Zabian R. Crosby, D.H.Ed. Disability Advocate

www.coofia.org

 

 

The California Office Of Federal Insurance Advocacy (COOFIA) provides helpful information and advice for persons applying for their Social Security Disability Benefits. You are invited to visit our websites and pick up helpful information, such as how to complete required forms, or determine when you really need an Advocate or an Attorney. Learn more about filing for Social Security Disability: What to do before you file your Claim, and what to do after your Application has been Denied. Contact us today for help with your claim for Social Security or Veterans disability benefits.

 

 

Dr. Crosby Comments on Health Care Disparities:

“The research by Dr. Poussaint and the social commentary by Dr. Cosby are pivotal in the reaffirmation of minority mental and physical adjustment in our society. I applaud the author of this article in bearing to light an issue that remains of critical importance but receives little attention from mainstream media. As noted by these researchers and in my own research, the problem of health care disparities represents both a societal as well as a personal problem, requiring accountability on the part of all stakeholders. Mutual trust, respect, and cooperation on the part of all is the only way that we will bring about true equality in health care for disadvantaged populations.”

http://www.oregonlive.com/health/index.ssf/2008/06/poussaint_in_portland_to_talk.html

 

Who are Disabled Veterans?

From the State of Vermont Office of Veterans Affairs:

“Some disabled veterans run Fortune 500 companies; some disabled veterans will never be able to work again. Some disabled veterans run in marathons; some disabled veterans need help performing daily life functions, like eating or bathing. In other words, disabled veterans come in all ranges of abilities. Many disabled veterans do not consider themselves disabled, nor do they meet our society’s definition of disabled. The stereotype of someone in a wheelchair or missing a limb isn’t an accurate description of the vast majority of our nation’s disabled veterans….Specifically, a disabled veteran is someone who has applied for disability benefits from the VA and had their application approved.”

http://veterans.vermont.gov/benefits-and-services/veteran-benefits/va-disability

 

COOFIA Explains: What is the difference between “Trial Court” and “Appellate Court”?

The proceedings in the federal and state appellate courts are quite different from those that take place in a trial court. At the trial level, witnesses are called to testify and a jury is often present to hear evidence and reach a verdict. At the appellate level, the trial court record and briefs prepared by both parties are reviewed, and oral arguments may be heard; witnesses are not called and no jury is convened. The trial court record usually contains the pleadings that first initiated the case, a complete transcript of the court proceedings, materials admitted into evidence, and documents indicating the final judgment.

An appellate court differs from a trial court in another important respect: Only the trial court determines the factual issues in a case. In its review, the appellate court does not try factual issues. Instead, it determines only whether there is sufficient evidence to support the findings of the trial court and whether the trial court correctly applied the law.

http://civilrights.org/

 

Dr. Crosby Comments on the 2017 COLA:

“We should also keep in mind that the COLA affects not only Social Security retirees, but includes those receiving SSDI/SSI as well as Veterans Compensation and Pension benefits. This is important because these groups often suffer from ancillary conditions as a result of disability that require additional expenses that may not be provided or reimbursed by the program. The end result is that these groups suffer even more when the increase does not accurately reflect the true cost of living under these circumstances.”

https://thefinancebuff.com/social-security-cola.html

 

Top judges resign at troubled Social Security Chicago headquarters

http://watchdog.org/279205/social-security-judges-chicago/

 

Obama Claims Power to Make Illegal Immigrants Eligible for Social Security, Disability

http://www.cnsnews.com/commentary/terence-p-jeffrey/obama-claims-power-make-illegal-immigrants-eligible-social-security

 

Dr. Crosby’s comments about disability claims and preventable death:

“These deaths may not be directly caused by the disabling condition(s), but rather through lack of financial resources to sustain life. This, combined with the illnesses that prompted the claim in the first place, may be overwhelming to the claimant, resulting in preventable death.”

https://www.massachusettssocialsecuritydisabilitylawyersblog.com/2015/04/social-security-benefits-finally-awarded-upon-death-of-claimant.html

 

Social Security Disability Claims and Credibility

 

Disabled Americans are Conservatives’ New “Welfare Queens”

Center for American Progress:

FACT: “Nearly 80 percent of applicants are denied at the initial level, and fewer than 4 in 10 are approved after all levels of appeal. Underscoring the strictness of the disability standard, thousands of applicants die each year while waiting for benefits. And one in five male and nearly one in six female beneficiaries die within five years of being approved for benefits. Disability Insurance beneficiaries have death rates three to six times higher than other people their age.”

What do you think?

http://www.ncpssm.org/EntitledtoKnow/entryid/2073/disabled-americans-are-conservatives-new-welfare-queens

 

Dr. Crosby’s comments regarding Social Security Disability Insurance and Fraud:

“The Government Accountability Office (GAO) reported as of 2013 that less than 1 percent of all SSDI payments can be attributed to fraud. Social Security has rigorous fraud detection systems in place to minimize and prevent fraudulent payments. While no program is perfect, the notion of a disability ‘free-for-all’ remains a myth.”

 

Dr. Crosby’s comments about filing a claim for Social Security disability benefits online:

“While it may be possible to file an appeal online with supporting documentation, it is important to remember that supporting documentation for the Initial Claim must still be filed in person at a Social Security office. This carries several consequences that all claimants should be mindful of before bringing their documentation to Social Security.

“Most disability claims are filed online. Claimants are then required to physically bring supporting documents to a Social Security office for processing. What is not explained to claimants is that this is actually the beginning of case management, that is, the employees who handle your paperwork are also making determinations about your qualifications for disability status. This represents a gray area in the process. Aside from the administrative determination to eligibility (verifying that the claimant has earned enough work credits and is therefore eligible to apply), none of the intake staff have presented credentials to make a medical determination about disabled status. Visual appearance alone has never been accepted as a valid measurement of a person’s overall health condition. This is more than likely an informal process used to reduce the backlog of claims by allowing non-medical staff to initiate decisions regarding entitlement. While a disheveled appearance may seem to be desirable, in reality, a clean appearance or unkempt attire could be used to flag a claim as “fraudulent”, resulting in a denial of benefits.”

