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Long Term Disability Insurance: What Are Realistic Return to Work Accommodations?

Published on January 23, 2015 by

Getting an RTW (or return-to-work) designation after your disability has led you to filing a claim for long term disability benefits can be incredibly disheartening. After all, you wouldn’t have gone to the trouble of filing the claim if you thought you could just make a few small changes and continue to go to work every day, so for many being told that they can return to work is like sentencing them to 40-plus hours of pain, guilt, and embarrassment every week.

Don’t give up hope just because your evaluator rated you as able to return to work, though. Instead, take a closer look at what it really says. One potential avenue is to try to show that the information they used to prove your abilities matched the requirements of your job is incorrect. We’ve discussed this previously, and it’s definitely worth looking into. But if that option isn’t available to you, the best thing to do is look closely at the RTW designation. Often when evaluators say that people can return to work, it will be accompanied by a caveat where they explain that you will require certain accommodations to do your job at a reasonable level. If you can show that the accommodations the evaluator is asking for aren’t realistic, the RTW designation may not stand.

Common Return-to-Work Recommendations and Accommodations

It’s hard to pinpoint what exactly might be deemed unreasonable where accommodations are concerned, but there are a number of typical accommodation requests that are usually considered reasonable. If the evaluator recommends something different or more extreme for you, you might want to talk with an experienced disability lawyer to see if it’s worth fighting.

Sit-stand desk. These desks enable the person using them to sit or stand as they need and continue doing their work. There are a wide variety of manufacturers, models, and styles that employers can choose from.

Ergonomic or alternative keyboards and mice. Traditional keyboards’ hand mice have been shown to contribute to musculoskeletal problems that include carpal tunnel in addition to other potential issues. Alternative devices can be obtained at a reasonable cost and are generally considered a “realistic” accommodation.

Floorpads and seatpads. Standing all day on a hard surface can lead to all kinds of problems, but many of these can be greatly alleviated simply by placing specially designed pads on the floor to act as shock absorbers. The same thing is true for placing seatpads on chairs.

Foot rests. The traditional office chair tends to put undue stress on multiple areas of your body. It’s possible to alleviate some of these issues with ergonomic chairs, but another option is to utilize foot rests that help to displace some of the stress and pressure.

All disability insurance policies have their own quirks, which is why we created our free eBook to help you navigate that world. As always, though, the best way to answer a question that relates to your specific situation is to speak with an experienced disability insurance attorney as soon as possible.

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How Can You Win Social Security Disability Benefits for Psychotic Disorders using SSA Listing 12.03?

Published on January 21, 2015 by

If you believe that you suffer from a paranoid, schizophrenic, or other psychotic disorder, it is possible you will qualify for disability benefits from Social Security. But even for someone dealing with such a serious condition, there are very specific medical requirements you need to meet.

These are described in the SSA’s Listings of Impairments, which is a compendium of different disabilities and their individual definitions and criteria. Meet the criteria for a specific disability, and you automatically qualify for benefits. Fail to meet the criteria, and you will have to go the alternate route of proving to the SSA that the issue you’re suffering from is equal to one of the conditions they have defined in their listings.

Matching the specific listing is a far more straightforward path, so that’s what we’re going to concentrate on first.

Meeting the Criteria for Listing 12.03

The SSA defines psychotic disorders like paranoia and schizophrenia as displaying “psychotic features” and deteriorating “from a previous level of functioning.” It’s a fairly vague description, but the real specifics come into play when you start to talk about severity.

There are three categories of requirements here – A, B, and C – and to qualify for benefits you either have to satisfy both A and B or category C. So what are the categories and requirements?

  1. Persistence of one of the following that has been medically documented:
    1. Hallucinations or delusions
    2. Catatonic behavior
    3. Incoherence or illogical thinking associated with blunt affect, flat affect, or inappropriate affect
    4. Emotional isolation or withdrawal
  2. Display at least two of the following results:
    1. Severe restrictions in the activities of daily living
    2. Difficulty with social functioning
    3. Difficulty with pace, persistence, or concentration
    4. Repeated episodes of personality disturbances that last for an extended time
  3. Have a chronic psychotic disorder that has been medically documented and:
    1. Has lasted 2 years or more
    2. Has caused basic work activities to be limited
    3. Includes signs or symptoms that require medication or psychosocial support
    4. Includes one of the following:
      1. Episodes of personality disturbances
      2. A history of 1 or more years of being unable to function without support
  • A residual disease process where even minimal change can lead to personality disturbances

The only objective clinical test the SSA considers important when determining whether or not you have a disabling psychotic disorder is the Protein test.

If you can’t meet the specific requirements described in the listing, remember it is still possible to get benefits. You need to show your condition is the equivalent of a disability already defined in the Listings of Impairments by going through the Five Step Sequential Evaluation Process and showing you have been unable to work for 12 months or more due to your condition. It’s not easy to do this, but a knowledgeable Social Security disability lawyer can help.

Learn even more about the claims process by reading our Social Security Disability eBook for free!

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Long Term Disability Claim: Fighting a Return-to-Work Designation

Published on January 19, 2015 by

 Most people, if they had a choice between sitting at home and receiving long term disability benefits or going to work and earning a living, would jump at the chance of being able to return to their job. It’s not about getting a paycheck for doing nothing – it’s about physically or mentally not being able to do the work.

