September, 2017: Kathy’s Fully Favorable Maine Social Security Disability Decision

Kathy’s story is a good example of how hard work and perseverance can pay off, both before and during the course of one’s application. Kathy looked to hire a Maine Social Security lawyer for her case at the very early point in time that her long term disability carrier began paying her long term disability (LTD) insurance payments (that is, 5 months after going out of work).

In the circumstance where one is receiving LTD benefits under a policy through their employment, it is important to know the LTD policy likely has a “coordination of benefits” provision that allows them to reduce their payout by the amount of money received in Social Security disability (SSD) benefits. This was the case with Kathy, who was found disabled from performing the “usual and customary duties of her ordinary occupation” under the terms of her LTD policy and thus deemed entitled to LTD benefits.

Kathy was in her early forties when it became necessary for her to go out of work as an administrative assistant (a position she held for many years). We assisted Kathy with her initial application for Social Security disability benefits through the Augusta, Maine Social Security office. Unfortunately, upon review by Disability Determination Services in Augusta, Maine, Kathy was denied. At that time it remained unclear the extent to which Kathy’s condition would remain unstable and long-term disabling. Unlike the need to show for purposes of her LTD claim that she continued to remain currently disabled from performing her own job, for purposes of Social Security disability, Kathy needed to show that her condition would remain severe and disabling from all manner of gainful employment for what was expected to be, or had been, a year or longer.

While recovery was expected for Kathy over the period of the intervening months as she proceeded with her reconsideration appeal request, it turned out to be a rocky road for Kathy. While she had periods where she was faring better, she did experience setbacks to her condition that over time that made it more evident that her condition was more severe than first thought. Additional episodes of decompensation made it increasingly clear that she was suffering from an unstable mood disorder referred to as bipolar disorder.

Hospitalization and psychiatric records over time made it increasingly evident that a period of longer term stability was not in the cards for Kathy. Unfortunately, as was the case here, one can be forced by an LTD carrier to apply for SSD well before it becomes clear that the condition will meet the requisite year.

To Kathy’s credit, while awaiting hearing, her mental health condition did improve to the point where she was able to attempt a return to work. She not only returned to a job that was much more physical than what she had been familiar with, but which paid much less than what she had been making. By showing her willingness to return to such work, she made clear to the presiding Administrative Law Judge (ALJ) at the hearing level wish and willingness to work.

As a result of the additional medical evidence we brought to bear at the time of hearing, the ALJ was able to recognize what the prior fact finders at her initial determination and reconsideration decision were not: that is, that her condition had remained severe and disabling. We were also able to show through the opinion evidence from her psychiatric nurse practitioner that her condition had remained severe and disabling, that she had been out of work for longer than a year, and that she was now attempting to return to work even though her condition remained severe: this allowed the ALJ to determine entitlement to what is called a Trial Work Period (TWP). Benefits were not only awarded for the past period, but also on an ongoing basis as she continued to test working.

Thus, I’m happy to say, Kathy was rewarded for her attempt at returning to work with a decision that served to make her load that much lighter for her as she made efforts to get back on her feet.

If you are someone you love has found themselves simply unable to maintain employment as a result of a severe illness or disabling condition(s), suggest they contact the Law Offices of Russell J. Goldsmith at (800) 773-8622 to see how we might be able to assist.