An Historical
Example
One such special circumstance
occurred in April of 1996 and represented a real opportunity for the experienced
disability consultant. This example of a special marketing opportunity will explain how
one takes advantage of a event.
Below, you will find a copy of the
March 1996 issue of the Denver Post. This article began with the headline, "Decision
reverses denial of benefits." This not so unusual article represents a subtle but
important financial opportunity for those of us in the disability consulting field. The
article reads as follows:
"Thousands of people in
Colorado and five adjacent states who were denied SSA disability benefits, will get
another chance to obtain benefits with the recent settlement of an eleven year old
lawsuit. The US District Court settlement which includes Wyoming, New Mexico, Kansas,
Oklahoma and Utah require the Social Security Administration to reconsider the eligibility
of applicants who were ruled ineligible between 1984-1991. Colorado rural legal services,
a government funded legal Aide agency, filed the class action lawsuit in 1984, alleging
that Social Security employees were disobeying the law by giving too much consideration to
the opinion of government hired doctors and not enough weight to the opinions of the
applicant's doctors. This action led to benefits being denied to eligible disabled
persons."
How this ruling will effect SSA:
This is not the first time we have
seen this type of ruling against SSA. In the early and mid eighties, there were no fewer
than three major suits against SSA. These suits resulted in the Social Security
Administration being forced to reconsider thousands upon thousands of individual cases
that had been previously denied.
Two of the more famous cases against
SSA were HHS v Polasky and HHS v Luna. These two lawsuits forced SSA to reevaluate tens of
thousands of cases. The issue in both cases centered around how SSA used or considered
pain in making their final decision as to eligibility for disability benefits.
It came to light during these suits
that SSA did not consider pain as a factor in causing disability, which of course is
fundamentally ridiculous. SSA immediately found itself buried in thousands of additional
cases nationwide that needed to be reevaluated. This was in addition to the ever
increasing case loads generated by day to day operations.
The re-evaluation of these tens of
thousands of cases during the eighties caused a back log at SSA that took until the early
nineties to clear up. SSA was forced to hire additional staff to handle the new work load.
However, in today's fiscal environment, I'm not so sure SSA will be granted the additional
funds needed to dig its way out of this new situation.
What this all means:
This blow to the Social Security
administration has costs SSA millions of dollars in staff time and administrative costs.
SSA is having enough difficulty handling current case loads, not to mention the surplus of
cases left over as a result of the two politically motivated government shutdowns that
occurred on the late nineties.
This ruling has also forced SSA to
reconsider how much weight it gives to the opinion of personal physicians in making a
final disability decision. SSA has issued a policy statement nationwide and directions on
how to reevaluate the previously denied cases. This process took months to resolve.
An incredible opportunity:
This above mentioned suit has
quietly created an incredible opportunity for the experienced disability consultant.
Suddenly, an additional 100,000 plus new cases came on line and where perfectly suited for
private representation.
Why are these cases valuable?
If you would recall from the
newspaper article, these cases are dated from 1984-1991. These dates are extremely
important and represent the potential profitability of these types cases. Here's why!
Recall from your training the concept of onset date. In all of these cases from 1984-1991,
the onset dates will be from as early as 1982 to no later than 1991. If for example a
person has an onset date of 1/1/1990 and was denied benefits in one of the above mentioned
states, that person's case must be reevaluated. If the person is found to be disabled on
this second review, he will receive back benefit payments from five months after onset to
the present date if he is currently disabled. This could represent some six years of back
benefits paid in one lump sum. If the claimant did recover and return to work, let's say
in 1994, he would still receive benefits for the closed period of 1990-1994. That's four
full years of possible cash payments to the client.
If you were to represent a case like
this, at twenty five percent of back benefits, this case would easily pay the consultant
up to four thousand dollars in maximum fees. If you were to acquire just ten of these
types of cases over the next year, you have forty thousand dollars in earnings potential
with no more work than you would have in an ordinary case.
Another historical
event:
This special situation is called the
CDR. A Continuing Disability Review (or CDR). is a case on a person that has
already been allowed benefits and is now up for review to determine if the disability is
continuing.
The CDR claimant has usually been on
benefits for three to seven years. SSA has a policy of periodically reviewing these cases
to see if any of the claimants can be removed from the disability rolls.
On 3/17/96, SSA announced that it
would review some 1.4 million CDR cases at a cost of $750 million dollars with the hope of
removing a third of the recipients from the rolls. The last time this happened was during
the Reagan administration. I'll never forget the community outrage against SSA when some
500,000 people had their benefits temporarily halted. SSA probably won't make that mistake
again! SSA's new approach will allow a person to continue on benefits until a CDR
decision is made. If the claimant is discontinued from benefits, SSA will allow benefit
payments during the appeal process to avoid a public outcry.
Disability consultants can take
advantage of this situation by targeting these CDR cases in the market place. CDR cases
usually take less than a month or two to complete and uses a similar criteria to
sequential analysis in making a decision. CDR cases use a formula called medical
improvement. If medical improvement of the claimant's condition has occurred, the next
question is, does that improvement allow the claimant to return to work. If the answer to
both these questions is yes, the case is denied and the claimant will be cut from the
rolls.
Medical improvement is determined by:
1. Looking at medical evidence
since the claimant was found disabled and determining from that evidence if the claimant's
condition has shown significant medical improvement.
2. SSA will often contact the
attending physician and inquire as to current medical status. If the AP says that there is
medical improvement, SSA must then determine if the improvement is significant enough for
that claimant to return to work.
3. SSA will usually order a
physical or psychological examination to determine if medical improvement has occurred.
Vocational evaluations may also be ordered by SSA to determine at what level the claimant
is currently functioning on.
As a disability consultant, you must
be sure that the claimant does not shoot himself in the foot when his case is reviewed for
CDR. You do this by acquiring as much evidence as possible that supports a continuation of
the claimant's disability status.
Since CDR cases are not part of your
basic training course, we are considering putting together a simple CDR training program
for those of you who may be interested. This current round of CDR reviews will take years
so there is no need to rush this training. We will keep you informed as to when the actual
CDR process will begin, how to get the attention of these customers and what strategies
work best with CDR cases.
The reason for presenting these
historical situations is to emphasize how a current event like the change of an SSA policy
can create an enormous opportunity for the astute representative. Keep your eye on
your local Newspaper. If you note a conflict between SSA and the public or a direct
policy change from SSA, review it carefully and determine how it might be used to create
profit for your firm.
Other Events:
We don't want to ignore community
events that can be used as an opportunity to get the word out about your
service. Go to and sponsor community events as a means of exposing your
service. Hand out business cards and flyers. Talk to people. Become a
known entity in your community!
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