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									      The Road To SSI:
How Collaboration and Networking
        Leads to Success
    Goodwill Industries of Denver
    Career Development Services
           Kerry Romero –
     Assistant Program Manager
   Velony Gomogda – Lead Worker
GOODWILL INDUSTRIES
    OF DENVER
Our mission is “to ensure that every
person in the community has the
opportunity to live to his or her
potential and to attain personal and
economic self-sufficiency.”
A UNIQUE PARTNERSHIP


Goodwill Industries   Adams County Social
    of Denver         Services Department


 Thomas A. Feldman
  Attorney At Law
                          Social Security
 Community Partner
                          Administration
Challenge Employment Program
            (CEP)
 Partnership of State, Adams County and Non-
 profit agencies (DVR, SSA, Home Base Therapy)

 Challenge Employment Program implemented in
 1999

 Two-Parent Household Caseload implemented in
 2004
  Social Security Application
          Assistance
Partnership began in 1999 with the Social
Security Administration
 Establish communication between Challenge
  and SSA staff
 Increase understanding of application,
  determination and appeal process
 Track clients’ progress and status through the
  entire claim process
       STATISTICS
 The approval process has improved greatly
in the last 4 years.
The processing time, from application date
to approval date, went from 24-52 months
to an average of 6-18 months
Our program had 23 approvals for the fiscal
year 2007-2008, in the last 4 years, our
average has been 16 per fiscal year
NETWORK -Intake Process
       Network with SSA
         Gather all medical/mental
         health records
         Start On-line application
         Make a phone interview
         appointment
         Send all records to SSA
         Update current status
         monthly
         Legal Aid if needed
NETWORK -Case Process
Keep Client Informed       Hearings and
  Monthly updates          Approvals
  Explain the process at     Prepare client for
  each stage                 hearing if no legal
  Explain any papers         representation
  received from SSA          Make sure client has
  Help give timeline of      recent medical/mental
  process                    health information
                             Explain appeal process
                             if case is denied
  Appeals – Collaboration with
     Community Partners
Assist with appeal paperwork
Offer legal representation referrals and
resources
Assist the client with paperwork timeliness
            Presenters
Kerry Romero - 303-227-2041
kerry.romero@dss.co.adams.co.us

Velony Gomogda – 303-227-2199
velony.gomogda@dss.co.adams.co.us
Questions
   Social Security Disability

Understanding and Collaborating
Social Security Administration’s
   Adult Disability Programs
       Presented by Colorado Disability
          Determination Services for
  Colorado Works Professional Development
                  Academy
                  10.02.08
      Learning Objectives
Social Security Disability Programs
Social Security definition of disability
Social Security disability evaluation
 process
What type of medical and other evidence
 Social Security needs and why
What Advocates can do to assist
Electronic Records Express (ERE)
      Colorado DDS Facts
FY07 CO DDS processed 31,334 SSA
 disability cases; allowance rate 34.6%
Disability Examiners- approximately 65
DDS Medical/Psychological Consultants—
 approximately 25
Follow national SSA law and regulations;
 subject to Federal Review
      DDS Special Projects
Quick Disability Decision & TERI
Homeless Cases
Wounded Warrior Cases (AKA Military Casualty)
IBAAP (Romanoff)-Dept of Corrections
Low Birth Weight
Craig Hospital
    Types of Disability Programs

   Social Security benefits for workers
   Social Security benefits for
    adults disabled since childhood
   Supplemental Security Income (SSI)
     children and adults
      Social Security Disability
         Insurance (SSDI)
SSDI (Title II of the Social Security Act)
 provides disability benefits for individuals
 who are ―insured‖ under the Act by virtue
 of their contributions to the Social
 Security trust fund through a tax on their
 earnings, and to certain disabled
 dependents of insured individuals.
Social Security Disability
   Insurance (SSDI)

