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Social Security Disability for the Mesh-Injured – What You Need to Know

Social Security image, CNN

Social Security image, CNN

Many Mesh News Desk readers find the complications they suffer as a result of their pelvic mesh or hernia mesh implant has left them unable to work.  This is no small matter but society provides a safety net in the form of Social Security, a federal program to help the retired, disabled, or children of deceased parents. Social Security Disability pays benefits if you’ve worked long enough and cannot work any longer, but many find it challenging to break through and actually receive Social Security after they’ve suffered a mesh-related injury. 

Bruce Feifer of Farah & Farah, a law firm in Jacksonville, Florida specializes on social security and workers’ compensation. He talked to Jane Akre, editor of Mesh News Desk. The following is sponsored content. 

Jane Akre, Editor MND

Jane Akre, Editor MND

Bruce Feifer, Social Security attny. Farah & Farah

Bruce Feifer, Social Security attny. Farah & Farah

 

Q: Bruce, let’s first define the terms under Social Security because it can be confusing.

 

Feifer: “There is Social Security Retirement (SSR), Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Social Security (SSR) is intended to be received after you retire. SSDI can be received if you are disabled medically from all work, permanently, not temporarily. SSDI is based on your work record.  You must have worked five of the last ten years.”

“SSI is less dependent on your work record and it provides just the basics. SSI requires that the claimant meet the same medical criteria as one collecting SSDI but it is paid to those who have not worked the requisite time required to collect SSDI. That person is considered financially indigent per The Social Security Administration (SSA).”

“SSI provides for basic needs. While it doesn’t have a work requirement, it does have economic requirements – if you’re single you can’t have assets greater than $2,000 excluding one car and your primary residence. The car could be a Rolls Royce or Bentley as long as there is just one car. If you are married, $3,000 in assets is the limit.  You still have to meet the same medical criteria.”

 

SSAQ: SSI comes from the states? 

Feifer: “SSI is paid by the state of Florida. Disability (SSDI) is paid by the federal government.”

 

Q: So for someone disabled and not near retirement, does anyone get Social Security Disability on the first pass?

Feifer: “Yes some do. Typically the people who will get it and qualify earlier are over the age of 55 (classified as being of advanced age) where transferrable skills from their past work history are considered by Social Security. If they can’t transfer their skills, they qualify.  Under age 55, it’s assumed you can assimilate.”

“So if they have a severe medical condition which is either terminal or expected to last greater than one year and they cannot perform their past relevant work (any past work performed within last 15 years) and that work also does not have transferable skills to a lighter level of work to which they are capable; they are found disabled.”

“Claimant’s between the ages of 50-54 (classified as closely approaching advanced age) and those under 50 ( classified as younger individuals) will have a tougher time of being accepted as they must prove the inability to perform past work plus the inability to perform any other type of work; irrespective of transferable skills. In other words, it’s perceived that it’s easier to teach a young dog new tricks!”

Q: What’s needed?

Feifer: “Objective medical evidence, X-Rays, MRI, diagnostic studies. And the treating physician outlining stringent restrictions.  He can’t say they’re disabled. That’s for the administrative law judge (ALJ). You have to have evidence that shows you can’t work.”

President Roosevelt signs Social Security Act into law August 14, 1935

President Roosevelt signs Social Security Act into law August 14, 1935

 

Q: The word of a doctor alone is not enough?

Feifer: “The medical opinions and reports are allowed in, but just saying “My patient is totally disabled” is not enough. There is a durational requirement. The inability to work has to be proven to last greater than one year. If they have problems now but a doctor says they may be able to go back to work in less than one year, then they would not qualify for Social Security.”

 

Q: If one has to reapply, what additional information is needed or helpful at the reconsideration phase?  How long should one expect the entire process to take?

SS claims form Huffington PostFeifer: “The process can be lengthy and there are possibly three stages one will go through by which one may or may not be accepted. The Initial Application process typically takes 4-6 months with the SSA gathering medical reports from the applicant’s doctors and also sending the applicant and possibly third parties questionnaires about their daily living and functional capacities. All of this information is then considered along with their work history to make a decision as to whether they meet the criteria to be found disabled. If medical evidence is lacking, the SSA may send the applicant to one of their doctors – known as a conductive examination (CE) – for testing and a physical or mental examination.”

