The Social Security Administration (SSA) takes initial applications for both Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI). The application can be filed online, in person at a local Social Security District Office (DO), or over the telephone (1-800-772-1213). In addition to filing the application for DIB and/or SSI, the applicant must complete the Adult Disability Report (SSA-Form 3368). The SSA makes a technical determination as to which disability programs you may be eligible for and gathers the necessary documentation to complete your application. After the application is complete SSA transfers the file to the Disability Determination Services (DDS).
The DDS makes a medical determination on your claim for disability. In order to make such a determination the DDS assists in requesting medical records for your file and may send you to consultative exams (CE). A CE is an exam by a physician or psychiatrist. The purpose of the exam is to assist the DDS in determining whether you are medically “disabled”. If you are scheduled for a DDS exam you MUST attend. If you do not notify the DDS that you will not be able to make your doctor’s appointment the DDS may dismiss your claim for “non compliance.” Generally, it takes DDS 90-180 days to issue a medical determination on your claim.
If the initial claim is denied, you have 60 days from the date stamp on the denial notice to file an appeal with the SSA. The form you must complete is the Request for Reconsideration (SSA-Form 561). In addition, you must complete the Disability Report Appeal (SSA-Form 3441) and submit it to the SSA. a representative can sign Form 561 on your behalf and complete Form 3441.
The file once again is transferred to the DDS and a different medical examiner will make a determination on your claim. (See above.)
If the Reconsideration claim is denied, you have 60 days from the date stamp on the reconsideration denial notice to file an appeal with the SSA. The form you must complete is the Request for Hearing (SSA-Form 501). In addition, you must complete the Disability Report Appeal (SSA-Form 3441) and submit it to the SSA. a representative can sign Form 501 on your behalf and complete Form 3441.
The Office of Disability Adjudication Review (ODAR) is a branch of the SSA. If you request a hearing – you are requesting that your claim be reviewed by an Administrative Law Judge (ALJ). It can take several months for ODAR to assign your claim to an ALJ, this varies greatly depending on each ODAR.
Once an ALJ is assigned, the ALJ determines if you should be sent for another consultative exam, if you need to have a hearing, or if your claim is strong enough for a favorable decision without a hearing. If you are scheduled for a hearing there is much preparation that must be completed in order to give yourself the best chance of winning your claim. First, you must gather all medical records from the various doctors and hospitals that you have visited. Second, the medical records must be submitted electronically to ODAR. Third, attempt to get medical evaluations completed by your physicians. Forth, prepare for your hearing.
Prior to your hearing, review your file at ODAR to make sure all of your records made it to the file. At the hearing, the ALJ may call witnesses to testify, such as a medical expert (ME) or vocational expert (VE). A medical expert can be helpful in explaining complicated medical conditions; however, it is usually necessary to ask pinpointed questions to the ME to establish the limitations that you will experience if you attempted to do a job. A vocational expert can assist in explaining what types of jobs the claimant may or may not be able to be competitive at based on the claimants medical limitations. Cross examining the VE is a specialized skill that is critical at the hearing.
It is highly recommended that you retain a representative if you have a hearing. Besides gathering your medical evidence, preparing your file, and arguing your claim to the ALJ, an experienced representative is necessary for cross-examining Social Security witnesses.
If you are not satisfied with the decision of the ALJ you have 60 days from the date of the hearing decision to appeal the decision to the Appeals Council. An appeal to this branch of the SSA is a request to review the quality of the ALJ’s decision. To file an appeal with the Appeals Council you must complete the Request for Review of Hearing Decision (SSA-Form 520). a representative can sign Form 520 on your behalf. Usually it takes 1 to 2 years to receive a decision from the Appeals Council.
If the Appeals Council denies your claim, you have 60 days of the Appeals Council denial date to file a claim with the Federal District Court. Navigating the Social Security disability process is difficult; however, the Federal process is extremely complex.