 

COOFIA Claimant Advocacy: Social Security Self-Defense Guide

https://coofia.tumblr.com/

 

COOFIA Disability Fact:

Did you know that you might be eligible for disability benefits even if you worked during a period of claimed disability? If you worked for a period of six months or less and had to stop working due to a medical condition, you are eligible for benefits during the same time frame. This is called an Unsuccessful Work Attempt and is allowed under SSA rules and guidelines in determining the onset date of disability. However, claimants should be wary of administrative law judges and SSA attorneys in federal court who may obscure this fact and use the same period of work to cast doubt on the integrity of claimants. Before you complete an application for disability you should carefully consider the onset date and any unsuccessful work attempt, as you will have to defend this decision in an ALJ Hearing and/or in federal court. Contact COOFIA for more information and assistance in filing a claim.

http://www.disabilitysecrets.com/resources/disability/disability-and-social-security/unsuccessful-work-attempt.htm

 

COOFIA Disability Tip:

You wouldn’t trust a mechanic, who told you that your car was in good condition just by looking at it, would you? Yet, SSA non-qualified employees and hired contract physicians do just that everyday by merely looking at claimants and making determinations without diagnosing specific illnesses. Before you go into a 15-minute walk-in appointment called a “Social Security Consultative Examination” it is imperative that you contact COOFIA for assistance in knowing what to expect and how the examination is designed to demonstrate functional capacity and not disability.

 

COOFIA Notice:

Did you know: – Currently, in Fresno, the average wait time for a SSI or SSD hearing is 12.0 months. The average case processing time in Fresno is 362 days. The Fresno average for winning a SSI or SSD disability hearing is 44%.

Dr. Crosby Advises:

Not only are wait times burdensome on claimants who are in immediate need of assistance, but the approval rates at ALJ hearings are grossly skewed at both extremes, depending upon the Administrative Law Judge assigned. For example, if you are assigned ALJ Callis, who has a 100% approval rate, you will most likely win your case. However, if you are assigned ALJ Thompson, who has a 28% approval rate, then you will most likely lose your case- independent of whether or not you actually meet the standard for disability. This is a difference of 72% between the most favorable and least favorable ALJ. With decision rates at both extremes, it is a logical conclusion that the person(s) who assign claimants to either judge has in fact made the decision as to whether the claimant should be approved or denied benefits.

 

COOFIA Disability Tip:

Beware of so-called “credibility determinations” made by ALJs and in federal court. Oftentimes, these are statements made by claimants and their treating physicians that have been taken out of context by the SSA to demonstrate non-disability or worse by a claimant. The SSA has attorneys who are skilled at mischaracterizing claimants in order to continue the denial of their claims. However, COOFIA has experienced advocates who are well versed in disability law and can maneuver through crafty storytelling of SSA representatives to uncover the truth. Before proceeding to an ALJ hearing or pursuing a claim through federal court, be sure to contact COOFIA for qualified assistance in these tricky legal matters- your future benefits may very well depend on it.

Dr. Crosby Advises:

Most people tend to think of a disability as a physical condition that limits mobility. This is erroneous thinking. There are literally thousands of disabling conditions, beyond the diagnosis of moving limbs, which qualify for benefits. These conditions include internal illnesses that are not outwardly visible along with mental conditions that often take years to treat.

If you have been diagnosed with a condition that prevents you from working, do not be dismayed by the stigma attached to non-visible disabling conditions. COOFIA advocates understand that most disabilities do not involve mobility, and can help you prove your case in an ALJ hearing or in federal court. Contact COOFIA to find out more.

 

COOFIA Disability Tip:

Social Security Disability Claimants are typically questioned about their lifestyle and habits during administrative law proceedings. Did you know that “shopping for groceries” is a factor in the Approval or Denial of one’s disability benefits? A growing number of Claimants now subscribe to Schwan’s, a reputable online grocery delivery service.

 

COOFIA Disability Fact:

Professional Vocational Experts are 3rd Party Independent Contractors, hired by the Social Security Administration for the purpose of reviewing your disability application and offer their recommendation for suitable work. The Administrative Law Judge typically agrees with the Expert, who will often describe “laundry sorting” as “appropriate work.” TRUE.

Due to the haphazard method of assigning ALJs, claimants are advised to contact COOFIA prior to attending an Administrative Law Judge Hearing in order to receive the highest protection possible against questionable actions such as those found by the Court against Administrative Law Judge William C. Thompson, Jr.

Administrative Law Judge William C. Thompson, Jr., has been found to substitute his own medical opinion for that of qualified physicians. Further, ALJ Thompson has been found to refuse to follow instructions of the Appeals Council when a case is remanded to him. In 2012, Federal Magistrate Judge Carolyn Delaney cited numerous errors and abuses of power by ALJ Thompson in John Oliveri v. Michael J. Astrue (Case Number 2:11-1634 CKD). The actions of ALJ Thompson were found to be so egregious that when Judge Delaney remanded the case to SSA, she ordered that it be sent to another Administrative Law Judge- a vote of “no confidence” in William C. Thompson, Jr.

Further, ALJ Thompson has been found to erroneously assign greater value to opinions of agency (contract) physicians, to the point of completely ignoring years of medical evidence by claimant treating physicians, as in Alexander Louis v. Michael J. Astrue (Case Number 1:10-cv-00656-SMS).