          To qualify, the disabled
           person must have a
           recent work history
          Special rules apply to
           younger persons who
           need less work to qualify
  Work Requirements (SSDI)
The amount of work depends on age at the time
disability starts
 Before age 24— 1-1/2 years of work in a
 three-year period before becoming disabled
  Age 24-31— work during half the time
 between age 21 and the time the disability
 began
  Age 31 or older— work during five out of the
    10 years before the disability began
        Work Credits (SSDI)

In 2008 it takes $1,050 to earn 1 work credit
  — $2,100 earns 2 work credits
  — $3,150 earns 3 work credits
  — $4,200 earns 4 work credit
   (maximum number of credits in 1 year)
 Amount of earnings needed to earn a work
   credit changes every year
    Amount of Benefit (SSDI)

 Benefits are calculated
 based on claimant’s
 entire work history
 If the Social Security
 benefit amount is lower
 than the full SSI payment,
 you may be eligible to
 receive both Social
 Security and SSI
  Benefits for Family Members
                          (SSDI)
Certain family members may be eligible for Social
Security benefits:
Spouse, if he or she is 62 or older OR at any age if he or
she is caring for a child of yours who is younger than age 16
or disabled
Unmarried child, including an adopted child, or, in some
cases, a stepchild or grandchild. The child must be under age
18 or under age 19 if in elementary or high school full time
Unmarried child, age 18 or older, if he or she has a disability
that started before age 22. (The child’s disability also must
meet the definition of disability for adults)
A divorced spouse if he or she was married to you for at
least 10 years, is not currently married and is at least age 62
Social Security Benefits for Adults
Disabled Since Childhood (SSDI)


              Benefits can be paid on the
              record of a disabled, retired
              or deceased parent to an
              unmarried child of any age
              if the child became disabled
              before the age of 22
Onset & Medicare Coverage
         (SSDI)

 Onset: Disability benefits will be paid
  for the sixth full month after the date
  the evidence shows the disability
  began. (Five month waiting period)
 Automatically enrolled in Medicare
  after being entitled to disability benefits
  for 24 months
  NOTE: People who have permanent kidney failure requiring
  dialysis or a transplant or have amyotrophic lateral sclerosis
  (Lou Gehrig’s disease) may qualify for Medicare almost
  immediately
     Supplemental Security
         Income (SSI)

SSI (Title XVI) provides for payments to
 individuals, including children under age
 18, with limited income and resources
 who are:
  Disabled
  Blind or
  Age 65 and over
  Benefit payment $637 (2008)
      SSI Benefits for Adults
 Resource limits
 — $2,000 for individual
 — $3,000 for couple
 We count
 — bank accounts (CDs, IRAs)
 — second car
 — stocks and bonds, 401Ks
 — liquid assets
 — property other than where
   you live
     SSI Benefits for Adults

 We don’t count as resources
 — home in which you live
 — first car
 — burial plots
 — some resources set aside
     for burial
     Onset & Medicaid--SSI

Onset: When SSI benefits are awarded
 payments begin the first day of the month after
 protective filing date (date first contacted SSA).
People who qualify for SSI also qualify for
 Medicaid. The local medical assistance office
 will contact claimant for additional information
 the agency needs for qualification
    SSA Administered Programs
•   Supplemental Security          • Social Security Disability
    Income-- Aged, Blind, or          Income- Retired and/or
    Disabled (SSI),Title XVI of       Disabled Workers (SSDI)
    the Social Security Act          Title II of Social Security Act
•   Federally-financed needs       • Federally-financed-not needs
    based-Low Income &                based—No Income/Assets
    Resources                         limits. Requires recent work
                                      history and paid FICA
•   Monthly Cash benefit-2008         taxes for specified quarters.
    monthly payment $637.          • Monthly cash benefit
•   Earliest Payment date -           dependent upon work &
    First day of the month after      wage history.
    the month of application.      • Payable after application is
•   Eligible for Medicaid-            filed. Five month waiting
    awarded automatically upon        period from date found
    award of disability.              disabled.
                                   • Eligible for Medicare after 24
•   Presumptive Disability            months of benefits; Medicaid
                                      if also poor.
   The Disability Application
           Process
Processed through network of local SSA
 offices and State Agencies (DDS)
Local field offices responsible for
 application & non-medical eligibility.
DDS—State agency fully funded by
 Federal Govt. Responsible for medical
 evidence & initial determination of
 disability.
Appeals Process
Non-medical Requirements

