Can I Get SSDI Benefits For Opioid Addiction From Prescribed Medication?

Can I get SSDI benefits for Opioid Addiction from prescribed medication?

Opioid addiction have become one of US’s biggest drug concerns. This type of drug can be either synthetically produced or derived from opium. Most commonly used as pain relief, they are effective, but also have the potential to become addictive in some patients.

The term “opioids” can include anything from the illicit heroin to synthetic versions like fentanyl (a very tiny amount can be instantly fatal) as well as prescription pain relievers such as morphine, codeine, oxycodone (also known as OxyContin), hydrocodone (also known as Vicodin) and a number of others.

Opioids are great at relieving chronic pain, but patients can’t just stop taking them or they quickly experience withdrawal. The unfortunate nature of their effectiveness is also the pathway to addiction.

More than 40% of individuals on Social Security Disability are prescribed opioids for pain relief. Many are on very high doses for musculoskeletal disorders, which comprised 94% of chronic users. Depression among opioid users is about 38%. But if you find yourself unable to live without them, even when properly prescribed by a doctor, you could be addicted.

What Is An Opioid?

The term “opioid” describes a class of drugs that bind to the body’s opioid receptors. Morphine and other opioids are frequently prescribed for pain.

Opioids can also offer a feeling of euphoria, leading to the continued use and eventual mis-use of prescriptions. This is how many people become addicted in a short period of time.

Prescription opioid addiction is a particularly difficult situation, because the patient is frequently in a certain degree of pain. As with any addictive drug, the patient may find themselves increasing the amount of medication to get the same degree of relief from the drug. Eventually, they can’t stop taking the drug, because they may experience severe withdrawal symptoms as well as the return of physical pain. In some cases, patients may turn to more illegal forms of opioid like heroin if they are unable to acquire additional prescriptions.

Disability For Opioid Addiction

Social Security’s rules for disability due to addiction are very straightforward, and the short answer is usually “no.” But it’s not that simple.

Social Security doesn’t consider a drug addiction of any kind a disabling condition, even if it prevents someone from working. Only until it produces irreversible, permanent conditions does the Social Security Administration consider someone eligible for disability. All cases are reviewed in the same manner, no matter how the disability occurred.

SSA does not consider an addiction to properly prescribed prescription drugs to need a drug addiction or alcoholism determination (DAA.) However, SSA can take into consideration the disabling effects and limitations caused by a prescription that is used to treat a condition that a claimant is applying for. The side effects of a medication should be included when describing the seriousness of a patient’s condition.

In Social Security Ruling 13-2p, the SSA clarifies this point by stating that a DAA determination is “not to be applied” in cases of “addiction to, or use of, prescription medications taken as prescribed, including methadone and narcotic pain medications.” This also means that any side effects of the prescription will be taken into account when considering if a claimant’s symptoms are severe enough to be disabling.

What SSA Will Consider

The SSA previously had a listing for drug addiction, but as of 2018, that listing no longer exists. Impairments that result from a substance abuse addiction include:

  • Depression
  • Anxiety disorder
  • Personality disorder
  • Seizures
  • Brain damage (neurocognitive disorders)
  • Peripheral neuropathy
  • Gastritis
  • Pancreatitis

Of course, as with any condition, the SSA will require evidence of your condition, including diagnostic reports, your treating physicians’ contact information, details of any hospitalization, and a list of your medications and associated side effects.

While chronic misuse of opioids such as codeine may not produce permanent organ damage, improvements in brain imaging offer evidence of abnormalities as a result of codeine. This may also apply to other forms of opioid narcotics.

Permanent limitations that result from opioid drug use may be considered disabling if they are to the degree that they are serious enough to rate.

Houston’s Opioid Addiction Attorney

Social Security Disability laws are complicated and complex. If you’ve been denied disability payments for drug addiction or other debilitating condition, call us immediately. We’re ready to help.

We’ve helped over 4,000 Houstonians get their disability benefits. The Herren Law Firm in Houston, TX can assist with your application, appeals and records gathering to prove your case, and win your claim. Contact us today at 713-682-8194 (or user our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, and we only collect a fee if we win your case.

