PRACTICE AREAS
You NEVER imagined that you would be facing the disastrous effects of fighting against our own government, its agencies, and insurance companies. Todd Hammond has witnessed first hand the excessive delays and denials of rightful claims that are destroying all that you and your family have worked for through the years. This is NOT a fight you can afford to undertake alone. With Todd Hammond, you are NEVER ALONE. With over 20 years of winning experience in this extremely complex practice area of law, Todd Hammond will stand by your side through the entire process, finding a way to help achieve your goals while protecting your assets.
You WANT my experience on your side and you NEED the results I achieve !!!
SOCIAL SECURITY
DISABILITY
:: How Do I Apply?
:: Request for Reconsideration
:: Request for Hearing Before an Administrative Law Judge
:: Request for Review by Appeals Council
:: How Long will it Take? This is a Marathon, Not a Sprint…
How Do I Apply?
You can initially apply for SSI/SSDI many ways:
Contact your local SSA office. You can find your local SSA office by typing in your zip code on the SSA “Find an Office Locator” on the www.SSA.gov website.
Online: www.SSA.gov.
Call the National Service Number: 800-772-1213.
The date you contact SSA indicating an interest in applying for benefits is your Protective Filing Date (PFD). The PFD is important when determining the amount of retroactive benefits you are entitled to should you win your claim.
Unfortunately, SSA grants few claims at the Initial levels. So, I encourage people to initially apply on their own and contact my office if their claim is denied.
Social Security Disability cases are won and lost on the strength of medical records. So, I only take cases where a person has medical records and preferably a treating physician who will cooperate in terms of providing records and writing a letter of support. Oregon and Washington have many free and low-cost health services available, and I encourage anyone who believes they are suffering from a disability which affects their ability to obtain and/or maintain any form of full-time employment to promptly seek out medical treatment and develop a relationship with a medical professional.
There are several different SSA appeal levels, each with specific paperwork requirements and timeframes for filing:
1. Request for Reconsideration
2. Request for Hearing Before an Administrative Law Judge
3. Request for Review by Appeals Council
Request for Reconsideration
Knowledge is power. Unfortunately, the SSI/SSDI appeals process is a frustratingly complicated maze. I make every effort to use my knowledge and experience to guide my clients through the process every step of the way so that my clients ultimately feel empowered - and not overpowered - by the System.
If you are one of the nearly 80% of people whose Initial or Reconsideration claim is denied, the most important thing you can do is to not take the denial personally.
A denial of your disability claim is discouraging, and the SSA’s denial letters are cold, form letters containing irrational assertions that you can work despite your limitations based on your age, education or past relevant work experience. If you have a good claim with strong medical records and you are denied at either the Initial or Reconsideration level, you are in good company. Your letter was not personal. It was computer generated and likely not given another thought. This is simply the SSA process.
If your claim is denied initially, you have no more than 65 calendar days to request Reconsideration. Unfortunately, the Reconsideration process is, more often than not, a rubberstamp of the initial denial. Furthermore, if the Reconsideration request is denied, which is often the case, we are poised and ready to go to the next level of appeal: Requesting a Hearing Before an Administrative Law Judge.
Request for Hearing Before an Administrative Law Judge
ALJ Hearings are where the most of the action is. Statistically, this level is where I have won most of my cases for the past 17 years. After your Reconsideration claim has been denied, you have no more than 65 calendar days to Request a Hearing Before an Administrative Law Judge at the Field Office where your initial claim was filed.
Your appeal of the denied claim at the Reconsideration level will then be processed and sent to one of the local hearing offices, typically, depending on your zip code, in either Portland, Eugene, or Tacoma at an Office of Disability Adjudication and Review (ODAR). The hearing office then organizes and compiles your information into an electronic file. I determine what, if any, information, including medical, legal or anecdotal evidence, is missing from the file, and we work together to compile all the medical and other supportive information and finally submit it electronically to the assigned Hearings Office for addition to the electronic file.
Eventually, your claim will be assigned to an Administrative Law Judge and a hearing date will be set. Before the hearing date, I extensively prepare my client for the hearing in order to zealously argue the claim before the Administrative Law Judge with file reviews and evidence collection reviews.
Please be aware that the time from Reconsideration denial to hearing date before an Administrative Law Judge can vary notably between hearing offices from as short as nine months to as long as two years, depending on the backlog at the field office or hearing office.
Request for Review by Appeals Council
If your case is lost at the ALJ level (yes, it can happen, there are no guarantees) the next level of appeal is the Appeals Council in Baltimore, Maryland. You have no more than 65 calendar days to “Request Review of a Hearing Decision.”
