Social Security Disability Claims

Social Security Claims - An Administrative Law Judge has denied my disability claim. What do I do now? This column is going to explain what happens if your claim is denied by an Administrative Judge. To make the process easier to understand, the steps used by Social Security Administration (SSA) to make a decision whether to pay or deny a disability claim will be summarized. The primary focus of this column will be to discuss what your options are if a Judge denies your disability claim.

Filing a Social Security Disability Insurance Benefits claim takes time and patience. Disabled workers have plenty of time because they are not working, but don’t have much patience for the same reason. The bills don’t stop when you can’t work. The SSA has four levels that can make a decision to pay a disability claim. This column will discuss those stages and will focus on what happens if an Administrative Law Judge denies a disability claim.

When you apply for disability insurance benefits you start that process by contacting the local SSA District Office. You can call your local office and request they send you the Disability Application package for you to complete and return to that office. The local office will also set up your file and assist you in getting your application filed. The application covers such matters as your health problems, your medical care providers, and your work history.

The completed package is sent to the Disability Determination Section (DDS). It is evaluated there to determine if the applicant meets the standards for the payment of disability benefits. The disability test can be summarized as follows: the person must no longer be working or earning above a very limited amount of monthly income; the person must have a medical condition which can be expected to last at least 12 months or result in death sooner; and the person must no longer be able to perform their past work or any other type of job that exists in substantial numbers in the national economy.

The first level of decision-making is the DDS. The DDS gathers up additional medical and other information about the claimant and makes an initial decision. If the DDS approves the disability application, it will notify the applicant in writing that his claim has been approved. If the DDS disapproves the claimant’s application, it will send a letter called the initial denial. The claimant has 60 days to appeal this denial in writing to request Reconsideration.

More often than not, if the claims denied at the initial decision will be denied at the Reconsideration level. A reconsideration denial can be appealed within 60 days to an Administrative Law Judge. The Judge will give the claimant a new hearing on his claim and is not bound by the fact the claimant has been denied twice before.

The Administrative Law Judges are much more likely to approve disability claims than the first two levels of decision making by the Disability Determination Section. It is vital not to get discouraged and let the 60-day time to appeal for a hearing before a Judge pass without filing such an appeal.

However Judges certainly do deny claims and the rest of this column will discuss your options after a denial by a Judge. The Judge’s denial can be appealed to the Appeals Council that is in Arlington, Virginia. The Appeals Council reviews appeals of Judge’s denials of disability claims. The claimant does not actually get to appear before the Appeals Council. The decision is made by the Appeals Council solely on the appeal documents and documents in the claimant’s file. Decisions by the Appeals Council can easily take more than a year to be issued.

In addition to filing an appeal with the Appeals Council, the claimant can file a new claim with the local District Office of the SSA. This new claim can be filed while the Appeals Council is still deciding the denial of the first claim. The new claim will be sent to the DDS for review. The DDS can approve the new claim at the initial or reconsideration level while the appeal of the original claim is still pending. The DDS is limited to approving a disability onset date on a new claim to the day after the Judge issued his decision denying the original claim.

A favorable decision by the DDS on a new claim will be forwarded to the Appeals Council to determine if there is new evidence in the new claim that might warrant the Appeals Council approving the pending claim on appeal. If the claimant is denied at the initial level on the new claim he can file a reconsideration request on the new claim on the same basis as any other claim. If the new claim is denied at reconsideration, the claimant can appeal the new reconsideration denial for hearing before an Administrative Law Judge on the new claim.

However the Hearing Office will not schedule a hearing before an Administrative Law Judge on a new claim until the Appeals Council has decided the appeal of the first denial by a Judge. If this sounds a bit complicated, it is. The important thing to remember is that you can file an appeal of a Judge’s decision and also file a new claim with the local District Office to be processed while the Appeals Council is processing the first denial by the Judge.

Notice: Since Social Security Disability is directed under Federal law, the information in this column will apply anywhere in the United States. However each Office of Hearings and Appeals and District Office have their own ways of doing things as does the various Federal District and Circuit Courts. I have kept this column primarily dealing the the mechanics of how the Social Security District Offices and Office of Hearings and Appeals evaluates disability claims.
- Pitt Dickey

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith, Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place and can be reached at 910-485-8020 or at . Or at the firm web site of www.smithdickey.com .