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At 37 years old, Michelle had stopped working as a teacher due to complications with gastro paresis and rheumatoid arthritis. Gastro paresis is a disease that prevents her stomach from correctly digesting food. Because her stomach muscles did not work properly, she could not digest food. Michelle contacted me in May of 2015. She came into the office with her mother because she needed to file for Social Security Disability. Quickly into the conversation, Michelle and her mother made it clear that her debilitating disease was the gastro paresis from which she had no relief.
She suffered from intractable nausea and vomiting daily. She could not keep food down. Over the course of our two-year representation, she was hospitalized nine times in 2016; six times in 2015 and ten times in 2014. By 2016, she received all of medicine and nutrition through surgically implanted gastric port called a GJ- tube for short. Her days consisted of infusing a specialized high protein prescription formula and medicine into two different ports; cleaning the ports after use; and dealing with some very difficult bathroom issues. If she was not in her bed, she was in the bathroom, resting on the cold tile floor for relief from her nausea.

One would think that Michelle’s case would have easily been approved at application. It was not. In May of 2015, we filed an online application for Michelle and sent in a mountain of medical records. We continually faxed over medical records to SSA and spoke with the adjusters each time Michelle entered the hospital. Despite her ten hospitalizations in 2015 and favorable doctor’s statements, the disability review team at the SSA determined that she could stand and walk and lift and carry as necessitated by her job as a preschool teacher and her claim was denied.
We requested reconsideration of this denial in September of 2015 and that was denied again in March of 2016. In the time period from September of 2015 to March of 2016, Michelle had five additional hospitalizations. Her disability file indicates that the second level of review was denied because during one hospitalization, the treating doctor prescribed Humira (a drug to treat her rheumatoid arthritis) and the reviewing SSA doctor thought that would work and she would improve. Also, the reviewing team ignored her treating doctor’s statements that she met a medical listing. A medical listing is a list from SSA of conditions that are considered to be disabling. Continue reading →

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Women, who suffer from pain as a result of some kind of medical condition or disability, are much more likely to have their reports of pain dismissed. This is even though women may actually be more likely to suffer from pain due to physiological and other causes.

women in pain.jpgDoctors have known for very long now that women and men vary greatly in the way that they respond to certain drugs, and even the way that they feel pain. Women have hormonal cycles that determine their level of tolerance to pain. Their organs are smaller, and their bodies are made up of a much higher body fat composition, which means that drugs affect their bodies differently.

These differences are even more acute for those women who live with chronic pain across the country. As many as 25% of Americans suffer from chronic pain, and a significant proportion of those Americans are believed to be women. There are millions of women who currently live with symptoms of chronic pain, and many of them are on Social Security disability benefits.

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A new estimate indicates that the number of Americans who suffer from Alzheimer’s disease could triple over the next 4 decades, if there is no progress made in treatment soon. Any Social Security disability attorney would also be very concerned about the implications for these patients, considering the slowness with which disability claims are currently processed by the Social Security Administration.

Fortunately, The Social Security Administration recently added early onset/younger onset Alzheimer’s disease to its Compassionate Allowances program, which means that people who suffer from these conditions could have their Social Security Disability Insurance claim processed quicker.

The new estimates were reported in the journal Neurology, and researchers say that by the year 2050, there will be at least 40 million Americans who suffer from Alzheimer’s disease. Alzheimer’s is the most common form of dementia, which normally affects senior citizens, and results in symptoms like cognitive deterioration, mental impairment, and a progressive loss of memory.

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Contrary to the picture of a person with mental or psychological disabilities that has been painted by the media in the wake of the recent school shootings in America, the fact remains that people who suffer from mental disabilities are much more likely to be victims of violence, than perpetrators. According to World Report on Disability, violence is the number one cause of morbidity among disabled people.

The researchers analyzed data between 2009 and 2010 in the United Kingdom, and estimated the chances that a person, who suffers from physical or mental disabilities, would experience violence including sexual, domestic, physical and non-domestic violence.

