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Navigating Through The Social Security Disability Claims Process

Navigating Through The Social Security Disability Claims ProcessA claim for Social Security Disability benefits could take anywhere from 6 months to 6 years! During that time, the claimant will have to complete an application, and possibly navigate his or her way through 3 levels of appeals at the Social Security Administration (SSA) and another 3 levels in Federal Court. What follows is an explanation of the major steps along this arduous path.

Application for Disability Benefits

Three forms are required to be completed to start the claims process for Social Security Disability Benefits: a Disability Benefit Application, Adult Disability Report, and a medical release form. These forms can be obtained at your local SSA office. However, SSA would much rather you apply online. While you can use an attorney to assist you at this stage of your claim, one is not required. In my experience, most individuals apply for benefits without an attorney and seek representation if their claim is denied.

The information requested in these forms falls into four basic categories:

  • work history
  • educational background
  • medical conditions, and
  • medical providers’ names and address.

With this information, SSA will open an official claim and begin the process of evaluating disability.

Disability Determination Services

Once a claim is initiated, SSA transfers your case to a state agency which gathers the evidence and makes the initial determinations as to disability. In Maryland, this state agency is known as Disability Determination Services (DDS) and is located in Timonium. A primary function of DDS is to request your medical records from the medical providers you identified in your initial application for benefits. If DDS finds that the medical records are lacking in some respect, they may scheduled an appointment with a doctor selected and paid for by DDS. This is called a “consultive examination.” This doctor will not provide treatment to you and will typically not provide any information to you. DDS will evaluate the medical evidence received from your medical providers along with any consultive examinations to make their determination. This process from completing the application for benefits to the initial determination usually takes between 3 to 6 months.

Despite what many believe, about 40% of the initial applications are approved at the DDS level. Why are the other 60% rejected? Please refer to my first post 3 Reasons Your Claim Was Denied.

Reconsideration

If your initial claim is denied, you have 60 days to file an appeal, a Request for Reconsideration. This is the juncture at which most people seem to hire an attorney. Two forms need to be filed to perfect the appeal: a Request for Reconsideration and an Adult Disability Report – Appeal. In the Request for Reconsideration form you indicate that you want an appeal and a brief reason. I say “brief” because the form itself only allows for a couple sentences. In the second form you note any changes in medical conditions or providers since the initial application.

Upon receipt of the 2 forms, your case is again transferred back to DDS. If additional medical treatment or providers were listed on the disability report, DDS will request those additional medical records. DDS may again schedule a consultive examination. A different person (or people) will evaluate your case. The decision usually takes another 3 to 6 months from the filing of the Request for Reconsideration. In the overwhelming majority of cases, the reconsideration is usually denied, usually for the same reasons.

Hearing

As with the last appeal, the Request for Hearing must be filed within 60 days from when the reconsideration was denied. Along with the request, another Disability Report must be completed with new conditions, treatment, and/or medical providers. Upon receipt of the required forms, your case is transferred to your local Office of Disability Adjudication and Review (ODAR). Once at ODAR, the case is assigned to a federal administrative law judge. That judge’s assistant requests the additional medical records necessary to bring the evidence up to date. Many times an “Attorney Advisor” will review the file to determine whether a hearing before a Judge is needed. In some cases the Attorney Advisor will issue a favorable decision without the need for a hearing.

If your case goes to a hearing, that hearing usually takes place within 9 to 12 months from when the Request for Hearing was filed. The hearing will be conducted by a federal administrative law judge. This hearing is your first (and potentially last) opportunity to actually testify. All the prior decisions were made solely on the basis of a document review. As you can imagine, the hearing level is very important as it is your opportunity to speak to and argue your case to the person making the decision.

Sometimes the judge will issue a decision from the bench. More often, though, the Judge’s decision comes in writing within 30 days. If you were adding up the time it takes at each of the stages, you will see that if the case goes to a hearing, a decision in your case could easily take 2 years from the initial application.

Post Hearing Appeals

And still there are more levels of appeals. The judge’s decision can be appealed to the SSA Appeals Council within 60 days. The Appeals Council will review the evidence (including a transcript of the hearing) and decide whether an error of law was committed. It can take a very long time, some times as long as 2 years, to get a response from the Appeals Council. If the Appeals Council does not reverse the judge (or remand it for another hearing), the case can then be appealed to United States District Court, then to Circuit Court, and potentially even to the United States Supreme Court.

On a final note, it is very important to be aware that all of these appeals are on the record. This means that even though your case may take 6 years with 3 SSA appeals and 3 federal court appeals, your hearing in front of the administrative law judge was your one and only opportunity to speak to the person making the decision and explain the nature of your disability.

By David Galinis

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