The application process for Social Security Disability can be a lengthy one. In most states, it consists of three preliminary levels: Initial, Reconsideration, and then a hearing before an Administrative Law Judge. If the application is denied at the hearing level, an appeal can be filed to the Appeals Council and then, finally, to U.S. District Court.
When a claimant first applies for Social Security Disability (DIB) or (SSI), the file goes through the Initial Application process. On average, it takes about 4-6 months to receive a decision. During this time the file is processed by a local District Office (DO) and then sent to the state’s Disability Determination Services (DDS) division. DDS is a state agency that works for SSA and uses their rules. A Disability Examiner at DDS will then request medical records and collect evidence. If there is a lack of evidence or clarification is needed, often a Consultative Exam (CE) is scheduled.
When the file has been completely developed, and all medical evidence has been processed, a Medical Examiner will make a decision. The decision is sent to the claimant and their representative and the file is sent back to the District Office. Approximately 80% of claimants are denied at the Initial level.
The next step is Reconsideration. Once the Reconsideration has been filed, the file is again sent to DDS for evaluation. The file is reviewed for any new or additional evidence. Then a different Medical Examiner makes a decision. This step takes approximately 3-5 months. The estimated denial rate at this level is 75-80%. However, ten states do not have a Reconsideration level. Their procedure requires filing an appeal for a hearing immediately after being denied at the initial stage. The states without Reconsideration are Alabama, Alaska, California, Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York and Pennsylvania.
Next is the Hearing level. Once a Request for Hearing has been filed, the file will be sent to the local Office of Adjudication and Review (ODAR). The ODAR is where hearings take place. A hearing is then scheduled before an Administrative Law Judge, who is tasked with making an unbiased decision based on medical records and testimonies from the claimant and expert witnesses. Once a decision is made, it will be mailed to the claimant and representative. The decision title will read “Fully Favorable, Partially Favorable or Unfavorable” depending on the outcome. The whole process takes 12-18 months on average. Approximately 2/3’s of represented claimants are approved at the hearing level.