The 5 Levels of Your Social Security Disability Claim
POSTED BY Jan Dils . April 25, 2019
Many people file for SSDI (Social Security Disability Insurance) daily. This can be a saving grace for those who need help financially but cannot find work that is accommodating to their disabilities. The length of the process can be trying and very intimidating. It will take a different amount of time for everyone, but the typical timeline that is followed through all applications is broken down here to ease the minds of those who are new to this process.
On average, it takes about three to six months for a decision to be made after the initial application is filed. During this time, Disability Determination Services (DDS) works on the claim. The DDS, which are fully funded by the Federal Government, are State Agencies that make the initial determination as to whether a claimant is disabled or blind under the law.
Your claim will be assigned to a Disability Examiner who will request and evaluate medical evidence with the assistance of doctors. At this time, you will likely receive questionnaires to obtain more information, such as any limitations of your daily activities, a description of your past work, specific details pertaining to location and severity of your pain, as well as specific information regarding seizures if you have been diagnosed with epilepsy.
If there isn’t enough information within your own medical records to allow DDS to make a fair decision, DDS may require you to attend a consultative exam. You are not responsible for paying for this exam. You will receive an appointment notice that informs you of the date, time and location of the scheduled exam. It is important for you to keep this appointment or contact the disability examiner if you need to reschedule. It’s also important to note that failure to attend could lead to a denial for insufficient evidence.
Most initial decisions are denials, but the good news is that these can be appealed within 60 days of the date on your denial letter.
Also known as the Recon Level, this step also takes about three to six months for a decision to be made after the request for the reconsideration has been filed. Your claim will again go to DDS, but it will be assigned to a different Disability Examiner. This level will seem familiar as it mimics the initial level. DDS will request and review any updated medical evidence. They may send you additional forms to complete and may send you for a consultative exam if needed.
Again, most reconsiderations are denied as well. To appeal the reconsideration denial, the next step would be to request a hearing before an Administrative Law Judge (ALJ) within 60 days of the date listed on your reconsideration denial letter.
This is the third level of the claims process. Once the Request for a Hearing before an Administrative Law Judge (ALJ) is made, the claim will be sent to the OHO – Office of Hearing Operations. At this point, the DDS will no longer be working with your claim. It can take anywhere from 15 to 24 months from the date the hearing is requested to receive a scheduled hearing date.
Many hearings take place via video with the ALJ who is likely in another city. The decision is generally made after the hearing and told to the claimant through letters mailed to them and their representative.
There are three possible outcomes: Fully Favorable, Partially Favorable or Unfavorable. SSA estimates that approximately 50% of disability awards are granted at the hearing level by an ALJ.
After receiving a decision from the ALJ, you have the option to appeal their decision for 60 days following the date on the decision notice. This is known as a Request for Review of Hearing Decision/Order. The Appeals Council (AC) is given the responsibility of processing appeals of less than fully favorable ALJ decisions. They can also review any decision on its own motion. This includes fully favorable decisions as well.
This level of appeal doesn’t have a set timeline, but they generally issue decisions within 90 days to 18 months.
Federal District Court
This is the fifth and final level of the claims process. The Federal District Court (FDC) is where claimants can take their cases if they do not agree with the decision made by the AC. The next step would be to file a civil suit; the appeal must be filed within 60 days of the date listed on the AC decision.
In this situation, the civil action is filed in the District Court of the United States for the judicial district in which the claimant resides. If they do not reside within any such judicial district, the civil action must be filed in the United States District Court for the District of Columbia.
Again, there is no general timeframe for a claim at FDC.
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