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Knoxville Personal Injury Law Blog

Social Security Disability Insurance (SSDI) - Hearing Wait Times and Approval Rates

Periodically, I report on the average processing times and approval rates for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cases at the hearing level. I last blogged about this issue in December.

Predictably and unfortunately the bad news continues for persons seeking disability benefits. The national average processing time for claims before the Office of Disability Adjudication and Review has risen to 432 days, which is up from 421 in December 2014, 397 days in July, 390 days in May of 2014, and up from 372 in December of 2013. Nationally, the average approval rate has remained at 44% since July though this is down from 46% in December of 2013.

In Tennessee, the average processing time has increased to 462 days, which is an increase from 455 days in December 2014, 433 days in October, 427 days in July, 419 in May of 2014, 407 days in February, and 388 days in December of 2013. The statewide average of cases approved is back down to 51%, which is down from 53% in December of 2013.

In terms of averages for local offices, the Middlesboro, KY office has jumped up to 410 days, which is up from 388 days in December 2014 and 378 days in July 2014. The average percentage of cases approved has dropped to 43% down from 44% in July 2014 and down from 45% approved in May of 2014.

The Kingsport ODAR is still the best performing Tennessee hearing office. The average processing time increased slight to 339 from 335 days in December 2014, which is a decrease from 344 days in July and 346 days in May. However, these numbers are still above the historic average for this top performing hearing office. The Kingsport hearing office has an average of 57% cases approved, which is down from 58% in October 2014 and 59% in July of 2014.

The Chattanooga hearing office continues to increase with an average processing time now of 519 days. This is up from 503 days in December 2014, days in October, 458 days in July of 2014, 429 in February, and 390 days in December of 2013. However, the Chattanooga ODAR currently has the highest average of cases approved at 60%. This is up from 58% in December 2014, 55% in October and 56% in July of 2014.

The Knoxville ODAR average processing time has ballooned! It is now at 540 days! This is up from 537 days in December 2014, 497 days in October 2014, 487 days in July, 474 in May, 457 days in February, and 406 days in December of 2013. The Knoxville average approval rate did actually go up to 49% cases approved. This is up from 44% in December 2014, and 46% in October. These numbers are historically low for Knoxville. In December of 2013, the Knoxville ODAR was at 53%. Unfortunately, these numbers confirm that on a whole the average processing times are going up everywhere while the percentage of case approved by Administrative Law Judges continues to decline.

 

Good Samaritans killed while helping at car wreck

A Tennessee family is still trying to come to terms with the tragic event in which a mother and her son was killed by a semi-truck on a recent Monday evening in early February. Authorities have released the video footage taken by the dash cam of the first response vehicle to arrive at the scene. They are hopeful that the video footage of the car wreck will raise awareness for the need for witnesses to help with the investigation.

It is reported that the mother and son was returning home after shopping for groceries, when they stopped at an accident scene. They were trying to help the passengers of an SUV, which had rolled after slipping on ice. While providing assistance, they were struck by the semi-truck. The 10-year-old boy died at the accident scene, while his mother passed away not long afterward at a hospital in the region.

Social Security Disability Insurance (SSDI) - Heart Transplant

In a continuation of my recent series on Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) for heart related conditions, this week I will look at the Social Security Administration's requirements for SSDI and SSI when someone has undergone a heart transplant. Feel free to review the rules on Chronic Heart Failure (CHF) and ischemic heart disease.

A person may be eligible for Social Security Disability Insurance (SSDI) if his heart condition is so severe as to require a heart transplant. The SSA will determine whether the person is disabled under a listing. The Listings are just that, they are listings of conditions that qualify for someone disability benefits. A person must show that he meets or equals the listed condition and required severity.

In terms of a heart transplant, the SSA's Bluebook or Code of Federal Regulations states:

4.09 Heart transplant. Consider under a disability for 1 year following surgery; thereafter, evaluate residual impairment under the appropriate listing.

After the one year from surgery, the SSA will reevaluate the claimant's condition. If the condition meets or equals another listing, then the person will continue receiving benefits. If the person does not qualify for benefits based on this Listing, the residual problems from the heart and other conditions will be considered when determining whether he can return to past employment or whether jobs exist in the local and national economy.

Tennessee mother killed in truck accident

A 54-year-old Tennessee mother and grandmother died after been hit by a garbage truck at 9.30 a.m. on a recent Friday morning. It is reported that the driver of the garbage truck stopped at a red traffic light. When the light changed to green, he turned right at the intersection.  At this point, the victim was busy crossing the road and was in the crosswalk when the truck hit her. The truck driver was put on administrative leave without pay after the truck accident and will not be allowed to drive a city vehicle until the city physician has cleared him.

The accident is currently under investigation by the Tennessee Highway Patrol. A spokesman for the city indicated that the city is cooperating with the authorities. Currently, the investigators are waiting for the toxicology reports of both victim and the truck driver.

Social Security Disability Insurance (SSDI) - Ischemic Heart Disease

A person may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) based on certain heart conditions. Recently, I discussed eligibility based on Chronic Heart Failure (CHF). This week I am going to focus on the Social Security Administration's evaluation when a person suffers from ischemic heart disease.

If someone is not working and suffers from ischemic heart disease, the SSA will determine whether the person is disabled under a listing or whether jobs exists considering the person's residual abilities. The Listings are just that, they are listings of conditions that qualify for someone disability benefits. A person must show that she meets or equals the listed condition and required severity.

In terms of ischemic heart disease, the SSA's Bluebook or Code of Federal Regulations states:

4.04 Ischemic heart disease, with symptoms due to myocardial ischemia while on a regimen of prescribed treatment, with one of the following:

A. Sign-or symptom-limited exercise tolerance test demonstrating at least one of the following manifestations at a workload equivalent to 5 METs or less:

1. Horizontal or downsloping depression, in the absence of digitalis glycoside treatment or hypokalemia, of the ST segment of at least -0.10 millivolts (-1.0 mm) in at least 3 consecutive complexes that are on a level baseline in any lead other than a VR, and depression of at least -0.10 millivolts lasting for at least 1 minute of recovery; or

2. At least 0.1 millivolt (1 mm) ST elevation above resting baseline in non-infarct leads during both exercise and 1 or more minutes of recovery; or

3. Decrease of 10 mm Hg or more in systolic pressure below the baseline blood pressure or the preceding systolic pressure measured during exercise due to left ventricular dysfunction, despite an increase in workload; or

4. Documented ischemia at an exercise level equivalent to 5 METs or less on appropriate medically acceptable imaging, such as radionuclide perfusion scans or stress echocardiography.

OR

B. Three separate ischemic episodes, each requiring revascularization or not amenable to revascularization, within a consecutive 12-month period.

OR

C. Coronary artery disease, demonstrated by angiography (obtained independent of Social Security disability evaluation) or other appropriate medically acceptable imaging, and in the absence of a timely exercise tolerance test or a timely normal drug-induced stress test, an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that performance of exercise tolerance testing would present a significant risk to the individual, with both 1 and 2:

1. Angiographic evidence showing:

a. 50 percent or more narrowing of a nonbypassed left main coronary artery; or

b. 70 percent or more narrowing of another nonbypassed coronary artery; or

c. 50 percent or more narrowing involving a long (greater than 1 cm) segment of a nonbypassed coronary artery; or

d. 50 percent or more narrowing of at least two nonbypassed coronary arteries; or

e. 70 percent or more narrowing of a bypass graft vessel; and

2. Resulting in very serious limitations in the ability to independently initiate, sustain, or complete activities of daily living.

If the person does not qualify for benefits based on this Listing, the impairments can still be considered when determining whether he or she can return to past employment or whether jobs exist in the local and national economy.

Tennessee authorities concerned by increase in car accidents

According to traffic officials in Tennessee, there have been more fatal motor vehicle accidents than in the corresponding 2014 timeframe. Authorities have called on road users to assist them in the matter. In the first four days of February alone, seven people died in car accidents in only four East Tennessean counties. The call for help followed after another fatal crash in which a motorcyclist was killed.   

