Millions of people suffer from disabilities and are unable to work because of this fact. For those who are faced with long-term and permanent disabling conditions, Social Security Disability benefits can help alleviate the financial burden of such situations. Unfortunately, not everyone understands the Social Security Disability application process or what to do if their initial application for disability benefits is denied.
Of the millions of applications received by the Social Security Administration (SSA) each year, only thirty percent are approved at the initial stage of the application process. What happens to the remaining 70 percent? If these applicants wish to move forward in order to receive Social Security Disability benefits, they must appeal the decision that was made during the initial stage of the Social Security Disability application process. Understanding the application and appeal process can make the process of applying for benefits clearer and less stressful.
The SSDI and SSI application process are the same. There are five main stages of the Social Security Disability application and appeal process. It is important to understand that not all applicants will need to go through each of these stages, however. Thirty percent of applicants will only have to go through the first stage of the application process while others may have to go through all five stages to receive a favorable Social Security Disability determination.
Most disability applications are denied on the initial review level, but there are several things that you can do to improve your chances of a claim approval. Here are some details about different aspects of the disability claims process.
The first step in the Social Security Disability claim process is to file an application for disability benefits. During the initial stage you will submit your application to the SSA along with all of your medical evidence and supporting documentation outlined in the Blue Book. It can take between 90 to 120 days to complete this stage of the disability claims process. Only 30 percent of Social Security Disability applications will be approved at this stage of the process.
Most claims are denied upon the initial review. You shouldn’t give up hope though. With the right evidence and documentation, you can have your claim approved during the initial review. There are two kinds of disability benefits, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). You should be aware of the differences and what is necessary to apply for each.
Most claims are denied because of a lack of supporting evidence and documentation. You should make sure Disability Determination Services (DDS) has access to all your medical records. These records should be detailed and include details about your conditions and all the limitations and restrictions that you suffer because of your medical issues. It should also detail any treatments and your response to those treatments.
The Differences Between SSI and SSDI
SSI is a needs-based disability program. While you must provide the medical evidence to medically qualify, you must also be able to meet the income requirements as well. You will need to provide proof of household income as well as proof of the number of people in the household. Not all income is counted.
You must show proof of all resources you own including cash, bank accounts, stocks and bonds, real estate, vehicles, life insurance, and personal property or anything that you own that could be converted to cash and used to pay for shelter and food.
The maximum resource limits for an adult or child is $2,000 per person and $3,000 for a couple. As of 2020, the federal benefit rate for SSI is $783 monthly for an individual and $1,175 per month for a couple. Since not all income is counted, you may be able to earn more than $783 and still qualify for SSI benefits. Talk with an SSA representative or a disability attorney to see if you meet the income requirements.
SSDI is based on your work history. To be able to receive SSDI benefits, you must have worked enough to earn adequate credits. For most people, that would be the equivalent of having worked full-time for 5 of the last 10 years. Most people – but it can vary based on age – will need to have 40 credits with 20 of them having been earned during the last 10 years, ending in the year that you became unable to work because of your medical problems.
If your claim is denied during the initial review, you will receive a denial notice. This notice will tell you exactly why your claim was denied. It will also tell you how long you have to appeal the decision. This appeal is called a request for reconsideration. You will want to file this request before your time runs out. Otherwise you will have to start your claim all over.
You should review why your claim was denied and provide supporting evidence that helps change the decision. However, many claims are also denied during this review. If your claim is denied on this level, you will need to request a hearing before an administrative law judge.
Your odds of having your claim approved when it reaches the hearing level increase significantly. At this level, you will be questioned by a judge and there will most likely be a vocational expert in attendance. Sometimes a medical expert will be asked to testify and to give details about your medical condition and if they believe your disability keeps you from doing your job.
You will need the help of a disability attorney at this level. Your attorney will help prepare you for the questioning and will be able to cross-examine the expert witnesses. When a disability claim reaches this level, there is an about 50 percent chance of having your claim approved. If your claim is denied, you will be able to advance to the Appeals Council.
The Social Security Disability hearing is the second step of the appeal process. You have sixty days from the date of your denied reconsideration request to ask the SSA for a hearing. When you request a hearing, your case will be examined by an administrative law judge. This judge will review your case and can either approve your claim, send your case back for review, or deny your claim. This stage of the appeal process can take up to two years to complete. In 2009 the average completion time for this stage of the Social Security Disability appeal process was 491 days. Fortunately, 63 percent of hearing cases are decided in favor of the applicant.
If you do not agree with the judge's decision regarding your claim for Social Security Disability benefits, you may appeal the decision with the Appeals Council. It is important to understand that fewer than 2 percent of Social Security Disability cases are won at this stage of the appeal process. The review by the Appeals Council will usually take between six months to one year to complete.
The Appeals Council is the third level of a disability review in most states. You must file a Request for Review to the Appeals Council within 60 days of receiving the decision from the administrative law judge. This request can only be done in writing. The Appeals Council is located in Falls Church, Virginia. This step of the claims process is much different because the purpose isn’t to evaluate your disability claim’s merits, but to determine if there was an error made by the administrative law judge.
The Appeals Council will review your entire case file along with any additional evidence you provide. The Council will check to see if the administrative law judge made any legal or procedural errors and if he or she properly considered all the evidence provided. The Appeals Councils has one of three options –
- Deny the Request for Review – if this happens, you have 60 days to file an appeal in federal district court
- Remand the Case to the Administrative Law Judge – They send it back to the ALJ for another hearing and review
- Make a Decision – make a new decision and award disability benefits for your claim
Working with a disability attorney can have a significant impact on the outcome of your disability claim. Those who are represented by lawyers through the claims process are much more likely to have their claim approved.
You can enlist the help of a disability attorney at any point during your claim. You can have a lawyer even file your initial claim for you, but if your claim is denied, you will want to retain legal representation before it advances to the hearing level. If your Request for Review is denied, you will definitely need an attorney to help you file an appeal in federal district court.
Disability attorneys don’t require upfront payment. Instead, they aren’t paid until you win your claim. At that point, they will recover 25 percent of your back pay, but the maximum pay is $6,000.
If your claim is also denied by the Appeals Council, you may ask for your case to be reviewed in the Federal District Court. The Federal District Court can approve or deny your claim for Social Security Disability benefits or they may send your case back to the SSA for further review. Thirty percent of appeals are decided in favor of the applicant at this stage of the disability claims process.
Completing the Process
If you are interested in applying for benefits, your first step is to file an initial application with the SSA with the help of a qualified disability attorney. Hiring a qualified attorney can increase your chances of successfully obtaining Social Security Disability benefits from the SSA.
Certain states deviate from the normal application process and may require additional information. A local disability attorney will have a good knowledge about the special state disability rules and will be able to help you apply for disability benefits in your state.