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The Process
The Initial Application
Reconsideration
Hearing
Appeals Council
Federal District Court
The Initial Application
The process of applying for Social Security Disability Insurance/SSI benefits can be a lengthy one. The first step is to file an initial application for benefits with the Social Security Administration. An application can be filed at any Social Security Disability Office or by contacting Social Security's toll-free number at 1-800-772-1213. If a claimant is represented by an attorney at this stage, the attorney will arrange to have the application filed and complete all the necessary paperwork in connection with the application process. The attorney will also contact the decision makers at Social Security to ensure that all evidence favorable to the claim is in the file and that the file is processed as expeditiously as possible.
If a claimant chooses to file an application without the assistance of an attorney, it is very important to keep copies of all paperwork submitted to Social Security and to get a receipt for everything dropped off at the office. Anything mailed to Social Security should be sent certified mail.
Reconsideration
If Social Security denies an initial claim, the next step is to file a Request for Reconsideration. A Request for Reconsideration must be filed within 60 days of the date of the denial letter, plus five days for mailing, giving the claimant a total of 65 days to file. If the Request for Reconsideration is not filed within the 65 days allotted, Social Security will usually dismiss the claim unless good cause has been established for the late filing. Once a claim is dismissed, a claimant must start the process again with a new application, which causes delays and usually decreases the amount of back benefits payable to the claimant if benefits are eventually granted.
At the reconsideration level, it is the attorney's job to make sure the paperwork for the initial Request for Reconsideration is completed accurately and submitted on time and to work with the decision maker at Social Security to make sure the records are complete and that the file is processed without unnecessary delays.
Hearing
If the case is denied at the reconsideration level, a claimant must file a Request for Hearing within 65 days of the date of the reconsideration denial letter. Like at the reconsideration level, if a claimant does not file within the 65 days and cannot establish a good reasons to the satisfaction of the Administrative Law Judge, the claim will be denied. In the Sacramento area, it is currently taking four to six months for a hearing to be scheduled after the Request for Hearing is filed.
At the hearing, the claimant will appear at the Office of Hearings and Appeals in front of an Administrative Law Judge. Testimony is taken under oath and the proceeding is tape recorded, although the hearing is informal compared to a civil or criminal proceeding in a State court. The Judge may have medical and vocational expert witnesses present to testify.
If a claimant is represented, the attorney will review the file prior to the hearing and update the medical records as necessary, prepare the client for the hearing, and give the Judge a written pre-hearing statement containing the attorney's legal theory of the case. At the hearing, the attorney will question the claimant and any witnesses the claimant has and will cross examine the medical and vocational experts as necessary.
Although it is not necessary for a claimant to have an attorney at a hearing, this is the level where the representation of an experienced representative can make the most difference.
Appeals Council
If the Administrative Law Judge denies the case at the hearing level, the next and final step of the administrative process is to file a Request for Review with the Appeals Council. The Request for Review must be filed within 65 days of the date of the Hearing Decision. At the Appeals Council level, the attorney will write a brief setting forth the legal reasons why the Judge's decision was incorrect and should be overturned.
The Appeals Council is currently taking two years to make a decision. In the meantime, a claimant should generally file a new application with Social Security to attempt to get the benefits granted while the case is pending at the Appeals Council. Filing a new application will not affect the pending claim.
The Appeals Council can do one of three things when they make their decision. They can decide that the Administrative Law Judge was wrong and grant benefits themselves. This rarely happens. They can send the case back to the Administrative Law Judge for another hearing, or they can deny the claim.
Federal District Court
Once a claimant has gone through the whole administrative process with Social Security and has received a denial at the Appeals Council, the next step is judicial review by the federal district court. The claimant must file a complaint in the federal court within 65 days of the date of the Appeals Council denial. The claimant's attorney and the United States Attorney (representing Social Security) both file briefs, and the Judge makes his or her decision based on the briefs. The briefs contain a summary of all of the evidence and detailed legal arguments in which each side states its position. Occasionally, there will be an oral argument in federal court if the Judge finds it necessary.
The federal court will do one of three things when making its decision. The court can grant the case outright, it can remand the case to Social Security for another hearing, or it can deny the case. If the district court denies the case, it can be appealed to the United States Court of Appeals, which will go through a process similar to that at the district court level.
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