Sick, I Swear

Fighting For Your Benefits (And Your Sanity) With Adriana M. de la Torre

• Kaitlyn Rohde • Season 2 • Episode 6

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Adriana M. de la Torre is a disability attorney and co-founder of Tower Law Group who has dedicated her entire practice to helping people fight for the Social Security benefits they deserve. In this episode we get into the disability process, denial rates, dynamic disability, invisible illness, fraud myths, and what it actually takes to get approved. If you are currently in the process, curious about disability benefits, thinking about applying, or have ever felt like the system just doesn't believe you, this one is for you! 


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Intro And Why This Matters

SPEAKER_02

Welcome back to another episode of Sick Eyes Swear. I am your host, Caitlin Rhody, and if y'all have been listening for a while, a lot of you know I personally receive disability benefits, and I know firsthand how overwhelming and intimidating the disability process can feel when you're already dealing with a bunch of other health issues. In this episode, I am joined by Adriana DeLatore, an attorney and co-founder of Tower Law Group. She has dedicated her work to helping people navigate the Social Security disability benefits. Adriana has extensive experience working in federal courts and advocating for her clients. And you can seriously feel her passion for justice and helping people through the system that can feel way too complicated. If you're currently going through the disability process, thinking about applying, you're supporting somebody who is or curious about how it all works. This one is definitely for you. Hi, Adriana. Let's just start off by kind of going over your background.

SPEAKER_00

Well, I went to law school not really knowing what my path was going to be. Like I didn't have a practice area. I didn't always want to do immigration or criminal law, but I knew going to law school that I wanted to help people. I was going to do either government or like a nonprofit at legal services. I that's what I knew I was going to do. And when I started, my first job was actually working for the Illinois Attorney General's office. And I was an attorney there in Chicago, and I was doing lots of litigation. And people were suing the state, and I was defending them. And I was like, I don't know if I could do this forever. So then there was an opening with Social Security, and it was to serve on the office of the general counsel. So their attorneys. And so I said, okay, well, you know, I definitely want to do government work. This is going to be it. This is going to be how I'm going to help a lot of people. But the type of job that they had there was defending decisions that got denied. So people would file for disability, they would go to the initial level reconsider level, then they'd go to reconsideration, then they'd have a hearing with an administrative law judge, and then they'd go to the appeals counsel. After they finished all that, then they would go to federal court. And as Social Securities attorney, you

Adriana’s Career And Mission

SPEAKER_00

would have to represent the agency and defend what they did. Right. So in those instances, we were saying the ALJ was right to deny this claimant disability benefits. Well, that quickly did not feel good after a while. So my sister and I opened up our firm, and it was with the idea of just helping people. So I moved from Chicago to Indianapolis at that time, where my sister and I set up our firm and then slowly moved to Florida. So now we have two offices. And what I do 100% of my practice is Social Security cases. So I help people when they've been denied. I am always happy to help with applications and how should I phrase this? And what do I need to get for Social Security?

SPEAKER_02

It's a big process. And I think, I guess for listeners, to kind of just go over the process of it, because a lot of us don't know unless we have to go through it. What is the process like?

SPEAKER_00

So Social Security affects everybody's lives, right? But it really affects the people who are disabled. When you have a condition that prevents your ability to work, and by working, Social Security means how much money you can bring in, the agency will find you disabled, and then they will give you cash benefit for your disability. That money is either coming from your work history or what you put into the system, or because of your low income. Now, the application itself is pretty tedious, right? Like I think it takes an hour and a half just to put in all the information of your name, your contact information, all your doctors, every job that you've had in the last five years. How much standing did you do at that job? How much sitting? What were you lifting? How much were you lifting? Right? Like all those things, they'll go through your schooling, they'll go through your contact, your medications. So there's a lot of things that they're gathering. You file the application itself, and what you're saying is, I have these conditions. I would love to work, I want to work, but because of my conditions, I can't. There's not a job that I could do on a regular and continuing basis. Right? Maybe you can do a job part-time, but that's not regular and continuing full-time work, right? Which is what you'd need to be able to do. So if you can't do that, you can file for disability. The process is long because there is so many moving parts to it, right? So you file an application with the agency, and the agency says, Great, let's go get your medical records. So the agency will contact all the doctors that you identify, they'll go get the medical records, but then they'll also ask you to go to one of their exams with one of their doctors. Then they will ask one of their doctors, another set of doctors, to review that report from their doctor and your doctor's reports. And then they'll come up with an opinion that says you can do A, B, C, and D. Social Security takes that and says, Well, based on this, you're either approved or denied. Then what happens is you go through the very lengthy battle of the appeal process.

SPEAKER_02

The damn appeal.