Unfortunately, at the Appeals Council level, like at the Reconsideration level, denials are often rubberstamped and only a small percentage of denials are overturned or remanded for a rehearing.
What’s the difference between a claim and an appeal?
Most of the phone calls and emails I receive from veterans say something like, “The VA owes me backpay for my claim that has been pending for over 10 years.”
Frequently, you have an appeal pending for too long of a time and not a claim. I want you to understand the difference between a claim and an appeal. Using the correct term can help me understand where to look or how best to advise you when discussing your case.
Claims defined:
You submit a claim when seeking VA disability benefits (or increased benefits) for medical conditions you believe are related to military service. These claims can be filed online through eBenefits or submitted by mail or in person at the nearest VA regional office. The claim submission, military service, healthcare records, and any other evidence associated with the claim are reviewed in order to provide you a rating determination.
Every claim in VA’s inventory is as distinct as the servicemember, veteran, or survivor who filed it. A complex set of laws, regulations and court decisions govern how, and to whom, the VA administers benefits. The laws and process allow Veterans and their survivors ample opportunity – and even assistance – to provide VA the evidence necessary to approve their claims.
Under these laws, VA grants service connection and pays disability compensation (if warranted) for a disability when evidence shows three things: injury or illness in service, a current disability, and a link — usually medical evidence — connecting the two. These laws also allow for service connection for conditions caused or aggravated (permanently worsened) by conditions that are already service connected, called secondary claims.
Once the decision is made to grant service connection, VA examines the medical evidence and assigns a level of disability under the VA Schedule for Rating Disabilities. You are always afforded the benefit of the doubt. This means that if the evidence is weighed equally, 50 percent in your favor and 50 percent against, the claim is granted or the higher of two evaluations is assigned.
Amazingly, the accuracy of claim decisions has little bearing on whether veterans appeal their claims. In fact, regional offices with the highest quality can often have the highest appeal rates. That’s not to say processing errors don’t happen, they do, and the VA has promised to continue to work to improve claims accuracy. Currently, VBA’s accuracy rate at the issue (or medical contention) level is 96 percent and the percentage of claim decisions being appealed remains in line with historical averages of 10 to 12 percent.
The Appeals Process:
The multi-stage appellate process is available to you after you have already received one or more decisions on your claim, but disagree with some aspect of VA’s decision.
During the appellate process, an appeal undergoes additional independent reviews, often multiple times and by different adjudicators, as you or your representative submit new evidence and/or a new argument. Nearly 74 percent of appeals are from Veterans who are already receiving VA disability compensation but are seeking either a higher level of compensation or payment from an earlier effective date.
Once an appeal has been filed, a Veteran may also engage an attorney, though at the Veteran's own expense. Attorneys’ fees are typically taken straight off the top of any retroactive award received from VA.
An appeal is different from a claim. I know firsthand that sending one or the other to VA can seem like the same thing, but understanding the difference and using the right terminology will help the VA and me provide you with the best information in the quickest amount of time.
Thank you for your service and Welcome Home!!!
VETERANS DISABILITY
SHORT & LONG TERM DISABILITY
If you are denied short or long-term disability benefits after filling out an application, you have the right to appeal the insurance company’s decision. Filing an appeal can be hard to handle on your own. It requires gathering and organizing information, doing research, and formulating legal arguments. You should consider my legal services for the following reasons:
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I understand and appreciate the deadlines involved with appealing an insurance company’s decision to deny benefits. If you get denied long-term disability benefits, the denial letter will most likely indicate that you have 180 days to appeal the decision. This may seem like a long time, but it is critical to get started on the appeal process right away. I will recognize whether or not your medical records need to be updated, and thus, I may make suggestions about whether or not you should see a doctor to get support for your claims.
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I have experience with how insurance companies are regulated and how they process claims for benefits. I can make legal arguments regarding mistakes that the insurance company made in evaluating your claim that you might not otherwise recognize on your own.
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I know how to request information about your claim from the insurance company. I will also recognize whether or not the insurance company provides complete information upon request.
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I will act as a buffer between you and the insurance company. No more distressing phone calls from the insurer and no more reading legal jargon.
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I will identify and collect information that is important to your claim for benefits. For example, I may collect information from your employer, coworkers, family members, and/or doctors. I know what types of questions to ask these individuals. I organize this information and present it to the insurance company as support for you claim for benefits.
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I will explain how your long-term disability benefits could be affected or offset by other benefits, including workers’ compensation benefits and Social Security Disability benefits.
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As your attorney, I will put you at ease during this very stressful process. I will listen to your concerns, but more importantly, I will alleviate your concerns by taking charge of your appeal while still involving you in the process.
