Colorado Social Security Disability Law

Tomasz Stasiuk July 2nd, 2008

I was recently on Gather and saw the following advice about keeping copies of all the forms Social Security Sends you to fill out.

Make sure everything is consistant the whole way through all of your paperwork and conversations. Keep copies for yourself and document all conversations with representatives you talk to, also. …. And yes, they do read all of the forms. That is why I am saying that you must be consistant the whole way through. It is all logged in and if you have to go before a judge he goes over all of it, too. He will actually refer to certain sections that were filled out, etc.

This is spot on! I have seen this happen many times. If you say something at your hearing that is inconsistent with your answer on a form, the judge may call you on it.  Or worse, the judge may find that you are not credible.  One of the main purposes of hearing is to let the judge see you in person and make a credibility assessment.  And, if the judge does not think you are credible, well… that is not good for your case.

If you can, it’s useful to have an a lawyer read over the forms and point out inconsistencies and show you how your words may be misinterpreted at your hearing to mean something completely different from what you intended. 

photo credit: ®ominitä

Tags: Applying, Forms

• Applying , Building a Case
• Comments(1)

Tomasz Stasiuk June 11th, 2008

If you are getting medical records from a doctor or hospital in Colorado, the maximum you can be charged is set by 6 C.C.R 1011-1, Chapter 2, Part 5.2.3.4. In 2008, the maximum price for medical records is “not to exceed $16.50 for the first ten or fewer pages, $.75 per page for pages 11-40, and $.50 per page for every additional page.”

This can quickly add up!

But, there is a way to get medical records for free.

The same regulation states, “No fees shall be charged by a health care provider of patient records for requests for medical records received from another health care provider or to an individual regulated pursuant to Section 25-1-802(1) solely for the purpose of providing continuing medical care to a patient.”

This means another of your doctors can request and obtain medical records at no cost, if it solely for the purpose of providing continuing medical care.

This allows a new doctor to obtain you records from your prior doctor.  This also allow one of your current doctors to get another of your current doctor’s records so that he or she is kept up to date about your treatment.  

The long and short of it is that your doctor can get your records for free.  

How does this help you?  Once you doctor has gotten the records, your doctor can provide you with copies at no charge or a very minimal charge.  

Obviously, your doctor cannot request the records for the purpose of providing them to you.  But, if the purpose was solely for providing continuing medical care, once the records are in the doctor’s possession, the doctor is not obligated to charge you for copies of the records. 

The gotcha is that you have to have a doctor who is enough on your side to provide copies of the records in his/her possession to you at no charge.  In practice, this does not happen too often.  

But, if you have a doctor who is very supportive of your Social Security claim, your doctor can save you A LOT of money by helping you get your medical records. 

Note:  this is Colorado specific, but other states may have similar regulations.

 photo credit: Lil Larkie

Tags: Costs, Medical Records

• Building a Case , Medical Records
• Comments(0)

Tomasz Stasiuk May 28th, 2008

The short answer is “yes.”

Ok. Great. Latte time! Well, maybe not. Knowing that a condition can be disabling does not tell you HOW to prove that social phobia is disabling in your case.

As in any Social Security disability case, you have to show that social phobia keeps you from being able to engage in substantial gainful activity (generally full time work).

Social phobia most likely affects your ability to work by making it impossible for you to have more than very occasional contact with the public, co-workers, or supervisors. That would be the workplace limitation that would preclude most kinds of substantial gainful activity and keep you from being able to work.

You can prove this limitation by obtaining supporting statements showing isolation, difficulty interacting with others, avoiding social events, or avoiding contact with others during social events, going to the store to shop at 1:00 in the morning to avoid dealing with others.  Several of my clients have shared with me that they have left their groceries at the check out line because there was suddenly too many people in line, or there was some kind of commotion, or some other problem.

These cases are very personal.  There is no recipe guaranteed to win your Social Security claim. But, it you just can’t be around people, if you avoid contact, even with people you like, you may qualify for Social Security.

It is often helpful to enlist the help of an attorney, or even a family member, to help you list all the ways social phobia/social anxiety disorder affects your ability to function.  Then figure out ways to document these problems.  

Of course, as I have talked about many (many) times before, medical records are critical.  But, especially in social phobia cases, you will need to go beyond the medical records when developing your case. 

 photo credit: A Touch of Glass

Tags: Social Anxiety, Social Phobia

• Building a Case , Disabilities/Impairments
• Comments(2)

Tomasz Stasiuk May 7th, 2008

Dr. Fink of The Bipolar Blog has compiled a great list of suggestions for when you filing for disability benefits.

