THE PROCESS
Many individuals file for Social Security disability everyday. According to the Social Security Administration, 2,179,928 applications were made for disability in 2017. Of those millions of claims, only 762,141 applications were approved for benefits. That's 34.96% of the individuals who made an application. Unfortunately, that leaves over 65% of applicants trying to figure out why their case was denied. So what's an individual entitled to benefits and others not? To get a better understanding of the process, this article will outline what happens to your disability claim from the time you file an application until a decision is made.
1. The Application
You have decided to file for disability. This can be achieved by either visiting your local Social Security office and filing a claim with a representative, or you can go to www.ssa.gov. and complete an online application. If you file an application online, there are two things that will help you file your application a lot faster.
- A complete list of doctors, hospitals, therapists, counselors, and specialists you've seen over the past 24 months. The disability office needs this information to request copies of the medical records each of these facilities will have for you.
- A 15-year job history. This is only applicable to adults filing for disability. Resumes will help out tremendously with this step. The disability office needs to know about the work you have performed in the past to determine if the work is "relevant" and if you still have the capacity to perform any of those jobs despite how your medical conditions limit you.
2. The Disability Claim
With your application now complete, the Social Security office transfers it to a disability office for processing. Your claim will spend most of its time here. Your claim is assigned to a caseworker. That person will be your primary contact. A general outline of the things a caseworker will do on your case includes the following:
1. Send introduction letters and questionnaires to you.
2. Request medical records from the doctors and facilities you listed on your application.
3. Review and analyze your medical records and questionnaires that are completed by you and people who know about your condition.
4. Create a summary of your medical records and questionnaire.
5. Discuss the details of your medical conditions with the physicians on staff to determine if your conditions are severe enough to be considered disabling.
This step needs to be discussed in greater detail to understand what makes a condition disabling or not. In order to be found disabled, you need to first understand the definition of disability according to Social Security. Disability is defined as a person who is not able to engage in ANY substantial gainful activity (SGA) because of a medically-determinable physical or mental impairment(s). The definition is further defined as a medically-determinable physical or mental impairment that is expected to result in death or one that has lasted or is expected to last for a continuous period of at least 12 months. So, in order to be found disabled, your medical condition or a combination of multiple medical conditions have to be so severe that they prevent you from engaging in ANY work related activities for a period no less than 12 months. To help the caseworker make a decision on your claim, Social Security has prepared guidelines for just about every major medical condition. A caseworker will compare the severity of your condition to these guidelines to determine if your condition meet or equals the severity of your medically-determinable impairment. These guidelines can be found in The Blue Book. If your condition does not meet or equal the criteria specified in The Blue Book, the caseworker must determine how much limitation, if any, your condition will have on your ability to perform work related activities. These limitations are placed on a residual functional capacity form (RFC). Once a residual functional capacity has been determined, the caseworker must turn their attention to your past work. The caseworker has to determine if the residual functional capacity assessment prevents you from doing any work you have performed in the past 15 years. The work analysis of your claim is very extensive. Your claim can be denied a multitude of ways if you make it this far in the process. Maybe you described your job as very physically demanding. However, the job may not be described that way in the national economy. If the way the job is described in the national economy fits with the limitations provided in your RFC, your case will be denied as being capable of performing the job as it is generally performed in the national economy. if your RFC prevents you from performing your past work as described and as it is performed in the national economy, the caseworker must then determine if the skills you have attained from all of your past relevant work would allow for an adjustment to less demanding work. If the caseworker is able to find jobs that are less demanding than your past work, your case will be denied. However, if your RFC limitations prevent you from performing your past work and less demanding work, you will be found disabled.
6. If you are found to be disabled, your claim process stops here. You will receive an award letter documenting the amount of benefits you will receive and an approximate time when you should receive your first payment. If your case is denied, you will receive a denial notice explaining the reason for the decision. The decision will also explain to you of your appeal rights.