STATE OF OREGON PERS
DISABILITY RETIREMENT
1. Am I eligible for PERS disability retirement benefits?
PERS has two categories of disability: non-duty and duty.
Non-duty criteria:
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you have 10 or more years of qualifying service under PERS (see Q 2), and
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you are disabled and unable to perform any work for a minimum of 90 consecutive days.
Duty criteria:
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you have established membership under PERS, and you are unable to perform any work for a minimum of 90 consecutive days, and
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your work activities were the major contributing cause of your injury or disease.
2. Must I have EXACTLY 10 years or more of PERS creditable service to be eligible for non- duty disability?
No. In some cases, eight years, six months, or even one day may be sufficient. For disability eligibility purposes, we can count the first six months of your employment before becoming a PERS member if you were required to serve a probationary period. We can also count service credits earned prior to the time your employer joined PERS if your employer agreed to do this. PERS may also consider up to 90 days of accumulated sick leave toward this requirement.
3. When and how should I apply for PERS disability retirement benefits?
You should apply as soon as you are physically off the job, whether or not you are on paid leave. Contact the PERS Tigard headquarters office to obtain an application packet. These forms are your official application to retire due to disability. Applying promptly will help us process your claim efficiently.
4. How can I expedite my claim?
You should speak with your physician(s) before applying for PERS disability retirement and explain that they will be contacted to confirm and document your disabling condition. If your claim is duty-related, your physician(s) must document how your disabling condition was caused by your PERS-covered employment.
Any mental or emotional disorder claims require a report from either a psychiatrist or a licensed psychologist and a medical doctor. Orthopedic claims require a report from an orthopedic specialist or neurosurgeon. When you complete your application for disability retirement, list only the physicians who can address your current disability period and disabling condition.
5. Must I be disabled only from my current job or from any work I can perform?
Your disability must render you unable to perform any work you are qualified to perform.
6. How does PERS make a disability determination?
When you apply for disability retirement benefits, you will complete a Medical Information Release form. PERS will then contact your doctor, health care provider, hospital, or clinic for medical
information. PERS may also require documentation from your workers’ compensation carrier or any insurance company involved.
After sufficient medical documentation is received and reviewed by PERS staff and our medical advisor, a recommendation of approval or denial is submitted to the PERS director. The director may approve or deny the recommendation or may require additional documentation.
1. Am I eligible for PERS disability retirement benefits?
2. Must I have EXACTLY 10 years or more of PERS creditable service to be eligible for non- duty disability?
3. When and how should I apply for PERS disability retirement benefits?
4. How can I expedite my claim?
5. Must I be disabled only from my current job or from any work I can perform?
6. How does PERS make a disability determination?
7. I was disabled and have since returned to work. Can I still apply for the time period I did not work?
8. I was disabled four years ago and have not been able to work since. Can I still apply?
9. What if I terminated employment and the disabling condition was NOT continuous from my termination date?
10. How long does it take to process an application for disability?
11. When will my disability retirement benefits become effective?
12. Do I have to use all of my vacation and sick leave before I will get a payment?
13. If my disability application is approved, how much will I receive for a monthly benefit?
14. Are the same payment options available for disability as are available for a regular retirement?
15. How much time do I have to make a disability option election?
16. What happens to my individual account if I receive a disability benefit?
17. How long will disability retirement benefits continue?
18. Will my case be reviewed periodically?
Law requires periodic reviews of your disability status to continue disability retirement payments.
19. May I cancel my disability retirement application?
20. Is health insurance available on disability?
21. If I go back to work and later retire under service retirement, can I select an option different than my disability retirement option selection?
22. What happens if my application for disability retirement benefits is denied?
23. Will my disability retirement benefits be adjusted because I am drawing workers’ compensation, Social Security benefits, or payments from a disability insurance policy?
24. What happens when I am medically able to return to work?
Your disability retirement benefit will be discontinued and your account balance will be reinstated to the amount in your account when your disability retirement first became effective.
25. Can I return to any work after I start receiving PERS disability retirement benefits? How will this affect my PERS benefits?
7. I was disabled and have since returned to work. Can I still apply for the time period I did not work?
No. You may not apply for prior periods if you have since returned to employment.
8. I was disabled four years ago and have not been able to work since. Can I still apply?
Yes, you can apply within five calendar years of the date you last worked for a PERS-covered employer. The disabling condition must have been continuous since your termination date, your termination must have been due to your disabling condition, and you must not have received a refund of your PERS account.
9. What if I terminated employment and the disabling condition was NOT continuous from my termination date?
You must apply within six months of your termination date if you were disabled within that six-month period, not have received a refund of your PERS account, and continue to be disabled.
