SSI and SSDI:

Basic Differences between the two.

Supplemental Security Income (SSI): Also known as Title XVI, this program provides benefits for aged, blind, and disabled people without regard to prior workforce participation. It is administered by the Social Security Administration, but it is not funded by Social Security taxes. Social Security Disability Insurance (SSDI): Also known as Title II, this program provides benefits to disabled/blind persons who are insured by workers contributions to the Social Security trust fund. These contributions are based on work earnings (a client, her or his spouse or parents) as required by the Federal Insurance Contributions Act (FICA). Title II of the Social Security Act authorizes SSDI benefits. Dependents may also be eligible for benefits from a clients earnings record.

The Dalles OR SSA office. We liked the pupdog.

Melissa Kenney, Esq. and Lisa Porter, Esq.

From Application To Hearing

INITIAL APPLICATION
Done by claimant, not attorney. Takes 2 to 6 mos for decision. Over 70% claims rejected at this level. Sixty days from rejection to request reconsideration of the initial determination.
Recommended claimants hire attorney at this stage. Takes another 2 to 6 months for decision. Over 65% claims rejected at his level. Sixty days from rejection to request hearing review by ALJ. Up to one year or more wait for hearing. Informal process: Some rules of evidence are relaxed, hearsay or use of leading questions are permitted within reason. Likelihood of claim approval significantly increases with representative assistance.

RECONSIDERATION

Melissa Kenney, Esq. and Lisa Porter, Esq.

HEARING LEVEL

Imperfect Client Case

Some issues, like present drug/alcohol abuse, or refusal to seek treatment, can hurt.
Know that you should be honest when talking about drug and/or alcohol abuse, particularly if in medical record. If possible, work with your attorney and treating provider to get into DAA treatment need approximately 30 days documented sobriety to see if DAA is MATERIAL to the case. If you have a physical problems only, DAA should not be material to client case unless abuse causes physical problem.

Melissa Kenney, Esq. and Lisa Porter, Esq.

Questionnaire forms at all three stages

Consistency in your answers will help your case. Claimants will receive claimant questionnaires from Social Security after applying for disability. The local SSA office sends the first form, DDS sends the second form, and the the Office of Hearings and Appeals (OHA) sends a third form. The last form arrives about 2 to 4 months prior to a claimants hearing. This is the time to schedule a meeting with your attorney or representative to update medical records and to share any new medical or work developments have occurred since the beginning of your application.

Melissa Kenney, Esq. and Lisa Porter, Esq.

Evidence, Evidence, Evidence!

(Or, What You Need To Succeed.)

Most recent medical and Psychological records Residual function capacity opinions from treating providers Vocational assessments Former Employer statements Witness statements

Melissa Kenney, Esq. and Lisa Porter, Esq.

Medical Evidence NOT Optional

While it is possible to win with little medical evidence, evidence makes your case. Here are some key tips in gathering needed evidence from providers.

Try to gather your own medical records if possible it is cheaper for you and if saved on disks, likely free..

Ask your attorney or representative to provide a residual capacity form for doctors and psychologists to use.

Melissa Kenney, Esq. and Lisa Porter, Esq.

But not just any medical evidence

Long-term Treating Sources Opinion Matters Most.
20 C.F.R. 404.1513(a) and (e), 416.913(a) and (e).[14] Acceptable medical sources specifically include licensed physicians and licensed psychologists, but not nurse practitioners, mental health counselors, chiropractors or other non-doctor practitioners. 404.1513(a)(1) and (3); 416.913(a)(1) and (3). However, a nurse practitioner or any other practitioner working either as part of an interdisciplinary team or in conjunction with a physician or psychologist constitutes an acceptable medical source. Gomez v. Chater, 74 F.3d 967, 971 (9th Cir. 1996).
Unless treating provider is Dr. Riviera

Melissa Kenney, Esq. and Lisa Porter, Esq.

Hearing Day - Finally.

Average 1 & Year Wait. What to expect at a hearing and what often ACTUALLY happens.
Weve encountered the full range of ALJ behavior and prejudices. Very similar cases before two separate judges often have radically different outcomes. It is a truism that practitioners will often correctly predict the expected outcome based on the particular ALJ. That being said, the hearing procedure is fairly predictable. Hearing lasts about one hour. Testimony taken under oath. ALJ follows 5 Step Sequential Process. ME testimony for steps 2 & 3; VE testimony for steps 4 & 5

Miracle in the Alcohol Aisle.

The ALJ shops here too

Melissa Kenney, Esq. and Lisa Porter, Esq.

Hearing Process in a nutshell

Swearing in client and expert witnesses (medical, psychological, and vocational experts present). You get to testify first. In some hearings the ALJ asks questions first, in some, your attorney will start. Medical and psychological experts provide testimony about steps 2 and 3 in the 5 step sequential evaluation process whether your condition meets or equals a listing, what are you limitations, and whether drugs/alcohol make you disabled. In some cases, they testify before you and your witnesses testify. At last, vocational rehabilitation experts provide testimony about steps 4 and 5 of the sequential evaluation process. They testify whether someone with your limitations can do your prior work or other work.

Melissa Kenney, Esq. and Lisa Porter, Esq.

Hearing is done. What next?

If lucky, a bench decision that day. Otherwise, determination issued 30-60 days later.

If no bench decision, or ALJ informing you and your attorney that a favorable determination will be issued, you will wait about 30-60 days for the determination letter. If favorable, hooray! If unfavorable, next avenue is to determine whether you should undergo the appeals route or start a new claim.

What? Its only $721 a month???

Melissa Kenney, Esq. and Lisa Porter, Esq.

Appeals Counsel, USDC and beyond

Appeals Counsel (AC)
Last level of appeal at the Agency level. Need to file within 60 days. Takes up to a year or more for decision. Success rates range from 12% to 20% at this level. Medical evidence may continue to be submitted. File for appeal. New medical evidence may not be submitted unless a case issue is that the AC Level refused to evaluate new/material evidence and that such evidence continues to be ignored. Takes up to a year or more for decision.

Federal DC (USDC)

Federal Circuit

Both USDC and 9th Circuit frequently remand for repeat hearing at Agency level to answer a question improperly ignored.

Melissa Kenney, Esq. and Lisa Porter, Esq.

credits
Thank you to our wonderful advocates, mentors and friends who inspire us.
Memes from www.quickmeme.com, www.xkcd.com, Know why theres so many meme-worthy comics on this presentation? The answer is right here Stay healthy during the flu season, and contact us if you have any questions about SSA practice. KP Law, LLC. www.kpdisabilitylaw.com, Like us on Facebook: www.facebook.com/kplaw.disability. Presentation found on Scribd.com.

Melissa Kenney, Esq. and Lisa Porter, Esq.