Win Your Disability Hearing with Quikaid

Win Your Hearing

Most claimants are not awarded benefits at the Initial Application Stage or the Reconsideration stage. In fact, most successful claimants are awarded benefits at a Hearing with an Administrative Law Judge. Accordingly, the Hearing itself is critical.

The Key To Winning Your Hearing

The best way to win your disability hearing is to be prepared for it, of course! While the Hearing itself is critical, the time leading up to the Hearing is arguably more important than the Hearing itself. Generally speaking, the wait time between requesting a Hearing and the Hearing itself is between 4 months and 16 months, with an average of approximately 10 months. It is during this "waiting" time that a case can be strengthened to the point where the Hearing itself is a mere formality. During the wait for a Hearing, a successful claimant will:

1. continue to receive medical treatment for her disabling conditions;
2. maintain regular contact with Quikaid to ensure we are "on the same page" as the case is being developed;
3. ensure contact information is up-to-date with Quikaid so that we can contact you as-needed;
4. ensure the claimant walks the "straight and narrow" - i.e., do not get in trouble with the law, do not do anything that might compromise the credibility of your claim. If all of these things are done, the likelihood of a favorable adjudication at the Hearing increases significantly.

At Quikaid, we "coach" you throughout the process to ensure your case is fully prepared and you, as the Claimant, are fully prepared for the Hearing itself. The Hearing can be emotional, as it generally delves into highly personal matters such as your family history, your work history, your income history and the details of your medical and health history. And, of course, there is much at stake. As we prepare for your Hearing, we speak with you several times to ensure we fully understand the details of your past and present situation, so that we may present your case in the most accurate and convincing manner. We instruct you on every detail - from what to wear to the Hearing, how to behave during the Hearing, what points to emphasize, de-emphasize, avoid, etc. All of this instruction is designed to ensure your comfort throughout the process, as well as a favorable outcome.

The Hearing Itself

The Hearing itself is conducted in an administrative court called Office of Disability Adjudication and Review ("ODAR"), which are often co-located with local SSA field offices, although typically the "Hearings Offices" are physically located on a separate floor or in a separate wing of the SSA office. The ODAR courtroom is generally small in size, more like an office than a "regular" courtroom. Disability Hearings are not open to the public. The Hearing itself can last anywhere from 15 minutes to 1 hour, depending on the complexity of the case. For straightforward cases with strong medical support, the Hearing is a formality and is, therefore, short in duration. For more complex cases with, for example, conflicting or inconsistent medical evidence, the Hearing may continue beyond 1 hour. In our experience, the average Hearing lasts approximately thirty minutes from beginning to end.

Who Attends the Hearing and What Are Their Roles?

There are generally four to six people present at a disability Hearing:

1. yourself as the claimant;
2. your Quikaid representative;
3. the Administrative Law Judge ("ALJ");
4. the Hearing reporter;
5. a Vocational Expert ("VE"), if the ALJ elects to have one in attendance, and
6. a Medical Examiner ("ME"), if the ALJ elects to have one in attendance.

The Hearing generally starts with the ALJ providing opening remarks and admitting the case file into evidence. The case file contains all of the forms, questionnaires, medical evidence, etc., that have been assembled related to your case since the Initial Application stage. Case files are generally anywhere from 100 pages to 1,000 pages, depending on the quantity and detail of the medical records. The ALJ reviews this information throughout the Hearing, which is why ensuring a complete, consistent and accurate case file is imperative. Depending on the ALJ's style and preference, she may start the questioning of the claimant directly, or she may ask the claimant's representative for an opening statement introducing the claimant, followed by direct questioning of the claimant. Questions can range from the mundane, such as confirmation of your name, address, date of birth, education level, etc., to the more serious questions related to your past work and your medical history.

Questions related to your work history are intended to give the ALJ a sense of how physically or mentally demanding your past work was, so that she may assess whether you can perform this type of work in light of your medical conditions. Obviously, if the ALJ believes that you can still do your past work, then she will find you not disabled. If, however, she determines that you cannot do your past work, she will then explore whether there is any work that you could do (that you have not previously performed) in light of your medical conditions. If you cannot perform any work due to your medical conditions, a favorable adjudication is made. She takes many factors into consideration in this analysis, including most importantly your age, education level and prior work experience.

At the Hearing, the ALJ reviews all of the information in the case file to assess its veracity. In addition, the ALJ can call on the expertise of a Medical Expert ("ME") during the Hearing itself. The Medical Expert is a doctor utilized by the ALJ to review the entirety of the medical evidence and to summarize it for the benefit of the ALJ. The ME can testify either in person or via telephone, regarding the following important matters:

1. Determining whether a medically-determinable impairment exists.
2. Determining whether the impairment meets or equals a medical "listing".
3. Providing information related to the limitations imposed by the impairment.
4. Concluding whether the alleged onset date is valid, or whether the medical evidence supports a different onset date of disability.
5. Providing a prognosis to ensure the duration requirement of disability is met - i.e., the disability must last 12 consecutive months or more or must be likely to result in death for a favorable adjudication to be made.

