Dear Client:
Thank you for choosing my firm to help you win your Social Security claim. We have the experience and knowledge you will need to make sure that the facts of your case are presented properly so that you have the best possible chance of being granted your benefits.
Even if we do everything right and have a “slam dunk” case, there are no guarantees in this process, and I cannot promise you a result or even “odds” of winning your case. I have plenty of “slam dunk” cases pending in Federal Court right now where the client and the hearing attorney did everything right but just got a bad decision out of sheer bad luck. So, knowing that even a perfect case is not a guarantee, we still want to do everything possible to make your case a slam dunk and maximize our likelihood of winning at or even before the hearing. If your case is pending on an appeal after the hearing, we still have the same goals.
Here is what a slam-dunk case looks like in terms of the facts and the evidence:
– Client has been out of work a year or more because of their medical condition
– Client has seen medical providers regularly the whole time, with at least one visit per month overall and one visit per quarter to a relevant specialist for each severe impairment
– Objective medical findings such as MRIs, blood tests, mental status exams, and/or other relevant findings all clearly document the severity of the impairments
– One or more doctor has completed a supportive opinion statement giving specific functional limitations incompatible with sustained full-time work
– The claimant can explain in detail how their medical condition has adversely impacted their day-to-day life and home situation
If all of the above conditions are met as of when your case comes before a judge for a hearing, your odds of being granted benefits go way up.
To translate those conditions into concrete steps, here is what I need you as my client to do:
– Go to your doctor regularly and talk to them about your work-limiting medical conditions on every single visit.
– See a relevant specialist at least once per quarter – not just your PCP.
– Get appropriate medication from a treating specialist. Do not have your primary care provider give you pain medication or psychiatric medication.
– Get appropriate medical tests done. If you have a joint or back problem, make sure you get an MRI of the affected part at least once a year. If you have a nerve or chronic pain condition, you should get an EMG of the affected limbs. If you have a rheumatological or whole-body condition such as fibromyalgia, you need an appropriate diagnostic examination from the relevant specialist such as a rheumatologist or neurologist. If you have headaches, you need a brain MRI.
– If you have a mental health condition (even if it’s not your primary impairment) you need to be in regular talk therapy with a qualified therapist and regular treatment with a psychiatrist. You should be seeing a therapist at least once a month, preferably weekly. Some people can’t see MD psychiatrists because of insurance or other access issues, and if you have to settle for a psychiatric NP or PA then at least have a regular relationship with them. You should be seeing your medication provider at least quarterly, and ideally every month or so.
– You need to demonstrate a good-faith effort to get better through your medical care. This means if a doctor recommends surgery, you either get the surgery or have a medically documented reason to put it off. If a medication is recommended, you take it. You attend all of your scheduled appointments on-time.
– Talk to your doctors about helping you prove your case. At some point I will ask you to identify doctors to complete opinion statements. This is best accomplished by knowing in advance that your doctor believes you can’t work and wants to help you prove it. Your doctor should know from their discussions with you what your limitations are when it comes time to complete these forms.
If you take the above steps throughout the time that your claim is pending, we will arrive at the hearing with a well-developed file of medical evidence, and that will give us the best chance of convincing the judge that you cannot work because of your medical condition. Besides that, putting full effort into your treatment actually improves the chances of you and your doctors finding an effective treatment that could allow you to get better and return to work. I don’t consider that a loss at all – in fact sometimes the best cases are closed period cases where medical improvement allowed someone to return to work.
Sometimes we do everything right and still lose at the hearing. Over the course of my career, I’ve typically seen anywhere from 10% to 50% of “strong” cases get denied by judges – that is to say, at least 10% of the time, you can still be denied even with a very strong case having done everything outlined above. But if you’ve done all of these things and still been denied, then we are going to have a very good case for the appeal. I am going to ask you to continue taking those same steps to continue bolstering our medical evidence in your claim, so that we can have the best chance possible of winning your case on appeal and/or a second application.
Thank you again for giving my firm the chance to help you through this challenging process. Working together, we are going to help you get the best possible outcome.
Sincerely,
James P. Ratchford, Esq.