“The Reconsideration Stage is typically shorter lasting 2-4 months. Another team at the local SSA office will make an independent evaluation of the file again having the opportunity to gather further information through questionnaires to the claimant and third parties, a possible CE and most commonplace updated records from the treating physician.”

“The Hearing Stage is the longest with it typically taking up to 18 months for one to get their case heard before the Administrative Law Judge (ALJ). The claimant appears at the hearing and gets to present medical evidence as well as direct testimony as to both their work history and their current medical conditions and how they impact their ability (or inability) to perform their activities of daily living and general functioning. The ALJ has the opportunity to put a face to the black and white reports in the file and further develop deficiencies found at the lower levels by directly questioning the claimant. It is the level by which most people fund themselves being accepted.”

 

Q: Is there a lot of fraud, is that why so many are rejected on the first pass?ss card

Feifer: “While there is fraud in every system, the rate of denials has more to do with so many people applying and their inability to meet the stringent requirements established by the SSA to qualify for benefits. In addition to having to be either terminal or have a condition lasting greater than one year, you also have to prove (especially those under 55 years of age) that you can’t do any other lighter area of work in the workforce such as be a ticket taker, a parking garage attendant or security monitor who sits in a surveillance room at Wal-Mart.”

“The SSA does not consider employer prejudices toward hiring the disabled; the fact that one cannot meet their financial obligations performing lighter and unskilled jobs to which the applicant is deemed capable; or even whether the jobs to which one is potentially capable are available in the local economy. The SSA can expect you to relocate to perform work. They find nothing wrong with concluding you can perform simple unskilled jobs as a ticket taker, security monitor, or silverware wrapper even though in their past careers they earned greater salaries than the jobs suggested garner.”

 

Q: If you move to another state are the benefits transferrable?

Feifer: “Your SSI may change but the federal disability would continue to pay. Usually cases are subject to review every three to five years regardless.”

 

Jade R graphic

Jade R graphic

Q: If you are rejected and you need to hire an attorney should the person be local or regional?  

Feifer: “The SSA has become much more technologically advanced in recent years and this includes the use of video conferencing capabilities that allow applicants to appear in one part of the country and their attorney and/or the judge in another region. Further, many firms service multiple regions. For example from our Jacksonville office we service not only the local community but also have attorney’s handling claims in Orlando, Gainesville, Tallahassee and Brunswick, Georgia where we routinely make live appearances before ALJ’s.”

“So the technology is there. Given the technology that allows all of the information to be electronically transferred, it’s really communication and gathering of records and reports from doctors. The laws are the same throughout the country. New York has the same laws as Florida since it’s a federal program.”

 

Q: How is an attorney paid?

Feifer: “The SSA pays the attorney directly out of back due benefits secured for the applicant. The fee is 25% of the past due benefits secured with a maximum fee of $6,000. In rare circumstances, such as when appeals are filed beyond the ALJ, hearing level fees may exceed the $6,000 sum upon application of a fee petition documenting that a larger fee is deserved for a greater amount of work performed. All fees require the approval of the SSA.  Basically it’s 25 percent of the back due benefit or $6,000, whichever is less.”

“In addition to fees, the applicant is responsible for costs incurred by their representative for such as items such as medical records, special reports from a treating physician etc. These costs are not overly burdensome and typically from $150-$350 per case.”

 

Q: Should one attempt to go it alone the first time around?

Feifer: “Retaining an attorney early on is highly recommended. We get involved in the case so we can direct clients how to fill out the forms. The forms the applicant is sent by the SSA may seem rather simplistic and easy to complete, however in reality, detailed answers regarding ones capabilities is important as is consistency in one’s responses throughout each stage of the application process.”

“If you go it alone, they may require too much information that is detrimental to the case. Experience and knowledge with regard to what information the SSA needs to know to make a well-grounded favorable decision is what an attorney specializing in SSDI and SSI brings to the table. For most applicants a successful outcome is the difference between having money and medical benefits to survive until reaching age 65 and becoming eligible for retirement and alternatively losing everything they worked so hard to gain prior to becoming ill.”