This is why it’s so important that claimants understand what it means when they receive a finding of RTW or return-to-work. What the evaluator is saying is that they believe the demands of your job are a match for your abilities – even with your condition. If you don’t agree with this, you need to look at the specifics and figure out where the disconnect is.

Every Functional Capacity Exam Evaluator has a form where they compare the demands of your job with the results of your tests. What does this mean? Well, if your job frequently requires you to lift 20 pounds and you are able to do this, that constitutes a match for the FCE Evaluator. But if you’re often carrying 20-pound objects around and this is a problem because of your condition, that’s not a match. Receiving a return-to-work designation means that you “match” all of the requirements listed.

Seems pretty clear cut, right? But what about when you don’t believe that the stated job demands are accurate? This is why it’s so important to be clear, specific, and exhaustive whenever you are given the opportunity to answer questions about job tasks. If the form your evaluator is using tells them that you you’re only lifting objects of 20 pounds or less but the reality is closer to 30 pounds, that can mean all the difference, and you need to get it down on record.

Talking to an experienced long term disability attorney like those at Marc Whitehead & Associates can provide you with the insight you need to help you answer to your benefit and win your claim. Want more information on disability insurance in general? Download our free eBook on disability insurance policies.

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How to Win Your Social Security Disability Benefits for Mental Disorders using SSA Listing 12.02

Published on January 16, 2015 by

Regardless of whether your affliction is physical or psychological, there are only two methods by which you can apply for Social Security disability. The first is to meet the criteria for a specific disability in their Listings of Impairments. The second is to show the SSA you have a condition that is the equivalent of one of these listed disabilities.

Option one is by far the most straightforward path to take, so matching a listing should always be your primary goal if you are applying. To do this, you first have to understand what the Listings of Impairments is.

As the name suggests, it is a defined list of medical conditions the SSA has agreed qualify as disabling conditions. But it is more than this – each qualifying condition has a specific set of criteria the SSA has laid down. In order to “have” this disability as defined by the SSA and get the benefits you need, you must be able to show you meet these criteria.

Criteria for Listing 12.02

Organic mental disorders, or Listing 12.02, is defined as “psychological or behavioral abnormalities associated with a dysfunction of the brain.” You need to have lost functional abilities you previously possessed, and there has to be a specific organic factor present related to this loss and your “abnormal mental state” that can be demonstrated through lab tests, physical exams, or your history.

Specifically, qualifying means you need to show medically documented evidence of something from both category 1 and 2 below OR meet the requirements in category 3.

  1. Demonstrated loss of cognitive abilities:
  • Time and place disorientation
  • Impairment of short-, intermediate-, or long-term memory
  • Delusions, hallucinations, or other perceptual disturbances
  • Personality changes
  • Mood disturbances
  • Sudden emotional outbursts and lack of control
  • Loss of 15 IQ points or more, or be clearly within the severely impaired range based on testing
  1. Display two of the following results:
    • Activities of daily living severely restricted
    • Trouble in functioning socially
    • Trouble with pace, persistence, or concentration
    • Ongoing episodes of decompensation (personality disturbances) that last for an extended time
  2. Have a chronic organic mental disorder that has been medically documented and:
    • Has lasted at least 2 years
    • Has severely limited basic work activities
    • Involves signs or symptoms that require medication or psychosocial support
    • Involves one of the following:
      1. Episodes of decompensation
      2. A history of at least 1 year of an inability to function without support
  • A residual disease process where even minimal change can lead to decompensation

Some of the tests that you can take to help bolster your claim include:

  • Visual Evoked Responses (VER)
  • Transcranial Doppler (TCD)
  • Somatosensory Evoked Potentials (SEPs)
  • P-Tau Protein
  • Positron Emission Tomography of Brain (PET)
  • Motor Evoked Potentials (MEPs)
  • Magnetoencephalography (MEG)
  • Magnetic Resonance Imaging of Brain (MRI)
  • Electroencephalography (EEG)
  • Echoencephalography
  • Deep Tendon Reflexes (DTRs)
  • Computerized Tomographic Scanning of Central Nervous System (CT)
  • Cerebrospinal Fluid Biomarkers for Alzheimer’s Disease
  • Cerebrospinal Fluid (CSF)
  • Cerebral Angiography
  • Brain Scan
  • Beta Amyloid – Plasma
  • Auditory Brainstem Response (ABR)

Not Meeting the Listing Is Not the End

As you might imagine with so many specific requirements, meeting this listing isn’t easy. But even if you can’t prove to the SSA that you meet one of their listings, remember that you don’t have to give up on benefits. People who can’t match a specific definition just need to show they suffer from an issue that is the equivalent of something the SSA has already defined as an impairment.

You can do this by using the Five Step Sequential Evaluation Process and proving that your condition has prevented you from working for at least 12 months. Because the process is more complicated and the path isn’t as clear, anyone who decides to try this route is advised to work with an experienced Social Security disability attorney.

Whichever route you choose to qualify through, it pays to understand how the SSA works and what evidence truly helps your case. Because of this, your chances of success can increase if you work with an experienced professional who can answer your Social Security questions and guide you through the process. Learn even more about the claims process by reading our Social Security Disability eBook for free!

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