As legislators argue about how to best "fix" Social Security, one of the repeated problems plaguing the system is the disability backlog. For most applicants, even a review of the initial application can take 3 to 5 months, with approximately 70 percent of those applications being denied. This places nearly 2 million Americans into the process of reconsideration requests and appeals. On average the time it takes from the application to the ultimate approval or denial of benefits can take a year or more.
To understand why it takes so long to fully process a disability claim, it helps to get an overview of the disability process. More than just a simple application and review, it is a multi-step process that often requires an applicant to continually demonstrate his or her disability and to prove an inability to maintain substantial gainful activity (SGA) or meaningful employment.
The steps that one must take to obtain approval of SSD benefits are as follows. While approval may be granted at any step along the way, a large number of applicants must endure the entire process before receiving benefits. Even then, the Social Security Administration reports that nearly 53 percent of disability claims are ultimately denied.
- Request for Reconsideration
- Disability Hearing
- Appeal of Denied Benefits
The initial application may be received from the local Social Security field office, or in some cases, it may be submitted online. The application process is more than a simple form. It is an extensive application that must be accompanied by documentation of the applicant's identity, disability, work history, prognosis, and inability to work as a result of the disability. Nearly three-fourths of these applications are rejected, many on the basis of technical errors in filling out or submitting the application. At this initial stage, only 20 to 30 percent of applicants are approved benefits.
If your application is rejected, the first step in overcoming the denial of benefits is to file a request for reconsideration. During this stage, a Social Security representative not involved in the first review of your application or the resulting decision will look at your application again in order to determine whether or not the initial denial was appropriate. You may request reconsideration for denials based on medical reasons or non-medical reasons. At this stage, approximately 3 percent of applications are approved.
If the request for reconsideration fails to result in benefits approval, you may request a disability hearing. This must occur within 60 days or your receipt of a letter of denied benefits. At the disability hearing, you will appear before an Administrative Law Judge to present your case. It is important to attend this hearing with representation by an experienced disability lawyer who can provide all the necessary documentation and witnesses to support your claim of disability. The SSA informs applicants of their right to legal representation:
"You may choose to have someone help you with your appeal or to represent you. Your representative may be a lawyer or other qualified person familiar with you and the Social Security program. We will work with your representative just as we would work with you. He or she can act for you in most Social Security matters and will receive a copy of any decisions we make about your claim. Your representative cannot charge or collect a fee from you without first getting written approval from us. If you want more information about having a representative, ask for Your Right To Representation (Publication No. 05-10075), which also is available online at our website, www.socialsecurity.gov."
Approximately 13 percent of applications are granted by the Administrative Law Judge at the disability hearing level.
If, however, the ALJ denies benefits after the disability hearing, you can appeal his or her decision to the SSA Disability Appeals Council. This council will not review the merits of your case or the evidence presented; however, it will review the ALJ's ruling. Appealable grounds may include technical errors, substantive errors, or faulty judgment unsupported by evidence. In other words, if the judge made a mistake or if he or she reached a decision that no other judge would reasonably reach given the evidence in the case, the Disability Appeals Council may reverse the ALJ's decision or remand the case back to the judge with specific instructions.
The Disability Appeals Council may also affirm the judge's decision to deny your benefits. In this case, the only recourse is a federal appeal.
At each step of the process, your chances of benefits approval are maximized with representation from a skilled Social Security disability lawyer.