The Social Security Disability and SSI appeals process in Texas
In the state of Texas, there are multiple appeals available to an indvividual who has been denied on their claim for disability benefits. Here are the two appeals which most denied claimants can expect to have to file for.
1. Request for reconsideration - Just as the initial disability claim, or application, in Texas is decided by a disability claims examiner at a Texas DDS agency (disability determination services) so, too, is this first appeal decided by a disability examiner. This time by a reconsideration-level examiner.
The reconsideration may be filed online, or a person may contact their local Social Security office and request that paper forms be mailed out to them. If they are represented, of course, their representative should file the appeal. Individuals who are represented at the time they receive a notice of denial should immediately contacted their representative's office to make sure the rep has received a copy. This way both parties will be aware of the status of the case and the appeal can be filed as soon as possible.
The reconsideration appeal must be filed (meaning received at a Social Security office) within 60 days of the date of the disability application's denial. If it is not received in a timely manner, a claimant will be forced to start over with a new application which will result in a considerable loss of valuable case-processing time.
The reconsideration decision will be made the same way as the disability application, meaning that if the medical evidence alone does not warrant an approval based on a disability listing, then both the medical evidence and work history information will be used to decide whether or not a person has the ability to return to substantial and gainful paid employment.
Because the process is the same, reconsideration appeals are usually denied. Approximately speaking, only about one out of ever six appeals at this level are won. This translates to 16 percent approved, 84 percent denied.
Fortunately, because most the case development will already have been done on the disability application, and very often the medical evidence will still be usable (meaning that at least some of it is still considered recent), a decision on this this appeal can often be received much more quickly.
Common questions about filing for disability in Texas
2. Texas disability hearing - If the reconsideration appeal is turned down, and this is usually what happens, then the claimant files the second appeal for a Social Security hearing, known as a "request for hearing before an Administrative law judge".
To request a hearing, simply contact the same Social Security office where the intial claim and reconsideration appeal were filed and ask that the appropriate appeal forms are sent out. As with the reconsideration, the hearing request appeal can be done online or paper forms can be submitted by the claimant. If the claimant has a disability lawyer or non-attorney claimant's representative, that person should file the appeal.
How long for a hearing in Texas?
The hearing level in Texas takes much longer than reconsideration appeals. This is due primarily to how long it takes to get a hearing. And how long this takes will depend on where you live in Texas and which hearings office will receive your appeal. There are two hearings offices in Houston, two in Dallas, one in San Antonio, one in Rio Grande Valley, and one in Forth Worth.
The amount of time it takes to get a hearing date at each is different. However, it ranges from 11 to 18 months so claimants can expect to wait at least a year for a hearing date to be received.
The problem, of course, with waiting so long is that, by the time the hearing occurs, all of the medical evidence in the file will be out-of-date. What do we mean by this? The evidence will be still be usuable for determining the history of the conditions and for establishing when the claimant became disabled according to SSA criteria (which is vital for determing things like back pay owed, and medicare coverage).
However, since SSA requires current and recent medical evidence to establish that a person is disabled now in order to award disability benefits, this will mean that a claimant will need to obtain recent medical records and send them to the judge assigned to hear the case. When should this be done? After all, if the records are sent too soon, they will again face the risk of becoming too old again.
When to get evidence for a hearing
Generally, the new record gathering should be done as soon as the claimant learns that their case will be scheduled soon. In many states, this will be when the hearings office sends out something known as the exhibit list, which is a listing of all the evidence on a case, including copies of prior applications and appeals. This can be construed as a tipoff that the hearing will be scheduled in the very near future.
In all likelihood, however, the individual handling the disability case, who can be a disability attorney or a non-attorney claimant's representative (if a non-attorney is involved, they may be a former SSA field office representative or even a former disability examiner), will know when the appropriate time is to begin acquiring medical record updates to send to the administrative law judge.
What does other preparation for the hearing include? Most likely, the claimant's representative will try to obtain a statement from a doctor supporting the case. These statements can provide information that the medical records by themselves usually will not provide. Therefore, they are very valuable and often help win the case.
How long will a Texas disability hearing take? As in other states, the hearing can occur in as little as 10 minutes and may last a half hour.
How long does it take to receive a decision from a Texas disability hearing? There is no way to know the answer on this question. Sometimes, a notice of decision may be received within 30 days. Sometimes, it may take months because the judge may still be waiting on outstanding medical evidence or simply because there is a large backlog at that hearing office. Claimants who are represented can have their representative occasionally perform case status followups.
How many Texas disability hearings are won? In a recent year, it was found that Texas judges approved 47 percent of the cases they heard while nationally about 56 percent of claims were awarded benefits by judges.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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