Administrative Law Judge William C. Thompson, Jr. denies up to 70% of the claims brought to him- do you really want to take a 70% chance of losing your appeal? Contact COOFIA today without delay!

http://ca.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20121030_0014845.ECA.htm/qx

http://ca.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20110811_0011182.eca.htm/qx

http://ca.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20120110_0000498.eca.htm/qx

 

COOFIA Disability Tip:

It is important to remember that a court opinion does not contain all of the facts of a case- it is a filtered version of events that is usually skewed toward the prevailing side (i.e., the side that wins). When a claimant appeals for review in federal court, he or she can expect significant portions of the medical record to be included in the opinion and made available to the public. Prior to filing a civil action in federal court, claimants are strongly encouraged to seek the assistance of qualified representatives, such as COOFIA, to ensure that their civil rights are protected.

 

COOFIA Disability Tip:

Beware of seemingly neutral statements such as this one:

“ODAR directs a nationwide field organization of administrative law judges (ALJ) who conduct impartial “de novo” hearings and make decisions on appealed determinations involving retirement, survivors, disability, and supplemental security income benefits.” (SSA, n.d., p. 1)

We see two problems with this statement that are inherently misleading:

1- ALJ hearings are not “impartial”. All ALJs are employees of the Social Security Administration, with a vested interest in limiting the number of claims approved.

2- ALJ hearings are not conducted “de novo”. By the time the claimant appeals for an ALJ hearing, the SSA has compiled years of information to be used against the claimant by the agency. This means that the ALJ is not looking at the claim with a fresh perspective, but based upon the statements and recommendations of other SSA staff who have observed the claimant and made notations as to why the claimant should not receive benefits.

COOFIA strongly encourages claimants to seek professional assistance before attending an ALJ hearing.

 

COOFIA Disability Fact:

Bacterial infections of any kind are serious medical conditions that can prevent gainful employment. The prevalence of infection has led to antibiotic resistance in many cases, which can quickly become a life-threatening illness.

FACT: Bacterial and fungal infections are included on Social Security’s list of impairments, which automatically qualify a claimant for benefits. All that is required is medical diagnosis of the infection, and symptoms that do not dissipate after three months of treatment.

If you suffer from a persistent bacterial or fungal infection, we encourage you to seek immediate treatment, and then to contact COOFIA for assistance with your claim for benefits.

 

COOFIA Legal Analysis:

In a case similar to Randall v. Astrue during the same period; Summer, 2012; COOFIA Representatives argued, that Administrative Law Judges [m]ust have materials developed by the SSA Examining Unit, where Treating Physician Medical Evidence must be reviewed at minimum, by qualified SSA Medical Personnel; that each evaluation be substantiated either by [h]ard copy and [s]ignature, or by [e]lectronic database reporting with the supporting [e]lectronic [s]ignatures as required.

In our Claimant’s Matter, the Administrative Law Judge (William C. Thompson, Jr.)

1. Developed the Medical Record, then

2. Opined upon his own medical assessment of our Claimant’s submitted medical record materials, and

3. Failed to incorporate 150 +/- pages of submitted VA Medical Record Information, provided by the Department of Veterans Affairs at the request of the Claimant via the Administrative Law Judge subsequent to the Initial Administrative Hearing.

Despite the Administrative Law Judge’s status as a Non-Medical Practitioner, Administrative Law Judge William C. Thompson, Jr. later rendered his assessment and conclusions, formulated a medical opinion, then denied the Claimant, stating; the developed medical evidence (created by Thompson) was incomplete, unsubstantiated, conflicted, and was not supported by “substantial evidence within the record.”

If your claim was rejected, you are encouraged to contact the COOFIA office today.

Dr. Crosby Advises:

This then presents a serious legal question: Does the administrative law judge in fact have the power to make a medical determination of claimant’s condition when there has been no physician review of the medical records? Even worse, do SSA attorneys have the authority to review medical records and then explain to a court the medical basis as to why a claimant is not entitled to benefits? If the answer is Yes, then the consequences are numerous and dire, for such people are practicing medicine without ever having attended medical school and receiving a medical license to diagnose signs and symptoms, and offer medical remedies in lieu of entitlement.

http://www.leagle.com/decision/In%20FDCO%2020120731630

 

COOFIA Legal Tip:

As in the Sullivan Law YouTube Video, the spokesperson @ 2:55 – declares that, “A CD of the (Your Submitted Medical/Work) Evidence will be provided.” MISTAKE NUMBER 1. This is one of the first common mistakes that will be made by either the Claimant or your Attorney prior to the Administrative Hearing. Often, the CD is never made, presented, or discussed prior to the Administrative Hearing, so in effect, you’re going into a Hearing to determine your Disability status without “any knowledge of what the SSA has determined and CONCLUDED prior to your hearing.” Why? Because their in-house medical doctors will likely have already deemed you “not-disabled” several months before this administrative hearing and so, you’re sitting there with absolutely no idea that you’ve already been denied by the SSA’s professional medical doctors.

So, what else do you think is going to happen during the hearing? Do you think that the Administrative Law Judge really wants to hear from a Claimant with no income and his Attorney who is likely working on Contingency?

Note: In Expert Crosby’s Case, his Attorney failed to request the electronic information and the ALJ never disclosed that the evidence for the case and the data / information WAS available to the Claimant. Does this seem fair? Make sure to obtain a copy of the COOFIA Disability Self-Defense Guide before attending an administrative law judge hearing.

 

COOFIA ADVOCACY DIRECTORY LIST

L. GILBERT LOPEZ, J.D.

L. Gilbert Lopez, J.D. is the Principal Consultant of this firm; Social Justice and Equity Advocacy Associates. A graduate of the University of LaVerne College of Law, he also holds an undergraduate degree in Sociology from Pitzer College of the Claremont Colleges and is also a graduate of Riverside Community College.

He has over 20 years of experience as an Equal Opportunity Officer for the Riverside County Economic Development Agency, and in that capacity developed model policies and procedures for grievances and non-discrimination that are used as models nationwide. In this guise, he has also acted as a Hearing Officer for other Counties and Cities. Other assignments included Procurement Administration, and Career Counseling.

As a Legislative Analyst he has interpreted numerous versions of federal Employment and Training legislation, as well as Disability legislation. In this capacity, sections of his concept papers have been incorporated into some of these laws. Other materials have been developed to implement such measures as the Welfare-to-Work program, as well as notification requirements of plant and workplace closing measures.

As the Vice-Chair of the City of Riverside’s Community Relations Commission, he was instrumental in mediating and resolving disputes and helping various segments of the community gain access to governmental process to redress pressing matters.

His experience in the Disability Community stems from simple removal of architectural barriers to finding ways to better open the workplace and society to those in search of a place. This is in addition to direct services and assistance to patients with various issues and problems, such as conducting Support Groups and Workshops in association with the National Multiple Sclerosis Society.

Dr. Crosby Comments Regarding Attorney Gilbert Lopez:

“I have had the privilege of working at Riverside EDA at the same time as Gilbert Lopez. Although we did not work in the same department, I became acquainted with and fond of Dr. Lopez as a person and coworker. Dr. Lopez brings a lighthearted and caring nature to the workplace, and is first and foremost a man of principle. California Office Of Federal Insurance Advocacy is very fortunate to have Attorney Lopez in its directory.”

http://socialjusticeandequity.com/home

 

COOFIA Legal Tip:

The third stage in the Social Security Disability appeals process is the Appeals Council. Claimants make this appeal after their claim has been denied by an Administrative Law Judge at the Administrative Law Judge Hearing.

“It is important to understand that it is not the Appeals Council’s job to review whether or not you are actually disabled. Its job is to determine whether or not the administrative law judge overseeing your case decided in error. If there is no evidence to support that the judge did decide in error, this appeal is likely to be rejected. If, however, your attorney can demonstrate how the ruling regarding your case was made in error, the Appeals Council will either award your benefits claim or send your case back to an administrative law judge for further review” (Social Security Disability Help, 2013, p. 2).

If you have a claim that has already been denied by an Administrative Law Judge of the Social Security Administration, do not give up! Contact COOFIA for immediate assistance with your claim TODAY.

http://www.disability-benefits-help.org/disability-application-process/appeals-council

 

COOFIA Legal Factoid:

Did you know: Administrative Law Judge William C. Thompson, Jr. has the [H]ighest rate of claims [D]enied for Claimants filing for Social Security Disability Benefits in Central California? If your claim is to be decided by W.C. Thompson Jr., you are encouraged to contact COOFIA today for no-cost assistance with your Claim and Materials.

https://www.disabilityjudges.com/state/california/stockton/william-c-thompson-jr

 

COOFIA Disability Tip:

The overall ability of a Claimant to perform effectively within the workplace is referred to as one’s Residual Functional Capacity, or RFC.

Claimants often file for disability benefits, not because of a “single condition” causing impaired function but due to a “combination of concurrent medical problems” that often produce an overall diminished physical and/or mental condition – making it effectively “impossible for a Claimant to function effectively for any practical and sustained period of time.”

If an Administrative Law Judge makes a determination that the Claimant possesses sufficient RFC to function, the claim is denied despite the Claimant’s array of day-to-day medical problems. Claimants, if you have been denied disability benefits by the Social Security Administration, you should contact COOFIA today for help with your claim.

 

COOFIA Media Review:

“Investigating Disability Claims”

This video news report is absolutely amazing; a 180-degree turnabout compared to the reality of the disability application claim and award process. The majority of claimants are typically denied disability benefits due to improper administrative determination and discretion by Social Security Personnel, serving in the capacity of an Administrative Law Judge.

http://www.cbsnews.com/videos/investigating-disability-claims/?lumiereId=50156580&videoId=20ae0dd3-3644-11e3-8ce8-047d7b15b92e&mpxId=52386883984&cbsId=50156580&site=cbsnews

 

COOFIA Disability Fact:

Nine years in court fighting for disability? TRUE. But only if you live long enough to collect- and can afford the cost of litigation.

FACT: “Efforts to collect disability payments often turn into legal battles that critics say are stacked against the claimant. The agency denies an average of two-thirds of applications from low-income individuals who are disabled and more than half of claims submitted by disabled workers. And some administrative law judges are far less likely than others to approve claims.” (Wenger, 2012, p. 1)

http://articles.baltimoresun.com/2012-10-27/news/bs-md-social-security-awards-20121027_1_disability-benefits-disabled-workers-retirement-age

 

COOFIA Legal Factoid:

Federal Judge Carolyn K. Delaney States VA and SSA Programs Serve Same Purpose, ALJs Should Not Automatically Dismiss VA Determinations.

http://ca.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20121030_0014845.ECA.htm/qx

 

COOFIA Review Rating:

Beware of seemingly helpful statements such as this one:

“Arguably the most important part of the agency review process is the step after the initial application that was denied, when a claimant is entitled to a hearing before an administrative law judge (ALJ). An ALJ is a Social Security Administration employee who takes a fresh look at the application after considering live testimony and any newly submitted evidence.” (Babut Law Offices, 2013, p. 1)

We find at least two problems with this statement:

1- The first sentence is inaccurate: The step after the initial application has been denied is Reconsideration, not the ALJ Hearing. A claimant may not request a hearing until he or she has first requested reconsideration of the initial determination.

2- The second sentence is also inaccurate: Contrary to popular belief, the ALJ does not take a “fresh look” at the testimony and newly submitted evidence. The ALJ relies heavily upon the documentation assembled by SSA staff prior to the hearing, and in some cases, even makes medical determinations without physician review of the medical records.

Before you select a disability attorney, make sure that he or she is well versed in SSA procedures to give you the best chance of winning your claim.

*COOFIA Rating: 1 of 4 stars

http://www.babutlawssd.com/Articles/Controversy-Over-Right-to-Know-ALJ-Identity-Before-Social-Security-Hearing.shtml

 

COOFIA Legal Factoid:

FindACase™ is designed to be used by non-lawyers, small businesses, pro-se litigants, part-time lawyers, schools, colleges, libraries, publications, and activists for legal research across a wide range of topics and jurisdictions. FindACase™ is a product of VersusLaw, Inc. and uses the same powerful search engine and extensive libraries.

