Need a 'walkthru' of an SSI appeals hearing

[BeckyScott]

I think we are finally getting close to the hearing, I got more info in the mail today, and it's been about a year so I'm guessing we're getting closer.

I was wondering if someone with experience in this could give me a walk-thru of how the whole thing works. I would like to be prepared as much as possible.

Some questions I had:
Who all is there? Am I allowed to bring my son with me? Are they usually at the local SS office or am I going to have to drive to a regional office?
How does it work? They go over the information with me? Then what? Do I get a chance to present my case, so to speak?
About how long does it last?

No I didn't hire a lawyer. I know, everyone tells me maybe I should get a lawyer, cause that's what you do when you have to appeal. I'm not going to hire one. Anyway, I just would like to know what to expect the day of the hearing.

 

[KirstenB]

Becky, I know nothing, sorry. But there's a lady who posts over on the Community Board, named Barkley. She's answered questions before about disability/benefits. You might try pm'ing her.

 

[mgilmer]

I think we are finally getting close to the hearing, I got more info in the mail today, and it's been about a year so I'm guessing we're getting closer.

I was wondering if someone with experience in this could give me a walk-thru of how the whole thing works. I would like to be prepared as much as possible.

No I didn't hire a lawyer. I know, everyone tells me maybe I should get a lawyer, cause that's what you do when you have to appeal. I'm not going to hire one. Anyway, I just would like to know what to expect the day of the hearing.

Who all is there?
The Admin Law Judge, his clerk, possibly a vocational expert, yourself, and any witnesses you want to testify.

Am I allowed to bring my son with me?
You are, but the judge may not want him in the hearing room, depending on his condition. Be prepared to have someone to sit with him outside, if the judge so chooses.

How does it work? The Judge will admit the "record" (the agency file) and ask you if you have any further medical exhibits. He will then ask you if you have any evidence (testimony) to present. You then present your evidence. At the end of your evidence, he then will ask the Vocational Expert (if there is one) to assess the evidence and determine if, in their expert opinion, your child meets the disability criteria. You may then ask questions in cross examination of the expert. Then the Judge will close the case and take the matter under advisement and issue a written opinion in somewhere around 30-120 days.

Are they usually at the local SS office or am I going to have to drive to a regional office?
They are usually at the Office of Hearings and Appeals for the district you live in. You can find out which one from your local SSA office.

They go over the information with me?
You can review the file before the hearing (highly advised) so you will know what is in it and you can dispute any inaccurate information therein. Other than that, they will not help you.

About how long does it last?
Normally an SSI hearing without an attorney will last 30-60 minutes.

FWIW, appellants with attorneys win about 70% of the time on appeal. Those who do not have attorneys win about 20% of the time on appeal.

 

[barkley]

if you don't want to use a lawyer you might want to contact your local social services office and find out if they have staff that help with the appeals process (the state i worked in offered this).

i ended up reading thousands of social security disability applications and appeals because i supervised a medi-caid unit in a state where it was routine for ssi applicants to apply for state medical services pending their ssi applications (and during the waiting period to get medicare). the most common reasons i saw for outright denials and denials of appeals were:

medical condition ssi outright does not cover (now at least they detail exactly what the conditions they cover are on their website),

person does'nt meet the full criteria for being considered disabled by social securitiy's standards (even if a person has one of the conditions unless they meet the other criteria they don't qualify-an example would be an adult who has a condition but has been successfully working; social security does'nt see them as disabled to the extent the are unable to work),

missing/insufficient information from medical providers (social security want's all the doctors to agree with each other in the diagnosis and their medical reports to support one anothers-so the primary care needs to say "i suspected this, referred the patient for this testing, which led me to refer to the neurologist for this, the neuro tested for this-he confirmed the diagnosis which i concur with", and then the neuro has to say "the primary tested for this, referred to me, i tested for this-i diagnosed this and i concur with the primary care's diagnosis"....(it gets to be a major P.I.T.A. if your child has a primary, a neurologist, a therapist, a consulting psychiatrist, an occupational therapist....and you have to make sure they all report the same info).


the reason the success rate with lawyers is higher is they can look at a denial letter and determine what the essence of the issue is-get what is needed and walk into the appeal locked and loaded. they also know how to look over that agency file and how to determine if your case was correctly processed-are they within their rights to ask for something, are they not accepting something that is entirely acceptable, is what they need sitting in that file right now and it's been overlooked or just unconsidered because it did'nt get submitted by a cut-off date they previously set....). they know the questions to ask.

good disability lawyers are worth their weight in gold-they can only take 25% of the BACK pay once the claim is approved (so no approval-no payment on your part whatsoever)-but that is capped at $6000.00. considering that an appeal can commonly cover multiple years-that's not an unreasonable fee (i saw appeals result in tens upon tens of thousands in back benefits).

good luck-and look to the social security website, they tell about how if you lose the inital appeal you still have recourse (always exhaust every appeal opportunity-that protects the begining date of aid).

