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Old 11-16-2011, 08:47 PM   #1
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help/advice needed

So to start I will give my background and then my situation and question

On October 14 2007 I went down for the count and had to be pickup by an ambulance and got xrays and after getting to my primary care physician he got me an MRI (the er said I was having middle spasms in my back) he was honest and said he knew nothing when it came to backs so he got me to a spine specialist and he immediately said I had a herniated disc at l4/l5 and got me on meds and took me off work and got me to physical therapy which did not help the pain in back or legs so tried epidural injections (3 total) which did not help either so he said next step is fusion. Also i kept telling my doctor that there are other areas in my back and neck are hurting and he said we need to deal with this problem first but would look into degeneration down the road.

This whole time I was on long term disability through my work as this was not a work injury who had me apply for ssdi when they realized it was going to take longer. So I did the app and had my surgery on march 31 2008 and at some point afterwards got the first denial for ssdi and my ltd had me appeal and got me their lawyer so in June 2008 my work finally had to take me off the books so I lost my insurance it I kept going to the doctor on a cash basis along with the pt on a cash basis which was fine. Well I was not improving much and then it all went down hill as my main dr left the practice in April 2009 and the new doc was trying to understand my case lawyer and then a week later I got denial #2 and a bit afterwards my ltd wanted me to see their dr who had me do some test that I could hardly walk after wards but because I was able to stand for 15 minutes and such he said I was good to go back for full time work even though my doc said no. ( I have a feeling it was because of the 2nd ssdi denial and they wanted to get me off them and they said even if I hurt myself after getting back to work their hands are washed of me and to toss another log on my fire they said i no longer have use of the ssdi lawer) so there was no way I could get back to my last job

so I started with a different company in june 2009 that was much easier on me. So I had no ins and and would not get it for 6 months and at some point throughout this I had to move to my families because of income. So now back to work and hurting all the time but having to do it to survive not remembering most of the first year because of all the meds just not to curl up into a ball. Now by the time my insurance kicks in i am working 6 days a week 10 hours a day always in pain crying and having feet legs and buttox numb hurting and feet swelling at this point i had no time to get back to the doctor because of work as i could not afford to lose my job so i lived with this and had it affect my work but i covered pretty well.

So after all this i was back to work for a year and a half barly able to move at most times and feeling like falling down. I get a letter in the mail for a ssdi hearing (at this point i completely forgot about it and just wrote it off but on November 8 2010 i went to this hearing because it said i must attend and figured i was just getting a pity hearing to make me feel better and first question was where's your representation and i said i don't have one as they dropped me after the second denial and then went have you been back to work and told them yes and I'm bearly able to get by because of pain but i grin and bear it. Well i was asstonished i got approved and got a lump sum. So i was quite surprised from the stories I've heard.

Now fast forward to now i have moved to Texas and am not working and am now running into huge problems can bearly get around and now neck is getting worse at same time have gone to general doctor to get specialist federal but it is going to take some time to get in but i cannot work. (here's the kicker he orders an xray and says i have muscle spasms in lower back and neck but he needs a specialist to probe deeper so great back at square one.)

So here's my question i was told by soc sec that i can restart within 5 years so has anyone had to restart their case and can i restart while i am waiting for a specialist appointment ( is a gp doc a start) or do i need to wait for a specialist to confirm to contact soc sec to restart case?

Also how easy is it to restart and do i have another waiting period?

Sorry so long and any help would be appreciated

Odd t

 
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Old 11-17-2011, 09:38 AM   #2
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Re: help/addvise needed

Question? Why did you not appeal or did you when LTD terminated your claim? IMHO, LTD IME's are on the side of the insurance companies although IME stands for independent medical examiner. These folks are suppose to be impartial but you can't get around the fact that they are being paid by the insurance companies to conduct these exams. Many of these contract examiners know that if they are completely neutral and impartial and do not find as many ppl not disabled as the insurance companies would like, they will eventually these very lucrative contracts and the insurance companies will find other doctors more to their liking. Anybody who thinks otherwise is just fooling themselves. It is unfortunately a sad reality. The SSA IME's aka CE's do not work for a profit driven private entity and you are more likely to get a fair, impartial exam by these doctors IMO unlike the LTD IME's.

It sounds to me like your lawyer appealed or somebody did (you said your lawyer dropped you) after the reconsideration denial and SS finally got around to scheduling your ALJ hearing. Since you had returned to work, they simply dismissed your case, altho you were awarded a lumpsum for the time you alleged disability (really unusual). I don't think you can restart the SSDI process at level 3 or appeal anything because of deadline constraints.

I think SS make be referring to your DLI (date last insured) when they told you you could restart in five years but I could be wrong. Let me ask my friend Jack who use to work for the SSA and see what he says. I think you are going to have to start over. I am really sorry all this has happened to you. Many ppl are forced to try and work even tho they really can't. What ends up happening usually is that this forced work attempt usually ends up causing them more pain and more disability until they can no longer continue. This is really sad but unfortunately, it happens to a lot of ppl.

