When applying for Social Security Disability, patience is the key. Even with the help of a disability attorney or non-attorney representative the process takes months to years. Like Workers’ Compensation or other disability programs, evidence is compiled on an ongoing basis and there are multiple levels of appeals.
Most people who apply for disability have non-severe impairments that are not life-threatening. For a small minority, Compassionate Allowance(CAL) may be applied to the claim, expediting it and resulting in almost certain approval. But most claims aren’t surefire and require tenacity and an investment of many months, from first applying to the disability hearing stage.
Most of the application process time will be spent waiting, but we provide a few tips on how to make it less stressful. The best way to apply is to get assistance, either with a disability attorney, professional representative, or knowledgeable family member.
A little over forty percent of all applicants do receive benefits, but while only a third are approved at the initial level, over two-thirds are approved after stepping before an Administrative Law Judge. A disability attorney who has been involved throughout the process can be especially supportive during court proceedings.
Because applying can take years, the financial burden of being unemployed isn’t quickly or easily remedied. It is important to have realistic expectations about time and effort when applying for benefits, especially for those with limited income.
Table of Contents
- 1 The Initial Application
- 2 Reconsideration
- 3 Hearing
The Initial Application
When first applying, the process can seem intimidating. This is why many people chose to get help from an experienced disability attorney, or a licensed non-attorney representative. Even establishing a positive relationship with Social Security office claims representative can make a big difference in how smooth or rocky the application process is.
If you have ever dealt with the Veteran’s Administration (VA), health insurance companies or Workers’ Compensation, you will understand the intricacies of the bureaucracy involved. While SSA has streamlined many of its services, and there are copious amounts of written information online, many people choose someone to help them navigate the system.
First Step: Help, or Not?
If your first step is to find a disability lawyer or representative, there are plenty of resources available locally in most cases. Getting help requires no up-front payment, and free evaluations are the norm. Lawyers and other representatives are paid when, and if, you receive benefits.
Once you’ve found a representative, he or she will walk you through the process and ask for specific documentation. Although it is possible to read all about the application process online, having a person answer questions is a plus because the process of getting social security disability benefits can be long and complicated, and it is impossible to know beforehand if your claim will be approved initially, or after an appeal process.
Applying On Your Own
If you choose to apply on your own, the application process begins online. Through the SSA website portal, you will enter your contact information, social security number and other personal information. The SSA provides a checklist clarify what information you should have on-hand.
The local Social Security office will contact all applicants and schedule an interview, but the online SSA application process cuts the interview time at the local office by half. At the local office, workers determine whether you will qualify for benefits under Title 2 (SSDI), Title 16 (SSI), or both. The more information you have, the faster and more productive the meeting with the claims representative is.
Some people choose to visit the Social Security office with a family member for support, especially during the initial claim application process.
Disability Determination Services (DDS)
The local office sends all your information in a case file (including whether you are eligible under Title 2 or Title 16) directly to an office called Disability Determination Services (DDS), where the medical decision is made. At this office, a Disability Examiner (DE) reviews your medical records, requests and compiles additional medical evidence, consults with an in-house Medical Consultant (MC), and uses SSA rules to decide if the facts support a denial or allowance.
The DE may contact you for additional information relating to your medical records or work history. Be sure to call the DE at least once (or have your attorney do so) and make sure the DE has your most recent phone number on file.
Every state has its own DDS that, typically, processes claims for that state only. Most big cities have a DDS office, although they can be hard to locate. If you have a disability attorney, they will call the DDS to check on your case’s progress and query the DE for any information related to your claim.
How Your Claim Is Managed
At the DDS office, the DE and MC are the people who manage the disability determination process, but they are working within a system of complex rules and have little personal influence on the claims process or decision. Your claim will be reviewed by an MC who specializes in a specific medical condition. For example, claimants who allege back pain and anxiety will have their claims reviewed by an orthopedic (bone) doctor and a psychologist.
The DE, who is the manager for your claim and the person to contact, also reviews the kind of work you have done. For SSDI claims that depend on work history, your past work can determine what kind of work you are qualified for now. Does your disability keep you from your usual work as, for example, a structural steel worker? The DE will evaluate whether you might be able to adapt to a new kind of work.
The Residual Functional Capacity (RFC)
The information a DE uses includes medical history, like medical tests and doctor’s notes. This information is collected, analyzed and summarized, then shared with the MC – either doctor or psychologist, or both – who uses professional experience and judgment to determine what is termed “Residual Functional Capacity” (RFC). In other words, the MC decides what you can still do. What work functions are you able to perform, despite being limited by an impairment?