  Local Social Security office
   verifies:
    earnings
    coverage
    income and resource
     information
    age
    employment
    marital status
Apply of Disability Benefits-Adult
        (Age 18 or Over)
Make an Appointment with SSA
   Telephone: 1-800-772-1213
   Online: www.ssa.gov/
   Walk In to Local Social Security Office
 First contact establishes ―protective filing date‖
Case Managers use SSA i3368pro
 for disability & work history report
www.ssa.gov/i3368prohelp
What You Can Complete Online
   Social Security Disability Benefits
     You can complete both the application
     and the
     Adult Disability and Work History Report
     (Form SSA-3368/3369)
What You Can Complete Online
   Supplemental Security Income (SSI)
     You can complete the Adult Disability and
     Work History Report (Form SSA-
     3368/3369)
     Call 1-800-772-1213 or contact your local
     Social Security office to set up an
     appointment to complete the SSI
     application in person or over the phone
    Advantages of Online
       Applications
When you apply for benefits online, you
can:
   Complete the application forms at
    your convenience
   Take several sessions to complete the
    forms
   Take advantage of online help
   Print a copy for your records before
    submitting them
   Authorization to Disclose
    Information (SSA 827)
This form (SSA-827) gives permission to
  healthcare providers and others to
 release records to Social Security
 This form will appear at the end of the
  online application
 Print it out and it must be completed by
  hand
 Claimant must sign it and mail it to Social
  Security
Before Filing an Application
(to aid in completion of SSA i3368pro)

   The claimant should:
     Identify all impairments;
     Identify treating doctors with
      addresses;
     Identify dates of hospitalization with
      addresses;
     Identify medications.
    Social Security i3368 for
     Professionals (i3368pro)
Online Disability & Work Report
www.ssa.gov/i3368prohelp
It’s a time-saving way for you to give SSA
 medical records and other information
 about your client’s medical condition,
 health care providers, medications,
 education and job skills so we can make
 the correct decision about your client’s
 adult disability claim.
  Where Does the Claim Go?

The claim is sent to the State Agency that:
  Obtains medical evidence
  Obtains vocational evidence and
  makes the initial disability decision for the
   Social Security Administration.
   Who Makes the Disability
       Determination?
Adjudicative team (who does not meet the
 claimant) working for the State Agency
 makes the disability determination.
Team consists of a
  Disability Examiner/Analyst and a
  Licenses Physician/Psychologist
     After the DDS Decision
After DDS makes decision case returned
 to SSA to compute and initiate payment on
 allowances OR to hold the file in case
 claimant appeals the denial.
The claimant receives written notice of the
 decision in either case.
Appeals Process—60 days to file appeal
 (hearing with ALJ, appeals council, federal
 district court)
Social Security’s Definition
        of Disability
The inability to engage in any substantial
 gainful activity
  by reason of any medically determinable
   physical or mental impairment(s).
  which can be expected to result in death
  or which has lasted or can be expected to
   last for a continuous period of not less
   than 12 months.
Physical Impairment Cases