 

The Role Of A “Vocational Expert” At Disability Hearings In Houston

One of the biggest sticking points in a disability claim is whether or not you can go back to work. Depending on your previous occupation, your disability claim may hinge on whether or not you can continue to work at your “old job.”

The Role Of A Vocational Expert At Disability Hearings In Houston

The Social Security Administration employs the use of an expert witness to help them determine your ability to return to work. Known as a “vocational expert,” these individuals assess both your abilities and the current labor market skills and needs, and testify in front of an Administrative Law Judge (ALJ) at your hearing.

What The Vocational Expert Does

This is the person who looks at your limitations, the current job market, current skills, and your past work history and decides whether or not you can return to some kind of work, or if you are too disabled to work. This testimony is important, and can be the difference between having your claim approved or denied.

A VE is not an attorney, and their opinion is considered to be impartial. He or she will have degrees and training related to the profession, as well as related work experience. The VE will review 15 years of your work experience to determine if you have any transferable skills to a different occupation.

Job Title Vs. Your Actual Job

Just because you had a specific job title doesn’t mean you did the same thing as others with the same title. The VE must also understand the actual responsibilities you had and the tasks you were required to perform. It’s important that the VE know what you did in your last job, rather than a generally accepted job description or the description in the Dictionary of Occupational Titles (DOT)  or the Occupational Outlook Handbook from the Bureau of Labor Statistics.

It is also important that you (or your disability law attorney) ask the VE to explain the job title and the associated duties used to describe your previous work.

During a hearing, your attorney will ask you questions about your last job, what you did, as well as things like physical requirements that were a part of the job. This clarifies the job title vs. actual job quandary so that your side is accurately represented. The VE should use the job title along with the skills and duties that were included in your previous work.

Residual Functional Capacity (RFC)

One option that a VE may use is a residual functional capacity assessment to find out what you can and can’t do in relation to your previous employment. This report describes the maximum exertion you can do in a normal work setting on a daily and continual basis.

Additionally, the VE and/or the ALJ will need to assess “function-by-function” to determine your limitations in the RFC compared to the requirements of your past occupations. If the RFC does not agree with the job conditions, you may be ruled disabled.

What A Disability Law Attorney Does For You

While the ALJ asks the vocational expert a series of questions, including hypothetical ones, a disability law attorney will cross-examine the VE and challenge their view on what you can and cannot do.

Cross examining the VE challenges him or her on his or her findings of your limitations and abilities and asking about things that the ALJ left out of the hypotheticals will increase your chances of winning your claim. Without an attorney, you’re at the mercy of people who may or may not have your best interests at heart.

Need Help With A Disability Claim? Let Herren Law Help

The Herren Law Firm has helped over 4,000 clients successfully win their claims. We can help with your application, appeals and help you through the process, and give you one less thing to worry about. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

How Does Divorce Affect Social Security Survivors Benefits?

One of the most important parts of financial security for retired and widowed individuals is Social Security. This is especially important for women, since women characteristically are younger than their spouses but outlive them.

Social Security Survivors Benefits

One of the lesser-discussed topics of Social Security is the survivors benefits paid to spouses, children, and occasionally parents of a deceased worker. The National Academy of Social Insurance estimates that 7.5 million individuals over the age of 60 receives SS benefits based on the work record of a deceased spouse, with about 3.7 million of them widowed spouses. As long as the deceased worker has collected enough credits to receive Social Security, survivor’s benefits are available.

In some cases, even if you were divorced from your spouse, it’s still possible to collect Social Security survivor’s benefits from your former spouse.

Criteria For Survivors Benefits

For a widowed spouse to collect survivor’s benefits, the following conditions must apply:

  • The deceased must be collecting Social Security at the time of death
  • You must be over the age of 60 (or 50 if you are disabled); you’ll receive anywhere from 71.5% to 100% of the deceased’s monthly amount depending on your age, or
    • There is no age limit if you are caring for a child under 16 or a disabled child of the deceased, or
  • You must be a child of the deceased, under 18 or 19 and 2 months if still in high school, or
    • You have a disability that began before the age of 22
    • You’re a grandchild or stepchild of the deceased
  • Parents of the deceased, aged 62 or older, who were financially dependent on the deceased. One parent will receive 82.5% of the deceased’s benefit for one parent, two will receive 75% each.

