payday from the Social Security disability benefits program. A lot of the recipients were told to link their conditions to 9/11.

The fathers who are a part of the accused include a retired police officer and a benefits consultant, they are a part of a group of four men that are thought to be involved in telling the disability retirees how to get away with faking their conditions. It is also alleged that these four men received tens of thousands of dollars in secret payments, all four of these supposed ringleaders deny the charges.

We don’t yet know if any of the accused are guilty because they have not yet gone to trial. While all of the accused will have their day in court, this second round of Social Security disability fraud accusations demonstrates why it is important to have a quality Independent Medical Examination (IME) at the beginning of any claim for Disability benefits. A quality IME means there will be less of a chance that a claimant will be able to fake their disability.

According to CNN “Prosecutors said the defendants were meticulously instructed on how to fail memory tests with plausibility, how to dress and how to behave. Nearly every application included identical descriptions of daily living.”

There will always be people who will try to lie to receive a check from disability benefits program, it doesn’t matter if it is private sector disability insurance or the Social Security disability system. Disability insurance is an important benefit for millions of Americans and the only way to protect the reliability of these systems is to make sure that the providers who examine the claimants are using the most rigorous standards.

There are ways to determine if a claimant is trying to fake a disability claim, this is true if it’s a physical or psychological disability claim. The best and most experienced providers use multiple testing methods to bring out a false claim. There are tests where the same questions are asked in different ways to see if someone is falsifying information.

Some providers who do IMEs for disability claims may have a large amount of claims that they need to do exams for, again this can be true for private sector disability or the Social Security. While each of these exams can be a daunting task, it’s important to know that your providers will pay attention to details with each IME they complete. The urge to rush through an IME must be resisted. The integrity of the private and public disability insurance systems depends on it.

The big lesson to take away from the NY Disability Fraud Case is this: it’s all about the providers. Disability insurance claims depend on providers knowing how to provide an unbiased and thorough IME. This will help to prevent fraud and make sure that disability insurance works for the people who really need it.

The One Key Report That Will Win a Social Security Disability Case

After over a 1,000 successful Social Security Disability cases, as a disability lawyer I have found there is one report that can make a difference. What is that report?

First, the agency considers the opinion of the treating doctor to be the most important document in the medical file. However, the critical opinion often does not exist. Why is this? Simply, doctors are involved in treatment. They are not concerned with legal disability issues.

Second, the agency will not allow doctors to make the legal determination in the case. Thus, if the doctor says a claimant is “disabled” the agency will reject this “naked” statement. The agency will say this is a legal determination to be made by the Social Security Judge.

Third, a mere statement that you are “disabled” will not be accepted. However, an opinion (from the treating doctor) stating what impact the claimant’s impairments have on important body functions can be extremely important and may be decisive in a case. For example, the doctor’s opinion on how long the claimant can walk, stand or sit is critical. Also, the doctor’s opinion regarding lifting, bending, etc. is critical.

Fourth, an experienced disability lawyer will have a set of evaluation forms for your doctor. They will be tailored for your individual impairment. For example, for a low back problem, there will be a lumbar spine form. This form will ask the doctor critical questions on how the low back problem impairs important body functions like walking, standing, sitting, lifting, bending, etc.

Fifth, unlike a “naked” statement of disability, this report will elicit what the doctor’s opinion is about the claimant’s ability to perform critical work activities. If the doctor’s opinion in this matter is supported by the doctor’s treatment records over a period of time, then the Social Security Judge may be compelled to give this report “great weight” in the claimant’s case.

Sixth, even if other medical evidence disagrees with the treating doctor’s opinion, the treating doctor’s opinion will prevail if the opinion is well supported by the treating doctor’s records.

In summary, a single report can win a Social Security Disability case. However, it has to fit the above criteria: (1) the doctor must be a treating doctor; (2) the opinion must indicate how critical body functions are affected by the impairment; (3) the opinion cannot just say the claimant is disabled; and (4) the doctor’s opinion must be grounded in the doctor’s treatment records. An experienced Social Security lawyer can work with the claimant’s to develop this winning report.

How a Disability Attorney Can Help You With Your Case

Navigating the bureaucratic process of Social Security benefits can be frustrating and confusing. Instead of handling the process by yourself, a disability attorney can guide you through it with positive results. Lawyers with this expertise understand the government process and how to move through it effectively.

Time is of the Essence

Disability claims have a finite period during which you can apply for benefits. If you miss this time period, you may not have a successful claim. Your lawyer will have expert knowledge of the time necessary for processing a petition and the best date to apply to ensure timely completion before the deadline. Without a lawyer working on your behalf, you might file too late.

Handling Details

Applications for benefits are complicated and detailed. Completing the application on your own without professional assistance could result in rejection. The Social Security Administration routinely rejects applications if they are not completed properly or if the claimant did not file them correctly. With a disability attorney working for you to handle your application, you can rest assured that the application will be filled out correctly and it will be submitted according to proper procedure.

Understanding of the System

A disability attorney will have an expert understanding of all types of claims and cases. This expertise will enable the lawyer to provide guidance and recommendations for the best way to handle the claim. The lawyer has first-hand knowledge of what the Social Security Administration wants in application claims. Consequently, the advice you receive will help you avoid common pitfalls that could lead to the rejection of your application.

Including Medical Evidence

A complete case will include strong medical evidence to back up the disability claim. The attorney will assist you by collecting this evidence, including details about the impairment, your work history, your age, and the events that led up to your current condition. It’s possible to submit your medical evidence and application online, over the phone, or in person with your lawyer present.

Rejection and Request for Reconsideration

Up to 70 percent of all initial applications are rejected by the Disability Determination Services Office of the Social Security Administration. If this occurs, your lawyer will be ready to help you file your request for reconsideration. To be accepted, your request for reconsideration must reach the Disability Determination Services office within 60 days of the first rejection. If your reconsideration request is denied, you can then file an appeal.

The Appeal Process

The appeal process involves a hearing in front of a judge, a council review, and a Federal court review. The hearing involves a review of your case with witness interviews, if desired. The judge will make a decision about your petition. If you wish to appeal the judge’s decision, you can request another review by a council. The council will provide a ruling on your case. If you wish to appeal the council ruling, you can request a review in Federal court.

Throughout this appeal process, a disability attorney can assist you to ensure that the evidence you present is factual and supports your claim of illness or injury. Having a representative in your corner may make the entire process easier.