The Law Office of James P. Shea - Exclusively Dedicated to the Practice of Social Security Disability and SSI Law

323-954-9605   
The Claims Process


I. The Claims Process
     A. Application
     B. Denial
     C. Reconsideration
     D. Request for Hearing
     E. Preparing for Appeal

II. The Hearing

III. The Decision


I. The Claims Process

A. Application: For either Social Security or SSI, an application for disability benefits may be filed at the local district Social Security Office. Our office can assist you in filing a disability application in the appropriate cases, particularly if you have been disabled for at least 12 months with documented significant disability.

B. Denial: You should not become discouraged if your claim is denied at first. It is estimated that 80-90% of the applications are denied. This is an appropriate time for you to seek legal representation. Our office can discuss the circumstances of the case with you and give you an opinion of the merits of your claim. The earlier we start working on the case, the better chance we have of being successful.

C. Reconsideration: The next step in the process is the "Request for Reconsideration" from Social Security. After approximately three to four months, a decision will be reached on the Reconsideration request.

The case will either be granted benefits or denied. If the case is denied, it is then time to request a hearing before an Administrative Law Judge. This may involve another delay of approximately 1 year until the hearing.

In certain designated areas in the city, claimants who are denied at the initial level do not file reconsideration appeals. These are called “prototype cases,” and the reconsideration appeal step is eliminated. Instead, claimants must file directly for a hearing before an Administrative Law Judge.

D. Request for Hearing: At this stage in the process, it is critical to have competent legal representation to give you the best chance of winning the appeal.

E. Preparing for the Appeal: An important service of this office is to make sure that you have the right kind of medical and other evidence to give a true picture of your condition. If appropriate, we may refer you to specialists to examine you and may request reports from them. These doctors will give an honest appraisal of your disability. (of course, we do not guarantee that they will find you disabled).

If you are receiving Medi-Cal, we will attempt to obtain a comprehensive report from your own doctor. Most doctors charge for preparing a report. If that is the case, we will discuss the fee with you before obtaining the report or referring you.

We will write to the doctors who have examined you, including your own treating doctor, to explain the Social Security regulations. Often times, doctors feel they are writing the kind of report which you need, but they may not understand what Social Security requires. It will be much more helpful to you if the doctor writes his report with the regulations in mind.


II. THE HEARING

The hearing is the most crucial stage of the appeal process, where the attorney's representation is most helpful. An Administrative Law Judge will preside and testimony will be taken under oath, but the hearing is generally somewhat informal. It is private, usually held in a small room with only the Judge and his assistant, you, your attorney, and possibly your spouse or a friend.

The medical records will be admitted into evidence. You will be asked questions, either by the Judge or by your attorney, which you must answer to the best of your ability or recollection. The Administrative Law Judge may call experts including "Vocational Experts" and "Medical Advisors," to testify about the possibility of training for a new job and the severity of the medical condition.

The attorney will prepare you thoroughly for the hearing, so there is no need to be apprehensive. Its purpose is to seek the truth and to carry out the purpose of the Social Security Act.


III. THE DECISION

The Judge will not announce a decision at the hearing, though we can sometimes tell from the general atmosphere of the hearing whether it appears that the decision will be favorable. A written decision will be sent to your lawyer and to you. It usually takes at least two to three months after the hearing to receive the decision, if not longer. You should always contact your lawyer after you have received a decision from the Administrative Law Judge.

If the decision is favorable, you should receive your first check approximately 8-12 weeks after the decision.

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