Additionally, there is a one-time death benefit of $255 available in a lump sum payment for the widowed spouse, minor children, or an adult child who is disabled. There are specific conditions that apply to this separate death benefit as well.

What If You’re Divorced?

Surprisingly, you can still apply for and collect these benefits from your former spouse, if:

  • Your former spouse was collecting SSDI or Social Security retirement at the time of death
  • Your marriage to the worker lasted 10 or more years
  • You did not remarry before the age of 60, or age 50 if you are disabled, if the disability happened within 7 years of the worker’s death
  • You are raising the child of children of your former spouse that are under the age of 16

As a divorced spouse:

  • You’ll receive 100% of your deceased ex-spouse’s retirement or SSDI benefit if you are of full retirement age.
  • You’ll receive between 71.5% and 99% of your deceased ex-spouse’s retirement or SSDI benefit if you are between 60 and full retirement age.
  • You’ll receive 71.5% of your deceased ex-spouse’s retirement or SSDI benefit if you are between 50 and 59 and disabled, and your disability happened before your former spouse died, or within 7 years of their death.

You can still apply for the one-time death benefit if the same conditions apply.

Divorced males as well as females can collect survivor’s benefits from their former spouses. However, if your own Social Security benefits are higher than the amount of your survivor’s benefit, you’ll receive that higher amount instead. Additionally, you won’t receive more than you would normally—your total monthly amount won’t exceed what you’d receive every month as an individual.

Remarriage

If you remarry before the age of 60 (or 50 with a disability) you will lose the survivor’s benefits from your former spouse. If your new spouse dies, you can resume receiving the survivor’s benefits from your previous spouse as you did before.

Remarriage after the age of 60 will have no effect on your survivor’s benefits, and you can continue to collect them.

Maximum Family Benefit

There is a total amount that family members—children, parents, etc.—will receive as survivors.

If you receive survivor’s benefits based on caring for a child, that will be taken from the maximum family benefit. The benefits you receive will be taken from the maximum amount, and decrease the amount of money that other family members may receive.

However, the money you receive as a divorced spouse will not affect that maximum.

Need Help With Social Security Or Disability? Get Help From Herren Law

The Herren Law Firm can help you with your application, appeals and help you through the process, and give you one less thing to worry about. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

How To Increase Your Odds Of Being Awarded Social Security Disability Benefits On Your First Try

Many people are denied when they first apply for Houston Social Security disability benefits. In fact, over 65% are denied on their first application, meaning less than 40% of applicants are approved. So what’s the difference?

Houston Social Security Disability Benefits

The Application Process

Contrary to popular belief, it isn’t SSA’s policy to delay and deny claims the first time around. One of the biggest reasons for an initial denial is an incomplete application form.

You’ll start with the application, and go from there. The Social Security Administration has a printable checklist on its website, along with instructions to complete it. You can download, print, and use this checklist to complete your initial application. If you meet certain conditions, you may be able to complete your application online, without visiting your Social Security office.

Your eligibility assessment is also assessed on your previous work history.

It’s important to have all of the requested information as well as medical information. If you haven’t been under the care of a physician, you may have a more difficult time proving a medical disability. You would need a very good reason, such as not having medical insurance or not being able to afford any, but you still have a very high chance of denial.

Ways To Increase Your Odds Of Approval

  1. File Your Claim Immediately. Getting approved for benefits can be a very long process, and if you wait, your disability insurance may expire. You will have to have worked five of the last ten years to be eligible, and waiting to apply may be too late.
  2. Get Help With Your Application If You Need It. Mistakes and missing information are the main reasons applications are denied. Contact a disability attorney, a family member, or someone from a Social Security field office for help.
  3. Find A Disability Attorney If You Have To Appeal. An attorney who specializes in disability work will know what to do and how to do it, and make sure you’ve done everything correctly by the deadline. More applicants win on appeal with an attorney than without.
  4. Keep Up With Doctor Visits And Medical Treatment. If your disability requires medical treatment, keep up with every appointment, test, prescription and doctor visit. Failing to seek medical treatment for your condition will lead SSA to believe that your condition is not serious enough to warrant disability. SSA believes you should be seen by a “provider” every two months. If you’ve lost your health insurance, using local “free clinics” or other available care may satisfy the requirement. You should also keep up with prescribed medications.
  5. Request An RFC Form From Your Physician. The Residual Functional Capacity (RFC) form is used by examiners to determine your functional ability with your medical condition. These forms are needed to close out a case, and are usually completed by a DDS physician or psychologist. If your treating physician completes it, the claims examiner may use it to create an internal RFC for your case.
  6. Use A Businesslike Demeanor With Everyone You Deal With. In other words, be nice, or it could make your journey a lot more difficult. Caseworkers deal with hundreds of individuals every day in the same situation, and losing your temper or being rude can lead to even more delays in your case. No matter what the situation, be polite and cordial no matter what the situation to maintain good relations and communications.
  7. Contact Your Local SSA Office or Office of Disability Determination Services to check on your case’s status. Don’t make the mistake of calling SSA’s toll-free number, where they don’t have the most current information. Contact the office where you made your application, or the Office of Disability Adjudication and Review if a hearing has been requested.

