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Obtaining Social Security disability benefits is accomplished through an administrative appeals process and is a Federally regulated administrative program. Congress gave the Social Security Administration the power to regulate itself. As such, a person must follow the administrative review process to receive Social Security disability benefits. Once the administrative process has been exhausted, the claimant has the right to appeal to Federal District Court.
The first stage of the appeals process is to file an application. A Social Security disability application ("DIB," "SSI," "DWB" and "DC") may be done online or at a local Social Security district office. This first stage is called the application or initial stage. Once an application is filed, the file is transferred to Disability Determination Services ("DDS"). DDS may require the claimant to complete a work history report and daily activity questionnaires. DDS should attempt to obtain the claimant's medical records and may schedule a consultative examination. Once all the information is gathered, it is reviewed by a state agency medical examiner, and a decision will be made granting or denying Social Security disability benefits. The average time-frame for a decision is be made is 60 to 120 days. The first decision is called the initial determination. If a claimant is denied, they have 60-days to file a written appeal with a district office.
The second stage of the Social Security disability appeals process is the reconsideration stage. A Request for Reconsideration is filed at the local district office and must be filed within 60-days of the initial determination. Again, the file is transferred to DDS. DDS may require the claimant to complete a work history report and daily activity questionnaires. DDS will sometimes attempt to obtain the claimant's medical records and may schedule consultative examination. Once all the information is gathered, a decision will be made. The average time-frame for a decision to be made is 45 to 120 days. If a clamant is denied at reconsideration, they have 60-days to file a written appeal with the district office.
The third stage of the Social Security disability appeals process is the hearing stage. A Request for Hearing is filed at the local district office and must be filed within 60-days of the reconsideration. The district office will forward the file to the Office of Disability Adjudication and Review ("ODAR"). When the file is received by ODAR, an Acknowledgement of the receipt of hearing will be received informing the claimant that they will be notified at least 20-days before the date of their scheduled hearing. The fille will then be placed in line for hearing behind all of the other claims that were received before it. Once the case is assigned to an Administrative Law Judge ("ALJ") it will be reviewed and worked up for a hearing. Once the case is ready, it will be placed on the ALJ's docket and scheduled for a hearing. ODAR usually contacts the claimant's representative about 30-days before the scheduled date to confirm the date. Once the hearing is held, the average time to receive a decision is 30 to 60-days. However, this is an average and there are no statutory timeframes requiring the ALJ to issue a decision within a certain amount of time. There have been instances where decisions were issued 12 or more months after a hearing. If the claim is approved, it will be transferred to the payment center for payment. If the claim is denied, the claimant has 60-days to file a written appeal to the Appeals Council.
The fourth stage of the Social Security disability appeals process is the Appeals Council. The claimant must file a written request for review. The written request may be filed with: the Appeals Council; the Office of Disability Adjudication and Review; or the district office. To be successful at the Appeals Council, the claimant must show the ALJ's decision was in error of the law, was not based upon substantial evidence or violated public policy. The average time-frame to receive a decision from the Appeals Council is currently 4 to 9-months. If successful at the Appeals Council, the usual remedy is remand back to the ALJ to correct the error. However, the Appeals Council can reverse and enter a Favorable Decision. If the Appeals Council denies the request for review, the claimant has 60-days to file a Complaint in Federal Court.
You, as the claimant, in a Social Security disability claim have the burden of proving your claim. You can only prove the severity of your impairments through medical evidence. Therefore, it is important you receive regular medical treatment. The more medical tests you have and the more physical or mental examinations you have, the better off you will be in substantiating your subjective complaints of pain and functional limitation.
Also, your doctor's opinions regarding your ability to function are entitled to great weight. Statements from your doctor such as "my patient is disabled" or "my patient cannot work" are not given weight by Social Security. This is because "disabled" or "cannot work" are conclusions. The ultimate conclusion that a claimant is disabled under the Social Security Act's definition is reserved for the agency. However, your doctor's opinion regarding your ability to function are helpful. If you doctor opine's on your ability to function (sit, stand, walk, lift, carry, etc.), the opinion is based upon specific findings and the opinion consistent with the other evidence, then the opinion is entitled to great weight under the Social Security Act. Steven Scoggin has specialized forms which ask specific questions from your doctor regarding your ability to function mentally and physically. Please have your doctor complete the forms as thoroughly as possible by documenting the basis of his/her opinion and have your doctor return the forms to Steven Scoggin.