Why Are There Levels of the Social Security Disability and SSI Application and Appeal Process?

by May 23, 2018General

Home » Blog » Frequently Asked Questions (FAQs) » Why Are There Levels of the Social Security Disability and SSI Application and Appeal Process?

The Social Security Administration (SSA) offers no fewer than five levels of its disability application and appeal process to ensure no person deserving of benefits should fall through the cracks, and that every applicant deserves ample opportunity to make their case for why they deserve benefits. Due to the extent of these levels, it varies how long it will take for a decision on social security disability.

The national approval rate for Social Security disability claims is 36 percent, and the odds worsen at the first stage of the appeal process. There, only 13 percent of claims get approved — roughly one out of eight. If you find yourself a member of the unlucky majority, do not despair. Even after two denials, there remain several levels of the social security disability and SSI application and appeal process available.

Initial Social Security Application

The initial claim involves filling out an application, gathering supporting documents, and attending an in-person or phone interview with a claims representative, who will ask questions about your medical treatment and work history.

A few things the SSA looks for as it reviews your initial application:

  • Medical records, including lab reports, doctor’s notes, medication schedule, and treatment history
  • Names of all doctors and hospitals where you have sought treatment for your condition
  • Your work history dating back 15 years from your application date
  • Information about your education, job training, and vocational skills

To promote timely processing of your application and maximize your approval chances, you should make sure your supporting documentation is as thorough and compelling as possible. Do not leave out anything the SSA might lead. If you do, the best case scenario is your application gets delayed while the SSA chases the missing information; the worst case scenario is a denial of benefits.

Request for Reconsideration

The first appeal, known as a request for reconsideration, allows you to update your medical information, attach new evidence and documentation that bolsters your claim, and submit it for a re-review by the SSA.

If you have received any additional diagnoses, undergone any additional lab testing, or suffered any setbacks from your condition, this information should appear in your request for reconsideration. The more, the better.

If you do not have additional evidence to support your claim or your evidence is scant, you can expect another denial at the request for reconsideration stage. Remember, only 13 percent of people get approved here, which indicates that the SSA is looking for evidence that is truly compelling or convincing before it will overturn a denial on a first appeal.

Administrative Law Judge Hearing

Following a denial of your request for reconsideration, you may file a request for a face-to-face hearing in front of an Administrative Law Judge (ALJ). This third stage offers the highest success rate of any level of the disability application and appeal process.

ALJ hearings lead to more positive outcomes because they provide the opportunity to explain the unique and compelling aspects of your claim and to answer questions as they arise, as opposed to filling out forms and giving written statements and hoping you provide what is needed for approval.

That said, success at an ALJ hearing is not guaranteed. To have the best chance of a favorable outcome, you must come prepared. That means preparing what you will say to the judge and being ready for any questions or concerns they throw your way.

You are allowed to have an attorney with you at your ALJ hearing, and you should take advantage of this privilege. A Social Security disability lawyer can help you prepare your case and can present it most compellingly to the ALJ.

If the ALJ does not approve your claim, you have two more levels of appeals — unfortunately, though, few veterans find success at either of them.

Appeals Council and Federal District Court

The Appeals Council reviews the claims that are denied by ALJs and can approve them, deny them, or remand them back to the ALJ for a second look. While you are waiting for an Appeals Council review, you have the option to start a brand new disability claim from step one.

As a final step, you may appeal your claim in federal court. The attorneys at the Disability Advantage Group, want to help you win your Social Security disability claim. No matter where you are in the process, we can fight for the benefits you deserve. To schedule a free case evaluation with one of our attorneys, call 1-865-566-0800.