Unfortunately, the answer to this is yes. We have pretty credible evidence of investigators following spouses of injured workers. In at least some of these instances it’s been done in a way that scared the heck out of the client’s wife. In another, case the investigator closely followed the teenage girlfriend of our client’s son, doing so for 15-20 minutes down a dark country road at night.
We’ve also taken issue with investigators who take what we believe to be unnecessary pictures of clients’ minor children. We’ve repeatedly argued against this practice at the Industrial Commission – even letting them hear tapes of the investigators laughing about forcibly shaving the head of a young African American child – but nothing has come of it. Similarly we’ve asked that insurance companies be prevented from hiring convicted child abusers to do private investigation work.
Until Gov. McCrory and the legislature intervene on these issues the best defense is a strong offense. If you have even a hint that you are being followed you should definitely call an attorney.
This may, or may not come as a shock to the adjuster but the answer is “absolutely not.” While she may think that enough has been done it is up to the treating doctor to say that you don’t need any more medical treatment. Even then, the adjuster must ask the Industrial Commission to sign off on closing your claim. If that has not happened your claim is still open regardless of what the adjuster may be telling you. There are deadlines and technicalities involved in this so it’s wise to give us a call and let us point you in the right direction.
This may be for a couple of different reasons. First, the doctor may have a standing agreement with your adjuster or employer that he won’t keep workers’ compensation claimants out of work as long as your employer will find something, anything, for you to be doing.
Second, many doctors believe there is a healing power in being active and out of the house. While we think that this may be overstated sometimes we’ve seen plenty of instances where clients were worse off sitting in the house afraid to go out because of the network of private investigators working for the insurance company than they would be if they could be active and stay in shape.
Third, the doctor may honestly not have a good idea what your job actually entails. Part of this is that they live in their own world sometimes, but we have seen a lot of instances where a rehabilitation professional gave the doctor a job description which had been edited – sometimes by the RP, sometimes by the employer – to remove all the heavy lifting from it. Thus the doctor is relying on what he believes to be an accurate statement of your job. Don’t count on your employer or your nurse showing this to you in advance. More than one client has reported having a nurse whip out a job description unannounced and presenting it to the doctor.
When we speak with new clients my office goes through a list of questions that, at first glance, seem unrelated to a disability claim. Have you received unemployment? What is your education level? What do you do on a typical day? We don’t do this boring version of the “20 Questions Game” to be nosy or wastea client’s time. Instead, the answers to these questions can sometimes make or break a claim.
Let’s be clear: A Social Security Disability (SSD) case cannot be won without strong medical evidence. But a good representative knows that it is important to show that the claimant as a person, not just a stack of medical records. In this mini-series, we’ll look at a few of the non-medical factors that can impact a claim.
Receiving unemployment benefits after the date you say you became disabled (“alleged onset date”) can be big issue. There is a conflict between saying “I am disabled” while certifying for unemployment. In order to receive Unemployment benefits the worker has to be *able* to work and *actively seek new employment.* Certifying that those statements are true for Unemployment while alleging, at the same time, that a person is disabled and *unable to work* doesn’t always add up.
There are long delays associated with disability applications and appeals; how are claimants supposed to survive when they cannot work? This is a tough question the Social Security Administration does not clearly address. In 2006 the SSA’s Chief Administrative Law Judge, Honorable Frank Cristaudo, issued a memorandum that stated that receiving Unemployment benefits did not make a aclaimant ineligible for SSD benefits. However, in 2011, a federal court case, Roberts v. Astrue, affirmed that a Judge was correct in using an application for Unemployment against the claimant.
Social Security judges are not consistent with how they approach unemployment. Some do not focus on the issue and leave it up to the State of North Carolina. Others will not award benefits for the time period when a claimant received unemployment; an amended onset date may be required. Changing the onset date may impact the amount of retroactive benefits (“back-pay”) and the date of Medicare eligibility.
In short, when it comes to Unemployment, honesty is the best policy. If you decide to apply for Unemployment be truthful about your Disability application status. Also be sure your SSA Disability representative knows if you received unemployment benefits.
“Trying to get Disability is like going out to dinner with a nosy person who asks rude questions. It gives me the creeps!” My client called after receiving a package from the Social Security Administration (SSA) questioning her daily activities, pets, eating habits, and chores. In my client’s mind the SSA had gone too far. They already knew her age, weight, and personal medical details. Why did they need to know what she had for lunch?
At the initial and reconsideration stages the SSA often mails lengthy questionnaires (“Adult Function Report”) to both the claimant and the claimant’s contact person. While it is unlikely that the intent of these questionnaires is to be sneaky the SSA does consider the claimant’s answers to get information not always directly asked.
My experience is that the SSA is not looking at if the claimant had a chicken salad sandwich versus pizza for lunch. What the SSA is looking at is if the claimant regularly chops, stirs, and stands for three hours slaving over a tricky recipe. Does the claimant say he cannot walk more than five minutes but takes his Labrador for a 20 minute job every day? Or, does the claimant say she cannot be around people but is an active member of her church or local Girl Scout troop?
The best way to answer the questionnaires is truthfully. Did you dust the living room but then spent the next three days in bed? If you go to the store once a week but your son carries all the groceries to and from the car, tell the SSA! If, on the bad days you can’t get out of bed, but on the good days you might eat dinner with your family, let the SSA know! It is important to not exaggerate your problems – but it is equally important to not put on a falsely brave face. The Social Security Administration can only make a fair decision if they know the whole story.
