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Social Security Procedures: The process of getting benefits

Attorney Dan Lenz writes about Social Security benefits and the process that you must go through to get these benefits. This is helpful information for anyone going through the process of getting Social Security benefits, or even just to know the process in case you ever may need it.

The process of applying for, and being found eligible for, social security disability benefits can be long and complicated.  It can take up to several years and involves many rules, regulations, laws and even the constitution.  The purpose of this post is to discuss, in a general way, some of the major steps that an applicant for social security benefits might face, and to give a broad sense of what to expect at each.

I. The Initial Application/Determination.
Each claim for social security disability benefits begins with an initial application for benefits.  An initial application can be made online, at ssa.gov, or in person at a local social security office.  The address and contact information for a local office can also be found online at ssa.gov.  A person can also apply by mail or by phone. If someone is planning on applying in person, they should contact the office in advance and see if the office makes appointments.  To apply for disability benefits, a person should be prepared to answer questions about their work history, including whether they are currently working, daily life activities (like hygiene, chores around the house) and medical condition and treatment.  As part of the initial determination, social security will gather medical records.  They may ask a claimant to see a doctor for a consultative examination.  They may send a claimant follow-up or additional questionnaires about their medical conditions or daily life.  The local office makes initial determination about whether a person qualifies for benefits.  The actual assessment of medical conditions is done by Disability Determination Services, which are part of the state in which the claimant live, but funded by the federal government.  They then forward the assessment to the local social security office, which sends the determination.  This process can take up to three to five months to complete.

II.  Reconsideration.
If someone’s claim for benefits is denied on the initial application, they should receive a notification of that denial in writing.  That determination contains instructions on how to file for Reconsideration – which is the first level of appeal in the social security process.  Reconsideration is basically just asking the administration to take another look at the case.  It works similarly to the initial determination, except a different set of people at the Disability Determination Services review the information.  During reconsideration, a claimant may be asked to provide additional information.  It also usually takes several months.

A claimant who has been denied benefits at the initial determination must make a request for reconsideration in writing.  This request must be made within 60 days of receiving the notice that the claim has been denied.  Social security will assume that a claimant received the denial within 5 days of it being sent.  Sixty days is not a very long time and claimants should try to get the request in sooner.  To make a request for reconsideration, a claimant should carefully follow the instructions included with the denial or consult an attorney.

III.  The Hearing Stage
If a claim is denied at reconsideration, he or she must request a hearing in front of an administrative law judge for the claim to remain open.  Requesting a hearing is, in many ways, similar to requesting reconsideration.  It must be done in writing and within sixty days.  Once a hearing is requested, it can take a long time for it to actually occur.  For example, in 2006, the hearing process took an average of 483 days, or more than a year. 

During the hearing, the claimant, or his or her attorney, has the opportunity to testify, to present evidence and to subpoena and call witnesses, as well as cross-examine experts.  The hearing is conducted by an Administrative Law Judge, who is part of the Social Security Administration.  It is an informal proceeding, meaning that there are fewer rules about what evidence will be considered and that there are not things like a court reporter, though the hearings are recorded.  Finally, it is a nonadversarial proceeding.  There is no representative or lawyer from “the other side,” just the claimant, law judge, and whatever expert witnesses or other witnesses that have been called.  There are a lot of details about the hearing and how to give a claim the best chances to succeed at hearing.  Claimants who are requesting a hearing or have already requested one should seriously consider hiring an attorney.

IV.  The Appeals Council
If a claim is denied by the administrative law judge after a hearing, the next level of review is an appeal to the appeals council, which is also part of the social security administration.  This appeal is in writing and deals with problems or mistakes with the hearing or that the administrative law judge may have made in his or her decision.  While a claimant or his or her lawyer usually has sixty days to request an appeal, they may only have thirty days in certain circumstances.  In some circumstances, the appeals council will choose to review a case even if no one has requested that it do so, and even if the administrative law judge has determined that a person is partially or completely entitled to benefits.  Even if a claimant did not have an attorney for their hearing, they should consider getting one to file an appeal to the appeals council.  Unfortunately, this can also be a long process, as there is only one appeals council that handles appeals from throughout the country. 

V.  Federal Court Review
If the appeals council denies review of a case, a claimant’s next level of appeal is a civil case in federal court.  This is a specialized proceeding, done without a hearing and based on the record that has already been developed.  Again, this is an area where an attorney may be very helpful. 

There are a lot of rules that govern each of the steps described in this post.  Hopefully, however, we have succeeded in giving a general overview of the procedure a disability benefits claimant might expect.  There are a few other general notes that a claimant should keep in mind:

-  At most steps, a claimant can have a friend, relative or attorney help them complete documents or present evidence.

-   It is very important to respond to requests for information from the administration by the time they are due, otherwise a claim can be denied for failing to respond.

-  The proceedings above generally apply to both SSDI and SSI claims, but there can be slight differences in every case.

Each case, however, is or can be a little different.  Talking to an attorney who practices in this area can be helpful in determining whether you might qualify for a social security program and how to go about claiming your benefits.

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