 

COOFIA Disability Tip:

ALJ abuse of power is more prevalent than commonly disclosed. A sweeping class action settlement was implemented in the New York area after five administrative law judges were found to have wrongfully denied thousands of claimants of disability benefits.

COOFIA representatives are familiar with the signs of ALJ abuse of power- contact our office before you attend an ALJ Hearing.

http://www.gibsondunn.com/news/Pages/HistoricClassActionSettlementProvidesNewHearingsandProtections.aspx

 

COOFIA Disability Tip:

Proper preparation for your administrative hearing is critical. Often, Attorneys and Administrative Law Judges may not demonstrate due diligence in observing your rights as a Claimant. In 2007, Dr. Crosby’s Attorney was poorly prepared for the administrative hearing, resulting in the Denial of Social Security Disability Benefits. During the hearing, Administrative Law Judge, William C. Thompson, Jr., failed to disclose or make clear, that as a Claimant, you have the right to review all pre-hearing data and information collected before and “during” the administrative hearing.

Today, Hearings are touted as open and non-adversarial, however, the outcome of your hearing is the final step prior to formal litigation that will determine whether you are considered qualified for benefits under this federal program. If you have questions or concerns about your Claim, contact our office today for a no-cost consultation.

 

Signs of Bad Faith Insurance: Part II

Do any of these signs of bad faith insurance look familiar?

-An insurer may be acting in bad faith if the insurer delays, discounts or denies payment without a reasonable basis for its delay, discounting or denial.

-Failure of Insurer to pay a covered claim as a result of failing to do a proper, prompt and thorough investigation as to reasonable liability and damages based upon all available information.

-Failure to offer or attempt to effectuate prompt, fair and reasonable evaluation of damages and equitable settlements of claims to insured within a reasonable time where liability is reasonably clear.

-Using harassing, intrusive or demeaning investigative methods and procedures, which victimize the insured.

-Unjustified contention and/or “low-balling” regarding the value of a loss.

-Intentionally withhold, misinterpret or misconstrue claims information and/or failure to not inform insured of provisions and covered benefits under the policy pertinent to a claim.

-Attempts to use indiscriminate measures, reference and/or procedures that diminish or reduce the top line amount or value representing full payment of the claim.

-Intentional or irresponsible non-disclosure and withholding of information, misinterpretation of file documents and/or policy provisions that would be in favor of the claimant.

-Utilization and/or development of deceptive insurer schemes or use of outside company services set up or conducted to carry out the same false pretense schemes (i.e. “Independent Medical Examiner Paper Reviews”) for the purpose to be able to wrongfully deny or reduce payment of claims.

-Treatment of insureds and claimants as adversaries.

-Using inaccurate or wrongful information of a factual or legal nature to diminish, deny or delay payment of a claim.

-Not being forthcoming with facts regarding coverage to deny, delay or reduce the amount of the claim.

-Using extreme undue persecution, wrongful and victimizing tactics and actions, meant to crush, threaten, thwart, intimidate, oppress, in order to scare away and get the claimant not to make or pursue a claim.

-Biased investigation of that which is supposed to be neutral and unbiased.

-Utilization of internal one-sided or outside companies biased schemes, such as in so-called “IME” bias (independent medical examiner bias), which are supposed to be objective and neutral, in order to wrongfully enable, facilitate and support insurer’s position to fraudulently deny, reduce or discontinue payments of claims.

-Intentionally misinterpreting or misconstruing the law to the disadvantage of the insured and benefit of the insurer.

(Bad Faith Insurance, 2005, pp. 1-4)

Contact COOFIA for assistance with your claim, and ask about the Social Security Self-Defense Guide for claimants.

 

Signs of Bad Faith Insurance: Part I

“The United States Social Security Administration (SSA) is an independent agency of the United States federal government that administers Social Security, a social insurance program consisting of retirement, disability, and survivors’ benefits. To qualify for these benefits, most American workers pay Social Security taxes on their earnings; future benefits are based on the employees’ contributions” (World Public Library, 2016, p. 1).

According to the above definition, SSDI is not “welfare”, but an “insurance” program- premiums are deducted from each paycheck. Claimants should not be ashamed to apply for disability when they are no longer able to maintain gainful employment. Why? Because they “paid” into this system, and therefore have already demonstrated a work ethic by means of employment. This is the opposite of welfare, which is a system of public assistance that is based on need, but does not require contribution from recipients.

http://www.worldlibrary.org/articles/social_security_administration

 

How Does SSA Determine Improvement of Medical Conditions?

According to the SSA, all medical sources of data (doctors, hospitals, etc.) will be used to not only determine “improvement” in conditions, but to determine if the improvement is great enough for return to work.

As most claimants with long-term disabilities usually suffer from chronic conditions, any observation in improvement must be analyzed as a continuum of care, and not as isolated events.

TIP: Some administrative law judges (e.g., William C. Thompson, Jr.) do not follow the regulations, and only view conditions separately and as isolated events. They may state that the condition(s) show “improvement” on a particular date, while not speaking to the side effects of medications, and the impact of one condition on the others, or of the status of the condition immediately before and after the cited date of improvement. They may even “string” together isolated instances of improvement without reference to relapses or secondary injuries resulting from sustained illness to create the illusion of good health.

Note: The stages of appeal within SSA (and how to prepare for each stage) are discussed at length in Chapter 2 of the Social Security Self-Defense Guide by COOFIA Publications. Be sure to purchase your copy of the guidebook to increase the likelihood of winning your case at the lowest possible level.

