Approval for Social Security Disability Insurance (SSDI) is a process that can take a long time, and usually does. Here are the 3 steps that most claimants will go through:
Step 1: File an application with the Social Security Administration (SSA). This puts the claimant under a lengthy process of review that may take 12 months or more to complete. Unfortunately, the denial rate here is around 75 to 80 percent. Yes, even well qualified claimants get denied.
Step 2: The second step (after being denied in Step 1) is called "Reconsideration." I place that word in quotation marks for a reason. It has an even higher denial rate than step 1. In "Reconsideration," the same office that denied the claim will "reconsider" it and usually deny it again. This step cannot be skipped.
Step 3: If denied at "Reconsideration," the next appeal takes the case before a federal administrative law judge (ALJ) for a hearing. The odds of being approved at the hearing level are much better. While each case is always different, and it is hard to generalize, a claimant has about a 50/50 chance at the hearing. These odds are increased by using a well qualified lawyer or Social Security disability representative who has experience with hearings. Most claims are decided at the hearing level.
But what if you get denied at the hearing? Is there still hope?
There are actually two steps after the hearing -- but the odds are poor at each of these steps.
Step 4: If the judge denies the appeal at a hearing, the claimant may file yet another appeal to the Appeals Council (AC)--a group of judges in Falls Church, VA. The AC will consider the case under the following circumstances:
- There appears to be an abuse of discretion by the administrative law judge or administrative appeals judge who heard the case;
- There is an error of law;
- There are actions, findings or conclusions in the hearing decision or dismissal that are not supported by substantial evidence; or
- There is a broad policy or procedural issue that may affect the general public interest; or
- Under some circumstances, the Appeals Council receives additional evidence that is new, material, and relates to the time period on or before the date of the hearing decision, and there is a reasonable probability that the additional evidence would change the outcome of the decision.
- Note: Just because the claimant disagrees with the decision of the Administrative Law Judge or Administrative Appeals judge is NOT sufficient reason for the Appeals Council to reconsider the case.
STEP 5: is a last ditch effort to win the case. Here a lawsuit is filed in Federal District Court against the Commissioner of Social Security. Only about 2 to 3 percent of cases are reversed and paid by the federal courts. A slightly higher number are "remanded," or returned to the administrative law judge for a new hearing or other action.
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If you need assistance with a Social Security disability claim in Alabama or Tennessee, please call The Forsythe Firm in Huntsville, AL. at (256) 799-0297.
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