FREQUENTLY ASKED QUESTIONS FOR SOCIAL SECURITY DISABILITY CLAIMS AND APPEALS
1. WHY WAS MY CLAIM DENIED WHEN, CLEARLY, I CAN'T WORK? THIS DECISION MAKES NO SENSE.
It is a harsh reality for many claimants, but you cannot always rely on common sense to determine who is and who is not disabled under Social Security laws, rules and regulations. This is so because Social Security's strict definition of "disabled" calls for a hypothetical determination of your ability to work.
That is, the Social Security Administration (SSA) only wants to know whether you are able to work; it does not care or even consider whether, in the real world, you can find suitable work.
That said, if you are not able to work because of your physical or mental condition, then it may be your claim was denied in error. The SSA is a large government bureaucracy and, like all large bureaucratic entities, it makes mistakes. This is especially true in the early stages of the disability application and appeals process, when the decision-makers tend to rigidly apply the Social Security rules and regulations, with little consideration for nuances of each individual case. About two-thirds of initial claims for Social Security disability benefits are denied, many of these are denied erroneously. Depending on the facts of your case, the possibilities of for error are endless:
:Determine(incorrectly) that your impairment is not severe;
: Fails to consider all your impairments;
: Fails to consider the impact of all your symptoms;
: Overestimates your ability to function in a work setting; or
: Overestimates your education level.
2. HOW DOES THE APPEALS PROCESS WORK?
In most instances, there are four levels of appeal available. A claim for disability benefits proceeds from one level to the next, in this order:
LEVEL 1: RECONSIDERATION
The first level in most, but not all, states is a Request for Reconsideration. This is a "paper only" review of your claim. Your request will be reviewed by a team of doctors and disability specialists ath the state Disability Determination Services agency. This will be a different team than the one that reviewed(and denied) your initial application, but the result is likely to be the same:denial.
LEVEL 2: ADMINISTRATIVE LAW JUDGE(ALJ) HEARING
If your Request for Reconsideration is denied, the next step is a hearing before an Administrative Law Judge (ALJ). At the hearing, the ALJ considers all the evidence in your case(including your testimony and the testimony of your witnesses), not just the medical records and other documents filed in support of your claim. You have the opportunity to present new evidence and evidence of changes in your condition since you first filed your application for benefits. After your hearing, the ALJ issues a written decision.
LEVEL 3; APPEALS COUNCIL REVIEW
The Social Security Appeals Council is made up of administrative law judges who are new to your case. If the Appeals Council accepts your claim, then it will review the hearing judge's decisionto make sure the ALJ followed all required procedures and applied the law correctly. The Council will not consider any new evidence. Upon concluding its review, the Appeals Council can affirm the hearing judge's decision, modify it, reverse it, or remand it(send it back to the ALJ) for a new hearing.
The Appeals Council also has the option to declining to review the ALJ's decision at all. In that instance, the ALJ's decision to deny your disability benefits becomes the SSA's final decision(subject to to federal court review).
LEVEL 4: FEDERAL COURT REVIEW
If the Appeals Council declines to review the ALJ's decision or, upon review, affirms the ALJ's decision denying your claim, then you may appeal to in a United States district court. The defendant(the party you are suing) will be the Commissioner of Social Security. If the District court affirms the SSA's decision, you may appeal to the U.S. Court of Appeals and then to the U.S. Supreme Court, but the Supreme Court rarely grants review of Social Security Act cases.
3. IS IT REALLY WORTH THE APPEAL EFFORT?
Yes. Don't give up on our claim, at least not until you get a hearing before an administrative law judge. The hearing is the first opportunity you have to present your case, live and in person, to the individual who will be deciding your claim. Your odds of success improve once you get to the administrative hearing level of appeal.
4. HOW LONG WILL IT TAKE TO GET A HEARING?
Generally, it takes about 18 months from the time you request a hearing until you actually appear before a judge. Even your chances of success are good, the long wait can be difficult-physically, mentally and emotionally. The SSA has been making an effort to reduce wait time by, e.g., identifying cases in which favorable decisions can be issued without a hearing; allowing ALJ's to issue favorable decisions from the bench; and increasing efficiency through better use of technology( electronic filing and video hearings). Despite these steps, the wait remains long, in most cases. Still, if you cannot work because of your impairment, the smartest course of action is to pursue your case all the way to an administrative hearing.
IT WOULD BE MY PLEASURE TO GUIDE YOU THROUGH THE SOCIAL SECURITY PROCESS. PLEASE CALL ME TO DISCUSS YOUR CLAIM!!!