Skip to main content

WHY SOCIAL SECURITY DOES NOT MAKE DECISIONS ON DISABILITY CLAIMS

The US Social Security Administration (SSA) is the largest agency in the United States government, apart from the military.  Yet, the Social Security Administration does not make the decision about whether you are disabled when you apply for disability benefits.

The SSA will send your application to a state agency for a decision.  In Alabama that agency is the Disability Determination Service (DDS) in Birmingham, AL.

Your Social Security office will gather all the forms and basic information from you, the claimant, then send it to the DDS in Birmingham.  The DDS will order medical records from your doctors and other providers.  It will spend the next 5 to 12 months reviewing your application to determine if you meet the requirements for an SSDI benefit.  Often, the DDS will send claimants to a consultative examination with an approved doctor before making a decision.  The DDS will also flood the claimant with additional forms to complete, such as a Work History Report, Function Report and possibly other questionnaires.  

Usually, DDS will provide an initial decision within 12 months of the application date.  Sometimes it takes longer.  Approximately 1 out of 4 applications will be approved at DDS and the others will need appeals.

So it is actually an Alabama state agency (DDS) which makes the initial decision about whether you qualify for disability benefits.  

Let me just say here that dealing with the DDS is a nightmare.  They are difficult to get on the phone, difficult to talk to, slow to take action and overall are just your worst nightmare. While you wait in pain and financial despair, wondering how you will make it from one month to the next, the state keeps stalling your application for months on end.  Sometimes it can take a year or more just to have your case assigned to an examiner.

If the DDS denies your application, you are not done with them yet.  You are required to file for "reconsideration" as your first appeal--where the Disability Determination Service (DDS) will again take months to "reconsider" your case.  About 9 times out of 10, your application will be denied a second time at "reconsideration."  So, for most claimants, "reconsideration" is a waste of time because the initial denial will be rubber stamped.

Now you are ready for an appeal that may actually give you a chance of being approved.  You are ready to take your case before an administrative law judge for a hearing.  So, here, in this third stage, your case moves from the state level back to the Social Security Administration (SSA).  If you consider national statistics, you have about a 50/50 chance for approval with the judge (hearing).  That's the best chance you're ever going to get.

So, for the first 12 to 24 months in a Social Security disability claim, you will be dealing with the state, not the Social Security Administration.  The state agencies appear to be stalled, backlogged, short handed and underfunded, incapable to rendering prompt decisions, even though nearly a million individuals nationwide are desperately waiting for benefits. Many of these individuals do qualify for benefits but must wait months or years for the state agency to examine, prod, investigate, reexamine and delay.

Getting a lawyer may help you keep your sanity during this heartbreaking process; however, it probably won't speed up your decision.  A lawyer will probably increase your chances for approval, at least eventually--in the appeals process.  A study by the Government Accountability Office (GAO) found that you are about 3 times as likely to be approved if you use a lawyer or qualified advocate.

 

 

Comments

Popular posts from this blog

RED FLAGS IN SOCIAL SECURITY DISABILITY CASES

  RED FLAGS IN A SOCIAL SECURITY DISABILITY CASE A red flag is something that causes concern or raises a problem in a Social Security disability case.   In short, it’s something that may get the claim denied or cause a big problem. Here are some of the red flags that we see crop up: ·          Work after the alleged onset date (AOD).   Since the process takes so long, many claimants feel that they are forced to return to work for income.   Social Security often sees this as a sign that the claimant is not disabled. ·          Severe substance abuse.   Chronic and frequent abuse of drugs or alcohol can pose problems. ·           A skimpy work record.   A claimant who has worked very little or has jumped from job to job frequently may not have good credibility. ·          Quitting wo...

WHAT YOU WILL BE ASKED AT A DISABILITY HEARING

Most Social Security disability claims will be denied twice:  First at the end of the Application process, and again after the "Reconsideration" process.  The third stop will be a hearing before a federal Administrative Law Judge (ALJ). It is here at the hearing level that most SSDI claims are paid.  So, what do you need to know about your Social Security disability hearing?     First, the judge will follow the rules established by the Social Security Administration.  His or her job is to determine whether you meet the particular laws and rules to receive disability payments.  So, it is a legal proceeding where you must prove certain things in order to get paid. Among the things you must prove:  Your insured status with Social Security:  You have worked recently enough and paid into the Social Security trust fund to gain the required "work credits" to support your claim.  You have a severe medical or mental impairment supported by adequa...

HOW TO COMPLETE A FUNCTION REPORT OR ACTIVITIES OF DAILY LIVING FORM

After you apply for Social Security Disability (SSDI), you will be sent a FUNCTION REPORT to fill out and return.  This form asks a lot of very detailed questions about your daily activities:  driving, cooking, cleaning, dressing, visiting others, hobbies, etc. The Social Security Administration will use your answers to determine whether you can work or not.  You must show on this Function Report that you have limitations that do not permit you to work a full-time job.  You do this by showing your limitations in activities of daily living. Your goal in the Function Report is to show the struggles and challenges you have with everyday life.  It may not be sufficient to answer a question with "Yes" and fail to explain. For example:  "Can you drive?"  If you answer "Yes," Social Security will assume that your ability to drive is unlimited:  you can drive anytime, anywhere and as often or as far as you want.  That may not be true and would need t...