What is the Application Process for Social Security Disability and SSI?
How do you Win Benefits under Social Security Disability or SSI?
If I am determined disabled, how far back will Social Security pay benefits?
How do you prove your disability case if you have a mental condition?
What Can I Do to Improve My Chances of Winning Disability Benefits
Common Mistakes after Receiving a Denial of Social Security Disability or SSI Benefits
How to File for Disability - Tips for Filing
If You Get Approved For SSDI Will You Also Get Medicare?
How much does a Social Security disability attorney get paid?
Social Security Disability SSI Criteria and the Evaluation Process
How long does it take to be approved for SSI or Social Security disability?
What do you Need to Prove to Qualify for Disability Benefits?
Social Security Disability SSI and Fibromyalgia
Social Security Disability SSI and Degenerative Disc Disease
Can I Qualify For Disability and Receive Benefits based on Depression?
Answers to questions about SSD and SSI disability
What Disabilities Qualify for SSI and Social Security Disability Benefits?
Social Security Disability Status
Social Security Disability Tips — how a claim gets worked on
Social Security Disability, SSI Disability - Terms, Definitions, Concepts
Who handles my case if I apply for Social Security disability ?
How to prove you are disabled
and win disability benefits
Your disability case will be handled by several people during the Social Security disability process. When you file your disability claim, a Social Security claims representative (CR) completes your Social Security and/or SSI disability application. They get your medical information including your physicians’ names, addresses, phone numbers, your medical treatment dates, the medications you are taking, and the testing you have had.
In addition to medical information, Social Security needs information about the types of work you performed in the fifteen years prior to filing for disability. Social Security uses your work and medical information to complete necessary disability forms. Once the claims representative at the Social Security Field Office finishes your disability folder, they forward your disability case to a state agency responsible for making Social Security disability determinations. This is where the actual evaluation of your claim begins
DDS and the Disability Examiner
When your disability case arrives at the state disability agency (DDS or disability determination services), it is assigned to a disability examiner, a case-processing specialist who has been trained to evaluate medical records, work histories, and consider them in the context of Social Security rules as well as Social Security Regulations.
The disability examiner is responsible for acquiring medical records from the medical sources you provided at your disability interview, scheduling any needed consultative examinations, and making a disability determination on your disability case. This means that your disability case will most likely be handled by state disability agency physicians, psychologists, and psychiatrists as well as medical professionals outside the disability agency should your disability case require a consultative examination.
Once the disability examiner gets enough information (and this usually means medical record documentation, though in some cases they will be required to more thoroughly research a claimant's work history) they make a decision on your disability case. Following this decision, you will receive a formal decisional notice in the mail.
Getting denied and filing the first appeal
If your disability case is denied at the initial claim, or disability application level, and you feel you are still disabled, you must file an appeal to continue your disability case. Your first appeal is a reconsideration appeal, more formally known as a Request for Reconsideration.
Reconsideration appeals are sent back to the same state disability agency for a review of your initial disability case decision. The only difference being, another disability examiner makes the decision on your reconsideration. Unfortunately, not many initial disability claim decisions are overturned at the reconsideration appeal. In most states, an even higher percentage of reconsideration requests are denied than disability applications. (see Social Security Disability, SSI Decisions – What Is the Rate of Approval? ).
The second appeal - Hearing before an ALJ, Administrative Law Judge
If your reconsideration appeal is denied, you have no choice but to file a request for a disability hearing in order to pursue your claim. Many claimants make the mistake of giving up on their claim following the denial of a disability application or the denial of a reconsideration request. However, this is a distinct mistake since the likelihood of approval increases substantially at an ALJ hearing, particularly for claimants who have representation.
Your request for an administrative Law judge hearing is submitted to the Social Security office where you initially filed your claim. From there, it is transferred to the hearing office, known as the Office of Disability Adjudication and Review. The hearing, of course, is handled by an administrative law judge. In principle, the ALJ performs the same function as the disability examiner. The ALJ will review the medical records and the work history. The ALJ will also review the past decisions of the case as well as all the information that was previously created during the application and reconsideration phases.
Unlike the disability examiners who adjudicated the claim at the earlier levels, however, the administrative law judge will not gather medical records or other evidence to support your case. This is because while the judge is a decision-maker, the judge is essentially reviewing the prior decisions on your claim for error. The judge will, of course, review any additional records that are entered into the case, but obtaining these records will be the responsibility of the claimant or the claimant's disability attorney.
The importance of getting evidence gathered before a hearing
An Administrative law judge (or disability examiner, for that matter) will only be able to approve a claim if A) the available medical evidence demonstrates that the claimant has physical and/or mental limitations that render them incapable of working and earning a substantial and gainful income and B) at least some of their medical evidence is recent, meaning not older than 90 days.
While older medical records may be essential for demonstrating the progression of a claimant's illness, or the ways in which it satisfies the criteria of a disability listing, and especially how far back the condition began (for the sake of determining how much back pay the claimant may be owed), the qualifications for disability, as set forth by the Social Security Administration, dictate that a claimant must submit recent evidence.
The issue of needing recent medical evidence presents a problem for cases that are being heard at hearings. Why? Because the elapsed time between the denial of a claim at the reconsideration level and the holding of a disability hearing can be well over a year, meaning that by the time a hearing comes to pass there will be no recent records in the file. Therefore, it is an absolute must that continued evidence gathering must be a principal part of preparing for a disability hearing.
Beyond the disability hearing level
If your disability case is not approved at this level, it may be handled by an Appeals Council review, or even by a Federal Court judge should you chose to pursue your disability claim that far. Most disability applicants, however, begin the disability process again if their disability case is denied at their disability hearing or the Appeal Council review level.
As you can see, in the disability claims process, no one person handles a case from beginning to end.
Individual Questions and Answers
SSD and SSI are Federal Programs
The title II Social Security Disability and title 16 SSI Disability programs operate under federal guidelines and, therefore, the program requirements--medical and non-medical--apply to all states:
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Recent approval and denial statistics for various states can be viewed here:
Social Security Disability, SSI Approval and Denial Statistics by state
Special Section: Disability Lawyers and unnecessary claim denials