Autism Advocacy Group Presentation 12-15-13

8/13/2019 Autism Advocacy Group Presentation 12-15-13

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SSI and SSDI:Supplemental Security Income (SSI): Also known as TitleXVI, this program provides benefits for aged, blind, and disabled people without regard to prior workforce

participation. It is administered by the Social SecurityAdministration, but it is not funded by Social Security taxes.

Social Security Disability Insurance (SSDI): Also knownas Title II, this program provides benefits to disabled/blind persons who are insured by workers contributions to theSocial Security trust fund. These contributions are based onwork earnings (a client, her or his spouse or parents) asrequired by the Federal Insurance Contributions Act(FICA). Title II of the Social Security Act authorizes SSDI

benefits. Dependents may also be eligible for benefits froma clients earnings record.

Basic Differences between the two.

Melissa Kenney, Esq. and Lisa Porter, Esq.

The Dalles OR SSA office. We liked the pupdog .


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From Application To Hearing


I N I T I A L A P P L I C A T I O N

Done by claimant,not attorney. Takes2 to 6 mos fordecision. Over70% claims

rejected at thislevel. Sixty daysfrom rejection torequestreconsideration ofthe initialdetermination.

R E C O N S I D E R A T I O N

Recommendedclaimants hireattorney at thisstage. Takes another2 to 6 months fordecision. Over 65%claims rejected athis level. Sixty daysfrom rejection torequest hearingreview by ALJ. H

E A R I N G

L E V E L

Up to one year ormore wait forhearing. Informal

process: Some rulesof evidence arerelaxed, hearsay oruse of leadingquestions are

permitted withinreason. Likelihoodof claim approvalsignificantlyincreases withrepresentativeassistance.


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Imperfect Client Case

Know that you should be honest whentalking 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 tothe case.

If you have a physical problems only, DAAshould not be material to client case unlessabuse causes physical problem.

Some issues, like present drug/alcohol abuse, or refusal to seek treatment, can hurt.



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Questionnaire forms at all three stages

Claimants will receive claimant questionnaires fromSocial Security after applying for disability. The localSSA 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 about2 to 4 months prior to a claimants hearing.

This is the time to schedule a meeting with your attorney or representative to update medical recordsand to share any new medical or work developmentshave occurred since the beginning of your application.

Consistency in your answers will help your case.



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Evidence, Evidence, Evidence!

Most recent medical and Psychological records

Residual function capacityopinions from treating providers

Vocational assessments Former Employer statements Witness statements

(Or, What You Need To Succeed.)



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Medical Evidence NOT Optional

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

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

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.



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But not just any medical evidence

20 C.F.R. 404.1513(a) and (e), 416.913(a) and (e).[14] Acceptable medical sources specificallyinclude 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 inconjunction with a physician or psychologistconstitutes an acceptable medical source. Gomez v.Chater, 74 F.3d 967, 971 (9th Cir. 1996).

Long-term Treating Sources Opinion Matters Most.


Unless treating provider is Dr. Riviera


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Hearing Day - Finally.

Weve encountered the full range of ALJ behavior and prejudices.Very similar cases before two separate judges often have radicallydifferent outcomes. It is a truism that practitioners will oftencorrectly 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

Average 1 & Year Wait. What to expect at a hearing

and what often ACTUALLY happens.


Miracle in the Alcohol Aisle.

The ALJ shops here too


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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 the5 step sequential evaluation process whether your condition meets or equals alisting, 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 5of the sequential evaluation process. They testify whether someone with yourlimitations can do your prior work or other work.



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Hearing is done. What next?

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 determinewhether you should undergo the appeals route or start a new claim.

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


What? Its only $721 a month???


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Appeals Counsel, USDC and beyond

A p p e a

l s C

o u n s e

l ( A C

)

Last level ofappeal at theAgency level.

Need to file within60 days. Takes upto a year or morefor decision.Success ratesrange from 12% to20% at this level.Medical evidencemay continue to besubmitted.

F e

d e r a

l D C ( U S D C ) File for appeal. New medical

evidence may not be submitted unless a case issueis that the ACLevel refused toevaluatenew/materialevidence and thatsuch evidencecontinues to beignored. Takes up

to a year or morefor decision.

F e

d e r a

l C i r c u

i tBoth USDC and9th Circuitfrequently remand

for repeat hearingat Agency level toanswer a questionimproperlyignored.


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credits

Memes from www.quickmeme.com , www.xkcd.com ,

Know why theres so many meme-worthy comics onthis presentation? The answer is right here

Stay healthy during the flu season, and contact us ifyou 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.

Thank you to our wonderful advocates, mentors and friends who inspire us.


Autism Advocacy Group Presentation 12-15-13

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