Disability Claims Process...

Applying for Social Security Disability is a lengthy and time consuming process. Advantage 2000 consultants can help you all along the way.  SSA's disability claims process consists of an initial application and up to three levels of administrative appeals. 

INITIAL APPLICATION    

RECONSIDERATION

HEARING                             

APPEALS COUNCIL

DISABILITY REDESIGN PROTOTYPE STATES

INITIAL APPLICATION- The medical and vocational forms needed for the basic disability application total 22 pages-more if specific additional information is required.  SSA estimates it will take over an hour to complete the basic application forms. Your Advantage 2000 representative will complete all of the application and required forms and forward them to your local Social Security office.  There it is reviewed for verification that you meet the non-disability requirements, such as, having enough work credits under Social Security.  Your claim is then sent to the State Disability Determination Services (DDS) office for a medical decision of disability.  An examiner there will contact your medical sources for information regarding your impairment.  At this level, you will not normally need to meet face to face with anyone responsible for making the medical decision, however, you may be sent for a medical exam at Social Security's expense.  On average, Social Security DENIES two out of three initial claims. If your case is denied, we will help you request an appeal of the decision.

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RECONSIDERATION-A reconsideration is the first step in the appeals process.  Social Security is currently piloting a program in 10 states that abolishes this level of appeal. [See Disability Redesign Prototype States]  When filing a Request for Reconsideration, there are additional forms that must be completed.  SSA estimates it will take over 30 minutes to complete the basic reconsideration forms. Your Advantage 2000 representative can complete these forms on your behalf.  Again, at this level, the person responsible for making the decision on your case is a DDS examiner, one who was not involved in the original decision.  Social Security, on average, DENIES 85% of the reconsiderations filed.  If you should receive an unfavorable reconsideration decision, we will help you request a hearing before an Administrative Law Judge.

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HEARING-At this level, you and your Advantage 2000 representative, will be given the chance to appear before an Administrative Law Judge (ALJ).  Many times, it is possible to avoid actually appearing at the hearing by submitting well-documented medical records and reports.  Your Advantage 2000 representative will work with you in securing the necessary information.  If it is necessary to appear at the hearing, you, together with your representative, can give testimony and submit any additional medical evidence to support your claim.  The ALJ will make an independent decision on your case without regard to the earlier denials.  A greater number of claims are awarded at this level than the previous levels.  SSA awards just over 50% of the claims at this level.  However if you are dissatisfied with the decision of the ALJ, you have still one more administrative appeal available.  You may request a review of the ALJ's decision by the Appeals Council (AC).

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APPEALS COUNCIL-This final level of administrative appeal is also completed with the decision maker never seeing you.  The AC, generally, will not consider new evidence about your disability regarding the period of time after the hearing decision.  Therefore, it is very important that you, and your Advantage 2000 representative, were fully prepared at the hearing and submitted all available medical evidence to support your disability.  The decision of the AC can be, to reverse the ALJ's decision, uphold the ALJ's decision, or send the case back to the ALJ for a new hearing.  SSA dismisses, denies or remands back to the Administrative Law Judge 98% of the requests for Appeals Council review. You will be notified in writing of the AC's Decision.  If you are dissatisfied with the AC's decision, there are no additional levels of administrative appeal.  If you wish to continue in your pursuit of benefits, you will need to take your request to the United States District Court and/or file a new initial application.

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DISABILITY REDESIGN PROTOTYPE STATES-Effective October 1, 1999, a pilot program is being tested to streamline the disability process.  Under this prototype the reconsideration step in the appeals process is eliminated for disability issues.  Appeals on disability denials are sent for a hearing decision as the first step of the appeals process.  The states involved in this process are: Alabama, Alaska, California (Los Angeles North and West only), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York (Albany-begins April/May, 2000 and Brooklyn only), and Pennsylvania.   If you are involved in a prototype state it is very important that your case is well documented.   Advantage 2000 consultants are there for you all though your disability claims process. 

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