Who makes the final decision on Social Security Disability claims depends on where you are at in the process.
The Initial Application for Social Security Disability Benefits
Most Social Security Disability Insurance – or SSDI – claims and in Supplemental Security Income – or SSI – claims are initially processed through your local Social Security Administration (SSA) field office and State agencies (usually called Disability Determination Services or DDS).
An initial application for disability begins with a local Social Security claims representative (also known as disability examiners) at your local Social Security office. The disability examiners at Social Security Administration field offices obtain initial applications for disability benefits in person, by telephone, by mail, or from online submissions. The Social Security Disability application and related forms ask for a description of the claimant’s impairments, treatment sources, and other information that relates to the alleged disability. (The “claimant” is the person who is requesting Social Security Disability Insurance benefits.)
The Social Security representative is responsible for verifying “non-medical” eligibility requirements, which may include age, employment, marital status, or Social Security coverage information. As long as the claimant meets the SSA’s non-medical requirements, the local Social Security office will send the case to Disability Determination Services for evaluation of disability for the second phase of the disability benefits application process.
What are Disability Determination Service Offices?
Disability Determination Services (DDS) is a State agency responsible for developing medical evidence and making the initial medical disability determination on whether a claimant is disabled or blind under Social Security law. The agency and its offices are fully funded by the federal government.
DDS usually tries to obtain medical evidence from the claimant’s own medical sources first. If that evidence is unavailable or insufficient to make a determination, the DDS will arrange for a consultative examination (CE) to obtain additional information about the applicant. This evaluation is also paid for by the federal government.
The claimant’s treating medical provider is the preferred source for the CE, but the agency may obtain the CE from an independent source. After completing its development of the evidence, trained staff at DDS makes the initial disability determination.
What Happens After DDS Makes a Decision on my Disability Claim?
The State agency returns the case to the SSA field office for appropriate action in your Social Security Disability claim. If the DDS found that the claimant is disabled, the Social Security Administration completes any outstanding non-disability development, computes the benefit amount, and begins paying Social Security Disability benefits. If the claimant was found not to be disabled, the file is kept in the field office in case the claimant decides to appeal the decision.
How Do You Know If You Are Approved for Disability?
The best way to know if you have been approved for Social Security Disability benefits is to wait for a written notice to arrive in the mail. If you are approved for disability benefits you will receive a Notice of Award letter from the Social Security Administration. Applicants whose claims for disability benefits are denied will receive a Notice of Disapproved Claim rather than an award letter. You can check the status of your claim online, but it will not indicate whether your claim for Social Security Disability benefits was approved or denied, only the status of a decision by the Social Security Administration.
The Request for Reconsideration
In most cases, reconsideration is the first step in the Social Security Administration appeal process for individuals who disagree with the initial disability decision. If you have been denied Social Security Disability benefits, or if you do not agree with the start date of your disability benefits, then you can file an appeal with the SSA. Your appeal must be received by the Social Security Administration within 60 days of the date you received the Notice of Disapproved Claim.
A reconsideration is a complete review of the disability case by someone other than the person who made the original decision. The Social Security Administration will reevaluate all evidence, plus any additional evidence submitted, and issue a new decision as to whether you qualify to receive disability benefits. You can either submit a written Request for Reconsideration (Form SSA-561-U2) or you can submit a Request for Reconsideration online with the SSA website.
Expedited Appeals Process (EAP)
An individual may request an Expedited Appeals Process (EAP), but only after appealing a disability case at least through the reconsideration step. EAP may be used in those cases in which the individual does not dispute SSA’s version of the facts in his or her claim. Rather, the claimant challenges the constitutionality of the law underlying the decision. The Social Security Administration, and all parties to the determination, must agree to use EAP.
A Hearing Before an Administrative Law Judge
In general, a hearing before an Administrative Law Judge (“ALJ”) is the next level of appeal after Social Security has made an unfavorable reconsideration determination. The ALJ will conduct a disability hearing. You and your attorney or representative go to the disability hearing and present your case in person. The Administrative Law Judge will evaluate all the evidence on record, including any additional evidence submitted up to 5 business days prior to the hearing, and will issue a decision as to whether you suffer from a disability. Use the Request for Review of Decision/Order of Administrative Law Judge (Form HA-520-U5) to appeal an ALJ’s decision to deny your claim for disability benefits or appeal the denial with the SSA website.
What Percentage of Disability Hearings are Approved?
In 2019, 45% of claims nationwide were approved at the disability hearing level. Approval rates for specific ALJs are also published and can be found online once an ALJ has been assigned to your Social Security Disability claim. It is also possible to receive a partially favorable decision. A partially favorable decision usually means that you have been approved for disability benefits, but the benefit period is different from the benefit period alleged in your initial application for disability benefits. An attorney can help you weigh the pros and cons of appealing a partially favorable decision.
If the claimant disagrees with either the ALJ decision or the dismissal of a hearing request, he or she may ask the Appeals Council (AC) to review the action. The AC may dismiss or deny the request for review, or it may grant the request and either issue a decision or remand the case to an ALJ. The AC may also review an ALJ decision (within 60 days of the hearing decision or dismissal) on its own motion. The AC has the final review authority for Social Security Disability claims.
Federal Court Review
The AC review completes the Social Security Disability administrative review process. If an individual is still dissatisfied, he may request judicial review which is done by filing a civil action against the Social Security Administration in a Federal district court.
Work With a Disability Lawyer
We help disabled individuals nationwide receive the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits that they deserve. If you suffer from a disabling medical condition and are no longer able to work then we will help you through the SSA’s initial application process. If your claims are denied we will also help you through the SSA’s appeal process. If your appeal is denied we can file a request for a hearing before an administrative law judge.
Do You Have Questions? We Have the Answers
If you have questions about the SSDI or SSI application and appeal process then you should contact our office right away. If you are disabled and unable to work, or if you have already received a claim denial you may be eligible for a free case evaluation.
You can call our office at (888) 321-8131, contact us through our website using the live chat feature, or complete the contact us form on our website to schedule your free case evaluation. We would welcome the opportunity to discuss your claim and how we can help you obtain a favorable decision from the SSA so that you will be paid the benefits you are eligible to receive.
You can also join our free support group for Social Security Disability claimants and their families. Social Security Disability Q&A is a support group focused on educating claimants and their families about the application and appeals process in SSDI and SSI claims. Topics may include the application, a request for reconsideration, an appeal requesting a hearing before an Administrative Law Judge (ALJ), and beyond. This group is moderated by the Disability Academy and Board Certified Social Security Disability Attorney Nick A. Ortiz.