SPEAKER_00

Yes. And that's where that's where it gets really tricky, right? Because you have to be denied, you go to reconsideration where you're telling the agency, no, you got it wrong, do it again. Right. So then they do that whole process again. If you get denied, then you have to go to the administrative law judge hearing, right? So you have a hearing with a social security administrative judge, and they will sit down with you for about 45 minutes, and they will figure out what is it that you say you're disabled and why you're disabled. And they'll go through that, which I don't know how you could really understand somebody's situation in just 45 minutes. But it's a 45 minute hearing. And then the judge will make a decision, and then that case will then, if you get denied, go to the appeals counsel, which is the body of judges above the individual lying judges who just heard your case. Now that's the process, and so it's interesting, but the more interesting part, I think, is the data behind it on the approvals and the denials, right? Because everybody thinks, well, I'm disabled. Of course, they'll just know. They just they'll see it in my records, right? I'm saying that I'm disabled. But Social Security releases, and I'm gonna show this. Uh, I have the form in front of me, a workflow chart, and it's for 2024. And what they do is they break down how many applications were there, how many reconsiderations, how many, and they break it down by approvals and denials. So for 2024, there were two million initial applications that made it to a decision, right?

SPEAKER_01

Wow.

SPEAKER_00

Because not all of them make decisions. Some of them file for disability and say, you know what, this is taking too long. I'm just I'm gonna take out my application, I'm not gonna do it. But there were

The Disability Claim Steps

SPEAKER_00

basically two million decisions. From that, more than 60% of the cases got denied at the initial level.

SPEAKER_02

At the initial level. So that uh obviously more than half.

SPEAKER_00

Yeah, more than half. Then you go to reconsideration. At reconsideration, which is that step of hey, you got it wrong, do it again. 84% got denied. 84% Wow. That's basically like a rubber stamp. Like there, there's no real approvals, then, right? There are, but it's it's such a low amount given the number of cases. Then you get to the administrative law judge hearing, and about 51% of those cases are approved. So you have a 50-50 shot at the ALJ level. At the appeals council, you file the appeal, they deny about 80% of those cases. So it's really hard to get disability.

SPEAKER_02

Why is that? Like, is are they following, like checking off boxes and just wiping you through the system? Or why is it so hard? Or is it because they don't want to give it out?

SPEAKER_00

I think it's a subjective process, right? So disability is you have these medical records, and you can read these medical records and come to one conclusion. Somebody else can read them and come to another conclusion. So where do you fall right within this line? The other problem is that everything nowadays is almost on a spectrum. There are people with back pain and stenosis who work, and there are people with back pain and stenosis who can't work, right? Right. It's but where do you fall on this line? And how you judge that line is a very subjective process. So that's what happens with Social Security. There's no, oh, well, we both have migraines and we're then we're both disabled. It depends on your age, your treatment history, uh, the medications that you've taken, your education. There's so many factors that go into it that no two people are exactly the same. So it is a very subjective process.

SPEAKER_02

Do you have the data or the statistic of women getting denied versus men, especially young women?

SPEAKER_00

Not really. The Social Security releases statistics of how many applications were filed. Okay. But we don't have it broken down into women versus men. I wouldn't be surprised if more women get denied because there is a lot of, well, stigma when it comes to women getting treatment, right? It's talked about a lot that they don't get the right kind of treatment. It's, well, take this and you'll be fine, or do this and you'll be fine. And it's there's an underlying autoimmune that wasn't checked. There's an underlying condition that they didn't see because it's not found on an MRI. It's not found on an X-ray. So I wouldn't be surprised given how much conversation out there now about women not getting the right treatment that they need. But I don't have the statistics on that. And I doubt that they would release right. I doubt that they could narrow it down in that way. Although it would be interesting. I doubt that they could narrow it down in that way.

SPEAKER_02

That's so interesting. I know when I was going through the process, that was back in 2021 when I started filling out the application process. And I I shit you not, that took me a week or two. And I I had help with it because, like you said, it is very long, it is very intense, and it's very lengthy. And being in the state that I was in, you're disabled, right? So you have X, Y, and Z that you're already dealing with, and a lot of it for me was migraine. So filling it out on a computer, or I mean, even writing, I had to write so much, and that was really difficult. But I went through the process. I got denied, obviously, the first runaround because I feel and I was kind of expecting that. Like I was prepared to be denied, and I went through the first time without having a disability attorney or advocate by my side. And once I got the denial, we're like, okay, well, we're gonna go through the um what's what's the second one?

SPEAKER_00

Reconsideration.

SPEAKER_02

Reconsideration. So at that point, um, I did get a disability advocate, and I got accepted the next time around. And I that took about a year for the reconsideration, which expected. Like we know that that was a very lengthy time to go through everything.

SPEAKER_00

You were one of the lucky, you know, 15%ers at reconsideration. Very lucky that gets approved because it's it's really rare. It's so rare. Part of the problem is at that initial level, they're really doing info gathering, right? And they're asking you things about do you cook, do you clean, do you do laundry, right? They're asking you all these questions. Then they ask you that again at reconsideration, and they look to see how consistent are your answers. Then they ask you that again at the hearing level, and they look to see how consistent are your answers. Now, it's very difficult to make them 100% consistent because your condition is changing. Right. Dynamic disability. Your treatment is changing. It depends on seasons and patterns and medications. And you know, you maybe you're on a medication for a little bit and you're stable, but then your body is now used to the medication, you have to switch it up and you have to get a new one. And what happens with Social Security in the denials that I see

Denials, Data, And Subjectivity

SPEAKER_00

is that they pick up on, well, you were stable for a couple of months, so then you must be okay. Well, you said that you cooked, so you must be okay. Well, you drive, so you definitely must be okay.