The motorcyclist was killed when a car pulled into traffic, causing other motorists to slow down. The brakes of a pick-up truck locked when the driver was forced to brake sharply. The truck rolled and struck the motorcyclist.

Social Security Disability Insurance (SSDI) - Chronic Heart Failure

     A person may qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) based on severe, such as chronic heart failure. If a person is not working and has been diagnosed with this severe condition, the Social Security Administration will determine whether the person is disabled under a listing or whether jobs exists considering the person's residual abilities.

     The Listings are just that, they are listings of conditions that qualify someone for disability benefits. A person must show that she meets or equals the listed condition and required severity.  In terms of Chronic Heart Failure, the SSA's Bluebook or Code of Federal Regulations states:

4.02 Chronic heart failure while on a regimen of prescribed treatment.  The required level of severity for this impairment is met when the requirements in both A and B are satisfied.

A. Medically documented presence of one of the following:

1. Systolic failure, with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure); or

2. Diastolic failure, with left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging, with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure);

AND

B. Resulting in one of the following:

1. Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living in an individual for whom an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance of an exercise test would present a significant risk to the individual; or

2. Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period, with evidence of fluid retention from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization; or

3. Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to:

a. Dyspnea, fatigue, palpitations, or chest discomfort; or

b. Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or

c. Decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise due to left ventricular dysfunction, despite an increase in workload; or

d. Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.

     If a person does not qualify for Social Security Disability Insurance (SSDI) or SSI benefits based on this Listing, the heart disease and any other impairments can still be considered when determining whether shecan return to past employment or whether jobs exist in the local and national economy.

     To read about the listing for recurrent arrhythmias, click here.

Pregnant woman suffers critical injuries in truck accident

A Tennessee accident on a recent Tuesday evening during the last week of January did not only leave one woman critically injured, it also killed her unborn child.  The father of the baby has been left devastated by the truck accident. Not only does he have to deal with the loss of his unborn child, but his mother was also fatally injured in the crash.

According to authorities, the accident was caused by an alleged DUI truck driver who skipped a red light. The truck struck a sedan driven by the father-to-be. The impact was so severe that the driver's mother was flung from the vehicle. She was critically injured and passed away in the hospital. The driver of the car escaped injury.

Social Security Disability Insurance (SSDI) - 2015 Budget Problems

     There is more bad news on the horizon for claimants and recipients of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). At the end of 2014, Congress passed the federal budget. The money allocated to the Social Security Administration (SSA) for its administrative budget was less than requested and less than fiscal year 2014! Congress did allocate more money for "program integrity activities" so one can expect more robust continuing disability reviews (CDR). Click here to learn more about CDRs and Social Security Disability Insurance (SSDI) claims.

     Also, the final bill included several other provisions such as:

•· An initiative for a "disability early intervention" program to test innovative and evidence-based approaches to help individuals with disabilities that are not yet receiving SSDI, but are likely to be eligible in the future. The goal would be to help the individuals remain in the workforce.

•· The Commissioner is directed to continue to make benefit verification letters available upon request.

•· The SSA is to resume mailing Social Security Statements in accordance with the plan submitted in March of 2014. Mailings will be sent to workers aged 25, 30, 35, 40, 45, 50, 55, and 60 or older who have not signed up for statements online.

Car wreck kills child pedestrian, critically injures another

January ended tragically for a Tennessee family when their 11-year-old son was killed in an accident. The deceased victim and a friend were on their way to a shop in the area when the car wreck happened. The boys were walking on the sidewalk among a group of people when a car struck them. The friend was critically injured in the accident and taken to a children's hospital in the area.

The driver of an SUV was traveling with her sister when she lost control of the vehicle. Both suffered non life-threatening injuries. According to a brother, one of the sisters was expecting, though it was not reported how far along her pregnancy had progressed or if there was any injury to the fetus. 

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