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Social Security Disability Process – The Basic Procedure

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Many people wonder why it takes so long to move through their disability claim or to get a favorable outcome. The answer is partly because of procedure and the fact that their are multiple stages to the disability claims process. The social security disability process or timeline can be broken down into distinct stages and I will go over just the basics of this process to give you an outline of what happens after someone applies for disability.

The first thing that happens after someone applies for disability benefits is that their local SSA office sends their file to Disability Determination Services (DDS) which is the agency responsible for making a medical decision on claims whether they are medically disabled or not. This is called the “Initial” stage. On average, this stage takes anywhere from 4-6 months to process. During the initial stage DDS will request all your medical records from all your doctors that you listed on your application. Once they receive all these records they will then write up a summary and along with the medical consultant at DDS they will come to a decision. DDS also takes into account any vocational information such as education, past work, and age in making their determination whether the claimant is able to work or not. Unfortunately, most people are denied at this stage. Once you receive a denial you have 60 days to file an appeal for the next stage.

The next stage is called the “Reconsideration” stage. Most states still have this stage in place but some do not. At this stage your file goes back to DDS to determine whether or not the Initial decision was correct or incorrect. Most likely DDS will gather your most recent medical records to update your file and will make a decision after that. This stage on averages takes anywhere from 2-4 months, however, sometimes it may only take a few weeks. Unfortunately, most people are denied at this stage as well and similar to the Initial denial you have 60 days to appeal to the next stage.

The next stage is the “Hearing” stage. This is where you will eventually have a hearing scheduled where you will testify in front of an Administrative Law Judge (ALJ) as to why you are disabled. You and/or your representative, if you have one, will submit medical records, forms, and any other evidence to the hearing office before your hearing and will be required to testify by answering questions about your medical condition and disability and why you cannot work. The Hearing stage is many times where claimant’s will get a favorable outcome and will have their claims approved by the ALJ. This does not always happen though, in fact statistics show about 60% of claimants are approved at the hearing stage, however, that is a much better approval percentage than the first two stages. The unfortunate part about the Hearing stage is that it easily takes on average at least one year to get a hearing scheduled and sometimes even longer. It is not out of the ordinary to have a claimant apply for social security disability benefits and have their hearing 2 years later. It can be frustrating and difficult to wait that long for a final decision, but most often that is how the process typically works out.

If the ALJ denies the claim, the next stage is to appeal it to the “Appeals Council” (AC). This stage can take anywhere from 10-16 months to get a decision. Basically, the AC is deciding whether or not the ALJ made some type of factual or legal error and if they did, then many times they will send it back (remand) to the same ALJ for a second hearing to correct the error. If the AC decides no errors were made, then they will uphold the ALJ’s decision and deny the claim. In rare circumstances, the AC will approve a claim without sending it back to the ALJ, but most likely the decision is either a denial or remand. Many times we disagree with the ALJ’s decision, but if the ALJ did not make any mistakes or errors of law there may be little chance of prevailing at the AC level.

The next stage, if the AC denies your appeal, is to file your claim in federal district court. Many cases do not ever reach this level of appeals and it mostly depends on legal issues and what if any mistakes or errors the ALJ made to which the AC didn’t correct. You and/or your representative should both be involved in making the decision about whether to appeal a case to the AC or federal court because it is a very long, times consuming, and arduous process, but for the right claim it may be the best decision.

As you can see, the social security disability claims process can be a long and difficult one filled with multiple appeals to different levels of SSA administration and state agencies. If you are thinking about applying for social security disability benefits or have already been denied, make sure you understand what stage you are at and what you are appealing for. At the very least, it would be beneficial to speak to a local social security disability attorney in Charlotte who can help you navigate the claims process and better understand what you may be up against.

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