SPEAKER_02

That's the line.

SPEAKER_00

But then the problem is they're not looking at it on a regular and consistent basis, right? The fact that you can do something for two hours, maybe once a week, isn't really evidence that you could lift 20 pounds eight hours a day, five days a week, week after week after week. So that's the trick with Social Security. That's the problem. It's this storyline, this consistent storyline that they really want to see and that there's no way to show. I mean, you've been doing this for how long? So I've been practicing social security exclusively since 2008.

SPEAKER_02

Oh, okay. So you've had a lot of time to really see how the system works. In those years, have you seen any kind of shift? Who is it even deciding? Like, is it literal people that are hired by Social Security sitting at a desk like saying yes and no to applications? Yes, 100%. Okay. So have you seen a shift with people kind of starting to realize that dynamic disability is a thing, invisible illness is a thing, or is it very black and white still?

SPEAKER_00

Social security is like driving the Titanic. Okay. It is slow to turn. When Social Security first started looking at fibromyalgia, it did not know what to do, right? Judges were all over the place. And they didn't understand. They were saying, well, you don't have objective testing to support your fibromyalgia. There really is no objective testing. It's a trigger point test. If you have 13, you have these issues. There's a little bit more to it, but there are diagnostic criteria. But judges were kind of all over the map on it. So Social Security had to come up with a rule that said this is how we consider fibromyalgia. But that rule took decades after fibromyalgia was really a thing.

SPEAKER_02

Right. Because people didn't start really knowing about it until I don't know, less than 10 years ago. It was like a really big change within more information on it.

SPEAKER_00

Right. So it's like driving the Titanic, right? Like it takes this long time to turn. I think finally there's enough cases, there's enough policy, there's enough explanation about fibromyalgia that that's not the big issue anymore. The big issue now is long COVID. Right? Ellers Daniels. Right? Like these are the things that is they're still so new for diagnosis. Not all doctors are are giving these diagnoses, not all, not all doctors fully understand these diagnoses. And if they don't understand it, how do we expect social security judges, social security field workers to understand it? They're not doctors either, right? They're just reading what are in the medical records.

SPEAKER_02

So how does an attorney help with the process? Like how does it speed it up? Or where can you find attorneys really being helpful within the getting approved part?

SPEAKER_00

So attorneys really can't speed up the process. There are special cases where if you have, you know, you're homeless, you don't have any access to safe location, safe, you know, safety concerns, or there are certain types of cancers or conditions where you have a limited time left, those cases can be expedited. But they're very rare, right? And those are the ones that generally get approved at the initial level. But the the average case, it does take about a year for that application to go through the process from that first decision. But during that time, an attorney can help by creating that consistent storyline, right? What are the things that Social Security is looking for? And other than saying, well, I have these conditions, right? They're in my medical records. The agency is not a diagnosis-driven agency. They're not looking at, oh, you have this diagnosis, great, you're now gonna get disability benefits. It is what are your symptoms? How do they affect you? What's your education level? Did you get any additional training? What is your age, your background? What work did you used to do? And where most people fall in is not can you go back to doing your past work? It's can you do any job? Because that's the ultimate standard for Social Security.

SPEAKER_02

Which that is also so complicated in itself, because some of us could do a job consistently for a week, but that'd be it. We would be out for two months after that. And so that's where the the narrative and the I think stereotype of what disability is kind of kicks in and doesn't really benefit people that have the severe dynamic disability and invisible illness that take over your life. And hopefully, like, I mean, like you said, it's a it's a slow turn, but hopefully the ship keeps turning and it like doesn't go under and we don't have any kind of change.

SPEAKER_00

Right. I think there's a lot of things that the agency can improve on. Right. One of the things that happened before is that the agency will change its rules depending on kind of what's happening in the situation, what what's the temperament going on? So, for example, they used to have a rule that said if you have a treating doctor, right? So board certified doctor, and they've been treating you for a while, they have medical records that Support their opinion and their treatment, and they issue an opinion that is these are the things that you can and cannot do. Well, if that's consistent with all the other evidence that we have in your case, then we're gonna give that opinion controlling weight and find you disabled. That had been the rule since the 90s, right? Like it's a very long time. Yeah. But then there was an increased number of remands at federal court because judges were saying, ALJs in particular were saying, well, yes, I see that opinion, but I don't agree with it because they could cook or they could clean, or maybe they did a couple of other things. So then the agency decided to change it. They just decided to say, you know what? We're not gonna give any opinions controlling weight. We're not gonna give any opinions, any controlling weight. We're just gonna find them persuasive or not, or somewhat persuasive, or we're just gonna see how we feel about these opinions. So you can have a person who has gotten maybe what five medical opinions from their doctor, all showing that they couldn't sustain work, right? They wouldn't be able to just sustain working on a regular basis. And the agency will still deny them. Right. Saying we just don't agree with these five doctors. Yeah. No evidence. Just we're just gonna say no. We don't agree with these five doctors.

SPEAKER_02

Where do you think disability claims get tripped up the most in your experience?

SPEAKER_00

I think the problem often lies in the step five aspect of it. So let's go over the steps, right? Because when somebody

Dynamic Disability And Slow Policy

SPEAKER_00

files for disability, the agency has a five-step sequential process, although it's really six steps and I'll explain why. But it's officially a five-step. The first step is are you working? Right? Are you making substantial gainful activity? If you're working, well then we're not gonna find you disabled, right? Your conditions don't prevent you from working. The second thing that the second step there is, do you have a condition that impacts your ability to work? How it impacts your ability to work, we're not getting there yet. What we're asking is, do you have a severe impairment? Right? Is it going to impact your ability to do basic job duties? If so, we proceed to step three, right? Step three is do you meet or medically equal one of the listings of impairments? So Social Security broke down all conditions, right? Broke them down by categories and by uh organs, things like that. And they have a checklist of if you meet these three things, if you have these three things, then you're automatically disabled, right? They're very hard to meet. Of course. And so most people don't meet them, right? So then you get to this in-between step between three and four. You get to the step of what is your residual functional capacity? What is the most you can do at a job, right? Can you sit for how long? Can you stand for how long? Can you reach? Can you grasp? What are you able to do physically? And what are you able to do mentally? Can you concentrate for two hours? Can you perform simple tasks? Or can you perform detailed tasks? Right. And then they come up with a this is the most that you can do at a job. And that is of residual functional capacity. The judge will then go to step four, which is they'll take that residual functional capacity and say, Well, can you do your old job? Right? Step four. Or step five, can you do any job in the national economy? It doesn't have to be in your area. They don't have to be hiring. You don't have to like get there. They don't care if you have to get there. They just want to know: is there a job in the national economy that you could do given this maximum residual functional capacity, the most that you can do?

SPEAKER_02

That's so what happens might not be good income anyway.

SPEAKER_00

That's not, yeah, we don't even we're not looking at that. We're just saying these jobs exist in the national economy. And so the jobs that they'll say are ticket taker, cashier, housekeeper, and they have several jobs that they use on rotation. But everybody's getting denied based on these same jobs. There used to be a job, surveillance system monitor. That is a job that the agency used a lot, a lot, a lot to deny cases. That was one of the top jobs that they had been using because it was a desk job. You weren't lifting anything, right? And they qualified it as unskilled, right? You weren't using any particular special judgment or knowledge, you something that you learned within 30 days. But as the world changed, right? Surveillance system monitor, you are making rapid decisions that are important. Is it that, you know, is that a gun? Right? Are you a threat? Right? Like these these really changed. And so there was a lot of back and forth and litigation on these jobs and how these are not unskilled jobs, these are not jobs that you can say you could do a simple task. That's not simple, right? Right. You're using a lot of judgment, but it had to go back and forth to court on several cases before the agency was like, okay, well, we'll just stop using that one, find another one. And so they did. And I think it's like nut sorter now. And they can use God. So many weird jobs that they use to deny cases. But I think that is somewhere where a lot of claimants get tripped up. It's not that they don't have the medical records, it's that the agency just says, we don't believe you.

SPEAKER_02

Which is so frustrating when you're already, that's already consistent within your medical journey, anyway, of not being believed. And all you want is to be able to, first of all, you have so many medical bills that when getting approved for social security, that is one of the biggest things that helps. It's not the income that you get because it's not anything that is sustainable over time, it's not a big chunk of money at all.

SPEAKER_00

And I think it's getting rich, nobody disgusting, like getting disability benefits. Nobody.

SPEAKER_02

So the narrative that people just want to be on disability and not work is I will never be able to comprehend it because it's it doesn't make sense to me because you're not getting the kind of money you'd want to be getting. We're grieving, like not having a career. Like we want to work, we want to have a career, and we have physical impairments that prevent us from doing so. So I think that's a huge misconception that I come across, I'm sure you come across as well, is and that people can fake and the fraud of disability. How often is there actual fraud?

SPEAKER_00

So the Office of the Inspector General releases a report about every six months on what's happening with the agency, right? And one of the big things in there is the discussion about fraud. Now, fraud happens in less than 1% of the cases. And remember, Social Security is touching every single person's life. So we're not talking about fraud just in the disability aspect. We're talking about fraud in survivors, we're talking about deceased records, we're talking about birth records. So you're talking about fraud over everything, and it's less than 1%. Yeah, that's this is not something that's rampant. You're not the agency, right? But yet the agency treats it as if almost everybody is somehow trying to defraud, or people understand that they're they're just lazy, they don't want to work, right? That one. And that happens a lot. I I get a lot of phone calls of I don't know why I'm not disabled, or why Social Security doesn't understand that I'm not that I'm disabled, because my neighbor who, you know, has nothing, right, is just collecting the check. And so my response is always, you don't know their medical records. Right. Right. They may not be outing the reason why they're disabled. They may not be shouting that from the rooftops, like, hey, I have bipolar. You know, I don't think that they're most of us aren't doing that. Yeah. Right. So you don't know what their record showed. And remember, it is a

Where Claims Get Tripped Up

SPEAKER_00

subjective process, right? So their records showed something that somebody saw and said, well, then this person is disabled.