Why Are More Applicants Approved On Appeal?

It’s a little odd, but true. Administrative hearings may take a year or more to be scheduled. A individual’s disability progresses in that time, increasing his or her inability to work. When appearing in front of an administrative judge, he or she will see you face-to-face and determine disability on sight, rather than on paper. If it’s obvious from seeing you that you’re unable to work, as it is in a hearing, your chances of approval increase as well.

Of the applicants that file an appeal, 60% who hire a disability attorney are approved, compared to the 34% who don’t have legal counsel. A disability attorney who is experienced with Social Security disability claims is familiar with the application and appeals process, and can guide you through it.

Houston Social Security Disability Benefits Attorney

Getting disability is a long process, but we can make it easier. We’ve helped over 4,000 Houstonians win their claims and get the benefits they need. We have the experience to help you with your Social Security application and/or appeals process.  The Herren Law Firm can help you with your application and any necessary appeals. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

What If My Application For Disability Benefits In Houston, TX Is Denied? Can I Appeal The Decision?

You’ve gathered all your medical records and filled out all the forms that were required. But after carefully preparing your application and sending it in on time, you were still denied. What do you do now?

The truth is, more than half the people who apply for benefits are denied the first time they apply. You have the right to an appeal within 60 days, so use it. Don’t assume that a denial is the end of everything, or worse, re-apply without legal help from a disability lawyer.

What If My Application For Disability Benefits In Houston, TX Is Denied? Can I Appeal The Decision?

The Process Of Appeals

Many people assume that a denial is the end of their application and either give up entirely or re-apply. Both are incorrect, and you will lose valuable time and your appeal rights in both scenarios.

There are four steps to the appeals process in Texas, and they have to be done in order.

  • Request for Reconsideration—this involves turning in your same paperwork to another SSA representative for review. You can also include additional information that was omitted from your original application. About one out of six people who request reconsideration are approved at this stage.
  • The Disability Hearing—you’ll go in front of an administrative law judge who will hear your case and decide if you are qualified for disability. Expert witnesses, such as a medical expert to discuss your condition and a vocational expert that can advise on what kind of work you may be qualified to perform. However, you are allowed to bring witnesses as well as present any new evidence that has come to light since your application or last denial.
  • ·The Appeals Council—if the judge denies your request, you can bring your case to the next level. This council consists of administrative law judges that were not involved with your case previously. These judges won’t consider any new evidence, however, they will make sure that the previous judge followed proper laws and procedure in deciding your case.

These judges can either agree with the original judge’s findings or overturn the decision and award your disability benefits. They can also send the case back to the prior administrative law judge with comments about any mistakes made in the case.

  • Federal Court Review—this is where you’ll file a lawsuit if you disagree with the decisions of the previous courts.

Why You Need A Disability Attorney

Just applying for disability is complicated and confusing. Going through the process of appeals is even more complicated as well as challenging. Finding an attorney who understands the process and knows what to do will make the process much easier, and increase your chances of winning on appeal.

Call Us For Help With Your Disability Appeal

If you didn’t have legal help with your disability application, don’t leave things to chance. The process can take many months, and in some cases, years. Don’t give up.  Let us help you with your appeal and increase your chances of winning.

We’re experienced in handling all types of disability claims and have helped more than 4,000 Houstonians get the disability benefits they need. Call The Herren Law Firm today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and we’ll take your case on a contingency fee basis, with no up-front charges.