3. Appealing a Decision
Appealing a disability decision is similar to the same process as filing a new application. You will either have to go into your local office and complete an appeal application, or you can complete the appeal online. If you are appealing your initial claim denial, your claim will be sent back to the disability office for reconsideration. A reconsideration follows a similar claims processing model as a claim being worked at the initial disability level. Your case will be reviewed by a new caseworker. Depending on the specifics of the case, the caseworker may request additional medical records. The caseworker will review all of the records and either affirm the decision made at the initial level or render a new decision. If the caseworker affirms (upholds) the previous disability decision, you will receive another denial notice, which will include your rights to file another appeal. Filing another appeal will transfer your case to your regional office of hearings and appeals.
At this level in the disability process, your case will be evaluated and decided on by an administrative law judge. The judge is not bound by any of the decisions that were rendered before hearing your case. The judge will render a new decision on your claim, which will override any of the previous decisions that were handed down. Unfortunately, the wait time for claims processed at this level are dramatically high. According to the most recent statistics, the national average wait time for you to receive a written administrative law judge decision once you complete an application is 595 days. Once your application is received by the office of hearings and appeals, no work is done on the case until it is actually assigned to a judge and the files associated with your previously denied claim are "exhibited." This usually takes 6-9 months to occur. During this time, you should continue to going to your doctors and trying to manage your daily activities as best you can. If you have obtain additional records after your initial denial, you need to forward them to the office of hearings and appeals as soon as possible so that they may be exhibited with the rest of the records. Once your record has been updated with your most recent medical records, the administrative law judge's clerk will schedule a date for your hearing. You usually receive your hearing notice at least 45 days before the actual hearing date. If you are represented, your attorney or non-attorney representative should consult with you regarding the process of how the hearing works and prepare you what kind of questions you may be asked.
A video explaining the disability claims process and the administrative law judge hearing can be found here.
On your hearing date, you and your representative will appear before the judge. Some other people who may also be in the room are a vocational expert and the judge's clerk. In some case but not all, a medical expert will be called to give medical analysis and opinions regarding the conditions you are alleging disability for. The vocational expert will testify about the jobs you've held in the past 15 years and provide information about the transferable skills that your past relevant jobs have. The administrative law judge's clerk is there to record the hearing. You and the vocational expert will be sworn in that the testimony you provide will be true and accurate to the best of your knowledge. The judge will ask you questions specific to your medical conditions and the limitations those conditions have on your ability to perform work-related and daily activities of living. Your representative will also ask you questions as well. Once you have provided your testimony, the judge and your representative will ask the vocational expert questions regarding your past work experience and your capacity for other work. Once the vocational expert has testified, the administrative law judge will either render a "bench decision" or inform you that your case will be reviewed in more detail and a written decision will be mailed to you.
You should receive your written decision notice within 60-90 days after the hearing date. If a bench decision was rendered, you will receive a decision much faster (usually within the first 30 days from the hearing date). If your hearing is denied, your decision notice will explain in great detail why you were not awarded benefits. The letter will also inform you of your appeal rights.
4. Appealing an Administrative Law Judge Decision
Appealing an administrative law judge decision can be done in your local Social Security office or online. Once the appeal application has been processed, your claim is sent to Office of Disability Adjudication and Review. This process can be quite lengthy as well. It usually takes about a year to receive a written notice from the appeals office. At this level of the process, you will not have to attend a hearing and testify. Your previous ALJ decision will be reviewed. The only way to get an administrative law judge's decision overturned is for the following reasons:
- The Administrative Law Judge appears to have abused his or her discretion.
- There is an error of law.
- The decision is not supported by substantial evidence.
- There is a broad policy or procedural issue that may affect the public interest
- The Appeals Council receives additional evidence that you show is new, material, and relates to the period on or before the date of the hearing decision. You must also show that there is a reasonable probability that the additional evidence would change the outcome of the decision. You must show good cause for why you missed informing Social Security about this information or submitting it earlier.
If the Administrative Appeals Judge does not determine that one of these reasons are why your case was denied, your case will not be reviewed and the administrative law judge's decision will be the decision on record.
At this point, you will either have to file an entirely new claim or file a civil action. Filing a civil action is beyond the scope of the services Disability Blueprint LLC provides, so that part of the process will not be covered in this article.
The road to obtaining disability can be a challenging and long one. How can you avoid the pitfalls that plague so many disability claims? Click here to view our FAQ section. If you would like additional information on how Disability Blueprint LLC can help you navigate the system more smoothly give us a call or you can email us.