SPEAKER_02

And given what we know about how hard it is to get accepted and approved, chances are there's evidence that backs it.

SPEAKER_00

Oh, yeah. There have there has to be. The agency will not grant benefits based on what you say alone. Right. And again, it's not diagnosis driven. So it's not just going to be like, here I have this diagnosis. It's not going to be based on this is the medication I take. So here I'm disabled. It's a combination of all these things and a clear discussion or a clear explanation of, and this is what I can't do because of my condition. I can't lift more than a gallon of milk. I can't, you know, walk the 50 feet to the mailbox. Right. Um, I use a cane. I have migraines every week, despite my medication. And when I have a migraine, it's that day I have to be in a dark room. I can't be exposed, right? So it's all those things that the agency's looking for. And a lot of claimants tend to say, well, I can't walk for too long. Okay, but that's not enough detail, right? We need detailed understanding of how it affects you.

SPEAKER_02

Once you are approved for the the few lucky that are overall, how long are you on that? Like, is that indefinitely? Are there reprocessings? Like, how does that all work?

SPEAKER_00

That's a great question because half the battle is getting approved, and then the next half is keeping it, right? Okay. So what happens is that depending on your age, the type of condition you have, Social Security will do redeterminations, right? They will just assess in every three to five years, hey, how's your condition? Anything changed? Are you still going to the doctor? Um, what new medications are you taking? That's what they'll be asking. And that's usually done every three to five years. Now, certain conditions we don't really need to check up on, right? Quadriplegia. Well, I don't think we're those are not going to change, right? Right. But when you have certain types of conditions that kind of wax and wane, right, that may get better, or maybe now that you got disability, now that you got potentially Medicare, Medicaid, well, now you can get treatment. And with that treatment, your condition is now better, right? So there is cases where they will do a review every three to five years. At that time, they ask the same thing. What's changed? Are you the same? Do you have any new limitations? There will be people who get denied then by saying, Well, we think you got better. And the trick there is that then the agency says, and we think you got better three years ago, two years ago. So pay us all that money back. No. So those are called overpayment cases. And they will make a decision and say, we no longer find you disabled, and we actually should have not paid you for the last two years. So we're now going to ask for that money back. So that means you have to both file, like appeal to say, no, I am still disabled, and appeal the no, I don't have the money to pay this back.

SPEAKER_02

Oh my God, I didn't know that. This gives me anxiety for the future.

SPEAKER_00

Oh man. Okay. Everybody's always learning something about social security because there's a lot of moving parts to it, right? Now, you know, depending on the type of disability and your age, sometimes it's less frequently that they'll do those checks. For example, there is somebody who they are 62 and they're disabled. You know, with all the things that the agency has to take care of, they may not be checking up because that person's going to get their full retirement, they're going to start getting retirement anyway. Right. The process is going to be quite difficult for somebody in their 20s or 30s, right? That might be a different scenario. There has been some talk at the agency, at least in the news, about the agency changing the age categories. Right. Like, you know, there are some guidelines that the agency has. They're called the medical vocational guidelines, they're grid rules. And they kind of give a guide of, okay, if you're 50 and you can only do sedentary work and you have no past work and no skills, well, it's going to be really hard for you to make adjustments to other work. So we'll find you disabled. There has been some talk about moving that 50 to 60. Now, whether or not that happens, I don't know. But I feel like Social Security has been in the news more than they have ever been. Yeah. I think it's been more in the past year. So I do presentations kind of throughout the year. I did one where it was at the National Association of Disability Representatives. Yes. And so that is an organization for Social Security representatives, right? So that is both attorneys and non-attorney reps. So you can get license to appear for others in Social Security cases without being an attorney. And so that organization has several non-attorney reps that help. And that's a great role for a lot of social workers, right? They can get approved and they can help the claimants walk through the applications and do those things. But there that is a program. So I did a presentation for them. So what I did at that time and was I took some cases in federal court. And they weren't my cases, but they were representative cases of conditions like migraines, like Ellers Daniels, like long COVID, and broke it down on what happened, how did we get here? And why did it need to get to federal court? Because remember, we talked about the process and how people get denied and the denial rates. There's a whole step outside of Social Security, which is called the federal court appeals, right? And you go to federal court and you say, hey, judge not associated with Social Security, this is what Social Security had. This is what they said, and here's why it's wrong. And this judge will look at it and decide whether or not Social Security got it right or wrong. If Social Security got it wrong, case goes back. If they got it right, well, that's kind of the end of your case. You now file a new application or you know, whatever the case may be. But about 63% of cases that go to federal court go back to Social Security because somebody did something wrong. Either they didn't believe the conditions when they kind of should have, or they rejected an opinion which they shouldn't have. There could be any kind of number of reasons why the agency made a mistake.

Fraud Myths And Strong Evidence

SPEAKER_00

And so 63% of those cases go back. That's that's that's a big number of cases going back.

