There are many potential levels of decision-making in a Social Security disability claim. These range from the initial decision on your application, through the administrative decision-making process, and all the way through the federal court system, including the United States Supreme Court. Needless to say, the vast majority of claims do not make it through all these levels. Most claims are concluded in the administrative decision-making process.
The first step in obtaining benefits is the initial application. The application process may be started at your local Social Security office or online at SSA.gov.
Your claim is first reviewed by disability examiners, who make the initial decision of whether you are disabled or not, according to Social Security rules. Only about 30% of all claimants are awarded benefits at the application level.
If you receive a denial on your application, you must submit a form entitled Request for Reconsideration. This must be completed and submitted online or mailed to a Social Security office within sixty (60) days from the time you receive your first denial. Your file will be reviewed by different examiners than those who initially denied your claim. Less than 20% of denied claims are allowed at the reconsideration level.
When you receive your second denial, you have sixty (60) days to mail or electronically submit a form entitled Request for Hearing Before Administrative Law Judge. This is the point in the process when many people choose to retain an attorney. If you are going to get a lawyer to represent you at the hearing, you should contact him or her as soon as possible after receiving your first or second denial.
Unfortunately, it usually takes a long time to get a hearing date. In the Portland-Vancouver area, it takes an average of 17 months to get to hearing from the time a hearing is requested. It is during this waiting time that your attorney should be collecting and evaluating relevant medical evidence. If necessary, he or she may request special reports from one of your physicians to present at the hearing. The hearing is the first (and usually the only) opportunity you will have to present your testimony to a judge. It is at the hearing that you “make the record”, that is, establish the documentary and testimonial evidence to support your claim for disability. In the Portland-Vancouver area, approximately 38% of claimants with denied claims prevail at the hearing level.
If you receive an unfavorable decision from the administrative law judge, you may appeal your claim to the Appeals Council. The Appeals Council will not take new testimony. In most cases, members of the Council simply review the record from the hearing, including a transcript of any testimony. The Council decides whether the judge’s decision was legally correct, and whether it is adequately supported by the facts in the record.
Although further appeals may be taken through the federal court system, relatively few cases make it that far. The majority of claims are concluded at some point during the administrative decision-making process described above.