Social Security Disability Claims Process Explained by Experienced SSD Attorneys

On this page, our social security disability lawyers will explain the somewhat confusing claims process to help you better understand how it works. In 2004, the average processing time for a social security disability claim - not counting appeals - was 120 days. The actual time it takes to process your claim may be more or less based on:

• the state in which you live
• the nature of your disability
• how quickly Social Security can obtain medical evidence from your doctor or other medical source
• whether it is necessary to send you for a medical examination

To help disabled people understand the claims process better, our social security disability lawyers have provided this general outline of how the claims process works:

• Diagnosis of a Medically Determinable Impairment
• Initial Application
• Hearing
• Appeals Council
• Federal Court Review

Diagnosis of a Medically Determinable Impairment

A medically determinable physical or mental impairment that results from anatomical, physiological or psychological abnormalities, which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings- not only by the individual's statement of symptoms.

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Initial Application

If you are disabled and cannot work, you can apply for Social Security Disability or Supplemental Security Income benefits as soon as you become disabled. You can apply for benefits by contacting the Social Security Administration.

Certain qualifications exist for each type of Social Security benefit program. You must check with the Social Security Administration to see if you qualify to receive these benefits.

• Approval of Benefits
  If you apply for Social Security Disability benefits and are approved, benefits will not begin until the sixth full month of disability. This waiting period begins with the first full month after the date the Social Security Administration decides your disability began.
  
  If you apply for Supplemental Security Income (SSI) benefits and are approved, the benefits are paid for the first full month after the date you filed your claim or the date you become eligible for SSI (whichever is later).
• Denial of Benefits
  If you are not approved for Social Security benefits and believe you are disabled, there are several levels of determination for Social Security Disability benefits. You have 60 days to appeal a denial to reach the next level of determination.
  
  If you fail to appeal a denial within the allotted time frame, you may reapply for Social Security Disability benefits or Supplemental Security Income. Please note: ‘appealing’ and ‘reapplying’ are not the same thing. Reapplying will mean that you have to start the process over again.
• Reconsideration
  In Ohio & West Virginia, a denied application is reviewed under "Reconsideration". A reconsideration is a complete review of the claim by someone other than the individual who made the original decision. All evidence, plus any additional evidence submitted, will be re-evaluated and a new decision will be rendered (the average processing time is 3 to 4 months). If an individual disagrees with the reconsidered decision, they can choose to go to the next level of the appeals process.

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Hearing

The average scheduling time for a hearing is 6 to 12 months. Your social security disability lawyer will meet with you prior to the hearing to discuss specific details of your case and to go over questions typically asked at the hearing. You will have an opportunity during this time to ask any questions that you may have about the hearing process.

You and your lawyer may come to the hearing and present your case in person.

• Please note: The hearing is a rather informal procedure, so there is no formal dress code. In other words, you do not need to wear your best suit of clothes. However, you should refrain from wearing sweatpants, sweatshirts, shorts, t-shirts, tank tops. Use your best judgment on how to dress for the hearing, keeping in mind that you will be going before a Judge and you want to appear respectful.

The hearing will be conducted by an Administrative Law Judge (ALJ). During the hearing, you will be asked basic background information regarding your education, work experience and your current medical treatment. You will also be asked to explain the symptoms and limitations you have because of your medical conditions, and how they keep you from working. This information will be the basis of your hearing and should be the only information on which you should focus.

In order for an Administrative Law Judge to determine whether you are disabled, a five-step evaluation must be preformed.

1. If you are performing substantial gainful work, you are not disabled.
2. If you are not performing substantial gainful work, your impairment(s) must be severe before you can be found to be disabled.
3. If you are not performing substantial gainful work and you have a severe impairment(s) that has lasted, or is expected to last, for a continuous period of at least 12 months, and your impairment(s) meets or medically equals a listed impairment, you are presumed to be disabled without further inquiry.
4. If your impairment(s) does not prevent you from doing your past relevant work, you are not disabled.
5. Even if your impairment(s) prevents you from performing your past relevant work, if other work exists in significant numbers in the national economy that accommodates your residual functional capacity and vocational factors, you are not disabled.

You may have been told that a Vocational Expert will testify at your hearing. A Vocational Expert is asked by the Judge to testify about your work history and how your medical problems could keep you from working. The Vocational Expert is there only to give their opinion; they do not make the decision in your case.

The Judge will not issue a decision on the day of the hearing. The Judge will issue the decision after evaluating all the evidence on record, plus any additional evidence brought to the hearing. You will not learn the outcome of your case until a long, written decision - a "Notice of Decision" - is issued to you and your social security disability lawyer at the same time. Your lawyer will not know the outcome of your case any sooner than you will.

In addition, your legal counsel cannot predict how the Judge will rule. Typically, it takes the Judge two to six months to issue a decision. These long waits occur mostly because of the tremendous backlog of cases pending at the Hearing Office.

If you disagree with the hearing decision, you can choose to go to the next level - the Appeals Council.

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Appeals Council

The average processing time for the Appeals Council is 18 to 24 months. The Appeals Council can choose to do any of the following:

• review your claim and render a decision
• choose not to review your claim
• remand your claim to the Administrative Law Judge for further consideration

You and your social security disability lawyer will receive a copy of the Appeals Council decision or a copy of the Order sending it back to the ALJ for further consideration.

If you disagree with the Appeals Council, or if the Appeals Council refuses to review the case, you can pursue your case in Federal Court.

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Federal Court Review

If you exhaust all administrative appeals, but wish to continue pursuing your case, you may file a civil suit in Federal District Court and eventually appeal all the way to the United States Supreme Court.

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