SPEAKER_02

I'm still like freaking out about my benefits getting taken away because I do fall under the category of being so young. Don't freak out.

SPEAKER_00

Okay. There's nothing to do about it at this time. Right. What we recommend is that once you've been approved, you need to have like this is my folder. And in that folder, you have your doctors, your treatment dates. You have in that folder letters from Social Security, any updates that they want to get. Most of the time, a lot of the cessations happen because Social Security requests information and the claimant never responds.

SPEAKER_02

Okay.

SPEAKER_00

If they don't have information to make a determination, I mean, what more can we expect from them? Right. If they don't have what they need. The other important thing is to keep a log of kind of these are my symptoms. This is what's happening, right? The medical records is a big part of it because the medical records are just one tiny snapshot of time of when you went to the doctor. And what happens to a lot of cleanants is they show up to the doctor that day and they say, How are you doing? I'm doing okay. Therefore, you're better. Therefore, you're better, right? That turns into, well, then you must no longer be disabled. And but that's not the case. And so what I did at that presentation, it's we talked about these cases and kind of how they got there, right? And what happened and where the court said, this needs to go back, this is fine, we're not changing this. Um, you shouldn't have made that decision, right? That it has to get outside of social security sometimes for claimants to have a really fair chance, right? Because up until then, it's all been Social Security. It's their local office, it's their doctors, right? It's their administrative law judges. They're all supposed to be independent, right? They're all supposed to be impartial. Um, but in practice, I don't know how how consistently all the time that worked, right? Right. So it can't be if 63% of the cases get remanded because Social Security did something wrong, but just kind of kept going.

SPEAKER_02

Is there any changes within the past year in this administration of how Social Security is working, or what kind of difference is there if there is any?

SPEAKER_00

Social Security is always working to improve the customer relations part of it. Okay. So they're always looking to see how they can reduce the wait times on the phone, the wait times in person, how quickly they can get applications in and appointments in. I think that's where the agency will try to change if they try to change things. But as I said before, it's just it's just it's moving the Titanic, right? Like when you're talking about policy changes, when you're talking about those kinds of things, it takes decades for anything to move. Right. There was a time with unemployment benefits, right? We talked about fibromyalgia, we talked about treating physician opinions. Let's talk about unemployment. Yeah. Because there was a string of decisions that said, well, you get unemployment, which means you're clearly not disabled, right? Because the definition of disability is that I have conditions, but because of my conditions, I can't work. I want to work, but I can't work. When you look at unemployment, it's I'm here, I can work, but nobody's hiring me. Right. So those two definitions. Are just they col they clash. They're inconsistent. So there was a string of judges who said, well, if you said that you're getting unemployment benefits, which means you must have said that you're able to work, but now you're telling us that you can't. Well, this is inconsistent, and therefore you're not disabled. Right? And then there was a memo that went out by the agency that says you cannot hold the mere fact that you get unemployment benefits as evidence that the claimant can work. What do you have to do instead? You have to look at, okay, you're getting unemployment, which means you're required to look for a job, right? Yes. Okay. What are you doing to look for the job? Are you pounding the pavement for eight hours? Are you sitting at a desk for eight hours filling out applications? Right. What is the activity level of what you're doing as part of that unemployment benefit? Not just the mere you receive unemployment benefits. And so what happens is that Social Security, for a long time, they had judges saying, oh, well, you get unemployment, you're not disabled. They're clearly inconsistent. It had to be years of these decisions before a memo went out that said, no, you can't find that. No, that's not how this works. So that's what I mean. It the policy changes take years, decades to fix. The agency can can immediately work with technology, right? More funding for technology, more funding for staffing to reduce the the client experience, the claimants, you know, relations part of it. But when it comes to policy, that's that's a titanic.

SPEAKER_02

Yeah, policy in general, that's just Titanic. With filing for disability, it there's like a big emotional side to it for the person applying. It's, you know, I mean, the paperwork and the stress and everything that comes along with that, but then getting denied and having that be like a whole emotional thing for them as well. What's like a good thing to tell people? Or what do you tell your clients when that kind of comes up?

SPEAKER_00

So it is disheartening,

After Approval Reviews And Overpayments

SPEAKER_00

right? When social security is saying, I don't believe you. Right. Like that is disheartening. What I say is Social Security gets things wrong all the time. The reason why I do what I do is because they get things wrong all the time. And what you need to do is this is a marathon and not a sprint.

SPEAKER_01

Right.

SPEAKER_00

This is one where we just need to keep going. You just need to find one person within Social Security that's going to find you disabled. Not 10, not 15, doesn't have to be a panel. You just need that one person who sees your records, understands your treatment history, sees you and your conditions, and understands on paper what's going on with you. And you got to keep going until you find that person.

SPEAKER_02

To give you the validation. Like you already can validate yourself, but having the external validation in this whole process, it really does help.

