The SSD Claims Process Explained
Applying for Social Security disability (SSD) benefits can be a long and confusing process. The Social Security Administration (SSA) denies over three-fourths of initial applications, which means it's critical to understand the claims process and when you should talk to a lawyer.
The general order of the SSD claims process is as follows:
- Diagnosis of a 'Medically Determinable Impairment'
- Initial Application
- Appeals Council
- Federal Court Review
First, you're diagnosed with a physical disability or mental health condition that prevents you from working. Once you determine that you're eligible for SSD benefits, you submit an initial application. If you're denied, you can choose to begin the appeals process. If you don't receive a positive result at the hearing, you can move on to the Appeals Council, and then finally to the Federal Court.
If you applied for Social Security disability benefits and your claim was denied, don't give up. But you need to act fast – you only have 60 days to appeal.
Diagnosis of a Medically Determinable Impairment
To be considered disabled, a physician – preferably a specialist – must diagnose you with a serious medical condition. You must be undergoing treatment on a regular basis. Your condition must be diagnosed by laboratory or diagnostic tests that are accepted by the medical community.
The SSA will not consider you 'disabled' if you don't have an official diagnosis; symptoms alone are not enough.
If your condition prevents you from working and you believe you're eligible, you can apply for SSD or Supplemental Security Income (SSI) benefits. You can apply for benefits by contacting the Social Security Administration.
You will receive either an "Approval of Benefits" or a "Denial of Benefits":
- Approval of Benefits – If you are approved for SSD benefits, your benefits will not begin until the sixth full month of disability. The waiting period begins the first full month after the date the SSA decides your disability began. If you apply for SSI benefits and are approved, the benefits begin 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 your application is denied, don't worry. The SSA denies over three-fourths of initial claims, and many qualify for SSD benefits. However, you must act quickly. You only have 60 days to appeal. If you miss the deadline, you can reapply – but you'll start the process over again.
Reconsideration – In Ohio and West Virginia, your application can be reviewed under what's called "Reconsideration" if your application is denied. When a claim is under reconsideration -- considered the first level of appeals in these two states -- someone other than the person who made the original decision reviews the application. All evidence, as well as any new evidence submitted, is reevaluated. The waiting period for Reconsideration is typically 4-6 months. If a person disagrees with the reconsidered decision, he or she can move on to the next level of the appeals process.
The first level of the appeals process includes a hearing, which typically takes anywhere from 12 to 18 months. We recommend you hire a Social Security disability attorney for all appeals.
Before the hearing, your attorney will meet with you to talk about the details of your case and tell you what to expect at the hearing. You'll have an opportunity to ask questions. Note: The hearing doesn't require a formal dress code, and you can wear what you would typically wear to a doctor's appointment. Some people wear T-shirts, button-down shirts, sweatpants, etc. due to their medical conditions.
An Administrative Law Judge (ALJ) will conduct your hearing. During the hearing, you'll be asked basic information about your background, including education, work experience, and your current medical treatment. You'll need to explain your condition and the symptoms and limitations you experience, and how they prevent you from working. Remember, this is what the judge cares about.
Usually a Vocational Expert will testify at your hearing. He or she will testify about your work history and how your medical problems keep you from working.
Hearing Evaluation Process
The ALJ will use a five-step evaluation process to determine whether you should be approved for SSD benefits:
- If you are working and receive above a certain amount, you are not considered 'disabled.'
- Your medical conditions must keep you from working and be severe before you can be considered 'disabled.'
- If your medical condition has lasted (or is expected to last) for at least 12 months, and you have a condition that is a listed impairment, you likely will be considered 'disabled.'
- If your condition doesn't prevent you from doing work related to jobs you held in the past, you are not considered 'disabled.'
- You will not be considered 'disabled' if you can do another type of work and make a suitable living.
Issuing a Decision
The ALJ will not issue a decision on the day of the hearing. He or she will evaluate all the evidence on record, plus any additional evidence brought to the hearing.
You will receive a "Notice of Decision" at the same time your attorney does. It can take the judge anywhere from 2 to 6 months to make a decision – mostly because of the many cases pending at the Hearing Office.
If you disagree with the hearing decision, you can choose to move on to the next level – the Appeals Council.
The Appeals Council can choose to:
- Review your claim and give a decision
- Not review your claim
- Give your claim back to the ALJ for further review
The average processing time for the Appeals Council is 18 to 24 months. You and your attorney will receive a copy of the 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 your case, you can move on to the final level – the Federal Court.
Federal Court Review
If you exhaust all administrative appeals, but you want to continue pursuing your case, you can file a civil suit and take your case to the Federal Court system. The highest and last resort of the Federal Court system would be to take the case to the U.S. Supreme Court.
You Only Have 60 Days to Appeal – Get Help From a Lawyer You Can Trust
The Social Security disability application process is a long road with chances to make mistakes at every turn. We can help you apply. Or, if the Social Security Administration denied your claim, we can represent you in your appeal. Edgar Snyder & Associates is ready to help you get the benefits you need.
Get started today with a no obligation, free legal consultation. Call us 24/7 at 412-394-1000 or submit a form at the top right of this page. Remember, the clock is ticking. Contact us now.
To learn more about the Social Security disability benefits process, read our Social Security disability articles and resources.