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SSD And SSI Cases Procedures Explained- Part 11

My name is Paul Badame and I am an attorney with the law firm of Rubin and Badame in Norristown, PA. We specialize in obtaining Social Security Disability for our clients. Today I want to talk to you about how the application process works.

How we get paid

First, you should know that if you were to hire us, we only get paid if we win your case. We get paid from your retroactive benefits only, i.e., your back benefits. It's 25% of the amount, capped at $6,000. Let's say your back benefits are $10,000 and then your monthly benefits thereafter are a thousand dollars per month. We would get paid 25% of that $10,000, which is $2,500. And all of the remaining benefits, the $1,000 per month, will be all yours. We don't get any part of that.

But let's say your retroactive payments are a total of about $40,000. 25% of $40,000 is $10,000, but we're capped at $6,000. So no matter how high your retroactive payment is, we can't get more than $6,000 with that cap. And again, your ongoing monthly benefits, they're all yours. We don't get paid from that.

How to get started

If you decide to hire us, you sign the paperwork, and we have you fill out an information packet. Then we'll file your application. We do all our applications online. That's the quickest, the most efficient and the most accurate way to get an application done. It takes us maybe a couple of hours. After that, your case gets sent to the District Office, and from there, it gets assigned to an adjudicator.

We're located in Pennsylvania, so I'll give you a step-by-step example of how it works in Pennsylvania. It works much the same way throughout the United States though. We practice Social Security law and handle cases in all 50 States.

The initial part of the claim

Once your application is filed, the District Office sends it up to Pennsylvania DDS. DDS stands for Disability Determination Services. That's a department with the state of Pennsylvania that is contracted by Social Security to handle the initial part of your claim. After about a month, an adjudicator is assigned to your case. That adjudicator's responsibility is to obtain all your medical records and to send you forms to fill out.

Typically there are two forms that are sent out. The first is called a functional report, and the second is a work history report. We ask all of our clients after they fill out their functional report and their work history report to mail those documents back to us. When we get them back in the mail, we'll call the client and we will review that application with them to make sure that it is accurate and correct. Once it's reviewed, we fax it straight over to the adjudicator at DDS.

The initial process typically takes about five to six months. And if you're approved, that's wonderful. The case is over. You get your money. But if for some reason you're denied, we both get notice of the denial and we file an appeal. That appeal is called a request for reconsideration.

The appeal

Once the appeal is filed for reconsideration, your case gets typically assigned to a separate adjudicator. That adjudicator will send you the same forms again. It's the same process again. You get those forms, you fill them out, you send them to us, we review them with you, and then we fax them over to Social Security.

Then they obtain updated records for you, or, when we review the case and find they missed any records, we make sure that they get those other records they might have missed. Once they get all your updated records, then your case is sent to the medical doctor at DDS to determine whether or not you meet their criteria for disability. If you do, wonderful. You're approved. We're good to go. But if not, then we file another appeal.

The request for a hearing

And this appeal is called a request for a hearing before an administrative law judge. Typically I'd say two to three years ago from the date the request for hearing was filed, it used to take approximately anywhere from 18 to 28 months to get a hearing before a judge.

As of now, September 2020, in the Philadelphia, New Jersey, Maryland, and Delaware area, it's taking anywhere from as little as five to maybe 10 months to get a hearing. The wait times have been cut dramatically. I could sit here for about an hour and explain to you how that has happened, but we'll leave that for another day.

Your case is then scheduled for a hearing before a judge. By law, they have to give you 75 days notice, which is about two and a half months. Right at about the two-month mark before your scheduled hearing, we set up a phone conference with you.

Preparing for the hearing

We have electronic access to your file, which includes all of your medical records and their initial decision and reconsideration decision. Then we go through those records, and obtain anything that might have been missed. And we also get your updated records. The updated records are from when you were denied up through the hearing.

We will also send you what are called medical source statements. These are also called treating source statements. They're for your doctors to complete. It's about residual functional capacity, whether you have a physical impairment, a mental health impairment, or both. We also have forms for procedures and for migraine headaches.

Not all doctors will fill them out, but nonetheless, we send them to you. We ask that at your next appointment with whatever doctor you have it with, you get them to your doctor. And hopefully they complete them. Sometimes they do, and sometimes they don't. It typically depends on the doctor.

Once that's done and once all your records are in, we submit them electronically to the system. It's called the ERE, the Electronic Record Express. And the day before the hearing, I like to do my prep. The closer you are to the hearing, the better it is to do prep.

I do all my preps either the day before the hearing, or if your hearing is on a Monday, we'll do the prep on Friday. And prep typically takes anywhere from 45 minutes to maybe an hour and a half. And we just review. I tell you how the hearing goes, and what the procedure is.

The actual hearing

We're very familiar with the judges in the area. My partner Scott and I, we've had them numerous times. We typically know how they hold their hearings, whether they ask a lot of questions or whether they rely on the attorney to ask the questions. We prepare the client and then, the next day or that Monday, will be the day of the hearing. Right now, in the fall and winter of 2020 with COVID, all the hearings are over the phone.

But if they're not over the phone, we would meet the client at the hearing office on the day of the hearing, about 45 minutes to an hour early. We prep them, give a little pep talk, prep them again, and review some things for the hearing.

If it's a phone hearing, we'll typically call them that morning, or later, if the hearing is in the afternoon, just to review again, calm the client down if they are a little bit nervous, and then we have the hearing. The hearing could take 20 minutes, or it could take two hours. It just depends on the judge. And it also depends on the kind of case.

Waiting for the outcome

Once the hearing is done, you typically don't know what the answer is or what the judge's decision is going to be, so you have to wait. And the judge can't just press a button or click the mouse on something to approve or deny. He has to write up a whole legal opinion on whether they're approving or denying your case.

If it's approved, that's great. We're in great shape. We win the case, which we typically do. But if for some reason it is denied, then in about 95% of the cases, we'll take the case to the appeals council. That's sort of the appellate court for Social Security.

The appeals council

And that's not another hearing at that level. Instead, we prepare a brief and submit it, and we argue to the appeals council, why and how the judge erred in denying your case. Then the appeals council typically takes about anywhere from eight to maybe 14 months to make a decision.

Hopefully my explanation of how a typical case starts, evolves and ends was helpful to you. And of course, if you have any questions or if you'd like to hire us as your attorney, you can contact us at (610) 382-5200. Or you can go to our website, www.rubinbadamelaw.com.