This column will examine the time
limits in processing Social Security Disability claims. Most of
the time limits are imposed upon the person who is filing for
Disability Insurance Benefits and not on the Social Security
Administration. In many cases the Social Security Administration (SSA)
will deny the persons claim at some level and then the burden
shifts to the applicant for the benefits to file a written appeal
of that denial.
If the person does not file his appeal within the
allotted time frame then his case can be closed or dismissed by
the SSA. There is no corresponding requirement on the SSA to
either approve or deny a disability application within a certain
time frame. The SSA moves as efficiently as it can but there are
thousands of new cases filed each year. The decision making
process by the SSA can be very lengthy and frustrating to the
person seeking the benefits.
A relatively easy way to
visualize the SSA Disability Insurance Benefits process is to
think of it as a ladder. There are two rungs on the ladder leading
up to a hearing before an Administrative Law Judge. The first rung
is called the initial decision, the second rung is called the
reconsideration decision and the third rung is the actual hearing
before an Administrative Law Judge. There are specific time limits
in which to appeal which must be met after each denial if the
applicant wishes to keep his claim alive.
An applicant for Disability
Insurance Benefits begins the process of climbing the ladder by
filing an application for Disability Insurance Benefits. People in
the Fayetteville area can contact the local District Office of the
SSA located at 111 Lamon Street and which has the telephone number
of 910-486-4325.
The SSA also has a toll free number of
800-772-1213. The applicant can call the local office and request
the application package of documents be mailed to them. The
applicant can also go personally to the local District Office and
obtain assistance there in completing the application materials.
The application materials will
include a statement as to the type of health problems the person
has, the limitations it places on their activities of daily living
and the names and addresses of the health care providers who are
treating or who have treated the applicant’s health problems.
Once this material is gathered together then the application is
sent to Raleigh, N.C. to the Disability Determination Section
which is actually a North Carolina agency which reviews, analyzes
and obtains additional information about the applicant’s health
problems. This Agency then issues a decision after gathering all
of the medical information that it thinks is necessary.
The first determination is called
the initial decision. If the Agency recommends approval of the
applicant’s claim then the SSA will review the recommendation.
The SSA can decide to either approve the applicant’s claim or
decide to deny the applicant’s claim despite the Agency’s
recommendation to approve the claim. If the claim is approved by
the SSA then the decision making process stops and the claimant
will begin to receive monthly disability benefits.
If the SSA decides at the first
level to deny the claim, then the SSA will issue the initial
decision that advises the claimant that his claim has been denied.
The applicant then has 60 days from the date of the decision to
file his next appeal.
The SSA assumes that the applicant has
received the decision within 5 days of the date of the denial
letter, which in effect gives the applicant a total of 65 days to
appeal by requesting a reconsideration of this decision. The
applicant can call the SSA to have appeal documents sent to him to
complete. It is not enough to just verbally request the
reconsideration decision. The applicant must actually file the
written request for the review.
The SSA will not follow up with
the claimant to determine if they got the mailing with the
reconsideration documents. If the claimant is denied at the
reconsideration level he has the same 60 days plus 5 days to
request a hearing before an Administrative Law Judge.
Unless there
is a reason satisfactory to the SSA for the appeal for
reconsideration being filed after the time limit, then the
applicant’s claim is dismissed and he will have to start the
process all over again.
There are certain reasons that
the SSA can waive its 60 day appeal deadline. The SSA can find
good cause for missing a deadline to appeal by reviewing the
circumstances that caused the person to miss the deadline. The SSA
will determine if the SSA had somehow misled the applicant about
the appeal; if the applicant didn’t understand the appeals
process; if the person had limitations involving physical, mental,
educational, or inability to read English that prevented him from
appealing on time.
Some factors that the SSA considers good cause
include serious illness of the claimant that prevented him from
appealing, a death or serious illness in the person’s family, if
records were destroyed by fire or some accidental means, or the
person was making a diligent effort to obtain documents necessary
to appeal but was not able to do so in the time frame allowed.
Other factors that could be considered good cause would include if
the SSA gave incorrect information about how to request the
review; or the applicant did not actually receive the notice of
denial; or the applicant sent his appeal in good faith within the
time limit to the wrong Government agency or if there are unusual
or unavoidable circumstances that prevented the applicant from
sending in a timely appeal.
The best thing to do is to appeal
in a timely fashion and not have to worry about a late filing.
However if a deadline has passed there is a process for requesting
the SSA to waive the missed deadline to keep the applicant’s
claim alive. Don’t give up.
