Filing your application with the Social Security Administration (SSA) is the first step in the process to receive compensation for your disabilities. The application will ask for personal information, monetary information, and detailed information about your disabilities, work history, medical providers, medications, etc. An application or information submitted to SSA, however, does not guarantee that you will be approved for disability compensation.
After your application has been received by the SSA office, the information will be processed into the SSA system. Once your case is in the social security system, which can take 2-4 weeks, SSA will send your case to the Disability Determination Service.
When the case arrives at the Disability Determination Service they will send you several forms that will need to be filled out completely before your case can move along any further. These will be called the Work History Report and the Function Report.
Once they receive these forms from you, medical records will be gathered. If there are any problems with getting the medical records from any of your medical providers, the Disability Determination Service may ask for you and/or your representative to assist them in retrieving the records.
During this time, the Disability Determination Service may request that you see a physician who works for the SSA. This is called a Consultative Exam or CE and, if they schedule you an appointment, you will be required to attend. This will be at no cost to you. You may qualify for travel reimbursement depending on the distance of the appointment.
When the Disability Determination Service has all the medical records and information needed, they will send your case to a review board made up of doctors and vocational experts to make a decision. Once the decision is made, a letter explaining the decision will be mailed to you. If there is a denial in the Initial Stage, an appeal will need to be filed and it will move on to the Reconsideration Stage.
There is a 60 day window to appeal a denial decision. Once the appeal is filed with the SSA, the process is similar to the Initial Stage.
The SSA will process the appeal into its system and send it again to the Disability Determination Service. Once the appeal is received by the Disability Determination Service, they will request any new information or medical records that have been produced since the first denial decision was made. Once the Disability Determination Service has received this information, or if there are no new medical records, they will send your case to a Review Board to make a decision.
The Review Board in the Reconsideration Stage will not be the same as the board that made the decision in the Initial Stage. The Review Board will examine the medical records and all of the information in the case, and then make a decision. This decision will also be mailed out in a letter explaining the reasoning behind the decision. If there is a denial, there will be 60 days to file a Request for Hearing before an Administrative Law Judge.
The Hearing Stage is the longest stage in the process, but this stage also approves the highest percentage of claimants. An appeal will need to be filed for this stage as well, within 60 days following a denial of your case in the Reconsideration Stage. Once the SSA has received the appeal, they again will process all of the information into their system.
The SSA will then send the case to the Hearing Office. Any new medical records that are not already in the claim’s electronic file will then be requested by the client or their representative, (such as Acadia Disability). A hearing will then be scheduled for the case to be brought before a judge.
The average waiting time for a scheduled hearing is 17-19 months after the appeal has been filed. It can be a shorter or longer wait depending on the caseload backup in your nearest hearing office. While you are waiting for the hearing, all medical records, a hearing brief, a function report, and other required forms will need to be uploaded into the electronic file of the case. This will be done by you or your representative (such as Acadia Disability).
The hearing will be at your local hearing office. There will not be a jury or a big courtroom. The hearing will take place in a small room with you, your representative, the judge, and a possible vocational expert who works for the SSA if the judge has requested one to be present. At your representative’s request, witnesses may accompany you at the hearing to testify of the severity of your disabilities.
A decision will not be made at the hearing except in rare instances. The judge will have up to 60 days to make a ruling on the case. Then the claim will be sent to a decision writer which can take an additional 2 to 4 months to receive a decision. This decision will also be sent in a letter explaining the details of the decision. If there is a denial decision made, it is your decision to take it to the Appeals Council. This process can take a year to receive another decision from the Appeals Council.
At any stage your case can be approved. Once your case has been approved, it can take 1-2 months before you start to receive your monthly benefits. The back pay amount can take anywhere from 1-6 months to receive.
It is very important that, after the approval, any information that Social Security requests, is submitted as quickly as possible in order to not delay benefits pay.
Your benefits will continue to be paid as long as you are still disabled and unable to work. Occasional reviews of your case and disabilities will be requested to make sure you are still unable to work due to your disabilities.