 

Dr. Crosby Comments on Fraud, Waste, and Abuse:

“According to the Government Accountability Office (GAO), less than 1 percent of all disability payments can be attributed to fraud. The idea of SSDI as a welfare system for those who are lazy and unwilling to work is a perception issue as well as a misconception that in recent years have been promulgated by the media. When the facts do not match the statements presented, the statements amount to nothing more than propaganda in order to mask the true situation. The Social Security system is a necessary and useful tool in preventing destitution for millions of Americans who are retired or too sick to maintain employment.

“Eligibility for SSDI first requires that these persons have worked and earned enough work credits to meet initial eligibility. Therefore, by definition, these applicants cannot be discounted as “lazy”. The real fraud and abuse occurs more often than not within the agency by allocating massive amounts of funding for employee social functions and staff bonuses to deny claims. Eliminate the internal abuse of Social Security funds and the problem becomes less pervasive.”

Note: Facts regarding SSA waste and abuse of funds, and the stigmatization of claimants filing for disability, are discussed in Chapter 1 of the Social Security Self-Defense Guide by COOFIA Publications. Be sure to purchase your copy so you can know the facts and be better prepared should you find yourself filing a claim for benefits.

 

Dr. Crosby Explains: “What Is DTAP”?

Excerpt from Chapter 4: Veterans and the SSA

Definition: DTAP stands for Disabled Transition Assistance Program, and is a half-day class that is MANDATORY for all service members receiving a medical discharge from the military. The class covers all benefits for which disabled veterans are entitled to receive upon discharge. These benefits include VA Compensation and Pension payments, Vocational Rehabilitation, VA Health Care, VA Home Loan Guaranty, and the GI Bill. It also reviews the benefits that are specific to the branch of service for the veteran, and how those benefits will affect any VA benefits they are eligible to receive.

Factoid: Interestingly enough, not only does DTAP review VA disability benefits, but also reviews Social Security Disability Insurance benefits. Service members receiving a medical discharge are also instructed on how to apply for SSDI, and are provided with a comprehensive packet of information about SSA qualifications and entitlement. Many veterans receive both VA and SSA disability benefits, as this does not constitute fraud.

Analysis: The problem occurs when veterans apply for Social Security disability benefits and are examined at their local Social Security office by SSA staff, many of whom have never served in the military. Ignorance on the part of SSA staff regarding military life and procedures can translate into discriminatory conduct against veterans for lack of qualified knowledge. In several cases, this ignorance on the part of SSA staff begets a chain of events that result in the denial of benefits for these veterans. For example, the behavior of the veteran, such as attire that is neat and clean, and speech that is goal-directed, to the untrained SSA staff member becomes misconstrued for deviant behavior and flagged as a fraudulent claim.

Recommendations for Veterans: (included in the guidebook)

Recommendations for Attorneys: (included in the guidebook)

Recommendations for the SSA: (included in the guidebook)

Note: To find out more about DTAP, how veterans who are medically discharged are often unlawfully denied disability benefits by the SSA, and what to do about it, be sure to purchase a copy of the Social Security Self-Defense Guide by COOFIA Publications.

 

COOFIA Case Review:

William Givens v. Carolyn Colvin
(Case No. 1:12-cv-0611 AWI- BAM)

This case was AFFIRMED by Federal Judge Barbara McAuliffe. The administrative law judge who denied this claim was William C. Thompson, Jr.

COOFIA has reviewed this decision and found similar patterns in case analysis for these types of claims:

1- Mr. Givens’ credibility was questioned whenever he stated pain or limitations, but accepted at face value whenever he stated feeling better

2- Mr. Givens’ treating physician statements were discounted where they noted his functional limitations, but accepted at face value wherever they noted improvement in conditions

3- Although Mr. Givens was prescribed a battery of heavy duty medications (including Vicodin, Morphine, Methadone, Neurontin, and Ultram) there is no mention anywhere in the opinion regarding the side effects of taking these medications, of secondary injuries resulting from taking these medications, or the effects of these medications on sustained activity for 8 hours a day, 5 days a week

4- ALJ Thompson based his recommendations for Mr. Givens on claimant’s ability to drive a car, buy groceries, lift a gallon of milk, go to Church, and attend baseball games

5- The Vocational Expert offered the job of “laundry worker” for Mr. Givens

Before you attend an ALJ Hearing or appeal in federal court, you are strongly encouraged to contact COOFIA for a no-cost consultation about your claim. You should also purchase a copy of the Social Security Self-Defense Guide by COOFIA Publications, to better prepare yourself for administrative proceedings and possibly federal court.

https://casetext.com/case/givens-v-colvin-1

 

What is COOFIA?

The California Office Of Federal Insurance Advocacy (COOFIA) is a regional collaborative of attorneys, educators, government employees, business executives and private citizens who have witnessed the corruption in the federal insurance benefits system and provides assistance to citizens facing tumultuous challenges at a time when they are most vulnerable and in need of help. Professional disability advocates have extensive knowledge of the complexities of the Social Security Administration and the overwhelming difficulties presented by the federal judiciary in meting out real justice against a monolithic system that is in dire need of change.

 

“Remembering Those Who Applied”

The California Office Of Federal Insurance Advocacy wishes to take this opportunity to honor all of the men and women who died while fighting for their disability benefits. Their loss of life is the epitome of a disjointed system that is in serious need of reform.

Persons such as Mr. Raul Garcia, who passed away while appealing his case in federal court should not be forgotten: Even though Mr. Garcia’s wife was able to successfully continue his appeal in court as substitute plaintiff, the Court still denied the appeal of a dead man. This represents a gross and tragic state of affairs between the SSA (who opposed the wife being named substitute plaintiff) and the federal judiciary in Central California, where even a dead applicant is not considered “disabled”. This represents a disturbing trend in the disability appeals process.

https://www.gpo.gov/fdsys/pkg/USCOURTS-caed-1_11-cv-00774/pdf/USCOURTS-caed-1_11-cv-00774-5.pdf

 

COOFIA Disability Tip:

Sometimes in the course of medical treatment, a patient may develop a second illness or injury that was caused by treatments provided to alleviate the initial ailment. Secondary illnesses may also be disabling conditions, which is why it is important to have a comprehensive review of all of your signs and symptoms, in order to establish a history of disease, and not merely isolated incidences of sickness and improvement of symptoms.

