Overview of Disability
Disability Back Pay
Requirements for Disability
Applications for disability
Tips and Advice for Disability Claims
How long does Disability take?
Winning Disability Benefits
Common Mistakes after a Denial
Mental Disability Benefits
Denials for Disability
Appeals for denied claims
Disability Benefits from SSA
Child Disability Benefits
Qualifications and How to Qualify
Working and Disability
Disability Awards and Notices
Disability Lawyers, Hiring Attorneys
Social Security List of Conditions
What Social Security considers disabling
Medical Evidence and Disability
Filing for Disability Benefits
Eligibility for Disability Benefits
SSD SSI Definitions
SSDRC authored by Tim Moore
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The Levels Of The Social Security Disability and SSI Application and Appeal Process
Social Security disability and SSI evaluation is a multi level process that begins with an initial disability claim and which could end with a federal court case, or at any of the levels in between.
Level 1 - Initial disability claim.
Initial disability claims usually involve an interview by phone or in person with a Social Security claims representative. During the interview, the claims representative will ask questions with regard to your medical treatment. You need to be prepared to provide Social Security with the names of your doctors, hospitals, or other medical professionals who have treated you for your condition, or conditions, along with the approximate dates of treatment, medications, and testing.
Additionally, you will need to provide Social Security with work information about the types of work you have done in the past fifteen years. Once you provide Social security with this information, your disability application is sent to a state disability agency (in most states, the agency is named DDS, which stands for disability determination services, and this is where cases are evaluated by disability examiners) for a medical determination. If your disability claim is denied at this level, you will have to appeal the decision if you are still unable to work due to your medical condition (or conditions).
Level 2 - Request for reconsideration.
If your initial disability claim is denied, you file a request for reconsideration appeal. This appeal basically involves the completion of a disability report form (form SSA 3441). The SSA 3441 is used to update the information that you originally provided for your initial disability claim. This means that if you have gone to your doctor since your initial claim was denied, you should, when completing the disability report form, include your treatment dates, medication updates, and/or any additional testing you have received during the time since your claim was denied. If you have new medical sources, they should be listed as well. Remember, this is a review of your initial disability claim.
If there is no new information, it is very unlikely that your disability denial will be overturned. Actually, statistically there is very little chance of your initial disability claim being overturned at this level unless there is new and convincing medical evidence, or unless the initial disability decision was in error. If your request for reconsideration is denied, you can stop the process, file a new claim, or appeal the decision a second time (which is usually the best course of action).
Level 3 - Request for an Administrative Law Judge Hearing.
While the reconsideration has the least likelihood of success, the second level of appeal, the administrative law judge, or ALJ hearing level, has the highest rate of success within the Social Security disability and SSI appeal process. In order to request your hearing, you must file your appeal request along with an updated SSA 3441 disability report form.
It has been my experience as a disability examiner that most disability applicants will need the services of a qualified Social Security representative for their hearing. Social Security representatives (a representative can be a non-attorney or an attorney) are familiar with all of the medical and vocational disability guidelines used by Social Security to make determinations and, therefore, are more likely to be able to present the facts of a disability case in the most favorable light.
A representative will also be able to cross examine any medical or vocational experts that the judge has decided to have appear at the hearing for the purpose of providing expert testimony. After the long wait for a disability hearing, you want everything to be in your favor, so show up for your hearing timely and be prepared to answer questions about your disabling condition as well as your history of medical treatment and your work history.
Even if you have a representative, the administrative law judge might ask you questions. Prior to the hearing, you can meet with your disability representative to prepare for such questions.
Unfortunately, if you are not approved at the administrative law judge hearing, you are unlikely to win your disability benefits at the next two levels of the process.
Level 4 - Request for an Appeals Council Review. An Appeals Council review is so unlikely to yield an approval for disability benefits that you are allowed by the Social Security Administration to file a new initial disability claim while the appeals council decision is pending. The Appeals Council can refuse to review a disability claim, award disability benefits, or remand a disability claim back to the administrative law judge who handled the first hearing for a review of his or her own decision.
As you might imagine, even if your disability claim gets a second review by the judge, it will most likely be the same decision unless your condition has worsened, the judge made a gross error in their decision, or you can provide evidence not considered at your last hearing.
Level 5 - Federal District Court. The last level of appeal for a Social Security disability claim or SSI claim is federal court. Very few individuals are able to pursue their disability claims to federal court because of the potential expense of pursing their claim. Attorneys are not bound by the Social Security fee agreement for federal claims; therefore some attorneys (though not all) require new contracts that can involve an hourly rate, more incidental fees, etc that will have to be paid whether the disability claim is won or lost. I have seen very few (percentage-wise) disability claims pursued to federal court.
Most individuals opt to file an Appeal Council review in the hopes that they might win their case upon review, and then also file a new disability claim to keep the process going if they have remained unable to work due to the limitations of their impairment.
Return to: Social Security Disability Resource Center, or read answers to Questions
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages answer some of the most basic questions for individuals who are considering filing a claim.
Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria