April 28, 2017

What are the Typical Steps Taken in an SSD or SSI Claim?

The steps are identical for both claims.

The first step is the initial application which can be done in several different ways.  A claimant can fill out an application online, in person with a SSA representative, on the phone with a SSA representative, or by working with an attorney.  In our office, we ask claimant’s to fill out a brief information form and then our staff files it online with the SSA.  The reason for the extra step is to ensure that everything written in the application is correct, written in the most favorable light for a claimant’s case and also to ensure that the right application has been filled out.

Once the initial application is received by SSA using one of the filing methods listed above, the date of that application is the protected filing date for that claimant.  The SSA then requests medical records from the doctors, hospitals, and clinics the claimant listed in the application.  The SSA may also send out additional paperwork that must be filled out by the claimant to give a more accurate and complete picture of the claimant’s disabilities and limitations in functioning.

Then the application is sent to the Disability Determination Services located in Austin, Texas.  The SSA case workers then review the file with all attached medical records and make an initial determination on the case.  If your application is approved, you will be mailed out an award letter.

Most cases are denied at the initial level and must be appealed.  If your case is denied at the initial level, that does not mean you will not be able to win.  This appeal is the second step of the case.

The second step of the case is called a reconsideration.  At this level, you may receive additional paperwork to fill out and update any new medical treatment that you may have had since the initial application was filed.  The records are sent for and all additional paperwork is attached and routed back to the DDS in Austin.  Another caseworker examines the file and makes a second determination as to whether the claim should be approved or if this case should be heard by and ALJ.  Statistically, the fewest claims are approved at the reconsideration level.  If the reconsideration is denied, which most are, the claim must be appealed a second time and a request for a hearing with an ALJ is made.

The third step is a hearing with an ALJ.  The claimant has a right to a face-to-face hearing with a judge to present their testimony, any witnesses to support their claim, have an attorney present and present their case fully.  Many times, the SSA will have a medical doctor and a vocational expert, someone who is an expert on all the jobs that exist in the local and national economy, how unskilled or skilled those jobs are, what the exertional demands of the jobs are, present at the hearing.  The hearings typically last an hour or so and are much more thorough and careful than the decisions made at the initial and reconsideration levels.  The hearing is the step with the highest approval rate.  Typically, a claimant does not know at the hearing whether their case has been approved or not.  The ALJ will write a written decision that is mailed out to the claimant within 4-6 weeks with the decision.

The fourth step is an appeal to the Appeals Council if a claimant does not win their case at the hearing.  It generally takes 6 months to 1 year to receive an answer back from the Appeals Council.  If the Appeals Council decides that there was an error made at the hearing, they can remand the case to be heard by an ALJ, can grant the case, or turn the appeal down.  Winning at the Appeals Council is infrequent but can happen.

There are additional appeals that can be made after the hearing with an ALJ.  Claimants can appeal to the Appeals Council, to federal court, and even to the US Supreme Court.  However, the chances of winning a case the higher up one goes become slimmer.  If a claimant does not win at the hearing at times, the best thing to do is to simply file a new initial application.