Contact COOFIA to find out how secondary illnesses could increase your chance of winning your SSI/SSDI claim. Also be sure to ask about the Social Security Self-Defense Guide for Claimants.

http://www.news-medical.net/news/20130711/Research-shows-proton-pump-inhibitors-may-cause-cardiovascular-problems.aspx

 

COOFIA Defines: Pro Forma Defects – Part III

FACT: Up to 65% of all initial claims for Social Security Disability are denied (Nolo, 2013). Claimants may then begin the appeals process, where they are allowed to submit additional medical evidence for evaluation by the medical doctors hired by the SSA, known as the Disability Determination Service (DDS). Procedure requires SSA to forward all medical records to DDS for medical certification that the claimant is either Disabled or Not Disabled per the guidelines.

Note: In 2007, Dr. Crosby’s Attorney forwarded over 200 pages of medical records from the Department of Veterans Affairs to the Social Security Administration. The SSA staff never sent Dr. Crosby’s VA medical records to the DDS for medical review and claim status update. Instead, Dr. Crosby’s medical records were marked “No DDS Development of the Medical Record Is Necessary” and the file was sent to Administrative Law Judge William C. Thompson, Jr., who, despite this fact, held a hearing and opined on the medical records in place of qualified medical personnel, ultimately denying the application for benefits. This entire chain of events constituted pro forma defects in case file construction, handling, management, forwarding, and adjudication. And, unfortunately, mistakes such as this are not rare when dealing with the SSA.

Make sure you protect your interests in filing a claim for benefits. Contact COOFIA for a no-cost consultation TODAY.

http://www.disabilitysecrets.com/disability-denial.html

 

COOFIA Defines: Pro Forma Defects – Part II

COOFIA Advocates are trained to look for pro forma defects, as the SSA is not immune from making mistakes in following its own procedures:

“Because the ALJ (William C. Thompson, Jr.) failed to follow the agency’s rulings and regulations, the Commissioner’s position was not substantially justified.”

“When the government violates its own regulations, its position is not substantially justified.”

“Such basic and fundamental errors include mischaracterizing evidence, relying on an opinion of a non-examining physician that contradicts the clear weight of the medical record, and discrediting the claimant’s subjective complaints as inconsistent with the medical record.” (p. 5)

Note: This particular administrative law judge, William C. Thompson, Jr., has been cited numerous times for defective reasoning in his decisions. W. C. Thompson Jr. also has the highest denial rate of all ALJs in Central California. Claimants are strongly advised to seek well-qualified assistance when filing a claim for benefits, especially those filing for benefits in Central California.

Contact our office today for help with your claim.

http://ca.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20120110_0000498.eca.htm/qx

 

COOFIA Defines: Pro Forma Defects – Part I

The term “pro forma” refers to an established procedure for completing a task, and usually requires accompanying documentation (forms) to record any number of transactions. Since these forms support the procedure, incomplete or missing forms is the same as not following procedure- a defect in pro forma. In a legal setting, pro forma defects can have serious consequences if it is proven that a process was not followed correctly.

Note: In 2007 and 2009, Dr. Crosby’s attorney failed to identify the pro forma defects that were present within the Administrative Record as provided by the Social Security Administration, resulting in the Denial of Benefits.

Make sure you protect your interests in filing a claim for benefits. Contact COOFIA for a no-cost consultation.

 

*COOFIA Recommended Special Report: “What Did 60 Minutes Get Wrong About Disability?”

http://fair.org/home/what-did-60-minutes-get-wrong-about-disability/

 

COOFIA Asks: “Why is it so difficult to qualify for disability?”

Response from Logan Wimer, Disability Program Navigator:

“Unfortunately, the system is adversarial and designed that way intentionally so that only those who persist and are consistent are those who receive any assistance. The belief is that only those who are of the deserving will stay…. SSA does not train their staff well or sometimes at all. The laws for it (Red Book) change each year and the staff are frequently not current with the changes in the law each year.”

For qualified assistance with your claim, contact COOFIA for a no-cost consultation.

 

*COOFIA Recommended Special Report: Data Mining

Persons appealing a disability determination through federal court should carefully consider the consequences, as all information compiled by the SSA and Court become public records. Due to the high number of cases affirmed, this can have a detrimental effect on claimants.

COOFIA has reviewed this report by Time Magazine and found it to be highly informative as to the amount of personal information readily available on the Internet, as well as how to remove personal data from the web.

****COOFIA Rating: 4 of 4 Stars

http://content.time.com/time/magazine/article/0,9171,2058205-1,00.html

 

*COOFIA Recommended Special Report: Stockton Bankruptcy

http://cironline.org/reports/who-took-down-stockton-4494?utm_source=CIR&utm_medium=social_media&utm_campaign=twitter

 

Dr. Crosby Advises: Social Security Consultative Examinations

SSA regulations require ALJs to consider all of the medical evidence as a continuum of care, and not as isolated events. Further, where a claimant has a history of care by a treating physician, the opinions of the treating physician are assigned greater value than that of a non-treating physician who has only observed the claimant and not treated the claimant. A Consultative Examination is a one-time evaluation by a hired contract physician of the SSA that lasts for a duration of approximately 15 minutes. It is not possible to establish complete medical history, diagnosis, and prognosis when compared with years of treatment notes by claimant’s physicians. CE doctors may be qualified to tell you what is “not” wrong with you (as in the ability to stand up, sit down, move your arms, and turn your head), but they are deficient in testing and treating for conditions that go beyond dexterity and include internal illness, along with reporting how the illness began, how to treat the illness, the side effects of medications used to treat the illness, how long the illness will last, and any occupational adjustments that need to be made during and after treatment.

http://www.disabilitysecrets.com/resources/should-you-trust-social-security-disability-doctor.htm

 

Dr. Crosby Comments on California State Disability:

“Unlike Social Security Disability, State Disability is a straightforward and painless process. With a properly completed application and declaration from your treating physician, benefits are usually paid in 2-3 weeks. If claimants are eligible for an extension of benefits, all it takes is a second declaration from the doctor attesting to the continuing disability. As a former recipient of SDI, I personally applaud the California State Disability Insurance system- the SSA would do well to learn from them in equitable practice, treatment of claimants, and streamlined processing of benefits.”