• Consult your doctor and therapist
• Keep your doctor appointments
• Have your doctor complete an RFC form for you
• Document everything
• File immediately
• Appeal
• Keep copies

This is just a summary, the article goes into quite a bit of detail about each point.

I do not agree with every point. For example, the article says the following about when to contact an attorney:

Most disability attorneys won’t even talk to you until you’ve filed a claim and been denied, so don’t waste your time consulting an attorney until you have filed and been denied. Of course, there is a chance that you will file and be approved, in which case, you’ve saved yourself the attorney fees!

Most attorneys will not take a case unless it has been denied, but it is wrong to say that most attorneys will not talk to you until the case has been denied. There is a big difference is saying an attorney will not talk to you versus saying an attorney will not take your case.

I talk to people all the time about their Social Security cases. About a quarter to half the time, I cannot take their case (for one reason or another). But the caller gets to discuss their case, bounce some ideas off of me and get some free advice!

Sometimes I take a case before the denial, sometimes after. But it is never a waste of time to get some early input into your Social Security case.

photo credit: swambo

Tags: Blogs

• Building a Case
• Comments(0)

Tomasz Stasiuk May 2nd, 2008

I was recently asked to write about how Social Security views disability claims based on anemia and other blood disorders.   First, I will address how Social Security generally handles disability claims. If that puts you to sleep, just skip ahead a few paragraphs.

In general, Social Security reviews cases using the five-step sequential evaluation process:

1. Does your impairment keep you from being able to work?
2. Is your impairment severe. That is, does her impairment have more than a minimal at effect on your ability to perform daily activities?
3. Does your impairment meet or equal one of Social Security’s “Listing of Impairments?” A listing of medical conditions, acceptable medical evidence, and the severity necessary for an impairment to be considered disabling.
4. Does your impairment prevents you from being able to perform any job you performed over the last 15 years which was also a substantial gainful activity?
5. Does your impairment prevent you from being able to perform any other type of work which exists in substantial numbers of the national economy?

This is just a quick rundown of the five-step sequential evaluation process. There are exceptions and corollaries to this but I just want to quickly state the steps that Social Security will go through in evaluating a disability claim.

Assuming that anemia and/or other blood disorder keeps you from being able to work (step one) and has more than a minimal impact on your ability to perform daily activities (step two), that brings us to step three: does the impairment meet or equal a listing level impairment.

Listing 7.02, chronic anemia, discusses  how Social Security looks at anemia.  You can read about how Social Security views other blood disorders here. 

7.02 Chronic anemia (hematocrit persisting at 30 percent or less due to any cause) With:

A. Requirement of one or more blood transfusions on an average of at least once every 2 months; or

B. Evaluation of the resulting impairment under criteria for the affected body system.

You may look at this, and say to yourself,

Whoa! I don’t need blood transfusions every two months! Does that mean I am not disabled?”

No. Just because you do not meet one of the Social Security listing of impairments, does not mean that you are not disabled. It simply means that Social Security will probably not find the disabled at step three.  Social Security may still find you disabled at steps four and five. This is where things really get interesting and a lawyer’s knowledge, experience and creativity come into play.

If you are skipping ahead, this is where you want to continue reading.

If the condition does not meet or equal one of the Social Security listing of impairments, the question becomes whether anemia, or other blood condition, keeps you from being able to do any job you have done over the past 15 years, and would keep you from being able to do any other kind of work. 

In my experience, anemia may cause fatigue,  loss of energy,  loss of concentration,  weakness, dizziness, shortness of breath, chest pain, and/or abdominal pain. Some of these symptoms, such as weakness or shortness of breath,  might limit the kind of work you would be able to perform, but might not eliminate your ability to do all kinds of work — in other words, it may not be enough to find you disabled.

For example: weakness or shortness of breath might make you unable to  work on a construction site, but these symptoms might still allow you to do office work.

Along the same lines, loss of concentration might mean that you are no longer able to do some type of skilled work, because you are no longer able to focus long enough on a project to complete it. However, you may still be able to perform an unskilled job which does not require extended periods of concentration or attention.

