We will analyze your claim to determine what needs to be proven to win benefits, figure out how to prove it, and gather the necessary evidence. You will likely be referred to specialists for additional reports in support of your claim. We will work with your treating doctors to obtain additional reports that answer questions of how your limitations keep you from being able to engage in work activity on a consistent basis according to Social Security regulations.
Application Process
You will be given worksheets to provide us the information needed to file your initial application via Social Security’s internet website. The exception would be an SSI or DAC Claim, which must be initiated by you, the Claimant, with a Social Security representative either in person or by telephone interview.
Once your application is processed, Social Security will forward the electronic file to your state division of Disability Determination Services (DDS). This agency will collect medical records on your behalf and will analyze your claim considering your education, training, work experience, symptoms, limitations, and daily activities. They will send additional questionnaires for you to complete, generally a Function Report and detailed Work History Report, and may also include questionnaires on Pain, Headaches, Fatigue, etc. We will guide you on the best way to answer the questions, then review and file the forms electronically for you. DDS may also send you for a physical or mental examination by an independent doctor to provide them with a report on your condition.
Initial Determination
The initial determination may take up to six months, or even longer to complete if the claim is selected for quality review. If you are awarded at this level, you can consider yourself very fortunate indeed, as only about 1/3 of claims are initially successful.
DDS may not always agree with the date you have alleged your disability began, issuing a “partially favorable” decision. They may determine that your condition did not become totally disabling until a date later than your alleged onset date. We will review the rationale to determine if an appeal of the established onset date is appropriate in your case.
If you are denied, we will ask you to provide us with updated information to file an appeal of the unfavorable decision. A very common and costly error is the failure to appeal an unfavorable determination.
Reconsideration
Reconsideration is an intermediate step in the Social Security disability claim process. If DDS denies your initial claim and you appeal, the claim goes back to a different claim examiner at DDS for Reconsideration. In 5 out of 6 claims, the new examiner denies the claim again. For most claimants, Reconsideration is an unnecessary detour on the way to a hearing by an administrative law judge.
There are ten “prototype” states, however, that skip the Reconsideration step. In those states, the appeal of a denied claim proceeds directly to a hearing with an Administration Law Judge. The 10 prototype states are: Alabama, Alaska, California (Los Angeles North and West areas), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York (Brooklyn and Albany areas), and Pennsylvania.
If your state is not one of the “prototype” states, we will attempt to obtain a copy of your electronic file for review to determine the rationale for the decision in order to try to obtain additional medical evidence to overcome any deficiencies. However, winning at this level continues to be statistically very poor.
Request for hearing
If dissatisfied with the results of reconsideration (or, initial application in prototype states), the claimant may request a hearing before a Social Security Administrative Law Judge (“ALJ”). As is the case for earlier appeals, the claimant must appeal to this level within 60 days of receipt of the reconsideration notice (or, in a prototype state, after the initial notice).
The ALJ hearing level is the critical level for the claimant, usually the first opportunity where the claimant actually appears in person and is able to meet his or her adjudicator face-to-face. The claimant presents oral testimony under oath and supplements the medical record with any missing records.
The good news about this level of review is this is where the claimant has the best chance of winning his or her claim. However, there may be a very long delay between the request for a hearing and the time a hearing is scheduled. ODAR average processing times vary enormously across the country, from a low of 320 days in Alexandria, Virginia, to a high of 694 days in Miami, Florida. The wait time for hearings with the Denver and Colorado Springs ODAR is currently about 14 months. (National Ranking Report by Average Processing Time for Month Ending 7/31/2015)
We will make sure your medical evidence is up-to-date and optimized. Unlike most representatives, we have a standard of preparing a hearing brief in almost all cases, along with providing an opinion by a vocational expert.
Appeals Council
The claimant who receives an unfavorable or partially favorable ALJ decision may request review by the Appeals Council (AC). As before, the claimant has 60 days from the unfavorable ALJ decision to file an appeal with the Appeals Council.
The statistical grant rates at the Appeals Council level are not particularly good. Additionally, there can again be a very lengthy wait for a determination from the Appeals Council. Depending on many variables, we will consider and discuss at this point the benefits of filing a new claim vs. arguing your claim through the Appeals Council.
