The Claims Process
If you become disabled and cannot work, you should contact a disability lawyer who will give you personal attention right away to get your claim started. The time you wait could result in the loss of benefits that you will never be able to receive in the future. With some exceptions, you can usually complete your initial application for disability through an online application at www.ssa.gov, or in person at your local SSA office.
The date you contact SSA indicating an interest in applying for benefits is your Protective Filing Date (PFD). The PFD is important when determining the amount of retroactive benefits you are entitled to if you win your case. (See the page on Applying for Social Security disability benefits.)
Although your disability claim is filed at a local Social Security office, the SSA office does not actually render the decision. All states have disability agencies that process medical decisions for Social Security. In Illinois, it’s the Disability Determination Services (DDS). When your claim reaches the DDS, it is assigned to a disability examiner.
Requests for records are usually made the same day that an examiner receives a case from the Social Security office. The examiner may also schedule additional medical examinations called consultative examinations when disability applicants have insufficient medical information or their medical information is out of date. Once all records are received, the examiner will review your case for a decision.
SSA grants very few claims at the Initial levels. This is often because the applicant simply does not know what information the SSA needs, or how to successfully present a winning case. Unfortunately, the SSA does not provide much help to educate you on the procedures because every case requires different types of evidence and presentation. However, we are often able to win cases at the initial level if your evidence is developed well, with good medical support.
At all levels, Social Security Disability cases are won and lost on the strength of medical records. Therefore, at McGreal Disability Law, we only take cases where we believe that a successful presentation of winning evidence can be achieved. We encourage anyone who believes they are suffering from a disability to seek medical treatment and develop a relationship with a medical professional.
If you are denied at the Initial Application level, there are multiple appeal levels, each with specific paperwork requirements and timeframes for filing:
- Request for Reconsideration
- Request for Hearing Before an Administrative Law Judge
- Request for Review by the Appeals Council
- Appeal to the Federal District Court
Request for Reconsideration
The SSA appeals process is a frustratingly complicated maze. We make every effort to use our knowledge and experience to guide our clients through the process every step along the way so that our clients ultimately feel empowered — and not overpowered — by the System.
If you are one of the nearly 80% of people whose Initial or Reconsideration claim is denied, the most important thing you can do is to not become discouraged. You are not along.
We understand that a denial can be discouraging, and SSA’s denial letters can be particularly disheartening, coldly and often irrationally asserting that you can work despite your limitations. If you have a good claim with strong medical records and you are denied at either the Initial or Reconsideration level, you are in good company. Your denial letter was not personal. It was computer generated and likely not given much thought. This is, unfortunately, the SSA process.
If your claim is denied initially, you have 60 calendar days to Request Reconsideration. Unfortunately, the Reconsideration process is often a rubberstamp of the initial denial. However, if you did not have an Attorney at the Initial Level, We strongly encourage people to get an Attorney involved at Reconsideration so that the record can be developed. Furthermore, if the Reconsideration request is denied, which is often the case, your case is poised and ready to go to the next level of appeal, Request a Hearing Before an Administrative Law Judge.
Request for Hearing Before an Administrative Law Judge (ALJ)
ALJ Hearings are the stage where your case has the best chance. Statistically, this level is where we win most of our cases.
After your Reconsideration claim has been denied, you have 60 calendar days to Request a Hearing Before an Administrative Law Judge. Your claim will then be processed again and sent to one of the local hearing offices depending on your zip code. The hearing office then organizes and compiles your information and evidence in an electronic format that we can review in this office. We then determine what additional medical evidence or medical opinions will be needed to fully develop the case for your hearing. Eventually, your claim will be assigned to an Administrative Law Judge and a hearing date will be scheduled. At this point, we update all medical and other supportive evidence into a Legal Brief for submission to the judge.
Before the hearing date, we extensively prepare our clients for the hearing in order to be prepared to zealously argue the claim before the Administrative Law Judge.
Unfortunately, due to the shortage of Social Security Judges and the huge number of claims in the nation, the time from Reconsideration denial to hearing date before an Administrative Law Judge can vary widely from six to eighteen months depending on the backlog at your field office or hearing office. The average is about 14 months.
Request for Review by Appeals Council
If your case is lost at the ALJ level, it is often because the Judge failed to properly apply all the complicated SSA regulations, or failed to fully consider all of your evidence in accordance with the those Regulations. In that case, we take the case to the next level of review which is the Social Security Appeals Council. Again, we have 60 calendar days to “Request Review of a Hearing Decision.” At the Appeals Council, we will file additional briefs to demonstrate where the judge made mistakes. If the mistakes are clearly evidence the Appeals Council will overturn the Judge’s decision or remand the matter for rehearing at the ALJ level.
Request for Federal District Court Review
If your case is lost at the Appeals Council level, the next level of appeal is in Federal District Court. In the Chicago Area, the appeal would be filed in the Federal District Court for the Northern District of Illinois. We have considerable experience filing in Federal District Court. This is a much more complicated process involving the filing of a Civil Suit against SSA. There are filing fees involved; however, we have been able to get the Court to waive or reduce these fees based on a client’s inability to pay. In these cases, We may ask the court to award higher attorneys fees due to the considerable extent of time and work required to win these claims.
How Long will it Take? This is a Marathon, Not a Sprint…
As our population becomes older, more people are applying for disability benefits than ever before. This means that more people are denied at the Initial and Reconsideration stages, which creates an extra burden of the SSA resources. More cases for the same number of judges means a longer wait for hearing. You must think of this process as a marathon and not a sprint.
Regardless of the strength of your case, anywhere from 60 to 80 % of people are denied initially, and of those who appeal to the next level (Request for Reconsideration) another 80% are denied. Getting through this Initial and Reconsideration process to the Administrative Law Judge Hearing level can take up to two years in some cases.
There is a large backlog in processing these claims. Currently, due to the budget limitations at the SSA, workers who evaluate claims at the Initial and Reconsideration levels are subject to heavier caseloads creating even more stress on the timeline.
The current average processing time in the Chicago area is just under two years.
We can not over emphasize that patience is key to getting through this process. Having a reputable and experienced lawyer will get you through the maze and likely lead you to a life-changing award. But it will take time. Again, this is a marathon, not a sprint….