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YOU MAY WANT TO THINK TWICE BEFORE WRITING
OFF THOSE OLD CLAIMS! (CONT.)
If relevant evidence was not discussed or impairments were not addressed in prior medical determinations, it can also be considered new and material.
What should be done with old cases where the claimant appears ineligible?
Kennedy recommends having the case reviewed by a third party, and not accepting the opinion of Social Security. "Let's face it, it's not in the best interests of Social Security to approve these old claims. Also, many of the representatives under their employ do not know all the issues. You cannot count on them to determine whether or not the case has a chance." By going into the process ready to address the technical restraints before the case gets dismissed, the claim stands a far better chance of getting heard."
Take, for instance, the claim of Judy Dotson (name changed). Judy had filed an application in the early 1980's but because of her disability (a serious mental illness), she withdrew her claim prior to attending her hearing. She filed another application over one year after her DLI. This application was also medically denied. Because of the medical denial, the claim was coded as "Ineligible" by her LTD provider, and sat filed away for over 11 years. On an audit of old cases the insurance company and other vendors had written off, Kennedy looked at the file and saw potential. "Most representatives prefer to stay away from the old cases because they can get pretty messy. When I saw this case, I knew that with the involvement of a mental impairment, Ms. Dotson's ability to understand and carry out the necessary steps for an appeal was questionable." Kennedy addressed the 'res judicata' issue with Social Security immediately.
Although the case was denied technically through the Application and Reconsideration levels, it was heard at hearing. "We addressed the issue of Administrative Finality long before this case went to a hearing. We secured statements from the claimant's treating physician which directly addressed her mental competence during the relevant period of time. By the time the Judge heard the case, reopening of the old claim was almost imminent."
Kennedy & Associates established that Ms. Dotson was not mentally competent to understand and carry out the appeals process, nor was she emotionally capable of handling the Hearing during her prior claim. In the end, not only was the current application of Ms. Dotson (name changed) approved (assuring 12 months retroactive benefits from application date), but her initial application from the early 1980's was reopened as well. This amounted to a Primary beneficiary retroactive award exceeding $125,000.00! "That is almost unheard of where Social Security is concerned," says Kennedy.
When asked what can be learned from this case, Kennedy responded, "Don't assume that claims are impossible just because of their age. Class Action suits and the regulations have given some old cases a real chance. Instead of being a write-off, an old case can be a windfall."
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