One thing that any new applicant for disability benefits will hear about shortly after submitting their application is the disability appeals process. It can sound like a daunting and difficult process filled with claimant participation and, occasionally, claimants can come to feel that they are doing more for their case than their representative is doing. Many times, however, these feelings come up because claimants are unaware of what is happening behind the scenes and that their representative . This post will take readers through some brief descriptions of the steps in the appeals process and the roles of the claimant and representative are at each stop.
Today’s post is going to discuss the third level of the SSI/SSDI appeals process.
In some ways, having a disability case at the hearing level is like starting your claim over again. It takes about the same amount of time as the first two levels of appeal, your representative will request as many or more records than they and SSA did in the first two levels, and you generally will also have a new SSA office to speak with since your case will now be at the Office of Disability Adjudication and Review (ODAR). Because there is a substantial wait to even be scheduled for a hearing, many people will lose interest in their cases and some will even forget that they have a pending claim with SSA. However, most claimants are harshly reminded that their claim is pending when they receive a notice that they have been scheduled to appear before a judge.
This can cause some panic for claimants. This can be doubly so when an advocate wants to re-interview them about their medical history and medical providers. This is a very standard and necessary practice. The medical records that SSA would have on file would now be over one year old. Presumably claimants would have received some treatment for their conditions and it is necessary to show that their conditions remain when they reach the hearing by securing updated medical records. It also does not make much sense to try to collect medical records until about sixty to ninety days from the hearing. Many ALJs will require records more or less through the date of the hearing, so requesting them too far out will mean that the advocate will need to do another round of requests. It usually saves everyone time if the records are submitted close to the hearing.
This is the level where the claimant is presented with his or her day in court, and often will have the first real opportunity to explain to a person that would listen what their conditions are and how their symptoms effect them. This is also the part of the process that takes the longest. Generally, the wait for a hearing takes over a year from the date of the request. The reason for this is that, based on 2015’s numbers, there were about 1.1 million claimants that requested a hearing, and about 1,800 judges to hear their cases. That breaks down to about 611 hearings per judge. Since each hearing is about an hour long, that leaves about 1,400 hours in the year (based on a 2,080 hour, i.e. 9-5 job’s work year) for ALJs to write decisions, decide fee petitions, correspond with medical experts, hear overpayment cases, and perform all of their other duties. There are simply not enough judges to hear cases and, so, the process is relatively drawn out.
At this level, the claimant’s responsibilities will be generally the same as at reconsideration with one notable difference. The claimant will also need to testify at a hearing. This testimony is usually presented through questions asked by both their attorney and the ALJ through questions about their conditions, what treatment they have received, how they spend their days, and many other topics.
The representative will prepare for the hearing in a number of ways. First, they will ensure that any and all relevant medical records have been brought up to date as it becomes the advocate’s responsibility to complete the record. They will also make sure that, not only have the records been received, but that they have been submitted to SSA. The representative will also renew any requests for consultative examinations, respond to those reports, make motions for subpoenas for any non-responsive record providers, collect medical source statements, and write and submit a pre-hearing memoranda to the judge, among others. The representative will also conduct the hearing and will have prepared for it by reviewing all of the records, researching the claimant’s conditions in detail, studying the listings of impairments related to those conditions, and interviewing the claimant to get the best possible idea of how they are effected by their symptoms. The advocate will also have the responsibility of addressing any issues that come up at the hearing through the submission of additional or missing records or post-hearing briefs to the judge on specific topics.
Probably more than any other part of the appeals process, the hearing level is where a claimant will benefit from an attorney’s help the most. Many ALJs will be understanding enough with pro se applicants and will try to get them through a hearing. However, most claimants have no little knowledge of what will and will not constitute evidence of a disability, will not be able to properly brief the judge on their conditions, or how to cross examine a vocational witness. It is by allowing the claimant to leverage their knowledge and experience that attorneys and advocates can benefit claimants.
If you are currently in the appeals process and would like to speak with an attorney contact us today!