Qualifying for Social Security and SSI Disability Benefits: Part II- The Application Process

Qualifying for Social Security and SSI Disability Benefits: Part II- The Application Process

This is the second article in a series designed to explain the Social Security and SSI disability application process and to provide helpful information to individuals applying for those benefits.  To review briefly, Social Security and SSI disability benefits are available to individuals who are unable to work for at least 12 consecutive months due to physical or mental impairments, or both.  An application for benefits should be filed as soon as the person believes he or she will not be able to work for medical reasons for at least 12 consecutive months.

How do I file an application for Social Security or SSI disability benefits?

Applications for these benefits can be made in one of two ways:  1) by calling Social Security’s toll-free number, 1-800-772-1213; or 2) via Social Security’s Internet site, www.ssa.gov.  The application is not complete until you have signed it and submitted it to Social Security.

What happens after I apply and  how long will the process take?

The initial decision.  All applications are first processed by a disability determination service in the state where the applicant resides.  Social Security contracts with these state agencies and delegates to them the responsibility for making the initial disability determination.  In Pennsylvania the agency is known as the Bureau of Disability Determination.  At the state agency level the case is assigned to a disability claims adjudicator.  He or she will attempt to obtain the medical evidence you identified in your application.  They will also send you at least one long questionnaire to complete and return.  As part of the evaluation process at the state agency level, you will normally be sent one or more lengthy questionnaires to complete.  In completing any forms, be sure that you describe your activity level and symptoms as they occur on an average or “bad” day.  The idea is to complete those forms in a way that gives a complete picture of your symptoms, limitations and functional abilities on a day to day basis.  Sometimes the state will schedule one or more consulting medical examinations with a doctor in your area.  After all of the documentation is received, the adjudicator will make a decision on the claim.  Expect it to take from 3 to 5 months to receive the decision.

Most individual who apply for disability benefits are denied at the initial level.  However, the quality of the decision-making process is very uneven and many claims that should be approved are denied.  If your claim is denied, you will receive a denial letter informing you of the reasons for the denial and explaining that you have 60 days to appeal the unfavorable decision.  Under all circumstances you want to appeal an initial denial decision and do so in a timely manner.  Also in all cases, you want to consult with an attorney who practices in this area of the law.

The next level of appeal is Reconsideration.  The claimant must request “reconsideration” of the initial denial decision from the state agency before the case can be heard at the administrative hearing level.  This means a second disability determination by the same state agency.  This step can add another 3 to 4 months to the process.

The administrative hearing level.  Once a timely appeal is filed from a reconsideration denial, the case will be sent to a Social Security hearing office.  At this point you will want to engage an attorney if you have not done so already.  The good news at the hearing level is that the prospects for success are greater than they were at the state agency.  For one thing, the judge who hears your case will give no weight to the state’s decision and will review the evidence anew.  Second, you will have the opportunity to supplement the medical evidence and third, you will be able to meet with the judge and explain why you are unable to work.  The bad news at the hearing level is that the wait for a hearing can be in excess of a year.

Beyond the hearing level.  Currently there are two more levels of appeal if you receive a denial decision from an administrative law judge (ALJ):  1) the Appeals Council and 2) federal district court.  Expect it to take a year or longer for a decision at each of these appellate levels.  For this reason, you want to make sure you present your strongest case to the administrative law judge and win the case at that level.

What if my disability application has been deniedWhat can I do thenShould I appeal, reapply or just give up?

Always talk with an attorney as soon as you are denied.  You should always appeal and in some cases reapply for benefits.  Never give up without consulting with an attorney.

If you or someone you know has any questions about disability benefits, call the Disability and Injury Law Office of David R. Machek for a free consultation at Jenkintown 215-385-5353 or Philadelphia 215-323-5320 or email us at:  [email protected]

The Disability and Injury Law Offices of David R. Machek maintains offices in center city Philadelphia and Jenkintown, PA.  The Disability and Injury Law Offices of David R. Machek focuses its practice exclusively on Social Security disability matters.