Reopening Prior Applications greater than four years prior to current Application

The Rules of Social Security Administration allow for the reopening of prior Claims under specific circumstances up to four years prior.However, in the Fourth Circuit a special Ruling applies which allowed me to reopen a Claim that was Filed seven years prior and never Appealed providing 75 months of retroactive benefits after 16 months of representation in my office. This has been a wonderful case to have won for a client who has been cared for by a dedicated sister for many years with little or no help from other family members, financially or emotionally.

Delay in Filing an Appeal

Many Claimants do not meet the 60 day deadline for Filing an Appeal when they have received Notice of the Determination. There must be an overwhelming reason for the delay or your case must start again from th beginning: new appliction, new disability report AND A MOTION TO REOPEN THE PRIOR CLAIM. A new Claim Filed within a year of the prior Claim Denial, can be considered a Motion to Reopen but at some point in the new Claim you need to actually request that the prior Claim be reopened and that is with a Motion to Reopen with case citations and applicable Regulations, Statutes, SSR, or AR.
Some good reasons for missing the date could be:
you were hospitalized for the majority of the 60 day period
your Appointed Representative was hospitalized for the majority of the 60 day period
neither you nor your Represenative received the Notice of Determination
on the date you had an appointment at the SSA local office you became ill and had to go to the Emergency Room
on the date you had an appointment at the SSA local office, weather closed their office.
You can see, there must be a verifiable and serious reason to miss your date.
When a Claimant is mentally retarded or has significant psychiatric disease, and they were unable to adeqautely understand the Notice giving them only 60 days to Appeal, a Representative may be able to have those cases Reopened.

Sample case from contact to review

Ideally, you will be referred to us prior to your last date employed so that we can review what your options are prior to leaving work. This happens in less than 2% of the cases we agree to represent.
Of course, many times you are disabled suddenly rather than a gradual onset of disease.
The sooner in the process that we can review your case, the more assistance we are in helping you avoid financial disaster.
We will give you an example of a case where we entered the case by making application for DIB online with our new client:

The client calls our office by referral from their physician’s office when we set an appointment to make the online application; we will mail directions to the office and a list of information that we will be required to have in order to complete the application and disability report; your appointment is usually within 7 days of your initial call and will generally take 1.5 to 2 hours. DIB application for benefits can cover retroactive benefits for as much as 12 months prior to the month of application, however you should apply as soon as you are unable to work to avoid possible loss of monetary benefits. There are certain forms that must be completed after printing and submitted to the local SSA office. If there is any information that was not completely provided, SSA will send a letter asking for correction or clarification, then the case is sent to DDS.
Usually within 30 days you will begin receiving correspondence from DDS such as work history reports, activity of daily living questionnaires, fatigue questionnaire, pain questionnaire, or referral for independent consultative examinations. We will meet with you and complete these forms.
Usually, within 60 days of the last request for information, DDS will make their determination of disability in writing. IF you are approved, you are a member of a very rare group. The American Bar Association conducted a detailed  analysis of the SSA statistics and found that approximately 20% of initial applicants are approved and most of those are catastrophically ill claimants. If you are denied, you will have 60 days from the date the Determination was written and mailed to you (60 days after you receive the Determination, estimating that you received the letter 5 days after it was mailed). Keep all envelopes!! We feel there is rarely a reason to delay the Request for Reconsideration so we will get you into the office to file the Reconsideration as soon as possible. Even if medical treatment is scheduled, do not delay. As soon as the Reconsideration is filed, the local SSA office will send your case file to DDS and you will not have access to the case file information. We suggest that you obtain a copy of the case file so we can review the medical records IMMEDIATELY after getting the Denial. This must be done before your Request for Reconsideration is filed in the local SSA office and before it is sent to DDS.
Occasionally, Reconsideration cases are placed in a hold status because the number of initial applications are so high and take a priority for the DDS staff allocation however when they are not being held, the process will begin again with the same forms and the same time period for a response. Again the chances of being approved are low however the next step, a Hearing by an Administrative Law Judge, has over an 80% chance of getting an Approval. The time to wait for a Hearing can vary from about 9 months to over two years, depending on the ODAR office where your case is located. Some cases can be expedited and a Favorable Decision can be made without a Hearing.

Our Philosophy

We believe that a disabled individual needs to have their disability determination completed as soon as possible.

We believe that a Client deserves to have their case processed as rapidly as we possibly can and under whatever exceptions might apply to their case to request that the case be accelerated by Social Security.
We believe that each Client has the right to be informed of each benefit they could apply for and be assisted in making those applications.

Disability Benefits-SSA:DIB, SSI, Medicare; DSS: Medicaid

From the Social Security Administration there are two basic benefits based in Disability: Supplemental Security Income and Disability Insurance Benefits We also specialize in obtaining Medicaid benefits for the disabled, which is administered through the Department of Social Services of the various localities. Our assistance with Medicare coverage, comes through DIB eligibility or End Stage Renal Disease.

DISABILITY

The definition that the Social Security Administration uses for defining disabled is the same for these three benefits: you must not be able to do the work you have done as your primary past relevant work, there are no transferable skills, there are no jobs in the national economy that those transferable skills transfer to that you can do without 18 months of training or more, and your disability is anticipated to last for twelve months, or end in your death. A Representative assists with cases which don’t seem to meet that definition. Very few cases meet that definition when first evaluated by SSA.

SSI

Supplemental Security Income is available to the disabled population who meet certain income and resource limitations. SSI eligibility creates eligibility for many services from the Department of Social Services, such as food stamps, Section 8 housing, and Medicaid. There is no earnings record requirement for this benefit.

DIB

Disability Insurance Benefits is not a resource or income dependent benefit which provides monthly benefits based on the highest five consecutive earnings years or the last full year earnings, if that is highest, as well as benefits to eligible dependents after six full months of a disability anticipated to last at least twelve consecutive months. If you are also drawing Worker's Compensation, your DIB benefits will be "coordinated" with your Worker's Compensation amounts.

EARLY RETIREMENT PENDING DISABILITY DETERMINATION

If you have attained the age of 61 years and 6 months, you can apply for early retirement benefits to be paid to you while you are seeking Disability Insurance Benefits. Generally, Early Retirement benefits are substantially less than your DIB monthly benefit therefore you will receive additional funds when you are approved for DIB.

MEDICAID

Medicaid is administered through the Virginia Department of Medical Assistance Services and provides medical coverage for the disabled who meet the same income and resource limits as set for SSI. 

MEDICARE

Medicare is available to End Stage Renal Disease patients who meet specific medical guidelines, and DIB  recipients after 24 months of benefit eligibility.