 Symptom –headache
     +
 Signs—abnormal reflex
     +
 Lab findings/X-rays—MRI of brain shows tumor
     =
 Medically Determinable Impairment
      Disability Decision
Legal or administrative decision made by
 SSA
NOT a medical diagnoses
SSA decides, not medical providers
Physician role is to document impairments
      Impairment Must Be
     Medically Determinable
Results from anatomical, physiological or
 psychological abnormalities
Established by medical evidence
 consisting of:
  Symptoms
  Signs, and/or
  X-rays, laboratory findings etc.
   Mental Impairment Cases
Symptoms are the claimant’s own
 description of his or her mental impairment
   Mental Impairment Cases
Psychiatric signs are medically
 demonstrable phenomena that indicate
 specific psychological abnormalities, e.g.,
 abnormalities of behavior, mood,
 thought, memory, orientation,
 development, or perception. They must
 also be shown by observable facts that
 can be medically described and evaluated.
   Mental Impairment Cases
Laboratory findings are anatomical,
 physiological, or psychological
 phenomena which can be shown by the
 use of medically acceptable laboratory
 diagnostic techniques. These diagnostic
 techniques include standardized
 psychological tests (WAIS, Stanford Binet)
Detailed Mental Status Exam with DSM
 Axis V diagnoses.
Acceptable Medical Sources
  Licensed physicians
  Licensed osteopaths
  Licensed or certified
   psychologists
  Licensed optometrists (vision)
  Licensed podiatrists (foot and
   ankle impairments only)
  Qualified S/L pathologist
   (speech or language impairments only)
Other Sources of Evidence

   Nurse Practitioners         Lay Evidence (used to
   Physician's Assistant        assess functioning etc):
   Social Workers/LPC’s        Family members, friends,
   Audiologists                 clergy
   Chiropractors               Employer
   Nurses
   Mental Health Therapists
   Social Service Agencies
   VR Counselors
   Teacher
Sequential Evaluation for
     Adult Claims
  A Step-by-Step Process
Engaging in SGA?
  Severe impairment(s)
   Meets or equals the listings
    Past work
     Other work
          Step 1
Substantial Gainful Activity
 Usually, the best gauge of a person’s ability
  to work is the amount of pay received.
 Currently, earnings from work activity
  averaging more than $940 per month are
  considered SGA. (2008)
 For the blind individual, the 2008 SGA level
  is $1,570.
 If working at SGA deny, if not proceed to
  Step 2
             Step 2
       Impairment Severity
Condition must interfere with basic work
 related activities. If no-deny.
Examples of non-severe—conditions well
 controlled by diet, medication or other
 therapies; duration issues
Consider combined effects of all
 impairments
If condition does interfere with work
 activity go to Step 3.
            Step 3
   Meet or Equal the Listings
Meets criteria in ―Disability Evaluation
 Under Social Security― also known as
 ―The Listing of Impairments‖ or ―Blue
 Book‖
Online:
 http://www.ssa.gov/disability/professionals/
 bluebook/
 Equals criteria in listing of impairments
 If yes allow claim, if no then go to Step 4
       Listing of Impairments
            Part A: Adults
• 1.00 Musculoskeletal      • 8.00 Skin
  System                    • 9.00 Endocrine System
• 2.00 Special Senses and     and Obesity
  Speech                    • 10.00 Multiple Body
• 3.00 Respiratory System     Systems
• 4.00 Cardiovascular       • 11.00 Neurological
  System                    • 12.00 Mental Disorders
• 5.00 Digestive System     • 13.00 Neoplastic Diseases
• 6.00Genito-urinary        • 14.00 Immune System
  System
• 7.00 Hemic & Lymphatic
  System
 Medical Listings for Mental
       Impairments

Require a medically determinable mental
 Impairment
 AND
Marked or Extreme functional limitations

Longitudinal Evidence is Vital to account for variations in
  functioning
           Functional Areas
Marked functional limitations in:
 Activities of Daily Living
 Social Functioning
 Concentration, Persistence & Pace
 Repeated episodes of decompensation,
  each of extended duration
  Marked-interfere seriously with ability to function
   independently, appropriately, effectively, and on a
   sustained basis.
Residual Functional Capacity

