When your physician fills up and mental residual functional capacity and rate your limitation as moderate, most ALJs will ignore the limitations and the District Courts that looked at that question usually stated that moderate does not mean inability to work. The SSA does define marked limitation as preventing work. Unfortunately most psychiatrist use marked as extreme limitation yet the Social Security regulation clearly define Mark as:” means more than moderate but less than extreme” This can effect your Social Security Disability claim.
Marked means interfere seriously with your ability to function independently, appropriately, effectively, and on a sustained basis.
1. Demanding documents from the Insurance Company. We write the insurer demanding a copy of: the plan; the policy; the SPD; the claim file; all documents relied on by the insurer in denying the claim; any internal guidelines used by the insurer; the reports of all medical and vocational reviewers; audio or videotapes of the claimant; and notes of any telephone conversations.
2. Demanding Specific Reasons for Denial. By law the insurer is obligated to provide specific reasons for their denial. We write the insurer demanding that they provide us with a more specific description of the reasons for denial. Often the initial denial letter only states that there was insufficient objective evidence in support of your claim.
Plaintiff argues that the ALJ erred in rejecting the diagnosis of fibromyalgia based
on the lack of objective medical evidence, that the ALJ failed to give weight to the
opinions of Plaintiff’s treating physicians, and that the ALJ misstated Dr. Goldfarb’s
opinion. These are all essentially contentions that the ALJ erred in rejecting the
assessments of Plaintiff’s treating physicians.
What Payments May Affect Your Disability Benefits?
In most cases, disability payments from other sources do not affect your Social Security disability benefits. However, according to the SSA, the types of payments that can affect your Social Security disability benefits are workers compensation payments and/or another type of public disability payments. Workers’ compensation is payment made to a worker due to a job-related injury or illness. It may be paid by federal or state workers’ compensation agencies, employers, or insurance companies on behalf of employers. Public disability payments that may affect your Social Security benefits are those paid under a federal, state, or local government law or plan that pays for conditions that are not job-related. These public disability payments differ from workers’ compensation because the disability that the worker has may not be job-related. Some examples of public disability payments are: civil service disability benefits, military disability benefits, state temporary disability benefits, and state or local government retirement benefits which are based on disability.
This article is largely based on the excellent work of Muhammad B. Yunus, MD, FACP, FACR, FRCPE Section of Rheumatology University of Illinois College of Medicine at Peoria and his article :A comprehensive medical evaluation of patients with fibromyalgia syndrome Rheumatic Diseases Clinics of North America Volume 28 • Number 2 • May 2002
and Nelson M. Gantz in Noble: Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc.
The legal discussion was excerpted from “Wilborn,s social security disability advocate’s handbook ( James publishing)
What is SSI?
SSI is Social Security Income. SSI makes monthly payments to people who have low income and few resources and are:
•Age 65 or older;
Disabled or blind children also can receive SSI. The basic SSI amount is the same nationwide. However, many states add money to the basic benefit.
Whether you can receive SSI depends on your income and resources (the things you own).
To qualify for Social Security benefits, you must first have worked in jobs covered by Social Security. Then you must have a medical condition that meets Social Security’s definition of disability. In general, SSA pays monthly cash benefits to people who are unable to work for a year or more because of a disability.
Benefits usually continue until you are able to work again on a regular basis. There are also a number of special rules, called “work incentives,” that provide continued benefits and health care coverage to help you make the transition back to work.
If you are receiving Social Security disability benefits when you reach full retirement age, your disability benefits automatically convert to retirement benefits, but the amount remains the same.
When you start receiving disability benefits, certain members of your family may also qualify for benefits on your record. Each family member may be eligible for a monthly benefit that is up to 50 percent of your disability rate. However, there’s a limit to the total amount of money that can be paid to a family on your Social Security record. The limit varies, but is around 150 to 180 percent of your disability benefit. If the sum of the benefits payable on your account is greater than this family limit, the benefits to the family members will be reduced proportionately. Your benefit will not be affected.
An ALJ is not required to believe every allegation of disabling pain or other nonexertional impairment.” Orn, 495 F.3d at 635 (internal quotation marks and citation omitted).Sometimes a credibility assessment must be done. When a medical impairment has been established, however, the ALJ must provide “specific, cogent reasons for the disbelief” and may not discredit a claimant’s testimony as to subjective symptoms merely because they are unsupported by objective evidence. Lester, 81 F.3d at 834.