The Social Security application process can be a lengthy one and involves several steps. This will outline those steps. The chances of success at each level vary greatly based on age, past work history, and the type of and severity of the condition(s) you are experiencing.
Step 1 – Initial Application
At the initial application stage, the Social Security Administration takes information including details of your treatment. Your file is sent to the state Disability Determination Service. This agency gathers and processes your medical records. A consultative examination could be ordered. A Determination is made, and notification is sent out. If this decision results in a denial of benefits, you have the right to appeal to the next step within 60 days.
Step 2 – Reconsideration
At the reconsideration stage, you are asking the Social Security Administration, and specifically the state Disability Determination Service, to take another look at your claim. Your case is reassigned to another examiner, who performs a similar analysis as is performed at the initial application stage. More often than not, this step results in another denial. If and when that denial occurs, you have 60 days to appeal and request a hearing.
Step 3 – Appeal
This is the step at which your odds of being granted benefits are at their highest. The appeal is very different than the prior two steps. At the appeal stage, your case is assigned to an Administrative Law Judge (ALJ). You have the right to a hearing. The ALJ does not need to abide by nor give deference to the earlier Determinations, s/he is free to make his or her own Decision in accordance with the rules of the Social Security Administration.
The Administrative Law Judge’s Decision is based, in large part, on the contents of your medical records. The more documentation of disability, and the more treatment you have received, in general, the better your chances of success. However, the ALJ’s Decision is also based in part on your testimony during the hearing, and whether s/he finds you to be a credible witness. In the event of an Unfavorable Decision, you have the right to file an appeal with the Appeals Council within 60 days.
Step 4 – Appeal to the Appeals Council
Unlike the prior steps, the purpose of the Appeals Council is not to evaluate the merits of your claim nor the severity of your disability. Instead, the only purpose of the Appeals Council is to determine whether the Administrative Law Judge made a mistake. Unfortunately, it is difficult to prevail at this step. In the vast majority of cases, the Appeals Council decides that the ALJ did not make a mistake. In some cases, the Appeals Council decides that the ALJ did make a mistake, and sends the case back to the same judge to correct a technical error. This often results in another Unfavorable Decision, but can result in a Favorable Decision. In a very small percentage of cases, the Appeal Council decides that the ALJ’s decision was so erroneous that they overturn the Decision and grant a Favorable Award of benefits. If you need to proceed to Federal Court, you have 60 days to do so.
Step 5 – Appeal to Federal Court
This step is different because your case is no longer pending with the Social Security Administration. Instead, you are filing a case in Federal District Court against the Commissioner of the Social Security Administration. You and the Social Security Administration file briefs with the Court, and sometimes there is an oral argument. The case will then be decided by a Federal Judge. You will often need an attorney who specializes in the area of Federal Appeals.
It is best to begin the process with an attorney. An attorney specializing in Social Security Disability law can work with you to help build your claim and increase your chances of success.