The SSD Decision and Appeal Process

The Social Security Administration’s process for the initial determination of disability may take three to five months and occasionally longer. Following the receipt of your application for disability benefits, a Social Security representative will review the information you have provided. If the representative is satisfied that the application meets certain basic criteria (like a long enough work history), the representative will forward the application and evidentiary materials to the state Disability Determination Services, which is charged with deciding whether you have a disability that qualifies under Social Security Administration standards.

The state agency may seek more evidence to further develop your file. State agencies employ doctors and disability specialists to review medical records and collect additional information from treating doctors, clinics and hospitals. The agency may also send you to your doctor or a new doctor for an examination.

The Standards Used to Determine “Disability”

The Social Security Administration uses a five-step evaluation process to determine if you are disabled according to its standards and definitions. According to the Social Security Administration’s Web site, it looks at these factors:

  • If you are working. Generally, if you earn more than a specified amount of money, you will be found not disabled. This amount increases slightly each year. If you are not working or make less that the threshold amount, the state agency will analyze your medical condition at step two.
  • If your medical condition is severe enough to render you disabled. Your ability to perform even basic work tasks must be significantly limited by your medical condition for at least one year. If the condition is not found to be severe, you will not be found to be disabled. If the impairment or combination of impairments is severe enough, the agency will proceed to step three.
  • If your condition on the List of Impairments. Conditions that are on the List of Impairments are considered so severe that a person with one of them is automatically found to be disabled. If your condition is on the list, or if it is not on the list but equals the severity of the listed impairments, you will be found disabled. If not, the agency will continue to step four.
  • If the disability leaves you unable to do the work you did before. If you can still do your previous work, you will be found not to be disabled. If you cannot return to that type of work, the agency will consider step five.
  • If you can do another kind of work. For this analysis, the agency will examine your age, education, past work experience, job-related skills and medical condition to see whether you could adjust to different work. If you can do other work, you will not be considered disabled. If you cannot adjust to new work, you will be considered disabled.

These rules vary for blind applicants.

You will receive a letter that accepts or rejects your application. If you have been found eligible for benefits, the letter will include information on the payments you will receive. If you are found ineligible, you may appeal the adverse decision.

Appeals

You have the right to appeal the decision on your eligibility for Social Security Disability benefits. If your appeal is denied at one step, you may move on to the next.

  • First, ask for a reconsideration. A person who has never seen your file will look at all the evidence, including any new information. Under a pilot program in some states, including Missouri, the reconsideration step has been eliminated.
  • Next, request a hearing before an administrative law judge (ALJ). You may be asked to provide more information. The ALJ will question you and your witnesses, if you have any.
  • You may then request a review of the ALJ’s decision by the Appeals Council. The Social Security Appeals Council may grant or deny your request. If it grants your request, it will either review your case or send it to an ALJ for review.
  • Finally, you may petition for review by the federal court. If you receive another adverse decision or the Appeals Council decides not to grant your request, you may file a lawsuit in federal court.

You have a limited time in which to file each appeal. An attorney who knows Social Security Disability law can be of great assistance during the appeals process.

Speak with an Attorney

Moving through the Social Security Disability application and appeals process can be time consuming and complicated. An experienced attorney from The Law Offices of Kenneth Hiller in Buffalo, New York, can answer your Social Security Disability benefits questions and help you with the qualification process.

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

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