How Do They Decide If I’m Totally Disabled Or Partially Disabled In Houston, TX?

If you’re unable to work due to a disability, “hurry up and wait” is probably a term you’ve heard at least once. Determining disability can be confusing. Are you completely disabled, or only partly disabled? There are a number of questions to answer before you receive an answer.

How Do They Decide If I'm Totally Disabled Or Partially Disabled In Houston, TX?

Qualifying For Disability

In order to receive Social Security disability, you must have worked long enough and recent enough to earn work credits, up to four per year. Once you’ve earned $5,290, you’ve earned the four towards your total of credits.
Social Security only pays for total disability, not partial. You are considered disabled if:

• You cannot do the same work you did before
• You cannot adjust to other work because of your medical condition(s); and
• Your disability has lasted or is expected to last for at least one year, or will result in death

How Disabled Are You?

This question is answered by Social Security’s five-step process that determines how much work you can do, as well as if and when you can be expected to return to work. There are a number of things that are considered the process.
Social Security will ask about your education and work experience. They will also ask about your current job—how did you do it? Can you still do some of it? Can you adjust to doing a previous job, or change professions to perform a new vocation?

One way to determine your abilities is to review your Residual Functional Capacity (RFC.) With the help of their Listing Of Impairments, SS will determine what abilities you have in spite of the conditions of your disability (standing, sitting, interacting, taking directions, etc.)

The determining questions asked involve:

• If you are currently working, and if you earn more than $1,180 per month
• If your condition severely limits your basic work abilities for more than 12 months (lifting, standing, walking, sitting, and remembering)
• If your condition is found in the List Of Medical Conditions that are severe enough to prevent you from doing “substantial gainful activity”
• If your medical condition or impairment prevents you from doing the work you did previously
• If you can do any other type of work. Your age, education, medical condition, experience, transferable skills, and other factors are taken into consideration

One determining factor is whether or not you can do “light or sedentary work.” If you are under age 50 and can do light, sedentary work, you will not be considered “disabled.” However, if you are over the age of 55 with an RFC of “light or sedentary work” and don’t have transferable skills, you will likely be granted disability under the medical-vocational allowance. However, if you can do light work, the SSA will assume that you can learn and perform a new job or vocation.

Need Help With A Disability Claim?

If you’re assembling your application, you may be overwhelmed. There are numerous forms to fill out, doctor visits and conversations to handle correctly. One wrong item can sink your claim.

Let us help. We’re experienced in handling all types of disability claims and have helped more than 4,000 Houstonians get the disability benefits they need. Call The Herren Law Firm today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and we’ll take your case on a contingency fee basis, with no up-front charges.

Can You Get Long Term Disability for Migraines in Houston, TX?

If you’re one of the 28 million Americans who suffer with migraines, you know the signs when you’re getting one. Lethargy, increases in pain and the so-called “auras” are sure indicators that it’s about to happen. You may have stressors or triggers that bring on a migraine (like a smell or bright light) that tell you it’s coming. Once that happens, you know you’re down for the count until it passes.

Can You Get Long Term Disability for Migraines in Houston, TX?

You may have relatives, friends or coworkers who don’t offer support. You may even hear the comment, “but you don’t LOOK sick.”  You know you’re in pain, even if they don’t. Medications have varying degrees of effectiveness; some don’t help at all. And if you go to work anyway, instead of staying home, you know your quality of work will suffer until it passes. Meantime, you manage the best you can.

What Is A Migraine?

A migraine is a headache and condition that can seriously impact your quality of life. According to Migraine.com, migraines are the 7th leading cause of disability worldwide. Common symptoms include:

  • Light and/or sound sensitivity
  • Throbbing headaches
  • Blurred vision or other visual disruptions
  • Nausea
  • An “aura”—visual disturbances that includes blind spots, flashing lights, zig-zagging lines, and/or “seeing stars”

There may be other accompanying symptoms, such as fatigue and/or lethargy. Migraine episodes typically last 4 hours to 72 hours. These symptoms can also make work, social events and other everyday activities difficult or impossible to engage in.

Proving The Disability

Getting disability for migraine conditions can be difficult, even though one in four households are likely to have someone who suffers with it. As a neurological condition that’s not visible or diagnosed by a regular blood test, filing for long-term disability can be more difficult.

Note that “self-reporting” your condition may severely limit your benefits, or see them declined Migraines aren’t obvious or detectible through conventional medical testing. Supplying sufficient evidence to prove your inability to work is essential, so you’ll need to use other means of reporting to support your claim. Insurance companies want objective evidence for your diagnosis. A series of documentation will be required to successfully defend your claim, including:

·         Your own journal: record everything related to your condition truthfully and thoroughly—pain, frequency, intensity, severity, treatment, and your level of difficulty. Include dates, times, duration, and other relevant details, i.e., hospital visits, treatments given, side effects of medicines, etc. Your physician may include a review of your notes in your patient record, making it part of any claim evidence.

·         Work with your doctor: you’ll need your doctor’s support for your claim, so you’ll need to follow his or her instructions, including taking prescribed medications. If you’re unable to comply with your physician’s instructions (i.e., side effects of medication) make sure to inform him or her of these difficulties. Their records should indicate that you are doing your best to follow their instructions.

·         Other documentation to support your disability claim: this should include days missed from work, test results taken to rule out any other conditions, any treatments or medications you tried, their effectiveness, and any side effects

·         Testimony from family/friends supporting your activities that are limited by the headaches

·         Your doctor’s notes about your migraines (intensity, frequency, severity, etc.), and if these headaches are compounded by other illnesses or injuries.

·         Records of any hospital visits (including ER) related to your migraines

·         If you’re a veteran, medical evidence verifying the service-related connection, such as an incident that occurred during service time, or that it’s related to another service-related condition.

Migraines As A Catalyst

As painful as migraines are, they can also be a catalyst for additional conditions, such as fatigue, depression, sleep disorders, additional pain as well as other conditions.  If you also experience the “aura” symptoms, you may also be at increased risk for strokes and heart attacks.

Houston’s Attorney For Long-Term Disability Help

Filling for LTD can be a chore under the best of circumstances. With a condition like migraines, it’s more complicated, and of course, can be more difficult. But an attorney experienced in disability filings and appeals can help you gather the necessary information needed to file and increase your chances for a successful outcome.

Over 4,000 Houstonians have received the LTD benefits they need, and we can help you too. The Herren Law Firm can help you with your application, appeals and help you through the process so you can concentrate on getting better. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

Houston Attorney for CIGNA Disability Claims

Most people don’t expect to become disabled. But in the US, one in five individuals is considered disabled, enough not to work. Some need time to recover from an illness or injury. Some may never return to work, and will be on disability for the rest of their lives. But in many cases, part of their journey to disability involves long-term disability insurance. And for many, that insurance company is CIGNA.

Houston Attorney for CIGNA Disability Claims

Who Is CIGNA?

It’s one of the largest healthcare insurance companies in the world, for both companies and individuals. Whether you’re buying on your own or through your company, CIGNA offers health and dental insurance, Medicare, and supplemental coverage to augment your regular insurance policies. These include accident insurance, two types of cancer insurance, heart attack/stroke insurance and “whole life insurance” for final expenses.  Companies can also choose from supplemental group plans, wellness programs, cost control options and benefit technology solutions.

If your company offers short- and long-term disability insurance, there’s a good chance it’s also through CIGNA.

CIGNA is also one of the world’s largest group disability insurance companies. Calling itself a “global health services company,” CIGNA was ranked #97 on the Fortune 500 list in 2014. The company has more than 37,000 employees worldwide, has over $35 billion in revenue and $10.8 billion in shareholder’s equity.

While CIGNA offers a wide range of related services worldwide, they are also in business to make money. Denying claims is part of their business.

What CIGNA Is Really Like

Company literature touts their slogan, “Together, all the way.”  But policy holders who have CIGNA will tell you that once you file a disability claim, it’s not always like that. For a vulnerable person who needs help, CIGNA turns their back on many of their policyholders.

The company has a reputation for denying claims immediately, with little or no investigation, and only minimal documentation is used to deny claims. They also have a reputation for ignoring policyholders, not responding to phone calls and emails, and issuing multiple requests for the same information.