“So I do not recommend anyone go it alone. Representation is on a contingency fee so if they don’t win they don’t pay the attorney a single cent. Further, if they get picked up early on at the initial level, the fees will be nominal or perhaps nothing if there are no back due benefits secured. There is really nothing to lose and far much more to gain hiring an experienced representative.”  #

LEARN MORE:

Lawsuit Financing – What you need to know before you borrow, Mesh News Desk, May 28, 2016

http://meshmedicaldevicenewsdesk.com/lawsuit-financing-what-you-need-to-know-before-you-borrow

Expecting a Mesh Settlement? Will a Special Needs Trust Work for You, July 7, 2015, Mesh News Desk

http://meshmedicaldevicenewsdesk.com/expecting-a-mesh-settlement-will-a-special-needs-trust-work-for-you

 

40 Comments

  1. Stopmeshimplants says:

    Excellent information. Thank you, Jane.

  2. Jane R says:

    Thank you Jane. I’m on my second round of waiting for a hearing. The judge denied me because the SSDI doctor said he didn’t see anything wrong with me even though I had medical reports that stated otherwise. He sided with their doctor and that doctor made false statements in his report. I appealed and was denied within 6 weeks. Applied again. New lawyer. That was April, 2014. Waiting for the hearing again.

    • Jane Akre says:

      Weve heard many cases of doctors falsifying reports when it come to mesh injuries. Too many. It is very disturbing. A little CYA going on perhaps? I’m sorry….

      • Bejah B says:

        This does not surprise me at all. I suspect it is quite widespread. Also, I can not help but wonder what the AMA’s position is in all of this. Clearly the AMA is not our friend.

        Bejah

    • Bruce Feifer says:

      Sounds like you are at the Hearing State of the process and it typically takes 18 months for one to get before a judge for a determination of their case. The treating physician’s opinions are supposed to be given the greatest weight by the reviewing panel, however, they must be substantiated by objective testing and physical examinations to support the doctor’s conclusions. If the judge can establish a rationale basis for why the treating physician’s opinions are not deemed credible then he can defer to the SSA doctor.

  3. stopmeshimplants says:

    I am curious how many people who visit this site have succeeded in obtaining SSD due to their mesh surgeries and or mesh complications. Can you share how long it took for you to get approval and what kind of documentation you included in your application? For those of you who were denied are you still fighting for it? How helpful have the attorney’s been in your efforts to secure SSD? I was told to wait until after the response for a reconsideration before I obtained the services of an attorney. Not sure if that was a good move now. Thank you in advance for your responses.

    • addison says:

      Dear StopMeshImplants – If remembering correctly, the amount of time from filing the application to receiving approval was 2-3 months. We didn’t hire an attorney but called the Social Security office with questions. Between instructions and helpful tips from the representative and articles online, we learned to be very specific and take our time with the paperwork. Including every surgery, procedure, symptom, medication, side effect, physician, complication or diagnosis, etc. seems to be very important as is thoroughly explaining how these affect your day to day functioning. I hope this helps. God bless you.

      • stopmeshimplants says:

        Thank you Addison for your response. The link to the article was very interesting and helpful. Take care.

      • Maria T says:

        Thank you for being a vessel. I got so fed up and I called and spoke to a representive. She was very helpful helping me go from question to question with help. Going through so much with this mesh and no one to help. I’m basically in bed from the pain and infections. My lost has been destroyed from this mesh. And on top of it I have mental issues and learning disabilities. I feel like the medical doctors are taking advantage of the weak and we are left to die. We trusted them and now we will never be the same. I’m waiting after the questions and trusting God to get some help. And to send the right people to move these mountains. I want my life back. Please pray for me. Mom of 5 and young grandma of 2. I was 37 when I got the bladder repair, aka tvt-o. Doctor didn’t tell me. I just saw in the hospital records also there are pages missing. Hmmm….

    • addison says:

      Dear StopMeshImplants – Do you think a family member or friend can help you with paperwork, online research and gathering records? You need and deserve help. I needed my husband’s help because of struggles with concentrating and sitting upright for extended periods of time.