The more important symptoms may be fatigued and loss of energy. These might make you unable to work any type of full-time job simply because you are unable to work for eight hours a day or 40 hours a week, or would require frequent breaks, or make you frequently miss work (excessive absenteeism).

This is just a quick review of how Social Security may review an anemia case and some thoughts on how to build a disability claim based on anemia or other blood disorders. Please note, there is no one-size-fits-all plan for every case or every impairment. Every case is different. Everybody reacts to an impairment in their own individual way.   I strongly recommend reviewing your case with an attorney to determine how best to pursue your case.

 photo credit: ncfc0721

Tags: Anemia, Blood Disorders, Sequential Evaluation Process

• Building a Case , Disabilities/Impairments
• Comments(1)

Tomasz Stasiuk March 21st, 2008

One of the best sources for a statement of what you can and cannot do, is your own doctor(s).

However, in Colorado, I typically see Social Security have one of their technicians or a Social Security doctor, who has never seen or examined you, determine what your limitations are.

When having this conversation with my clients in my Colorado Springs office, I am often asked why? Why does it seems like Social Security purposefully avoids getting this information from the best source, your own doctor?

This is a difficult questions to answer and I can only provide a guess. My opinion on this matter is that Social Security wants to ensure an objective opinion and believes that their is too much chance that your own doctor cannot be objective. Because your doctor has been treating you for some time, he or she may be more likely to write what you want rather than what the doctor feels your limitations may be.

I personally feel this is just bologna!

I try to make sure that my client’s doctors’ voices are heard by Social Security. Sometimes this means getting a doctor to fill out a form. Sometimes, it mean having the doctor write a letter. Sometimes, a doctor feels so strongly about a case, he or she will come in to testify during a hearing.

It may seem like a small thing, but just getting your doctor’s perspective on your condition can make all the difference.

photo credit: Katie Tegtmeyer

Tags: Doctors

• Building a Case
• Comments(1)

Tomasz Stasiuk March 19th, 2008

People in Colorado contact me at all stages of the Social Security disability process: when they are applying, after they are denied, just before the hearing, even after they receive a denial from an Administrative Law Judge (ALJ).

The single most common problem I see in Social Security disability claims is a lack of a statement of limitations from in a Social Security is the absence of a statement of limitations from a doctor.

To be found disabled, you generally have to show that you are unable to perform some type of full time work. This is a simplification of the Social Security disability standard, but it sufficient for this article.

In order to show that you are unable to work you must prove that your impairments limits your what you can do. But, how do you do this?

Is there a statement of limitations in your medical records? Probably not. Most medical records contain a description of your symptoms, the objective findings, the doctors assessment, and the treatment plan. Most medical records do not have any statement of your limitations.

Doesn’t Social Security get a statement of my limitations? They do. But that is part of the problem.

If you are reading this, chances are you have already been denied. This means Social Security has already reviewed medical records and formulated a statement of your limitations. Since they denied you, Social Security’s statement of your limitations is not enough to find you disabled.

That also means that even if you appeal, unless you have your own medically supported statement of your limitations, you may be denied again. That is because Social Security has a statement of what your limitations and you do not. Even if their statement is wrong, if you do not have your own statement of limitations, you are at a disadvantage.

Even if Social Security has not yet made a decision on your case, do you really want a Social Security technician who does not know you, or a Social Security doctor who has never examined you, deciding what your limitations are. Do you want that to be the only statement of limitations Social Security has when they decide your case? Of course not.

The best people to provide evidence about your limitations are your treating physicians. Your doctors know you and how your impairments affect you. They are the best people to provide a statement of your limitations.

You can ask your doctor to help you by providing a statement of your limitations. Then, provide this to Social Security so it can be evaluated along with the other evidence in your case file.

Personally, I feel that the statement of limitations is such a critical element of any Social Security disability claim that you want to have help from a skilled attorney. A lawyer specializing in Social Security will have a library of questionnaires and letters which can be customized to elicit a true and complete picture of your limitations from your doctors.

Whether you are fighting to get Social Security disability benefits on your own, or with a lawyer, keep in mind that a statement of limitations is a critical part of building your case, and the one element missing in most Social Security claims.

photo credit: wilhei55

Tags: Appeal, Denial, Hearing, Medical Records

• Building a Case
• Comments(1)

Tomasz Stasiuk March 3rd, 2008

A 100% impairment rating from the VA is usually a strong indicator that you may qualify for Social Security disability benefits.

