While a claim for benefits from the Social Security Administration based on disability may go all the way to the U.S. Supreme Court, most cases favorably decided end at the hearing before an Administrative Law Judge. Here are the various claim steps:
•Initial Application
•Reconsideration
•Request for Hearing before an Administrative Law Judge
•Additional Appeals
INITIAL APPLICATION:
Whether for SSI or DIB entitlement, a claim starts, and determination of past due benefits are tied to the filing of an application. At the initial level, preliminary determination is made for meeting the non-medical requirements; Meeting the financial resources rule for an SSI claim or meeting the work credit requirements for a DIB claim. Once the application is perfected, the claim is sent and reviewed by the State Disability Determination Services agency for a recommendation on meeting the medical rules of establishing disability. Additional documentation of pain, activities of daily living and work history may be requested. In many to most cases, a request for a Consultative Examination may be made to document physical or mental health issues. A determination is typically made at this level in 3 to 5 months.
RECONSIDERATION:
A denial at the initial level provides for appeal rights to the reconsideration level. In most cases, absent extenuating circumstances, an appeal MUST be filed with the Administration within 60 days. The claim is returned to the State Disability Determination Services for a second look, and new recommendation of meeting the disability rules. Most cases are denied at this level.
REQUEST FOR HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE:
The second level of appeal involves an appearance before an ALJ assigned to make a new and independent determination on the validity of the claim for disability benefits. It is here (and only here) that you appear face to face with the person who makes the determination on your claim. ALJ’s apply case law, administrative rules and regulations and Social Security Rulings to the decision in your case. The Judge may call experts to testify, providing guidance on medical and vocational issues. In many jurisdictions it may take a year or more from the date a request for hearing is filed to the hearing date.
ADDITIONAL APPEALS:
Claimants dissatisfied with a decision up to this point may continue their appeals to:
- Appeals Council
- Federal District Court
- Circuit Court of Appeals
- Supreme Court