The RFC is a critical part of the disability claim process. We will explain more about it in future articles, but for the sake of the disability application process, be aware that deciding if someone can engage in SGA (substantial gainful activity, or full-time work) is based substantially on the RFC.
When the DDS Makes Its Decision
Once medical evidence is collected, or an additional medical exam is scheduled and completed, the disability evaluation is concluded and the claim is sent back to the local Social Security office as a denial or allowance. The local office sends the claimant a letter of denial and approval. If approved, funds are often automatically deposited in the claimant’s account.
Although it is possible to make a phone call to the DE while he or she processes your claim, the main contact throughout the disability application is the local Social Security office which represents the Social Security Administration, or your disability attorney. The DE cannot, by law, tell you of the decision at any point in the process.
Since only about one of three individuals is approved at the initial level, there is an appeal process that begins with resubmitting the original (initial) claim. Even if nothing has changed, and there is no new medical evidence, the resubmitted to the DDS is mandatory.
Benefits of Reconsideration
There are three reasons why Reconsideration (“Recon”) may help you. At the Recon level, your social security disability claim is reviewed by a new DE and a new MC. This means if there was bias or incomplete work, a new set of eyes could result in approval. The new DE and new MC are the first two reasons why Recon could change the decision, but the next is the medical evidence.
Social Security Disability Insurance is based on medical evidence and work history. If the initial claim was denied because the MC judged the medical impairment as less severe, new medical evidence including recent tests and doctor’s notes could change the outcome. Even one new test showing a worsening in condition can make a difference. It is likely the new DE will contact you to update medical records.
Problems with Reconsideration
The usual complaint about Recon claims is that, since fewer than 15% of initial decisions are reversed, the Recon process takes months but usually results in another denial. Although the Recon, theoretically, should be faster it usually takes about the same amount of time as the initial claim – three to four months.
The Hearing level of the appeals process is where odds for gaining approval go up a bit. At this stage, many applicants we’ll have spent at least six months (often longer) seeking social security benefits. At every stage, the information from each prior stage is saved in the casefile, so only new information – usually medical evidence – is added. At the Hearing level, having a disability attorney is especially beneficial.
The Administrative Law Judge
After a Recon claim is denied, claimants may submit their claim to an Administrative Law Judge, or ALJ. The only type of claim the ALJ reviews is disability appeal cases, so he or she is an expert at how the law applies to the specific case. The average wait times for getting a case heard before an ALJ range from ten to twenty-three months, depending on the jurisdiction.
Advantages to ALJ Review
By the time the claim has reached ALJ level, the claimant – whether represented by a disability attorney or not – is experienced, and will notice several differences in this next step. Some advantages of the ALJ review include:
- Case is reviewed by one individual
- The ALJ process makes allowance less burdensome than denial
- The claimant is seen in person, before the ALJ
- Statistically, the ALJ approves almost 75% of claims
- ALJs are more concerned with legal than medical requirements
If an ALJ rejects a disability claim, there is an Appeals Council that will review the ALJ decision. The claimant (or his or her attorney) has 60 days to file an appeal. The single purpose of the Appeals Council is to determine the quality of the ALJ decision. One of the three possible outcomes may occur. The Appeals Council may:
- Reject the request for review
- Remand the case back to the ALJ for further review
- Make a determination to allowance, resulting in an award of disability
If the Appeals Council takes option one, the next step for the claimant, who by now usually has hired an attorney, is Federal District Court. In the case of option two, which occurs in about 22% of cases, the claimant will go through the ALJ process again.
Only about two percent of claims are approved by the Appeals Council, but the average time for this level of review is 345 days from the time the claim is received.
Federal District Court
The last stage of appeals is taking the claim to Federal District Court, where only one percent of all disability claimants’ end up. In court, a lawyer is almost a necessity, as the proceedings do not include review of the existing file, with all its evidence from initial to Appeals Council stage. Instead, briefs about your case are filed and a judge listens to oral argument. The judge makes a decision, and there are three possible outcomes:
- The Appeals Council decision is upheld
- The case is remanded back to the SSA
- The judge decides to approve benefits
At this level, about 70% of claims are approved, although in many cases they are awarded benefits after the SSA does further investigation. The Federal District Court typically takes a full year to adjudicate their cases, and there is a filing fee to do so (although claimants can request that the fee be waived).
Completing the Process
During the disability process, an applicant can choose to get help with an attorney or can refile an initial claim. The most successful stage for approval of SSDI benefits is at initial level and again at ALJ level. Continuing to appeal and apply have no downsides, except the time invested.
Hiring an attorney is a recommended way to get started, especially since each state has specific rules for the appeal process. Whichever foot you decide to put forward, the application process has specific steps to gain the benefits you are entitled to.