Un camino claro a través de su proceso de recuperación

Social Security Disability Insurance (SSDI) is an insurance program. Every worker is required to have about 7.5% of their earnings withheld for Social Security, and the employer contributes an equal amount. To be eligible for SSDI a worker needs to have 20 "quarters" (each quarter is 3 months) of a minimal level of contributions out of the last ten years (having worked and paid in 5 of the 10 years prior to becoming disabled). The amount of disability benefits is determined by the amount of earnings the worker has made during the 20 quarters. In contrast, Social Security Supplemental Insurance (SSI) is a welfare program where people who have not worked enough to be eligible for regular Social Security disability can receive benefits when disabled. There are certain requirements to be eligible for SSI, and the amount of benefits is limited. It is possible to be eligible for both SSDI and SSI benefits. Benefits will be paid back to the time the medical / mental health condition caused the person to become disabled, but only after the claim has been approved. Since this can take months to years (see below), the claimant will eventually be paid a large retroactive benefits check after finally being approved but will not receive benefits until the claim has been approved.

The criteria for being determined disabled is the same for SSDI and SSI, and require that the person be totally disabled, not partially disabled as in workers compensation. There are two ways to be determined eligible: meeting certain regulations for each type of disability automatically makes the person eligible; or a second way where the medical / mental health disability doesn't meet those criteria but does meet additional criteria relating to the type of job, education, and other things that are taken into consideration.

SSDI and SSI require an initial application, which is completed at a local Social Security District Office or online/by phone. That application is reviewed by a "state agency," which is a local state office contracted by the Social Security Administration (SSA) to review and either approve or deny disability applications. Only about 2% of initial applications are approved. If denied, a claimant can then request reconsideration, which is reviewed by the same state agency. Only about 2% of reconsiderations are approved. If denied, the claimant can request a hearing before a Social Security administrative law judge (ALJ). [It is important that there are very strict time limits to request a reconsideration after an initial denial and to request a hearing after denial of a reconsideration]. It usually takes many months before a hearing is scheduled. Less than half of the people who go to a hearing will have their application approved (called a "reversal" since it reverses the earlier denial of benefits). Having a good attorney can make a real difference. In his prior practice Dr. Kelly was highly successful in winning Social Security / SSI disability cases.

While an attorney/representative is not required for a hearing, if you have a good attorney, it can make a great deal of difference. For one thing, your file gets "flagged" as having an attorney and is given more careful attention by the hearing office staff and the administrative law judge. Unfortunately, many attorneys / representatives do not do a whole lot to help with the hearing because they know that a certain percentage of claimants will win no matter what they do. However, Dr. Kelly undertakes a very active role in the claims he represents. This includes:

1. 1. Obtaining medical records (sometimes Social Security is unable to obtain all records or may not have the latest records).
   2. Directly requesting medical and mental health providers complete other tests or evaluations that would be helpful (and being a doctor is quite useful in knowing what to ask for and in having the claimant's providers cooperate).
   3. Completing a comprehensive medical-legal review of records to understand the claimant's disability and then be able to explain it to the judge. Dr. Kelly's experience and knowledge from being a Social Security hearing office staff attorney, disability attorney, practicing medical doctor, and medical-legal evaluation examiner provide the basis for being able to knowledgeably do both the medical and legal parts of this.
   4. Often Dr. Kelly is able to obtain the claimant's medical and/or mental health providers' willingness to testify at the hearing or submit declarations about the claimant. This is important because Social Security disability law gives the highest importance to the actual providers.
   5. Dr. Kelly provides the hearing judge with a "pre-hearing brief," which concisely lays out the reason the claimant meets criteria for SSDI/SSI.
   6. Dr. Kelly will directly question the claimant at the hearing, paying attention to the information critical for the judge to make a favorable decision. Too often attorneys/representatives will just sit back and let the judge do the questioning because they are just not prepared adequately.
   7. Dr. Kelly will make legal "arguments" before the judge at the end of the hearing.
   8. If needed, Dr. Kelly submits an additional brief and/or medical records after the hearing to address any issues brought up by the judge during the hearing that were not addressed in the earlier pre-hearing brief or medical record.
   9. In some cases, if the ALJ decision is not favorable, Dr. Kelly will continue to assist the claimant with an appeal to the national Social Security Appeals Council near Washington, D.C.