Did you have any kind of STD/LTD with the last employer?

Last edited by BlueSkies14; 11-17-2011 at 12:23 PM.

 
Old 11-17-2011, 11:41 AM   #3
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Re: help/advice needed

Here is what my friend Jack had to say orguss1. This is just as I thought.

I asked Jack>>>>
Quote:
Can anyone answer this? Ok, here it is in a nutshell. A friend applies
for SSDI. He is denied at levels one and two and appeals. While he is
waiting on his ALJ hearing, he is forced to go back to work in pain.
SS eventually sends him a letter scheduling his ALJ hearing. He
attends this hearing. Since he returned to work, SS dismisses his
claim and awards a lumpsum for when he was disabled but tells him if he is unable to continue working, he has five
years to re-start the claim. I have never heard of this. Is this true
or not? This friend of mine worked for over a year but now the pain is
so bad that he had to stop working again. What are his options as far
as trying to obtain SSDI again? I told him I thought he had to start
the process over again but I could be wrong. You are the expert Jack.
What are your thoughts on this. Thanks for any replies.
Jack replied>>>>>
Quote:
Work that begins 30 days or longer after the alleged onset date and
then stops within 6 months under conditions that satisfy the
"unsuccessful work attempt" provisions does not result in a denial.
Your friend worked a year and so he was denied.
The part about the five years is nonsense but he does have to file a
new claim. The old application is dead, done, finished. His new date
of onset should be the date he had to stop working the second time.
When they ask him when his impairment first bothered him, he can give
the onset he alleged for his first application if he wants, but it
wont do any good to cite that date as his alleged onset date because
they won't use it. The earliest date they will use will be the date
he stopped working the 2nd time.

Last edited by BlueSkies14; 11-17-2011 at 11:50 AM.

 
Old 11-17-2011, 11:49 AM   #4
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Re: help/advice needed

I was re-reading your post. Am I correct in that you got a lumpsum for the time they considered you disabled but you never received monthly SSDI checks because you did go back to work in pain?

 
Old 11-17-2011, 01:20 PM   #5
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Re: help/advice needed

I am sorry you have to re start your claim again. you have to use your Date Of Onset later now which will affect any backpay benefits. Hopefully you can get through the process quickly and be easily approved .
if you had earned more then $1000 a month while working then this would be considered a Substaniel Gainful Activity. After the trial work period ends.

Last edited by mscat40; 11-17-2011 at 01:55 PM.

 
Old 11-17-2011, 02:01 PM   #6
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Re: help/advice needed

Quote:
Originally Posted by BlueSkies14 View Post
I was re-reading your post. Am I correct in that you got a lumpsum for the time they considered you disabled but you never received monthly SSDI checks because you did go back to work in pain?
yes I got approved got paid the back lump sum but was back to work in pain for a little over a year at that point so had no monthly checks the time back was considered my trial period but was sent a letter about a 60 month extended period eligibility which I did see this below which I cut and pasted. So I was trying to figure out what this entailed. If anyone knew how to go about it or has needed to do it.

Can I get my SSDI check back again if I lose my job after the trial work period?

It depends on whether Social Security thinks you are still disabled. During the three months after your trial work period, Social Security will look at your medical records to see if your health has improved enough that you are no longer considered disabled. If Social Security finds that you are still disabled, then you will be covered under what Social Security calls an "Extended Period of Eligibility" for the next 60 months. You will automatically be eligible for your SSDI check in any month during the Extended Period of Eligibility in which your earnings drop below $980.

On the other hand, if Social Security looks at your medical records and decides that they show "medical improvement" then they will send you a notice saying that they no longer consider you disabled. Then the only way you will be able to get your SSDI benefits back will be by appealing (and winning) or applying all over again.


I found this on another site but don't understand it too much

 
Old 11-18-2011, 12:07 AM   #7
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Re: help/advice needed

OIC what you are saying now. There are so many little nuances when it comes to SSDI. Question? Did SS ever send you a notice saying that they no longer considered you disabled because they thought you had improved medically? I am going to copy and paste for my friend Jack to see if he has any thoughts on this. I will report back.

 
Old 11-18-2011, 12:18 AM   #8
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Re: help/advice needed

Quote:
The Social Security Administration understands that while you may be successful in returning to work, your disability or medical condition may worsen and force you to stop work once again. If that is the case, within five years after you return to work, you will be eligible for “expedited reinstatement,” meaning you will not have to reapply for benefits and you will not have to wait for benefits while your medical condition is being reviewed.

 
Old 11-18-2011, 12:25 AM   #9
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Re: help/advice needed

It seems to me like they might pay you immediately while they review your medical records to determine if you are disabled and not the other way around.

 
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