Protecting Your Client’s Financial Rights Now &
Prospectively
The Social Security Disability Law Office of Stephanie O. Joy
Why you need to recognize when Your Client has a
valid Right to Claim
II. How to recognize a Social Security-defined Disabled
Client
III. Prevalent Myths Debunked
I.
IV. The Two Federal Programs and How They Differ
V. The 5-Step Sequential Evaluation Process
VI. The Stages of a Properly Represented SSD/SSI Claim
VII. Hotspots
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RIB Repercussions of not claiming when able –
despite WC benefit or PI award
2. Earlier is often better than later
1.
a.
b.
c.
d.
Term Insurance
Remote DLI and evidence development problems
SSI possible but…
Back benefits limits
Securing a Protective filing date
4. Possible added evidence for a PI or WC case
5. Earlier Medicare coverage or Medicaid coverage
3.
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 The CFR: “The law defines disability as the inability to
do any substantial gainful activity by reason of any
medically determinable physical or mental
impairment 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.”
http://www.ssa.gov/OP_Home/cfr20/404/404-1505.htm
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1.
Inability to engage in substantial gainful activity
(CFR § 404.1572)
a.
2.
Medically determinable physical or mental
impairment
a.
3.
Catch 22: Doing it = Not disabled & SGA
Know your acceptable medical sources http://www.ssa.gov/OP_Home/cfr20/404/404-1513.htm#a
Expected to result in death or… of not less than 12
months.”
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Practical Tips
 Has your client been out of work due to medical reasons




(WC related or other)? - If Yes,Consider SSD.
Knowing his medical file, can you reasonably expect him to
be able to work 35+ hours a week in his old job now, or in
the very near future, on a sustained basis? - If No, Consider
SSD.
If back to work or going back to work, was he out of work
for over a year? - If Yes, Consider SSD (Closed case).
Have you considered all of his medical problems, not just
the ones involved in your case?
If he has not yet left work, has he indicated that working
the full day or full week is getting very, very difficult, due to
pain, fatigue, or other symptoms? – If Yes, Consider SSD
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1.
2.
3.
4.
5.
6.
7.
Permanency - Inability to work SGA need not be
permanent.
Durational requirement - The 12 month durational
requirement need not have passed already, to file, so long
as it is expected to last 12 months.
Part time work - that is not SGA is not inconsistent, per
se, with being disabled.
Unemployment Insurance claim - is not per se
inconsistent with a Social Security claim.
Illegal aliens - are not permitted SSD benefits.
SSD is not welfare.
Alcohol or drug abuse is not an absolute bar to disability.
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Social Security
Disability Insurance
Benefits
Supplemental
Security
Income
 Title 2 (SSD, SSDIB, DIB)
 Title 16 (SSI)
 Medicare
 Medicaid
 Insured status requirement and
 No Insured status nor work record
recent test
 Must be disabled as defined in the Act
 Income and resources are not factors
 Benefit amount is based on individual
lifetime SS earnings up to maximum.



 Dependent benefits

 Can work and earn minimally without

benefits loss.

requirement
Must be disabled as defined in the Act
Household income and resources
limitations apply
Benefit amount is capped at Federal
benefit/unrelated to earnings
No dependent benefits
Near all working will reduce SSI benefit
No waiting period
 Waiting period
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Is client working SGA? (If Yes, not disabled)
2. Is his medical condition “severe”? (If No, not disabled)
3. Does his condition meet a Blue Book Listing? (If Yes,
1.
Disabled; if No, what is his RFC?)
Can he do his prior work? (If Yes, not disabled)
5. Can he do any other kind of work? (If Yes, not disabled; if
4.
No, claimant is disabled)
http://www.ssa.gov/OP_Home/cfr20/404/404-1520.htm
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 Initial Representation Documents – at a minimum: SSA-1696,
Legal Fee Agreement (R) (sent by mail)
 Title 2 (SSD) claim – online for Title II or paper SSA-16-BK (R)
 Title 16 (SSI) – in person or phone interview or SSA-8001-BK (R)
 If paper claim, add Disability Report – Adult (SSA-3368) and
Work History Report (SSA-3369) (R)
 SSA Medical Authorization - (SSA-827) (R)
 Your firm’s HIPAA compliant release
continued
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 Your own specific RFC form – to obtain 1 or more MSSs
 Function Report (SSA-3373)
 Third Party Function Report (SSA-3380)
 Possible SSA ordered CE
 SSA orders medical records from sources noted on
Disability Report (online or paper) plus after-provided
medical providers
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Stages, B., continued
 NJ enjoys a Reconsideration stage (PA/NY do not)
 Represented claimants: Attorney must file Appeal online