 Functional Capacity-The most the
  individual can do despite the functional
  limitations resulting from physical and/or
  mental impairments.
 Need Medical Evidence & Information re:
  Activities of Daily Living (SSA-3373)
Physical Residual Functional
          Capacity
Physical Exertion- ability to sit, stand, walk, lift,
  carry, push or pull for work-related activities
Do Manipulative & Postural Activities-reach,
  handle, finger, feel, stoop, balance, climb, kneel, crouch
  and crawl
Tolerate environmental conditions-
  temperature, humidity, hazards, dust, noise, fumes etc.
See, hear and speak
                    Exertion Levels
   Sedentary                  Light               Medium
• Sitting up to 6      • Walk or stand 6      • Walk/stand up
  hours a day            hours/day              to 6 hours/day
• Standing or          • Lift frequently      • Lift frequently
  walking up to 2       (2/3 day) up to         up to 25 lbs.,
  hours a day           10 lbs,occasionally     occasionally up
• Lift 10 lbs           up to 20 lbs.           to 50 lbs.
• Good manual          • Bend/stoop           • Frequent
 dexterity (usually)                           bending/stooping
  Mental Residual Functional
          Capacity
 Maintain concentration & attention at
  work.
 Understand, remember and carry out
  instructions.
 Respond appropriately to supervisors,
  co-workers, and usual work situations.
 Cope with changes in the work setting.
    SSA 3369 Work History
Job Title with dates worked
Job Duties—Main Responsibilities and
 Tasks Performed
Tools, Machinery and Equipment used
Knowledge, Skills & Abilities required
Extent of Supervision
Amount of Independent Judgment needed
Physical Demands
            Step 4
           Past Work
Does the claimant retain functional
 capacity to perform past work as he or she
 describes it?
Does the claimant retain functional
 capacity to perform past work as done in
 national economy (past 15 years)?
IF yes deny, if no proceed to Step 5.
              Step 5
            Other Work
 Use of Vocational Rules to direct decision.
 Residual capacity to perform other work
  ―transferable skills‖ ?
 Age- affects a person's ability to adjust to other
  work
 Education, ability to communicate in English,
  and literacy—the more you have, the more
  options there are for learning a new vocation.
Treating Source Evidence

          The claimant’s treating
           source is often in the
           best possible position to
           provide detailed
           longitudinal information
           about the claimant.
     Treating Source Report
A medical report from the claimant’s
 treating source should be detailed
 enough to determine:
  nature, severity and limiting effects of
   impairment
  probable duration
  remaining capacity to work.
      Essential Elements of a
    Medical Source Statement
Medical history (one year’s records for
 physical and two year's for mental
 impairments)
Clinical Findings, testing & lab findings
Diagnosis
Treatment
Medical Source Statement
Medical Source Statement
This statement describes the applicant’s
  ability to:
     stand
     sit
     lift
     carry
     walk
     handle objects
     hear
     speak
     travel
Medical Source Statement
Mental Impairment Reports
 This statement describes the claimant's
  capacity for:
   Understanding and memory,
   Sustained concentration and
    persistence,
   Social interaction, and
   Adaptation
How Clinicians Can Go Wrong
  Respond as if to other clinicians and SSA
   doesn’t fully understand the import of what is
   being said
  Say ―patient doing well, stable, no c/o‖ without
   explaining the specific circumstances of patient
  Do not fully document symptoms such as pain or
   fatigue
  Do not document functional impairments
        “TIPS” (MEDICAL)
Medical records should:
 Reflect client’s abilities and disabilities
 Be consistent with what is reflected in
  the documents to SSA/DDS
 AVOID: ―no c/o‖, ―stable‖, ―doing well‖
 INSTEAD: state specifics: ―SOB after
  walking one block, stops to catch breath
  after 20 minutes.
 Subjective information must have
  objective evidence to support
           TIPS (MEDICAL)
• Opinions—Do They Help?
• Helpful: There is significant swelling and
  loss of motion of the fingers that would
  limit ability to do work that requires fine
  finger dexterity.
• Not Helpful: The patient is totally disabled.
  OR The claimant cannot work as a
  secretary.
        Tips (Mental Health)
Be specific about symptoms & use
 examples
  Auditory hallucinations
  Delusions
  Intrusive thoughts
  Irritability
Provide information on any functional
 limitations
Document adherence to treatment
     Tips (Mental Health)
 Rather than: ―severely depressed‖ state
  ―he was very withdrawn. He rarely made
  eye contact. He sat slumped looking at
  the floor most of the time…‖
 Instead of saying ―there is no evidence of
  thought disorder‖ say ―there was no
  evidence of looseness of association,
  circumstantially…‖
  Medical Documentation
         Needed
Hospital records (Physical—one year;
 mental two years)
Outpatient/Clinic Notes
Psychiatric/Psychological Records
Laboratory Studies/Radiology/Pathology
 Reports
Treating Source Notes/Letter
Capability
       Drug & Alcohol Use
If impairment primarily due to
 substance use SSA will deny claim.
However, if has irreversible adverse
 effects from drug/alcohol use (cirrhosis,
 OBS etc) then claim may be allowed.
If would be disabled based on another
 impairment even without substance
 use claim may be allowed.
   Treating Source & DA&A
Address any medical evidence of
 substance abuse
State whether impairment would resolve if
 substance abuse ended; if unknown ok to
 state that as well
Report all irreversible adverse effects
Attempt at self-medication
Payee Recommendation
Why DDS Obtains Consultative
       Exams (CE’s)
The evidence already received is not
 sufficient to support the determination.
Necessary evidence is not available from the
 treating source.
A conflict must be resolved
 and DDS has been unable
 to do so by re-contacting
 the treating source.
Continuing Disability Review

 The timing of the review is determined by
   - the nature of the impairment
   - the severity of the impairment
   - likelihood of improvement
 Medical Improvement Standard
 Current disability
   Speeding up the Process
      How You can Help
Provide Contact Person (on 3368)
 –need name, address & phone #.
 Need an English speaking contact
 if claimant does not speak
 English.
Report change of
 address/phone#, new treatment
 and new medical conditions
     Speeding up the Process
       How You can Help-2
SSA-1696 Appointment of Representation
 Assists with all aspects of the application
 Allows communication with SSA and DDS
 Receives copy of all correspondence sent
  to claimant
 Representative held to higher standard
  than claimant
 Speeding up the Process -3

Supply copies of your client’s medical
 records for prior 12 -24 months
Provide as much information as
 possible re: treating sources
 (3368)
Release of Information Forms
 (827)
  Speeding Up the Process-4
Inform DDS of transportation or other
 problems that may interfere with attending
 a Consultative Examination
Keep the appointment
If unable to keep the appointment, inform
 DDS immediately.
    Evidence from Claimant
ALWAYS RESPOND TO REQUESTS
 FOR EVIDENCE—If you do not
 understand the request or need more time,
 CALL DDS
Activities of Daily Living (SSA 3373)
Description of all jobs performed during
 the past 15 years (SSA 3369)
Pain and other symptoms
Other information on case-by-case basis
    Electronic Records Express
"Embracing Technology to Deliver Benefits"
 SSA submits disability case and records brought
  to interview electronically to DDS
 Ask medical providers to send records
  requested by DDS electronically (fax or upload).
  MUST USE BARCODE sheet.
 Advocates can contact DDS for copy of barcode
  sheet to fax records directly to electronic file.
  Fax #: 866-452-5062
 http://www.ssa.gov/ere/
             Conclusion
You should understand:
Social Security Disability Programs
Social Security definition of disability
Social Security disability evaluation
 process
What type of medical and other evidence
 Social Security needs and why
What Advocates can do to assist
SSA using electronic records (ERE)
    For More Information:
ssa.gov (800-772-1213)
Disability Determination Services (DDS)
 303-368-4100 or 800-332-8087
DDS Professional Relations:
LaVonne Mercure 303-752-5676
 lavonne.mercure@ssa.gov
Iris Salladay 303-752-5738
 (electronic records)
Karen Nelson 303-752-5595
Learn More About SSA Disability

    Go online (ssa.gov) to find
     any of these pamphlets
        Disability Benefits
     Publication No. 05-10029
Supplemental Security Income (SSI)
    Publication No. 05-11000
      Benefits For Children
         With Disabilities
     Publication No. 05-10026
Questions
        15 Minute Break
Please join us for Session 2
Welcome Thomas A. Feldman –Attorney
At Law
 Social Security
Disability Claims:
 An Advocate’s
  Perspective