 

[Lachesis00]

Thank you Becky for asking! I too am up for an appeal before the judge. I've gotten 2 letters but no date yet. Their reasoning for me is I can walk up and down stairs for 8 hours a day... which couldn't be further from the truth. LOL

The other thing, they said they looked at records from 2006 (which those would have never stated the above) and I sent a letter and records from 2009... I don't know if who reviews them really reviews them or what.


Thank you mgilmer for your incite!!

I contacted several lawyers who said they worked in SSI issues and no one has contacted me back.

 

[BeckyScott]

barkley-

DS was diagnosed with autism at 2 1/2. We applied for SSI then and qualified, within a month's time we got our first check.

He was on it for 6 years (? roughly) then DH's income went up too high and we were booted. (we were booted out of everything, LOL)

About that same time he was re-assessed and the diagnosis was changed to PDD-NOS, and the school had done evals and such too, which we didn't have before because he was too young. He does get therapy and such at school.

Then DH's income went back down so I reapplied. They are saying he has a disability, but it's not severe enough. Now, also, since he's older, they have received info about his asthma and eczema, that's in the mix, although I'm not applying for SSI b/c of his eczema, I know that won't work. But they requested records from everyone, including for example our family physician, who deals with the eczema/asthma but really doesn't *do* anything with the autism. If that makes sense.

I don't know what happened, exactly. His autism diag changed to PDD-NOS b/c his speech improved enough to no longer fit the criteria for autism, so that might be the kicker right there, from their perspective. I certainly didn't CURE him, if you KWIM. If I'd done that, I'd be rich right now.

I'm not sure exactly what their defense is because I don't know their magical line for disabled enough vs not disabled enough.

As for your three most common probs, I have figured out this much: 1. Autism and/or the autism umbrella is covered. 2. He isn't old enough to work, of course. He is in a regular classroom but has a shared para and receives therapy thru the school. 3. everyone agrees he is on the spectrum. His educational diagnosis is autism (which is an umbrella diagnosis they use for the whole spectrum), the big psych report has him at PDD-NOS. The report they got from our family physician is solely about his asthma and eczema. They even got a report from his dentist in there, for heaven's sake.

Maybe that's what the problem is. Too many reports that aren't relevant.

 

[Lachesis00]

((((Becky))))


I am still trying to find a lawyer... thankfully I haven't gotten my "20 day" letter.

I found a great website.... Preparing to go before a judge and how obtaining Social Security works

 

[Lachesis00]

Becky, I talked to a nice man from www.disabilitygroup.com (who is going to represent me) named Craig Scott. Check out that web site. There are lot of Q&A's.


I am so excited! I had a 2 hour phone interview yesterday.

 

[EllenFrasier]

Becky, I talked to a nice man from www.disabilitygroup.com (who is going to represent me) named Craig Scott. Check out that web site. There are lot of Q&A's.


I am so excited! I had a 2 hour phone interview yesterday.

We are applying for SSI for our son for the first time, and I was just wonderig how you made out with your claim - were you successful and did you end up using the lawyer? This is our first time around with this, so any pointers you may have will be appreciated.
Thanks.

 

[deerhart]

I do social security law (and have been involved in ssa law for over 7 years etc etc).

In fact, I recently wrote the appeals council appeal on a person who went to a hearing without an attorney. The hearing was a joke as the vocational expert basically didn't get any of their testimony right and the claimant doesn't know enough about SSA rulings, vocational testimony or the DOT to even begin to question the VE.

Further, most claimants will not show up to hearing with all the updated medical records and if your docs don't respond within like 15 days to the judge's request, they make the decision based on the record they have. Considering SSA probably got records well over a year ago AND the chances are extremely high they only got a small portion of the available records then, the decision is probably going to be made on about 25% of the available medical records.

Further, you need to know what it is YOU need to prove in order to obtain benefits. What you need to prove is NOT the same for each person because its based on a variety of factors. You need to understand BEFORE you go into hearing what SSA actually means by the term disabled (because its not the common definition) and what SSA uses to define disability and what SSA uses to define each residual function category.

And that is not even considering whether or not you should argue that the condition meets or equals a listing or arguing any of the roughly 200 Social Security Rulings apply in your case.

Also, the time frame of your case will depend on what state your in and which hearing office your assigned to (based on your location). There are 10 prototype states which do not have the reconsideration step (I work in one of them). Also, hearing offices will have different backup times. For example, here the average time from filing the appeal to hearing is roughly 16 months. The last I checked (which was 2 years ago) the 2 Atlanta hearing offices had average wait times for hearings of over 3 years.

You will have to go to the hearing office they have assigned you to. They DO do video hearings, so the ALJ may or may not even be in the same location as you. Heck the ALJ could be hundreds of miles away with the VE and clerk and you could be somewhere else by yourself. The hearing notice will tell you if there is going to be a VE and or a medical expert.

I have had backpays in excess of $70,000 on some cases and I have had some cases with very little backpay. Its really all based on what the monthly amount is for the person and the time frame for backpay.

As for DDS OMG the stories I could tell you about their crazy denials...