A New Frontier for Advocacy: Social Security Disability Insurance Approval

Written and submitted by GNA member, Avrom Fox

If a person has contributed to Social Security (SS) for at least 10 years and has a debilitating illness such as stroke, ALS, muscular dystrophy or blindness, the individual can simply apply for Social Security Disability Insurance (SSDI) and get approved. These are clear cut medical conditions which can keep disabled people from working.

A recent case of mine showcased the complexities of the system for people who have uncommon medical issues. My client had a rare autoimmune disease. It was hard to diagnose such that many physicians did not even believe she was sick. She was written off as mentally challenged and psychosomatic, yet she was regressing. She had no strength, no energy, was easily fatigued, could not work, and could barely care for herself.

My client applied for SSDI in 2019, but, due to the complexity and rarity of her situation, the SSDI did not conclude that she was unemployable and ultimately rejected her claim. She submitted years worth of medical records and lab reports totaling over 1200 pages. She had a team of physicians that she was seeing, which made the process of gathering the records and reports extremely difficult. Once her file was completed, the SSDI reviewer concluded that there were jobs she could pursue, and she was rejected.

This strong minded woman would not give up. She had no income, no possibility of employment and was quickly regressing. She recognized that SSDI was her only lifeline. She requested another appeal which was granted.

She submitted more documentation and medical record evidence. She had consultations with other specialists who verified that she had this rare disease. The confirmation of a hearing date was significantly delayed because of COVID. Finally, a hearing date for the final appeal was granted. The hearing was convened on zoom, and, after a brief period of time, the Judge recessed the hearing and recommended that the client needed an authorized representative to help her gather the materials, consolidate them and help her before and during the hearing.

The Judge suggested she engage an authorized attorney. She opted not to do this. Attorneys can charge a cap of 6,000.00 dollars, and those fees would be withheld from any award the claimant is granted. I was approached and asked if, as a patient advocate, I would agree to be engaged as her representative. Given that the materials, medical records,

financial data etc had already been submitted, I agreed to represent her.

Most advocates would not spend the time to gather the materials and help a client with the initial claim as it is time consuming and purely administrative. If an appeal was necessary, and a hearing was required, most advocates would not feel comfortable serving in a lawyer-like role, representing an SSDI claimant before a judge, in a trial setting.

I reviewed the materials, organized them, spent time with the client, and concluded that her case was rock solid. I consulted with some SSDI experts, and was confident that representing her within the scope of our Code of Ethics.

What I felt I needed to know were three primary things: The medical issues; the reasons why she could not work; and, most importantly, I needed to understand the nature of the client’s depression and anxiety in order to be able to support her. I concluded that this is where there could be a major difference in the role of a lawyer and a patient advocate. This client was fragile, vulnerable and volatile. She needed an empathetic advocate.

I did not feel there was any risk, except the possibility she would not win the award, and I would be blamed. But that is the risk involved in any legal matter. She understood that. I also agreed not to charge her unless she won the award. Most advocates would not make that compromise. I recognized that her only source of funds to pay my fee would be from the SSDI award.

Ultimately, with me as the representative, the hearing was convened and it lasted for several hours. We WON!

After waiting three weeks for the results. This client will not only be awarded SSDI going forward, but will receive a retroactive payout from the time of the initial claim in 2019. This a substantial amount of money, which will greatly assist this woman.

Cases like these are tough. I had to learn on the job and do my research to make sure I could help. This case has given me the confidence to explore areas of advocacy that I am less familiar with. It was a delicate balancing act of making sure to not overstep legal and personal boundaries in addition to learning and researching along with my client. I am hopeful that I can use the adaptability and problem solving skills that I learned in this case to broaden my skill set and help more patients in need of advocacy.

(For more information on Social Security and Medicare, check out this blog and this blog )