The Claim Process (Application, Reconsideration, Appeals)
Social Security disability benefits are benefits paid to people who have worked throughout their lives but can’t work any longer because they have a medical condition or an injury that makes it impossible for them to work. The Social Security Administration awards disability benefits for more than 200 different physical and mental illnesses. To be eligible for disability benefits a person must have worked in the past and expect that they won’t be able to work for at least 12 months.
When someone submits an application for disability benefits it can be denied or approved. If an application is denied the applicant can ask for reconsideration. If the reconsideration is denied the applicant can go through several appeals to try and get their application approved.
The Application Process
The application process for Social Security benefits is the same whether you are applying for Social Security disability benefits or Supplemental Support Income. To qualify for either type of benefit you must meet the requirements for eligibility set by the SSA. If you are applying for Social Security disability benefits you must have a letter of diagnosis from a doctor indicating you have one of the conditions that are recognized by the Social Security Administration. You must also have worked and earned work credits. And you must expect that you won’t be able to work for at least a year.
If you are applying for SSI you will need a letter of diagnosis showing you have one of the conditions that are recognized as disabling by the Social Security Administration and expect that condition will prevent you from working.
When you apply for benefits from the Social Security Administration no matter what type of benefits you are applying for you will need to submit medical documentation of the condition you have. Medical records, including a letter of diagnosis, are a very important part of the application.
Your medical evidence needs to show that you meet the SSA’s requirements for the condition that you have. All of the requirements for each individual condition that is recognized by the SSA are listed in the SSA’s Blue Book. You can search the Blue Book on the SSA’s website to find out what the requirements are for the condition that you have.
In addition to the completed application form you will need to submit copies of these documents with your application for Social Security benefits:
- Birth certificate or other proof of birth;
- Proof of U.S. citizenship or lawful alien status if you were not born in the United States;
- U.S. military discharge paper(s) if you had military service before 1968;
- W-2 forms(s) and/or self-employment tax returns for last year;
- An Adult Disability Report that collects more details about your illnesses, injuries or conditions, and your work history;
- Medical evidence already in your possession. This includes medical records, doctors' reports, and recent test results; and
- Award letters, pay stubs, settlement agreements or other proof of any temporary or permanent workers' compensation-type benefits you received
The SSA will accept photocopies of W-2, but most other documents need to be certified copies of the original documents.
When you submit your completed application and all of your documents they will be processed through your local SSA office and the state Disability Determination Service office. The DDS will check all of the supporting documentation you submit and make a determination on your application. They will either approve or deny it. You will receive a letter in the mail stating their decision.
If your application is denied initially don’t worry. This is very common. Denials can happen for many reasons, usually because something in the application isn’t filled out correctly or some piece of evidence is missing. If your application is denied you can ask for reconsideration. Reconsideration is the first step in the appeals process.
Reconsideration
If you think that the Social Security Administration has made a mistake and you want them to look at your application for disability benefits again after your initial claim is denied you can submit a request for reconsideration.
Reconsideration means that the SSA will take another look at your case. You can add to your claim to help the SSA make a judgment about your case. You may want to use this opportunity to make sure that all of the forms are filled out correctly or to submit new documentation that will help prove you are disabled and meet the SSA’s requirements. Submitting more evidence can help get your application approved.
To start the reconsideration process you can submit a request for reconsideration through the SSA’s website or you can complete a form downloaded from the SSA’s website and send it in by mail. You have 60 days to submit a request for reconsideration to the Social Security Administration.
When reconsidering your application for disability benefits the DDS officials will look at the SSA’s stated requirements and the documentation you submit. They will be looking specifically to see if your medical documentation and supporting documents explain why you can’t work. Once the DDS makes a determination you once again will receive a letter with the SSA’s decision.
If your application is denied again in reconsideration you can file an appeal. You must file your appeal request within 60 days. When you file for an appeal an administrative judge will look at your application and documents.
Appeals
If your application for Social Security disability benefits or SSI reaches the appeals stage an administrative judge will take over the case and look at your application and supporting documents. Administrative judges are made up of disability experts and lawyers who know the SSA’s rules and regulations very well.
There are four types of appeals. So even if your first appeal is denied you can keep going through the process until you have exhausted all four types of appeals. The appeals process is:
- Reconsideration
- Request a Judicial Hearing
- Appeal Judicial Hearing
- Ask for Federal Court Hearing
In most cases it’s not necessary to go through all four levels of appeals.
Disability Determination
When the Social Security Administration decides whether or not an application for disability benefits should be approved they are looking for evidence that you have an illness that makes it impossible for you to work and evidence that you meet the criteria that they have set. There must be no type of work that you can do with the training and experience that you have in order for the SSA to declare you disabled.
Medical evidence is an important part of disability determination. The medical records you submit will show the DDS whether or not you meet the requirements established by the SSA that are listed in the Blue Book. The medical evidence that you submit will show that you are physically incapable of working.
But vocational factors impact the SSA’s decision too. The SSA doesn’t consider retraining or reeducation when they make a determination. If you have a degree in something, and have only ever worked in that field, but you can’t work in that field anymore you will be considered disabled whether or not you could work in another field.
The Approval Process
Once your application for Social Security disability benefits is approved there is a five month waiting period until benefits start to be paid, unless you have ALS or you qualify for the Compassionate Allowance program. After that you will start receiving benefits monthly. You could also be eligible for back pay or retroactive pay in addition to your monthly benefit.
The amount of the benefit that you are awarded depends on factors like the cost of living where you are and how much money you have earned during the time you were able to work.
Benefits can be paid either by receiving a check in the mail, direct deposit to a bank account, or having funds loaded on the SSA’s branded prepaid debit card. You don’t need to have a bank account to start receiving your benefits.
Programs for Expediting Claims
The SSA recognizes that sometimes people can’t wait to start receiving benefits. Anyone who applies for disability benefits who has a medical condition that is on the Compassionate Allowance list will have their application fast-tracked for approval. Once the approval is given they can start receiving benefits right away without a waiting period.
The SSA also helps make benefits accessible to children and adults who have housing instability or other considerations that could make it difficult for them to access benefits. The SOAR program was set up to provide case managers and support to people who need help accessing benefits because of their age, housing situation, or extreme poverty that creates lack of access to things like bank accounts.
Conclusion
Applying for Social Security disability benefits can be a lengthy process. But taking the time to complete the application thoroughly and including medical evidence and other supporting documents can speed up the approval process. Don’t give up if the initial application is denied. Use all of the appeals available so that you will be able to get the disability benefits you need. Fill out the Free Case Evaluation to get connected with an independent attorney who subscribes to the website and may be able to help with your claim process.