In addition to the Medical Examiner, the ALJ can, again at her discretion, call on the testimony of a Vocational Expert ("VE"). The role of the VE is to determine whether someone with the claimant's medical conditions, age, education level, etc. could perform work the claimant has previously performed ("past relevant work" or "PRW"). If a hypothetical person could not perform the claimant's PRW, the VE then determines whether there is any work this hypothetical person can perform if they had medical conditions materially similar to the claimant's. The ALJ may present hypothetical scenarios that are similar to the claimant's situation and question the VE regarding whether a person with similar mental or physical impairments could perform work in light of those impairments. It is critical at this time to have strong representation, as your representative has the opportunity to cross-examine the VE to ensure that all of your impairments and related limitations are presented in the hypothetical scenarios presented by the ALJ.

Ultimately, the questions posed during the Hearing are attempting to assist the ALJ with the requirement that she complete the 5-step sequential evaluation process:

1. You cannot be working above a substantial, gainful activity ("SGA") level, which is generally approximately $1,000 per month. The ALJ, therefore, questions your past and present work situation.
2. You must have one or more "severe" impairments that limit your ability to work. The ALJ can review this in the case file, or enlist the assistance of a Medical Examiner.
3. If your impairment meets or equals a medical listing, you are disabled. A "listing" is framework used to evaluate each major bodily system, including mental and physical conditions. However, if your impairment does not satisfy a medical listing, the evaluation continues to Step 4. The ALJ determines whether your impairment meets or equals a listing, or relies on the expertise of the Medical Examiner for this purpose.
4. You must no longer be able to perform the type of work you have done in the past, due to your impairment. The ALJ reviews your work history and considers it in light of your medical impairments, and can rely on the testimony of the Vocational Expert to ensure an accurate assessment.
5. You must not have the ability to perform any other work based on your age, education and work experience, due to your impairment. Again, the ALJ can make this determination or solicit the input of the Vocational Expert for this purpose.

It is critical to have strong representation during your disability Hearing. At Quikaid, we are Hearings experts, having conducted 1000's of Hearings since our inception in 1993. We understand the framework of the law, the structure of the Hearing itself, and the key points to make to ensure a favorable outcome. If you need help with an upcoming disability Hearing, contact us today to ensure you have the best representation possible at your upcoming Hearing.

What Happens After The Hearing?

We review the Hearing with you immediately following the Hearing itself. On occasion, the ALJ will provide a verbal (or non-verbal) indication of her intent to award disability benefits at the conclusion of the Hearing itself. More typically, however, the ALJ does not indicate at the Hearing whether she will adjudicate favorably or unfavorably. At Quikaid, we do extensive research on each ALJ and understand his or her tendencies. Accordingly, we generally, have a good "sense" of whether benefits will be awarded following the completion of the Hearing itself.

Whether we have a strong indication or no indication, ultimately the adjudication is made in writing by the ALJ. Generally speaking, we receive notification of the outcome of the Hearing between 30 days and 90 days following the Hearing itself. The delay is due to the requirement that the ALJ document the details of her findings related to your case. This is done in painstaking detail, covering every aspect of your disability claim - from your work history, to your medical records, to the details of the Hearing itself. Often a written decision can exceed 10 pages in length. The document must be reviewed by a staff of writers before it is released to the claimant and your representative. At Quikaid, we remain in constant contact with the ALJ's staff to ensure they have all of the information needed to write and deliver a timely adjudication.

Following the receipt of the "Fully Favorable" written adjudication letter [click for a sample] , Quikaid begins the process to ensure you are "set up" to receive benefits. This includes conducting a resource review meeting with your local SSA office (to determine Supplemental Security Income, or SSI, eligibility), ensuring your bank information is provided accurately to SSA to enable direct deposit of benefit monies, ensuring your Medicaid or Medicare benefits are activated when they should be, etc. At Quikaid, our job is not done until you actually receive your benefits!

What Happens If I Lose My Hearing?

In the unlikely event that you receive an Unfavorable ruling following your Hearing, we continue to work hard on your behalf to ensure the correct course of action is taken and the desired outcome ultimately achieved. If we believe the ALJ has erred in her determination by omitting or minimizing important facts of your case, we will encourage you to allow us to file an Appeals Council action on your case. At this stage, the Appeals Council (a section of the Social Security Administration, based in Baltimore, Maryland) will review the entire case, including a recording of the Hearing, and will determine whether:

1. the correct decision was made in light of all relevant facts
2. the ALJ made a material mistake in the analysis of the facts of the case, and the case should, therefore, be remanded back to the local ODAR office for a subsequent Hearing, or
3. the ALJ's decision was so clearly in contrast to the evidence presented such that the ruling itself is overturned by the Appeals Council, and a favorable adjudication is rendered.

It is difficult to know with certainty at the outset of a case exactly how it will play out. There are many variables outside our control - how capable are the caseworkers at DDS? How compassionate is the ALJ? How supportive are your doctors? Despite the uncertainty inherent in the disability process, you can be certain that you will have exceptional, hard-working and smart advocates "in your corner" throughout the disability process. We will work hard and earn your trust and confidence every day until a favorable determination is made and you start to receive the benefits you need.