The company is governed by ERISA guidelines, but uses them to its advantage. CIGNA’s deadline for deciding your claim is 45 days, but the company routinely asks for 30-day extensions to delay that decision. They also continually ask for additional bits of information to further delay decisions—every request stops the time, and then starts it over. When you receive these requests, answer them immediately. The initial claim decision generally takes about 105 days with the extensions.

If your claim is denied, you’ll have 180 days to appeal. Don’t wait—begin your appeal immediately (and if you have a disability attorney, he or she will know what to do.) Your appeal will take time to prepare—don’t wait. CIGNA will take 45 days to respond to your appeal, but may also request a 45-day extension, making it 90 days.

Another tactic CIGNA uses is to continually ask for information and stalling their decision. You may also be told by one of the many “case workers” you speak to that if you’ll just write a simple letter, your claim will be approved and your checks will begin right away. This is another stalling technique, and can be used to deny your claim. Talk to your attorney if you’re being ignored or treated badly.

Don’t Ignore Appeals

Appeals are essential to getting your claim approved if you’re denied the first time. Pay attention to the deadlines given—if you miss it, you’ll lose your ability to appeal, and possibly your entire claim to long-term disability.

CIGNA allows two appeals before either approving your claim. If you’re still denied, you may opt for a lawsuit. If you don’t have an attorney at this point, you’ll need one now.

Are You Fighting With CIGNA?

Fighting with your insurance company can be worse than having a disability. It doesn’t have to be that way. A thorough and complete application is the best way to start, and we can help.

We understand the process of applying for disability and dealing with appeals—we do it every day. The Herren Law Firm in Houston, TX can assist with your application, appeals and all documentation. Contact us today at 713-682-8194 to schedule your free consultation. We’ve helped over 4,000 Houstonians get their disability benefits, and we only collect a fee if we win your case. Don’t fight alone—call us today.

Social Security Disability and Workers’ Compensation in Houston, TX

Confused about Social Security Disability and Workers’ Compensation? If you’ve become disabled, it’s important to know the difference, because the application processes and outcomes are different.

Social Security Disability and Workers’ Compensation in Houston, TX

Workers’ Compensation

This is a public insurance funded by employers and includes both medical treatment for on-the-job injuries and/or illness, and partial payment for lost wages. Injured employees can heal away from work, and be paid for their temporary disability. Should an employee discovered that he or she is permanently disabled, permanent benefits are paid. If an employee’s death occurs, benefits can be paid to the survivors.

Texas calculates an employee’s Average Weekly Wage (AWW) as the amount of wages they receive during the period 13 weeks prior to the work-related injury/illness, and uses it to determine the amount of WC benefit payments. The maximum benefit will not exceed that amount, and will vary depending on the type of injury (temporary, longer-term, or life benefits.)

In Texas, employers may offer WC coverage for employees who become injured on the job, but they can opt-out of the state’s plan and offer their own private coverage (self-insure.) If your employer does carry the state of Texas WC, and you apply for Social Security Disability, there may be some overlap. Should you receive both at the same time, you may see a decrease in one or the other.

Social Security Disability

This federally funded program pays you based on your average monthly lifetime earnings, not to exceed 80% of your previous average monthly earnings.  SSD pays you benefits if you are unable to work due to a medical condition that will last a year, or is terminal.

You can complete your SSD application online, by phone or in person by appointment at your local Social Security office. However, you may not receive benefits right away. The Social Security Administration examines your case and makes a determination based on your application. Therefore, it’s important to completely fill out your application and have all of your important information handy when you do. This information includes your name, date/place of birth, Social Security number, the same information on your spouse or former spouse(s), any minor children, earnings, and other pertinent information. (A complete listing of required information is available on the Social Security Administration’s website.)

Possible Offsets

If you are receiving Workers’ Compensation and apply for Social Security Disability, you may receive a smaller amount of SSD than if you would if you did not receive Worker’s Compensation. Social Security calculates the amount that you would receive monthly, and you’ll only receive the difference between your WC payments and the SSD amount. Your total payments cannot exceed 80% of your average monthly income when you were working.

For instance, if you made $3,500 a month while you were employed, your total disability income would be $2,800 per month. If you are receiving disability payments of $1,800 from Workers’ Compensation, then your monthly SSD payment would be $1,000. If you are no longer receiving Workers’ Compensation, then your SSD payment would be the full $3,500 per month.