 

From Cradle to Grave: Government Records and Your Privacy

https://www.privacyrights.org/consumer-guides/cradle-grave-government-records-and-your-privacy

 

Dr. Crosby’s 9 Myths About Filing For Social Security Disability Benefits:

MYTH #1: Applying for disability benefits is a non-adversarial process.

FALSE: From the moment you enter a Social Security office you are being scanned, analyzed, and notated regarding several subjective factors that will be used against you at each step of the appeals process. SSA heavily relies upon the miseducation of the public in its complicated determination process to deny claims and continue the denial until the claimant either

1- Gives up
2- Has exhausted the appeals process
3- Returns to work despite illness
4- Dies

MYTH #2: My doctor(s) said I am no longer able to maintain employment due to my health problems, so the SSA will eventually approve my claim.

FALSE: The SSA uses a scoring system based on RFC (Residual Functional Capacity) to determine other types of work that the claimant can do, despite the array of health problems. These types of work are usually repetitive, unskilled tasks such as sorting laundry or filling cans (laundry sorter/can filler), and are used at the Administrative Law Judge Hearing with the aid of a Vocational Expert to recommend any kind of non-skilled, repetitive task(s) for claimants. Note that such recommendations only describe the types of work that the claimant is qualified to apply for, but not necessarily maintain for 8 hours per day, 5 days per week, as required in the regulations.

MYTH #3: To qualify for disability, I must be blind, paralyzed, missing one or more limbs, comatose, or near death.

FALSE: Social Security has a Listing of Impairments, divided into Parts A and B, each with 14 categories of body systems, each category divided into several subsections of impairments. Duration of any one listing for 12 months or longer that has been medically certified is all that is required to qualify for benefits. Separate conditions not specifically mentioned in the Listing, when considered in combination, may also equal one or more listings to qualify.

MYTH #4: If my Alleged Onset Date for disability covers a period of time that I worked, then I do not qualify for benefits, and am committing fraud.

FALSE: Social Security considers any period of employment that lasted six months or less to be an Unsuccessful Work Attempt (UWA), if the claimant had to stop working due to one or more medical conditions. Social Security allows claimants to collect benefits that include unsuccessful work attempts in the period of disability. THIS DOES NOT CONSTITUTE FRAUD.

MYTH #5: Any Social Security Disability lawyer or law firm is qualified to help me with my claim for benefits.

FALSE: Not all disability attorneys are alike: Some have limited experience in the machinations of the agency, some have multiple clients and may not pay much attention to your individual circumstances, some law firms use paralegals to do most of the work and limit contact with the attorney, other law firms do not represent clients beyond the Administrative Law Judge Hearing, while those attorneys who do represent clients in federal court sometimes lack sufficient knowledge of SSA policies and guidelines to successfully defend their clients against the statements made by SSA attorneys. For all such reasons, claimants must exercise due diligence in researching a qualified disability attorney to represent them throughout the appeals process.

MYTH #6: If I apply for SSI/SSDI, I am really applying for welfare.

Partly TRUE and Partly FALSE: Supplemental Security Income (SSI) is a disability program established for those who have not worked and are unable to work due to disability and have limited assets. Since claimants have made no contribution to this program, applying for SSI is applying for welfare. However, Social Security Disability Insurance (SSDI) is an insurance program whereby payroll deductions are made from each paycheck, and claimants must earn a required number of work credits to be eligible to apply for benefits. Hence, SSDI is not welfare, but an insurance program, with premiums deducted from each paycheck.

MYTH #7: If I am a veteran and I receive VA disability benefits, then I do not qualify for Social Security disability benefits.

FALSE: VA Compensation payments are made to veterans with service-connected disabilities. SSA disability payments are made to those who are no longer able to maintain employment due to one or more medical conditions. These are two separate programs with independent criteria for entitlement. Many veterans receive both VA and SSA disability payments. THIS DOES NOT CONSTITUTE FRAUD.

MYTH #8: If I file a civil action in federal court, at the very least I can expect to receive fair and impartial judicial review of my case and claim for benefits.

FALSE: Less than 5% of the cases appealed in federal court are reversed. The reasons for the low reversal rate have little to do with the merits of each case, and are based more on subjective factors such as the demographic characteristics of the claimant, the financial standing of the claimant, the egoistical relationship between the SSA and the judicial system, and the reward system within SSA that pays yearly bonuses to SSA attorneys that range from $10,000 to $20,000 based on the number of claims successfully denied. Of all federal district courts in California, The United States District Court for the Eastern District of California (handling the entire Central California Valley) has been deemed the least claimant-friendly forum for Social Security cases in the last 10 years.

MYTH #9: Social Security is facing insolvency due to the prevalence of disability fraud- there are too many people committing fraud, and too many applications being approved for benefits.

FALSE: According to the Government Accountability Office (GAO), less than 1 percent of all disability payments can be attributed to fraud. Up to 65% of all initial claims for Social Security Disability payments are denied. Less than 5% of all claims appealed in federal court are reversed. The Central California Valley has the highest denial rate of claims in the United States: Fresno, California has only a 44% approval rate at the Administrative Law Judge Hearing (touted as the stage with the best chance of winning a claim). And, of all administrative law judges in Central California, Administrative Law Judge William C. Thompson, Jr., has the lowest approval rate of them all- less than 30% of the cases brought before Judge Thompson are approved for benefits…

 

 

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