However, that still does not make a case a slam dunk. A number of problems can arise which may cause Social Security to deny your case.

1. Lack of treatment. Social Security expects an individual to try to exercise a reasonable amount of self-help. That means getting regular ongoing medical treatment. Of course, some conditions may not be helped with on-going medical treatment (e.g. a loss of a limb), but others may be.
2. Non-compliance with treatment. Social Security regulations allow a claim to be denied if the individual is non-compliant with treatment and that treatment is prescribed and estimated to restore functioning to the point that the individual is no longer disabled. In practice though, I see cases denied simply for failure to follow treatment, which is less than the regulations require. Note: there are exceptions that excuse non-compliance with treatment, such as inability to afford the treatment or medication.
3. Drug or alcohol abuse. This is one of the biggest obstacles to what otherwise might be a fairly clear cut case. Under Social Security regulations, if drug abuse or alcoholism is a material factor contributing to the disability, benefits can be denied.
4. Family or marital issues. If periods of symptom aggravation coincide with periods of trouble with a spouse or other family matters, it may be difficult for Social Security to separate whether the disabling symptoms come from the underlying impairment (which may allow for approving benefits) or from the situational issues (which may cause a denial of benefits).

None of these problems is necessarily insurmountable. But, the first step in resolving one of these issues is knowing it is there and that it is a potential problem.

This is one of those instances when having an attorney objectively and impartially review your case may be extremely useful. What may seem to you like a minor matter or an easily explainable situation, may turn out to be a major hurdle in approving your case.

photo credit: mike (el madrileño)

Tags: VA Rating

• Building a Case , Medical Records
• Comments(0)

Tomasz Stasiuk January 9th, 2008

photo credit: tm_lv

In Colorado the cost of medical records are based on the number of pages in the records. This can quickly get expensive. But, you do not have to request every single scrap of paper, phone message, or referral that was ever generated by your doctor’s office. If you want to, you certainly can. But, chances are you will be paying for records you do not really need.

One way to keep the costs of your case down is to limit the scope of the medical records you are requesting. You can do this in two ways: Limiting the dates of service: how far back you want the records to go. Or, limiting the types of records.

So, what records do I need to get?

Before I try to answer this, a warning: While I can give you some very general guidelines, there is a very good chance that your case may fall into an exception. This is an area where good judgement becomes crucial!!!

Generally speaking, you want to get records about a year before the disability began, or a year before you filed for benefits. More recent records are usually more valuable than older records.

Some exceptions to this: if there was a significant accident, treatment or diagnosis before this one year period, you may want to get those records.

As far as types of records, records from specialists are generally more valuable than records from a primary care provider. But, you usually want to get records from both.

When my office is requesting records from a hospital, I usually tell the hospital not to provide medication logs or nurses notes as they can double or triple the number of pages, and thereby greatly increase the cost of the records.

Please note: you could reverse the information here and it still may be correct. Sometimes older records are more valuable than newer records and a family doctor’s records that go back for ten years may be more important that the records of a one time evaluation with a specialist. There are not hard and fast rules. In this area, it is all a matter of judgment.

• Building a Case , Medical Records
• Comments(0)

Tomasz Stasiuk January 5th, 2008

photo credit: austinevan

So, how do you actually get your medical records?

The easiest way is to work with an attorney. I know. I know, that is self serving since that is what my office, The Stasiuk Firm, does. But, whether you work with my office or another attorney, there is nothing easier than handing over your case to someone who has gotten the kinks out of working with doctors’ offices and can help you get the most relevant records to Social Security.

Ok, but how can I get my own records without an attorney?

Well, if you insist on doing things the hard way read on…

In Colorado, where my practice is located, anyone over the age of 18 can get a copy of their medical records by making a written request to their doctor’s office.

There are some exceptions to this. For example: menal health providers will sometimes refuse to provide their records to the patient because of concern that this may put the treatment at risk. However, the patient should still be able to authorize the release of records to third parties, such as spouses, parents or attorneys.

You may be required to fill out a HIPPA compliant authorization allowing the doctor’s office to release your records. Unfortunately, while HIPPA provides guidelines of what should be in the authorization, there is no standard authorization form.

If you are working with an attorney, he or she will have their own authorization that should be accepted by most doctors. If you are doing this on your own, your doctor’s office should have the form you will need to fill out.

Tags: Medical Records

• Building a Case , Medical Records
• Comments(0)