SPEAKER_00

Yeah. The other thing I tell claimants a lot is when you file for disability, it's kind of like your own come to Jesus moment, right? Because a lot of claimants think that their limitations are kind of normal, right? Like everybody has this. Everybody has some back pain. Everybody has depression. Well, no, you're your normal is not normal for everybody. So we need to truly understand what our limitations are before we're even filing for disability. Right. There are some people who file for disability thinking, well, it's just my back pain. It's just my leg. It's just my knee, right? These are these are my issues. Well, it turns out there's depression there, and it turns out there's anxiety there, but we're not recognizing that because we're not being honest. And so that's one of the other things that I tell the claimants is you have to be you have to be honest with yourself before you can even start to be honest with social security. Yeah.

SPEAKER_02

Because like there's a lot of self-denial and a lot of internal thoughts that happen as well that aren't always positive or on the side of uh validating yourself with this.

SPEAKER_00

Or they rationalize something. It was just that day. It was because I didn't sleep well that day. Well, that same day, you haven't slept well for weeks now. Why? Because it's you're being manic, right? You have this phase that is happening because of your condition. And that's something that we need to really understand ourselves before filing.

SPEAKER_02

And that goes to show that people aren't just left and right filing out there for the hell of it. Like we don't want to, we don't want to do it. It's our last resort, you know? Right. Like I said, for me, I had my parents to really help me through the process and to make it less stressful. For people that might not necessarily have that resource. Do you have a tip as to what can help make the whole initial process easier?

SPEAKER_00

I would say contact an attorney, right? And make sure that you contact maybe several attorneys. Make sure that you're comfortable with this person because you're going to be with this person for a while. As we talked, it's a long process. So this is not, oh, I'm just going to need to talk to them for three months. No, no, no. You're talking about three years you're going to be, you know, with this person. And you want to make sure that you feel comfortable giving them all your updates, giving them your information. It's it's a lot to go through. So I think if you don't have the support of family, I do think that finding an attorney or representative that works with you in that way is going to be really good. There are also organizations and groups that have resources, right? The Cancer Societies and the Lupus Societies and MS. And so sometimes they have resources or counselors or people to talk to that can also help you get over this hump of how do I really understand my condition before kind of trying to file with disability and go through a three-year-long process of this.

SPEAKER_02

For lack of better words, it's literal hell to go through the process. And I'm sure it's not, I mean, for you, it's what it's your job. It's like consistent for you. You know you're a professional at it. But for somebody that's dealing with the disability and dealing with the claims that they're just like completely clueless about, and the paperwork is so hard to understand. Like it's it's a lot.

SPEAKER_00

And that's why I went to law school, right? Like that's why I love what I do because I wanted to help. And then here in doing this, I feel like I'm helping. Yeah. You know, when the claimants need to get to federal court, and those cases come to me, they've lost hope, right? They've been through this process for like three to four years. Social Security has denied them four times. At this point, you know, not everybody goes to federal court. Like what they're just like, they want to not have any hope. They're just like, well, I'm I guess I'm not. And it's really, I love it because when I can win the case, and I can't win everything, but when I can win the case, you know, it gives them their hope back, right? Like they understand this is that vindication. Social Security got it wrong. They didn't get it right. And, you know, that doesn't mean that you're not disabled, right? Um, it doesn't mean that you don't need assistance. It just means that they didn't get it. And this is your now, your new opportunity to prove what you need to prove, which is this consistent storyline of understanding your condition. When did it start? How has it progressed? And what is it like now?

SPEAKER_02

That's what I love about you too, is you have so much passion and purpose behind

Federal Court And Rules That Lag

SPEAKER_02

what you do. And I would hope that would be across the board for positions like this, but I don't necessarily know if you run into that all the time. Um, so I think it's really great that you're really wanting to help people when they've, like you said, they're at a place of just losing hope and they've just been denied and denied and denied in multiple different facets than just social security. And so when we finally land on somebody like you, it's just like a breath of fresh air.

SPEAKER_00

Thank you. I appreciate it.

SPEAKER_02

I think a big thing for people is okay, hiring an attorney, like that's gonna be money. Like they just like think that off the bat. But I think a lot of what people don't understand, which I didn't for a really long time, where you don't have to pay an attorney until you win the case.

SPEAKER_00

So it is nationwide, it's regulated by the Social Security Administration. There's nothing that you're really paying out of pocket for your disability attorney. The way that it works is that when you file your claim, Social Security eventually approves you, right? That's based on when you filed, when you became eligible, and when you became disabled, right? So there's a formula on when they figure out we should have been paying you money as of this day. What the agency does is that they reserve 25% of any past due benefits, things that we should have paid you, 25% to pay the attorney. The future benefits go to the claimant like clockwork, and 75% of their back pay goes to the claimant. 25% is reserved to pay the attorney. Now there are limits to that, right? Certain guidelines that they do, but it's generally 25%. It's the same thing for veterans' administrations, right? So this is very typical, and it's at 25%. Now, if the claimant's never approved, the attorney never gets paid. Right. So everybody takes a risk.

SPEAKER_02

Right. Yeah. It's a it, yeah, you are in a risky position.

SPEAKER_00

Yeah.

SPEAKER_02

And do you pick and choose cases that you think we'll end up going through, or do you kind of just normally accept all cases?