Both Social Security Disability and Workers Compensation are publicly funded programs, as are others (i.e., civil service disability benefits.) Therefore, disability payments from private sources, like pensions or insurance benefits, don’t affect your Social Security disability benefits. VA benefits, state and local benefits and SSI also do not impact Social Security benefits.

In Texas, offsets to WC aren’t allowed for SSA retirement benefits, and lump-sum payments aren’t usually authorized, except for accrued benefits that haven’t been paid yet.

Need Help? Call Us

If you’ve submitted applications and are denied benefits, don’t give up. The Herren Law Firm has helped more than 4,000 Houstonians get the help they need dealing with Social Security and Workers’ Compensation cases. Call us today at (713) 682-8194 or (800) 529-7707 to schedule your free consultation. Our contingency fee arrangement means you won’t have to pay any fees until we win your case.

Do My Long Term Disability Payments Affect My Social Security Payments?

The short answer: Yes.

It’s called an “offset.” Payments from a long-term disability policy can (and very likely will) be reduced by the amount you receive from Social Security. This is true whether you receive SSI or SSDI. The Herren Law Firm understands the process and can help you manage your claim and get you the benefits you deserve.

Do My Long Term Disability Payments Affect My Social Security Payments?

What’s The Difference Between Disability Payments And Social Security Payments?

Long-term disability is private insurance that you either purchase yourself or receive as a benefit through your employer. Disability payments provide income while you are disabled and are unable to work for a long time. Long-term disability provides a portion of your income (usually 50% to 65%, depending on the policy) while you are disabled. This insurance starts when short-term disability ends, usually after three to six months.

SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income) are government-funded programs that provide income when you are unable to work due to a disability. You pay into the system with the Social Security deductions from your paycheck.

What Is “Disabled?”

Generally, it means that you are unable to work at your regular job; “long term” is more than 30 or 120 days. You must be able to prove that you are medically and physically unable to work for an extended period of time. Your policy may specify that you must be unable to work the job you were in, or if you are unable to work any job, full or part time. Review your individual policy to find out about disability payments and more.

Disability criteria differs for insurance companies and Social Security, which is much more stringent. The Herren Law Firm can help you apply for Social Security benefits, and increase your chances of approval.

The Offset

When you file your Social Security claim, your benefit payments will take a very long time. However, the date your first file is your date of disability. Individuals frequently receive a lump sum for the period before their regular benefits begin, called a “backpay.” The insurance company may require you to refund some of the payments they previously paid to you using the backpay, to offset the monies already paid.

How It Works

Some long-term disability policies will require you to apply for Social Security when your insurance payments begin. Once it’s approved, your disability plan will pay you the difference between your Social Security payment and your policy payment. That is, if your policy payment is $2,000 a month, and Social Security is $1,500, your policy payment will change to $500 instead of the entire $2,000. The “offset” is the $1,500 per month that Social Security pays you, and your total income remains the same.

Backpay Is Taxable

Even if you are required to make a large, lump-sum payment to refund your insurance company, the IRS will also collect taxes on the lump sum. Many individuals are shocked to receive a tax bill for that amount, and may be unable to pay it. If you expect to receive a lump sum from Social Security, consider saving a small monthly amount from your disability payments to protect yourself against an unpleasant surprise later.

Long-Term Disability or Social Security? Or Both?

It depends on the insurance policy you have, and how long you may be disabled. Individually purchased disability insurance may allow both without offsets, whereas group or employer policies may have more restrictions. Some policies may require you to apply for Social Security once the insurance payments start.

Reading and understanding your individual policy is essential before starting and submitting a claim, so that you understand what you can expect, and if there is an offset once you receive your benefits.

The Herren Law Firm Is Ready To Help

Applying for Social Security for disability is a long process, and most claims are denied at the outset, requiring appeals. This is where you may need an attorney to handle your claim so you can start receiving benefits. If your insurance company is denying your claim, an attorney can step in and get the process moving again.

We’ve helped over 4,000 Houstonians just like you get the disability benefits they need. Call us today at (713) 682-8194 or (800) 529-7707 to schedule your free consultation. Our contingency fee arrangement means you only pay us if we win your case.