The process of applying for disability benefits can be long. But the longer you wait to begin, the more time you’ll ultimately add to the process. We’re ready to dig in and get busy. Here’s a brief description of the levels of the process and what you can expect at each stage.
Level 1 – Initial Application: The Fact-Gathering Stage
Usually six to eight months for a decision, although some claims take longer.
The first step in obtaining Social Security disability benefits is filing an application. You will also complete a Disability Report requesting information about your medical conditions, doctors, hospitals, medications, treatment, work history, and education. It is important to provide complete and accurate information so Social Security can properly develop your claim.
After your application is processed by the Social Security field office, it is generally forwarded to the state Disability Determination Services agency for a medical decision. The claim is then assigned to a disability examiner who will request relevant records from the medical providers and facilities identified in your application. Listing every provider and treatment location is important because missing information may delay the claim or leave important evidence out of the record.
During this stage, you may receive additional forms asking about your symptoms, daily activities, work history, or ability to function. Social Security may also schedule one or more consultative examinations when it needs additional medical evidence. Please promptly complete all requested forms, attend scheduled examinations, and notify our office of any new treatment, diagnoses, hospitalizations, or changes in your contact information.
Once sufficient evidence has been gathered and reviewed, Social Security will issue a written decision. The Social Security Administration currently advises that an initial disability decision generally takes six to eight months, but the actual processing time varies depending on the state, the complexity of the claim, how quickly medical records are received, and whether examinations are required.
You will receive a copy of the decision by mail. Although Social Security should also notify our office, notices are sometimes delayed or not received, especially during the early stages of representation. If you receive a denial and have not heard from us within one week, please contact our office immediately and provide us with a copy. An appeal generally must be filed within 60 days after you receive the notice, and we do not want to risk missing that deadline.
If you are turned down on your initial application, don’t give up! We feel strongly about your case and we will continue fighting for you.
Level 2 – Reconsideration: Taking a Second Look
Usually about six months for a decision, although some reconsiderations take longer.
If you are turned down on your initial application, we will file a Request for Reconsideration for you. The Reconsideration process is an opportunity for a different Adjudicator to take a look at your claim and determine whether to change the Administration’s decision. By law, the Adjudicator must order new medical evidence and/or evidence not listed on the initial Disability Report. Therefore, when we ask you for an update regarding your medical care, please be sure to tell us every new doctor you have seen and every new hospital you have been to since you filed your initial claim.
During reconsideration, you may receive additional forms or be scheduled for a medical or psychological examination. Please promptly complete all requested forms and contact our office regarding any scheduled examination.
Again, you will receive a decision on your Reconsideration within about six months. If you are denied at this level also, please don’t despair! We have only just begun to fight!
Level 3 – Administrative Law Judge Hearing: Your Day in Court
Usually about nine to twelve months from the hearing request to a decision, although timing varies by hearing office and case.
If your claim is denied at reconsideration, we will request a hearing before an Administrative Law Judge. The judge will conduct an independent review of your claim and is not bound by the prior decisions.
Social Security’s recent national data reflects an average hearing-processing time of approximately 266 days, or about nine months, from the hearing request through final disposition. Actual timing varies by hearing office, and some cases may take longer than one year.
Once your hearing is scheduled, our paralegal, Erin Flynn, will contact you to review all relevant medical providers, treatment, testing, imaging, hospital visits, and other evidence. She will begin requesting updated records and carefully monitor the claim file to make sure the evidence is received and submitted in a timely manner. At times, she may ask for your assistance in completing forms, contacting a medical provider, or obtaining records that have not been provided.
After the evidence has been gathered, the attorney will review and summarize the medical records and prepare the legal and factual issues in your case. As the hearing approaches, the attorney will contact you with any remaining questions and will prepare you for your testimony, including the types of questions the judge may ask about your conditions, treatment, daily activities, past work, and limitations.
After your hearing, you should receive a decision within approximately three weeks to four months, depending on the judge. Most cases are successfully concluded at this stage.
Level 4 – Appeals Council: Reviewing the Judge’s Decision
Usually about 12 to 18 months for a decision, although some cases take longer.
If we do not win your case with the judge, we can appeal your case to the Appeals Council. You will not need to be present for a hearing at this level. It is a written review only. We will usually appeal when we believe the judge made a legal or factual error or the evidence supports a favorable decision. If the Appeals Council sends the case back for another hearing, it is generally remanded to the same Administrative Law Judge.
Level 5 – Federal District Court: Final Review
Usually about 12 to 24 months for a decision, although timing varies by court.
If we are unsuccessful with the Appeals Council, we can appeal to Federal Court. We do not appeal every case to Federal Court, only the ones in which we feel the Judge erred as a matter of law. This is because the Federal Court cannot “second guess” the Administrative Law Judge’s opinion, but must determine whether the judge abused his discretion or erred as a matter of law.
The court may uphold the decision, reverse it, or return the case to Social Security for further proceedings.