      Were you able to obtain any of your medical records? I know contacting every specialist, hospital, etc. for release forms, filling out each of these and then reading many charts is not easy. A few contributors have described significant errors, and some mistakes can affect disability claims and future care. Also, some physicians record more than others. If there are uncharted complications and symptoms or these are mentioned but not in detail — particularly in relation to how they affect your daily functioning — it might be beneficial to ask if more can be done.

      It seems as though you are doing all you can and are as optimistic as possible under such circumstances. I hope you receive better news soon.

      • stopmeshimplants says:

        Hi Addison,

        I sent in two additional documents last week. I had requested information from my physican but it did not come until after the due date of the reconsideration packet to be submitted. I also sent an independent letter from a physician from my pension board who awarded me a disability pension with my early retirement. That physician, one who I had never met, was just responsible for interpreting all of my surgical notes from my operations. He then wrote a letter why he felt I was due a permanent disability pension instead of a regular pension. I am still hopeful the medical documents they had not received from UCLA and this additional infomration will give them what they need to better understand my mesh complications and major nerve issues. Thank you again for all of your support, Addison.

        • addison says:

          Good morning, stopmeshimplants. We’re sorry for not seeing your last message sooner. I really struggle with infections and medications but have been excessively weak, sick to my stomach and tired the past few weeks. I know you understand.

          Have you heard if they received the additional documents and physician letter? Documentation of your conditions and daily struggles, especially with the extensive nerve damage, should help. I hope the letter does, too. I’ve been thinking of you and hope you receive good news soon. God bless you!

          • stopmeshimplants says:

            Hi Addison,

            Yes, unfortunately I understand all too well. They have all of the paperwork. I received a phone call telling me I would hear in the next three weeks. I have not heard anything yet. Thank you for your concern.

        • addison says:

          Dear stopmeshimplants,

          How are you? Thinking of you…

    • Mamohio says:

      Denied 1st time had all kinds of records and the judge made false decisions on my reason why I was denied. I appealed and have been waiting 3 yrs. The judge told me he didn’t want to hear anything about my mesh problems. Sonon the outside we look ok but they don’t know the inside of physical pain, mental and emotional torment etc. They don’t care. I don’t have anymore evidence to add cause I am out ofnmoney to keep paying all these des. So inwill pron be denied again. My attorneys aren’t worth a crape. Get one in your own state so you can have a face to face. Good luck.

    • Mamohio says:

      I signed up in July 2013. Got an out of state lawyer which I would recommend one in your own area. I have done all the work on my case. It took 18 mths before I went in front of the ALJ Judy thrum video conference. I was supposed to have a female lawyer with me and she said I should have no problem Bc I have a whole litany of health problems. The day of my case which was SSDI and I worked 30 yrs paying into it. She didn’t show Bc her friend got killed. Ok I felt bad for her but they sent a guy in her place that knew nothing about my illnessses, injuries or mesh. He didn’t know my name Bc he was late to the meeting. So I know he didn’t even have a chance to look at my case. He sit there and never hardly spoke a word. They had a rehabilitation specialist on speaker phone who said I could work in a toll booth etc mainly sit down jobs. I was making $75,000 a year and they want me to support myself on menial labor? I mentioned my incredulous pain every day and I am on pain mess and a patch due to my mesh. The judge says I DONT WANT TO HEAR ABOUT YOUR MESH, MOVE ON. I was so hurt and felt like a piece of crap with a crappy lawyer who sit there like a bump on a log. All together 10 mins? They were behind schedule. WTF? Now I am waiting on the appeals court to determine I truly had a case. So far 15 more mths of waiting. I will prob get denied cause I would get around $2800 a mth they could service 10 SSI people with $280 mth and make them SSA look like they are helping more people. Yea the ones that are too damn lazy to work, not everyone but we got a lot of people scamming the system that we worked our butts off to get denied. Some America!!!!!! Good luck and yes I had all my paperwork turned in by more than 6 professionals. Its all about the money. Almost 3 yrs and waiting………………..

      • Jane Akre says:

        Sounds like a very rude person.

