Claims Process: Social Security Disability/Supplemental Security Income
The claims process in a Social Security Disability or Supplemental Security Income case can be very confusing and complex.
In the year 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, Edgar Snyder & Associates, LLC, has provided this general outline of how the claims process works. (Click on a specific topic below or scroll down the page to read all topics consecutively.)
- Diagnosis of a Medically Determinable Impairment
-
Initial Application
- Reconsideration (for cases in Ohio & West Virginia only)
- 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.
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. For an overview of eligibility requirements, click here.
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.
In Ohio & West Virginia, a denied application is reviewed under "Reconsideration". If your case is being reviewed in Ohio or West Virginia, click here to read more about Reconsideration. Cases submitted in Pennsylvania, Maryland, or New York can proceed to "Hearing".
Hearing
The average scheduling time for a hearing is 6 to 12 months. If you have obtained legal representation, you will meet 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.
The individual and/or their representative may come to the hearing and present their case in person.
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.
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 representative at the same time. Your legal counsel 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.
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 the claim and render a decision
- choose not to review the claim
- remand it to the Administrative Law Judge for further consideration
The appellant, or the person filing the appeal, 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 the disabled person disagrees with the Appeals Council, or if the Appeals Council refuses to review the case, the disabled person can pursue their case in Federal Court.
Federal Court Review
If a disabled person exhausts all administrative appeals, but wishes to continue pursuing the case, he or she may file a civil suit in Federal District Court and eventually appeal all the way to the United States Supreme Court.
Injured and unable to work? Put our experience to work for you
It is important to know your legal rights if you are injured and unable to work. Our attorneys have been helping injury victims for over 25 years. We have represented over 30,000 people and have answered 350,000 injury-related questions. Let us put this experience to work for you.
Free Legal Evaluation
If you are injured, unable to work, and have been denied social security disability benefits, you should contact our law firm for a free consultation on your rights to collect benefits by:
- Filling out a simple online form so we can evaluate your claim
- Calling toll free 1-866-867-9914. Our phones answer 24 hours a day/7 days a week
It won't cost you a dime to have our staff take a look at your claim. We will listen to what you have to say and will let you know what options you have based on what you have shared. It's free and there's no further obligation. And, as always, there is never a fee unless we get money for you.