(R)
Unrepresented claimants: paper SSA-561 (Notice/Request
for Reconsideration) & SSA-3441 (Disability Report –
Appeal)
New SSA-827 (R)
Deadline: 60 days + 5
May be another request for SSA-3373 or CE
SSA orders updated medical records
Order CD of claimant’s SSA file from local FO
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Stages, C., continued
 For Attorneys: Same as if denied on Initial, must file
appeal online for Appeal/Request for Hearing Before
ALJ
 Pro Se Claimants: May use paper forms: HA-501
(Notice of Appeal/Request for Hearing before ALJ),
SSA-3441 & new SSA-827
 Order updated medical records: SSA does not order
medical records; ODAR?...
 If no ERE/ARS access, request CD from ODAR
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 Attorney orders medical records updates, not the SSA
 Can charge client for the expenses/charges
 Prepare a pre-hearing brief
 Analyze option of a requesting OTR
 Prepare client/witnesses for the hearing
 Request that hearing remain open for ____
 Wait for written decision
 If denial after hearing, advise client on option of AC
appeal v. option of new application
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 Work related injury? - May be an offset to SS benefit
http://www.socialsecurity.gov/pubs/10018.html
 Workers Compensation settlement? - Medicare derived from
Social Security beneficiary status may not cover WC related medical costs
later – look into “set aside” requirements
http://www.cms.gov/Medicare/Coordination-of-Benefits/Workers-
Compensation-Medicare-Set-Aside-Arrangements/WCMSAP-Overview.html
 Veteran’s Pension? – May be reduced or eliminated upon receipt of
Social Security Disability
http://benefits.va.gov/PENSIONANDFIDUCIARY/pension/vetpen.asp
 Taxation? – Some portion of Social Security Disability may be subject to
income tax
http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/493/~/paying-incometax-on-social-security-benefits
 Unemployment Insurance benefits? – Not an automatic bar to
SSD or SSI, but be prepared for…
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 SSD case involving a Workers Compensation case can
result in No Attorney Legal Fee
 SSD case involving state welfare benefits, can result in
No Attorney Legal Fee
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 BlueBook of Listings
http://www.ssa.gov/disability/professionals/bluebook/AdultLis
tings.htm
 Program Operating Manual System (POMS)
https://secure.ssa.gov/apps10/
 Social Security and Acquiescence Rulings (SSRs)
http://www.ssa.gov/OP_Home/rulings/
 Code of Federal Regulations (sections 404 & 416)
http://www.ssa.gov/OP_Home/cfr20/
 Hearings, Appeals & Litigation Law Manual
(HALLEX)
http://www.ssa.gov/OP_Home/hallex/
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Stephanie O. Joy, Esq.
The Stephanie O. Joy
Social Security Disability Law Office
East Stroudsburg, PA 18301
www.MySsiCase.com
Ph: 201-317-0610
Fax: 888-550-7517
stephaniejoy@myssicase.com
Stephanie Joy is a 1989 Economics graduate of Rutgers University and 1994 graduate of Seton Hall Law School.
In her initial years of practice in New Jersey, Stephanie was a litigation associate in two New Jersey law firms,
practicing insurance defense, personal injury and family law. She started her Morris County New Jersey
general practice in 2000 and by 2005, after moving to Pennsylvania, made the decision to focus her practice
exclusively on Social Security Disability matters. She represents clients in most of the 50 states, with a focus on
those in the mid-Atlantic-to-northeast area. In addition to her practice, she provides Social Security
consulting services for 3 firms and a large internet-based corporation. She is a volunteer E-mentor to
Pennsylvania high school students, and in June 2013, participated in the American Cancer Society’s Relay for
Life of Stroudsburg, as well as the ALS Association’s Somerset NJ Walk to defeat Lou Gehrig’s Disease, in
Honor of her close friend, Morristown Sgt. Detective Elaine Stewart Tyrrell, who is currently contending
bravely with an ALS diagnosis. She resides in Stroudsburg, Pennsylvania with her husband and two children.
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