      • Lori says:

        I have been told by my SSDI Lawyer to not get upset at the first 2 denials and appeals. It is standard procedure for them to deny and no one really investigates and reads everything until the 3rd time around. Be patient, follow instructions and like they say, “third time’s a charm”

  4. Jane R says:

    With me the SSDI doctor asked me to touch my toes. I told him I get stabbing groin pain. I said I cannot reproduce it, it happens. Sometimes once or twice a day sometimes 10 times a day. I touched my toes and didn’t have any pain.

    So that’s what he based his decision on. The SSDI likes to see a lot of tests and medical reports. I didn’t have current medical reports because I didn’t have insurance. My husband made $20 over the limit for any medical assistance. We were $1,000 short on bills each month at that time. If I had an emergency I would have gone to the ER. I paid cash for 2 visits to a doctor before the hearing. My attorney did not get the full report from him so it was never sent to SSDI. And it said I had severe neuropathy. I just got that report now. Maybe a deciding factor who knows? But because of lack of income even now with insurance, the deductibles and co pays are high I am suffering from not getting all the treatments I need. Had I received some support 2 years ago I might be back to work now. Now I am really having health issues.

  5. Jane R says:

    Thank Jane Akre. I have hired a new lawyer. And he’s a pit bull. 2 totes of medical records now. And two years older. Hopefully a hearing soon. And some mesh settlement.

  6. sandy says:

    ? Jane

    for american medical are they paying the lowest teirs first

    or the higher tiers first i had a phone call on my packet

    being sent 2 months ago and havent recieved it yet and

    i got my ssdi the first time on my medical lots of deposition

    from my doctors i had to pay for it. got it for incontince and

    other issue that goes with it.

  7. Cindy Stokes says:

    The problem is, I worked for several years, then quit to be home with my kids while they were young. I also was homeschooling my kids and had to quit because the pain was so bad. I’m at the age now where the kids are old enough for me to go back to work, to start saving some for their college. (I have four teenagers.) I work as I can doing freelance writing and editing, but the pain is always worse if I try to even put in a half-day of work. But there is no disability for those who got injured while raising kids , who planned to go back to work.

    • cece says:

      Cindy:

      That is true, I am in the same boat. I stayed at home to raise the kids had the mesh surgery and wham I could not go to work if I wanted to I was in so much pain. If your married and your husband works or has an income you can’t get SSD or SSDI.

      Yet those popping out baby;s can get welfare.

  8. MAMOHIO says:

    I am waiting on my 2nd hearing. I had a ton of evidence but when I tried to explain the mesh problems I have. The judge said”I don’t want to hear anything about the mesh so move on” I was so pissed I could have slapped him but it was a video conference. My attorney who is a female said I shoukd have no problems with so much documentation. She had a death in her family the day or my hearing so they sent a man who didn’t even go my case or talk to me. He showed up late and he didn’t say a damn thing to help my case. It was denied of course and all the reasons were incorrect. I told my attorney I wanted to meet with them but they are from Missouri (get a local attorney in your own state). I have done all their work and I have been waiting a total of 3 years so my IRA savings are depleted. I have to pay taxes to the gov$14 000 dollars. Where am I going to get that money? I either get a part time job which will favor another denial cause I can do something or draw from my IRA again. Who’s going to help me recoups the losses of my job my IRA IRS TAXES? No one cause they don’t see our pain on the inside nor do they want to get educated on the mesh, its ridiculous. I cant update anymore info on my case cause I don’t have the money to pay a damn Dr. Where is our justice? We just go round and round. Good luck to anyone who gets SSDI/SSI. It truly is a battle. But by God if you are bipolar or hurt your back you can get it. Sorry just had to get this off my chest. 3 yrs waiting……………,……….

    • Jane Akre says:

      MAM- He didn’t want to hear about mesh? Unbelievable. I can’t believe there isn’t a law firm that will take your case and do a good job….. let’s see..

      • Mamohio says:

        Jane,

        I have a law firm but if I start all over again I will lose around $72,000. Yes the judge was an $#%! What is the SSR or disability pension the lawyer was talking about? Never heard of it unless he’s talking long term with an insurance company at our work Cigna. They turned me down also. I don’t get it the ole mighty $$ is worth more than our livelihood. What an outrage!