The research found that people who suffer from a mental disability are much more likely to be victims of violence, and not perpetrators of violence. The report also found that persons who suffered from disability, suffered severe psychological impact after suffering violence. These people were deeply traumatized, and not surprisingly, also sustained a much higher economic burden after the violence.

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Multiple Sclerosis is an autoimmune disorder that is characterized by a general progression of symptoms. Over time, symptoms which typically affect the brain, the spinal cord and the central nervous system, will worsen making it impossible to perform even daily routine functions.

multiple_slerosis.jpgIt can be a challenge for a person who has multiple sclerosis to qualify for Social Security disability benefits. To qualify for benefits, it is important that your condition have lasted for 12 months or is expected to last for 12 months.

This can be easier to calculate for other conditions, but when a patient suffers from multiple sclerosis, it can become much more complicated because people who suffer from multiple sclerosis typically have periods during which they have no symptoms of the disorder at all, interspersed with relapses or periods of sickness. Additionally, the periods of sickness differ in intensity and severity.

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The Atlanta Journal-Constitution reported Sunday that Georgia is expected to announce a plan this summer that would dramatically expand the use of for-profit insurance companies in a new approach to managing Medicaid in Georgia.

Georgia’s Medicaid program costs $7.8 billion annually with the federal government covering seventy-five percent of the cost. Georgia pays approximately $2.3 billion dollars in Medicaid coverage. The federal matching dollar rate in Georgia is one of the highest in the country. This matching rate is based upon state poverty rates. Georgia predicts that this year Medicaid will have a $350 billion dollar deficit with projections to double in three years. David Cook of the Georgia Department of Community Health maintains that, “the current Medicaid program cannot be sustained.”

Roughly two out of ten citizens in Georgia receive Medicaid. The aged, blind and disabled make -up twenty-five percent of the two million Georgia residents receiving Medicaid. However, this group accounts for over half of all Medicaid spending. The bulk of costs for the elderly and disabled tend to come from long-term care.

State legislatures report that Medicaid costs are expanding and putting increasing pressure on state budgets. Legislatures attribute the cause to rising health care costs and an increase in enrollment numbers due to the stagnant economy. Medicaid enrollment in Georgia grew 9.5% from 2009 to 2010. Medicaid enrollment grew in every state during the same period. At the same time, the economic downturn means that state budgets are experiencing shortfalls, making it harder to meet Medicaid needs. In other words, as tax revenues dip, Medicaid enrollment swells. Conversely, when state revenue grows due to a strong economy, Medicaid needs diminish.

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Persons with disabilities who are receiving Medicaid are doing so through a program called Supplemental Security Income (SSI). The SSI program covers disabled workers whose income and assets meet stringent resource tests. Unlike Social Security Disability Insurance, SSI is not dependent on years of paying into the disability insurance program through FICA taxes to qualify. SSI is a need-based program.

In an effort to restrain rising costs, many states are considering allowing for-profit managed companies to run the Medicaid program. Federal law prohibits states from lowering Medicaid eligibility. However, states can apply for waivers to test new or existing ways to deliver or pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP) programs. Under Section 1115, states can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP services. Under section 1915(b), states can apply for waivers to provide services through managed care systems.

Many health care advocates and medical providers question whether for-profit companies in a Medicaid model can improve care, spend less and earn a profit, particularly when provider payments are at the lowest level already. States that have implemented cost-cutting measures and/or hired for-profit managed care companies to run Medicaid programs instituted reforms such as charging higher co-pays to dissuade recipients from “unnecessary” treatments.

A significant body of research shows that while cost-sharing ideas (co-pays) may reduce Medicaid costs, they also create barriers to treatment for low-income populations. Shifting costs onto the population Medicaid was meant to serve – those who can least afford it – should not be an option. Those with permanent disabilities are often the most affected by Medicaid cuts. A chronic, medically disabling condition means one cannot return the workforce no matter what the state of the national economy.
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