10. How long does it take to process an application for disability?
The total disability process can take up to six months or longer from the day PERS receives your initial application. The actual length of time is determined by how quickly PERS receives adequate physician and employer documentation. This is why PERS encourages you to alert your physician that forms are coming which require a quick response.
11. When will my disability retirement benefits become effective?
Your disability retirement benefits become effective the first of the month following your last day of work or the last day of paid salary or paid leave, whichever is later. However, no payment can be made until the required 90-consecutive-day period of incapacity has elapsed.
12. Do I have to use all of my vacation and sick leave before I will get a payment?
No. PERS does not require you to use all of your leave. However, PERS cannot pay you for any month in which you receive salary or paid leave from your employer.
13. If my disability application is approved, how much will I receive for a monthly benefit?
PERS will send you an estimate of your disability benefits at the time you apply for disability retirement. The same calculation methods are used to calculate either disability or service retirement benefits.
If you are a general service employee, the years and months of service you would have accrued had you been able to work to age 58 will be used to calculate a monthly disability benefit.
If you are a police officer or firefighter employee, the years and months of service you would have accrued had you been able to work to age 55 will be used to calculate a monthly disability benefit. If your disability was 100 percent job-related (duty disability), you may choose to receive a monthly disability benefit of 50 percent of your final average salary.
14. Are the same payment options available for disability as are available for a regular retirement?
The lump-sum options are not available under disability. All other payment options are available.
15. How much time do I have to make a disability option election?
You will have 60 days to change your option from the issue date of your first benefit payment.
16. What happens to my individual account if I receive a disability benefit?
Just as for a service retirement benefit, your account balance is used to help pay for your benefit.
17. How long will disability retirement benefits continue?
Disability retirement benefits will continue as long as you meet the PERS disability criteria.
18. Will my case be reviewed periodically?
Law requires periodic reviews of your disability status to continue disability retirement payments. Reviews are no longer required once you reach normal retirement age (58 for general service Tier One members, 60 for general service Tier Two, 55 for police officer or firefighter members).
19. May I cancel my disability retirement application?
Yes, you may cancel your application for disability retirement benefits anytime before you are in constructive receipt of your first disability retirement check. You must complete a cancellation form provided by PERS and sign it before a notary.
IMPORTANT NOTE: By completing this form, you are canceling all membership rights to PERS disability retirement benefits, including appeal rights.
20. Is health insurance available on disability?
Yes. Your employer may provide health insurance coverage. You should contact your payroll or personnel office for information. If you receive notification that your disability retirement application has been approved, you will receive PERS Health Insurance Program information regarding PERS- sponsored health insurance plans in which you can enroll.
If you have questions, call the PERS Health Insurance Program at 503-224-7377 or outside Portland toll–free at 800-768-7377.
21. If I go back to work and later retire under service retirement, can I select an option different than my disability retirement option selection?
Yes. You will need to apply for a service retirement and make a new option selection.
22. What happens if my application for disability retirement benefits is denied?
PERS will notify you by certified mail, citing the reason. You will be allowed an additional 30 days to provide PERS with further documentation to support your claim.
Upon the expiration of 30 days, you
will be provided an additional 30 days to appeal the denial of your claim.
Upon the expiration of 30 days, you will be provided an additional 45 days to appeal the denial of your claim.
23. Will my disability retirement benefits be adjusted because I am drawing workers’ compensation, Social Security benefits, or payments from a disability insurance policy?
For benefits payable beginning January 1, 2010, PERS disability retirement benefits will not be reduced due to a workers’ compensation benefit.
All PERS disability retirement benefits payable before January 1, 2010, will be reduced for Tier Two members (hired on or after January 1, 1996) when the combined workers’ compensation benefit and the PERS disability retirement payment exceed the member’s gross monthly salary at the time of disability.
Although PERS does not adjust disability retirement benefits based on Social Security or disability insurance benefits, Social Security and/or insurance plans may adjust your awards or benefits based on your PERS disability retirement benefit. This could mean you will receive less in Social Security or insurance payments than you anticipate. You may want to check with Social Security or your disability insurance provider to see if this is the case.
24. What happens when I am medically able to return to work?
Your disability retirement benefit will be discontinued and your account balance will be reinstated to the amount in your account when your disability retirement first became effective.
25. Can I return to any work after I start receiving PERS disability retirement benefits? How will this affect my PERS benefits?
Yes, you can return to work. In some cases, members can return to work and still receive a disability retirement benefit. In other cases, a member’s disability retirement benefit is reduced based on the amount of earnings from his or job, or stopped entirely.