SPEAKER_00

So I am very selective about the cases that I take because I know how much is writing on this for the claimants, right? I don't want them to go just through the motions, right? If if I'm selecting them, they're also selecting me. So this is a two-way process, right? And we're both here to work, right? We're both here to work to get those disability benefits for the claimant. So I am very selective about the cases that I take. There are some cases where I think the person might be disabled. 100%. But if they don't have any treatment, there's very little I can do. Right. Same thing with when they became eligible for disability benefits, right? If they have to show that they're disabled by a certain time period, and we have gone well past that time period, there's some things we can do, but not a lot. So I am very intentional about the cases that I take. So I don't want to give any false hope.

unknown

Yes.

SPEAKER_02

Or waste anybody's time too. Like if you know that there's not going to be, you know, the give on the other side of things, too.

SPEAKER_00

And also we need claimants who are responsive. We need claimants who want to get back to us with information, right? And I we understand that there's struggles. I get it. You know, like you have this, as you remember, you were talking about those forms that Social Security had you fill out. They're like 12 pages, single space, like all over the place. You have to write forever.

SPEAKER_02

So overwhelming.

SPEAKER_00

It's definitely overwhelming. And we understand that there are roadblocks to that, but what we can't have on the other side is silence, right? So we need you to get back with us. We will we will carry you on our backs and we will get you across that finish line to get you those records in there, okay? But we need you with us, right?

SPEAKER_02

We're a team here. We're doing this together. It's not true, yeah. And I think too, if you're at a point of acquiring for an attorney, hopefully you're at that point. But I guess you would know better than that might not necessarily be the case.

SPEAKER_00

It I think it it kind of waxes and wanes based on conditions and you know how long they've been in the system, how long they've been working for the benefits. Like I think there's a lot of factors that go into it.

SPEAKER_02

So for somebody that is starting the process, thinking about starting the process, what is one tip you would have for them?

SPEAKER_00

The first thing I would do is I would talk to their doctor, right? Like I would have the claimant talk to their doctor and let them express, hey, these are the struggles that I've been having. And what do you, you know, what do you think? Like, is this a good idea, right? If the doctor's like, no, I just need to give you this injection and you'll be fine, well, okay. I mean, I suppose great, let's talk about that. And that's usually not the case, but okay, great. So I think talking to your doctors is one of the most important steps to kind of figure out where you kind of land and then always talk to an attorney, right? If there's they're not gonna charge you anything,

Coping, Hiring Help, Costs, Closing

SPEAKER_00

right? They're not gonna charge you anything until you take their case. So you can call them and and talk with them and talk to multiple attorneys and again figure out who it is that you connect with.

SPEAKER_02

I think, yeah, that's you do have to connect with your attorney because, like you said, like you're with them for years. It's not just a quick thing. Are you currently taking clients or how does that work? Are is it state to state? Are you do you have multiple states?

SPEAKER_00

So we can take cases for at the agency level. So anybody who needs to file an application or appeal something or have an ALJ decision, we can take those cases across the board throughout the nation. And we do. I have cases in Texas and Idaho and our Arkansas and Florida, which is where we are right now. But I have lots of those cases. When it comes to federal court, there are certain districts or certain states where you have to be a state-specific licensed attorney to take those cases. And I have since retired from bar exams, so I do not plan on taking any more. Don't blame you. So there are several states that we can help in. But for example, I can't do California because I'm not a California attorney, but you know, I do lots of cases in a lot of places. And if I don't, if I can't take the case, I will definitely try always to make sure that somebody else can. And I will try and connect them with someone else.

SPEAKER_02

If somebody's listening to this, then they're like, I want Adriana to be my attorney. How do we find you?

SPEAKER_00

I would love for them to give me a call. They can call 866-205-4014. And they ask for Adriana, the disability team, and we will figure out how to route them, route them to where we need to go. And they can also email us at disability at tower law group.

SPEAKER_02

Awesome. I will I will link that in bio too. So it's written out.

unknown

Thanks so much.

SPEAKER_02

Thank you for being here and sharing all your knowledge. And this is a very good episode to have. I think it's very different and it's also very informative for people that have disability, are going through the process or don't know anything about it and are curious about how it all works. So thank you for taking your time and being here.

SPEAKER_00

Of course. And if you have any, if any of you need another episode or to break down those cases, I know we didn't even get a chance to even get to cases.

SPEAKER_02

Yeah. Oh, you're gonna go over cases.

SPEAKER_00

But we could definitely do another one to go over cases, just specifically to talk over cases.

SPEAKER_02

That'd be good. That'd be fun.

unknown

Yeah.

SPEAKER_00

Break those down. That'd be great. Yeah.

SPEAKER_02

All right, y'all. You know the drill. Follow, rate, subscribe, sit guy swear podcasts along all socials. Make sure you're hitting that little bell so you know when the next episode is out. And if you are looking for a disability attorney, seriously, Adriana at Tower Law Group is your girl. I would pick her again and again again if I did this process over. Thank you all for listening and happy healing, bitches. Love y'all, and we'll catch you next time.