   Thomas A. Feldman
     Attorney at Law
      October 2008
   tfeldman@qwestoffice.net
      Case Progression
•   1. Initial application (DDS)
•   2. Hearing level (ODAR)
•   3. Appeals Council
•   4. Federal Court Appeal
•   SSA estimate for case to get thru federal
    Court appeal level: 5-7 years
      APPROVAL RATES
INITIAL (DDS) LEVEL …… 35%

APPEAL (ODAR) LEVEL… 60%
                Why?
•   Workload
•   Expertise
•   The Cases
•   Face-To-Face Contact
        ODAR Backlog
• Denver – 452 Days
• National Average – 529 Days
      EXPEDITING CASES
• On The Record (OTR) Favorable
  Decisions
• Dire Need
• TERI Cases
          OTR Decisions
• ODAR Attorney Advisor
• ALJ
             OTR Decisions -
              What Works
•   Undisputed Evidence
•   Simple Rationale
•   Credibility Not An Issue
•   Unusual Diseases
•   Attorney Judgment
           OTR Decisions –
            What Doesn’t
• Common Conditions
  – Back pain
  – Depression
• Conflicting Evidence
  – DDS Consultative Exam
  – Treating Physician Records
• Credibility Issues
      OTR – Success Stories
• Mental Retardation Cases
  – School Records
  – Current IQ Test Results
  – ―Something Else‖
                Dire Need
• ―…insufficient income or resources to
  meet an immediate threat to health or
  safety, such as the lack of food, clothing,
  shelter or medical care.‖
   Dire Need Success Stories
• Nursing Care
• Eviction
• Foreclosures
  Advice To Clients…

EXPECT A HEARING!!!
   Winning At Hearing
• Know The Client
• Medical Evidence
• Non-Medical Evidence
          Know The Client –
          The Initial Interview
•   Be Patient
•   Listen
•   Open Your Eyes
•   Forgive No-Shows
•   Follow Up Meetings
      Problems & Opportunities
•   Limited Work History
•   Lots of Jobs
•   Personality Disorders
•   Drugs and Alcohol
•   Somatoform Disorders
•   Obesity
      Medical Evidence
• Go To The Doctor!!!
 – Typical Clients
 – CEP Clients
         Medical Records
• Typical Client
• CEP Clients
          Medical Opinions
• Treating Physician Rule
  – Controlling Weight
  – Consideration Required
          Medical Opinions
• The ―Dreaded Envelope‖
  – From A Private Attorney
  – From CEP
          Medical Opinions
• ―My patient is unable to work.‖
    Issue reserved for the Commissioner
    Worthless
        Medical Opinions –
        Forms vs. Reports?
• Doesn’t Matter
• Functional Limitations
• Rationale Explained
  – Medical Signs/Findings
  – Symptoms
       Non-Medical Evidence
• School Records
  – Grades
  – Test Results
• Employer Records
  – Payroll
  – Attendance
  – Performance Appraisals
• Client Diaries
              The Hearing
•   Most Work Already Done
•   Claimant’s Testimony
•   Expert Testimony
•   Non-Expert Testimony
         Never Give Up!
•   2/14/06 ……Claim Filed
•   8/24/06…….Claim Denied
•   12/12/07…...First Hearing
•   1/16/08…….―New Evidence‖
•   4/15/08…….Subpoena The Doctor
•   6/30/08…….Supplemental Hearing
•   8/13/08…….Favorable Decision
          Bits and Pieces

• Attorneys’ fees structure: 25% back
  benefit IF case is won. No upfront
  charges. Sometimes can achieve longer
  back benefit period.
• Reopening old claims – possible but
  difficult.
      A CLOSING THOUGHT
• ―The moral test of government is how it
  treats those who are in the dawn of life,
  the children; those who are in the twilight
  of life, the aged; and those who are in the
  shadows of life, the sick, the needy and
  the handicapped.‖
                     Hubert H. Humphrey

								
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