Who Makes the Decision on a Social Security Disability or SSI Case?

by Apr 11, 2018Disability Benefits

Home » Blog » Frequently Asked Questions (FAQs) » Who Makes the Decision on a Social Security Disability or SSI Case?

The Social Security Administration (SSA) has many decision-makers who determine the fate of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) applications. The person who makes the decision on a Social Security Disability or SSI case depends on what stage of the process your claim is in.

The application process for SSDI and SSI is long and complicated. It gets even more convoluted once the SSA denies an application and the claimant decides to appeal the decision. In all, a disability application can pass through as many as five different stages before the SSA issues a final decision.

The five disability application stages are:

  • The initial claim;
  • The first appeal or “request for reconsideration”;
  • The Administrative Law Judge (ALJ) hearing;
  • The Appeals Council review; and
  • The Federal district court.

At each level, a different person reviews your application and supporting documentation, and determines its fate.

The disability attorneys at the Disability Advantage Group, can help you understand the application or appeals process. For a free legal consultation, call 865-566-0800.

What Is the Initial Claim Stage?

The initial claim refers to the application you submit when you first apply for benefits. While the SSA does approve some applications at this stage, many SSDI and SSI applicants receive denials on the first try.

At the initial claim level, the first place your application gets reviewed is at your local Social Security office. From there, it goes to a disability examiner at your state’s disability agency. The disability examiner has the authority to approve or deny your claim based on the information on the application and supporting evidence.

In some cases, the disability examiner holds off on a decision until you have had a consultative medical examination with a designated doctor or psychiatrist. The disability examiner uses the results of the exam to corroborate the information in your application before rendering a decision.

An approval at the initial claim stage removes the need to go through any of the subsequent claim levels. If you receive a denial and want to challenge the decision, you will move on to the appeal process.

What Is a Request for Reconsideration?

You can request a reconsideration of the disability examiner’s decision to deny your application. By doing so, you effectively start the process over. You must resubmit your application, plus any additional information you believe could strengthen your case. It again starts at your local SSA office and then proceeds to the state level, where a disability examiner reviews it.

The only difference this time is that a different examiner decides on your application. This makes the appeals process notoriously tricky. Even though your file goes to a different examiner, they use the same criteria to judge your application.

What Happens During an ALJ Hearing?

If the SSA denies your request for reconsideration, you can request a hearing in front of an ALJ. Many disability approvals occur at ALJ hearings, for the likely reason that you can argue the unique merits of your case directly to a judge.

The judge has the final say on the fate of your application at the ALJ stage. Though, like the disability examiner at the first two levels, the judge has the option to bring in a doctor, psychiatrist, or vocational expert to gather additional information to help in the decision.

What Is an Appeals Council Review?

Even if the ALJ denies your claim, you have two more chances to get the decision reversed. The first is an Appeals Council review.

The Appeals Council is a board that reviews ALJ decisions. Unfortunately, they rarely challenge the ALJ, meaning the most likely outcome at this level is another denial. From time to time, the Council will send an application back to the ALJ for additional review, known as a remand hearing. If this occurs, you can face the judge again and perhaps offer additional information to strengthen your claim.

What If My Appeals Council Review Fails?

If you make it all the way to the Appeals Council without success, your last option is to appeal to your Federal district court. Applicants rarely use this option, as it tends to be time-consuming and costly.

A disability attorney can strengthen your claim and help you understand the steps to approval. Particularly at the ALJ hearing stage, having a lawyer to argue on your behalf is invaluable. You can work with a disability lawyer at any stage in the process.

How Can I Talk to a Disability Lawyer?

The attorneys at the Disability Advantage Group, focus on disability law. We can help you fight for the benefits you deserve. Whether you are applying for the first time or trying to reverse a denial, we can help. Call 865-566-0800 for a free consultation.