  9. Bruce Feifer says:

    Regrettably the process is long and frustrating. I see all too many people face financial crisis similar to you. Despite your limited resources getting medical documentation to support your claim is necessary to experience success. The previous medical evidence cannot be considered by the judge at the second hearing under a legal concept of res judicata; as it was already considered. Contact public health units, government funded hospitals as well as local charities for assistance in getting medical help and testing to support your claim so that you can prove your case this go round. If none of these avenues work have your lawyer request that the SSA pay for a conductive exam for you. While often just a cursory exam; it’s still better than no evidence at all.

    • Mamohio says:

      Bruce,

      Could you explain the SSR? Never heard of it? Thank you.

      • Jane Akre says:

        Bruce says-

        SSR is retirement benefits which are paid when one becomes the designated retirement age; currently 67 years of age; although the benefits can be drawn at age 62 at a reduced monthly rate. There are no medical requirements for this benefit. Just payment into the system over one’s working career and the age requirement.

  10. Bejah B says:

    I receive SSDI and have for some time but not due to mesh. I turned 67 in May (How did this happen I ask myself!). Will my benefit amount change because of this (terrible) birthday? I have received no notice to that effect. I have been paying into Social Security since I was about 19 years old. Can anyone tell me? Thanks.

    Bejah

  11. Mamohio says:

    I first signedup in 2013. Bad documentation, pt, Mt, pschciatrists, Pscsycogists, my primary Dr filled out the paperwork saying I can’t. Work. I have had so many surgeries. All the paperwork was turned in. Inwas denied the first time after waiting 2 yrs and now in the appeal process. My lawyer says they do not need any more paperwork or to submit anymore tests, prescriptions, therapy or any newndrs. The appeal could take up to 3 more years. I broke and cannot afford to start all over again in which that’s what my lawyer said. She said if I lose the appeal I can take it to the supreme court but they will not represent me. I have to do it on my own.Hell that’s what I hired them for. I am too sick to start this process over again. I have already spent my savings to keep my house and car. I paid into SSDI for 30 yrs. What can I do? I cannot physicaally or fininancilly start all over again. They already oweme 3 yrs of work I cannot perform Bc I am too sick. If i start over I will lose that money? Any advice? Thanks

  12. Mamohio says:

    Sorry had all the documentation

  13. Patricia S says:

    I am on Social Security, however, I continued to work part time in order to help make ends meet. Because of my extreme mesh pain, I am now unable to do any kind of work. I have been told by a law firm that I cannot receive SSDI because I am already on SS. Does anyone know why or even if this is true? Thank you.

  14. Brad S. says:

    First surgery- open umbilical repair using Ethicon mesh- leads to 10 years of chronic pain, staph infections, loss of 14 teeth within the first 12 months proceeding the umbilical mesh implant, immediate degradation of perfect 20/20 vision as well as substantial hearing loss. Hernia redevelopment within 15 months-2nd surgery + mesh removal, antibiotic resistant strain of staph. More complications, 3rd hernia redevelopment in same area. Spleen enlargement, chronic COPD, skin rash condition, on & on as we all know.
    18 months now unable to perform any type of work and no income.
    Social Security Disability- 13 months now with 2 denials, reconsideration process, Appeal process on & on.
    Say what you may concerning the Social Security Disability system. The last bit of national news I recall was that the SS system was financially predicted to run out of money within the next 9 years.
    Gee, ya don’t suppose that a large portion of their dwindling operating capitol is wasted foolishly due to their ludicrous department policies & procedures? My 1st round of applying for benefits involved interviews from 2 reps from OK, 2 reps from Utah, 1 rep from Las Vegas, one from my local SS office, then 2 more individuals from my state’s Medical Examiner Department- The same questions were asked of me over & over from EACH rep- BUT worded in slightly different ways. I told each that I had multiple health problems but the main one was the failed mesh & muscle erosion, 3 surgeries, and 3 more hernias in the same location.
    -The medical examiners response was “Oh we’ll just add that problem in on the next round”
    WTF -Efficient System? You decide, and I think we all have already.
    I say “Come live a day in our shoes”

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