Starting a Social Security Disability Insurance Claim or a Supplemental Security Income claim is a bit like getting on a ride at an amusement park. It goes through dark tunnels, then through bright spaces, then through dark areas again. You know you’re on the ride, but you don’t know what is coming up around the next bend.
Here are some questions my staff and I hear frequently in my practice as a Southern Illinois Social Security Disability representative:
“I just filed my claim but I haven’t heard anything from anyone, how do I know they are working on my claim?”
“I filed my claim a few weeks ago. Today, I received a letter from The Department of Education in Missouri. How could that be? I thought this was a Social Security claim, why am I getting letters from another state?”
“My claim was denied, then I filed an appeal, but I don’t know what happens next or what I should do. Will they call my doctors? Will they call the people I listed as contact persons? Will they call me? Who do I call if something changes in my medical care?”
“My claim was denied twice, I filed both appeals on time. It has been over 6 months. Shouldn’t I have a hearing soon? I am not sure how much longer I can make it without any income.”
Here is a brief description of each stage of a claim from filing to hearing date and highlights of what happens at that stage:
Getting ready to file your claim:
The Social Security Administration will help you get organized by providing you with the Adult Disability Starter Kit--https://www.ssa.gov/disability/Documents/SSA-1170-KIT.pdf.
This contains a checklist of items you should have available at the interview and a worksheet to list your jobs and doctors. These are valuable organizers that will streamline the application process, avoid delays, and assure complete development of your record by the agency. If you later decide to hire a representative to help you with your claim, the jobs and medical worksheet will help your new representative get the big picture.
Scheduling the interview—by phone or in person:
Whether you have a Social Security Disability Insurance claim or a Supplemental Security Income claim, you will be scheduled for an interview. The local office (called a field office) usually schedules these by telephone, but you can request an in-person interview.
I generally recommend that people request an in-person interview whenever their impairments (medical or psychological problems) would be obvious to someone sitting across the desk from them.
If you have a live interview the caseworker has the opportunity to make notes in your file at the very beginning which are valuable candid observations about your difficulties sitting, standing, walking, answering questions, etc.
Once the field office has verified your identity and your eligibility for benefits, and gathered a brief overview of your impairments and work history, the electronic claim is then assigned to a decision-maker (adjudicator).
The adjudicator’s job is to gather evidence relating to your impairments. In most cases the adjudicator will do the following:
- send records request to your doctors and hospitals
- send you a function report for a detailed description of daily activities
- send you a work history report for a detailed description of your past work
- send a friend or family member a third-party function report for a detailed description of your daily activities
- arrange for a consultative examination with a physician and a psychologist ( if you have mental impairments)
- call you to get more detailed answers to questions on the initial forms
The initial consideration phase generally lasts from 3 to 5 months. Your Social Security disability attorney will communicate with the adjudicator to keep him or her up to date on your medical or psychological care. In many cases this is an appropriate time to request a medical source statement (opinion) from your doctor detailing what you can and cannot do.
If you live in Southern Illinois, you might receive a letter from Springfield or Chicago or the state of Missouri because the Social Security Administration assigns cases to disability determination services in each of those locations.
If you have records to submit you can take them to the field office, mail them in the envelope you receive with the special address showing through the envelope window, or fax with the special barcode cover page. If you have important new medical information you should call your adjudicator at the number and extension shown on the correspondence you receive. Your Southern Illinois Disability attorney will do this for you.
You should not make a habit of calling the adjudicator frequently just to check the status of your case. If you receive a letter from your adjudicator stating they have tried to get medical records from one of your doctors and they need your help, you can call your doctor to see if they received the request and try to help the adjudicator get those records. Your Southern Illinois Social Security attorney will do this for you.
Keep in mind the adjudicator has dozens if not hundreds of cases to process and you should not waste his or her time.
Your file will be sent to a medical consultant who will reach a conclusion about how your medical or psychological problems affect your ability to function. This is called a residual functional capacity assessment. You will never meet the medical consultant who makes this critical determination in your case.
You should also keep in mind that the adjudicator will make notes in your file about comments you make during your conversations. For example, if you answer the phone and say you can’t talk right now because you and your children are at an amusement park, and you have a knee injury, the adjudicator might make note of the fact that you are capable of walking for long distances with your children even though you claim your knee problem keeps you from working.
Your Social Security disability attorney can efficiently and effectively keep the adjudicator up to date and help the adjudicator get records from medical providers.
My clients have the opportunity to review the forms they fill out with me and my staff to make sure they have not omitted anything and to make sure they have clearly described the daily impact of their impairments on their life.
Appealing the first (initial) denial:
If you receive a denial of your claim based on medical reasons, the decision will list the doctors and hospitals that provided records to the adjudicator and will briefly describe the reason that the claim was denied. The decision will usually list the alleged onset date for your disability and the last insured date if you are no longer insured for Social Security Disability Insurance benefits. That denial will have a date stamp in the top corner. Your appeal is due 60 days from that date plus 5 days for mailing.
This first denial letter is a very important document and you should bring it with you to your first appointment with a Social Security disability attorney. It contains a lot of valuable information.
You can appeal the first denial either online (https://secure.ssa.gov/iApplsRe/start) or by requesting forms from the field office. To perfect the appeal you must provide three items:
- Request for Reconsideration-- https://www.ssa.gov/forms/ssa-561.pdf
- Authorization for release of information-- https://www.ssa.gov/forms/ssa-827.pdf
- Disability Report Appeal-- https://www.ssa.gov/forms/ssa-3441.pdf
Here is a link to a Social Security pamphlet explaining your appeal rights-- https://www.ssa.gov/pubs/EN-05-10041.pdf.
The most common mistake claimants make at this step is providing incomplete information on the Disability Report Appeal. The form requires information about all treatment since the date that the claim was filed. For each doctor or hospital you need to know the first date you saw them since the claim was filed, the most recent date you saw them, and the next scheduled appointment. You also need to be able to list all medical tests and medications. If you leave this information out your case may not be properly developed at the next step.
It is my personal preference to meet with clients at this step because 99 times out of 100 when I go over the Disability Report Appeal page by page my client has forgotten or omitted important information.
Once the appeal is submitted, the field office will send it to another adjudicator usually in the same disability determination office that handled the case at the first level. The purpose of the Reconsideration process is to further develop the medical evidence in the file. A new medical consultant will review the record as a whole.
This is a very important step of the process; if you do not win your case at this level you will wait for nearly a year and a half before you have an administrative law judge hearing.
It is at this level that your Social Security disability attorney will make every effort to secure supportive medical opinion evidence. In many instances, this is the right time to get statements of laypersons (people who know you at work or at home) in support of your claim.
Appealing the second (reconsideration) denial:
Appealing the second decision is very similar to the first decision with the exception that the appeal form is called a Request for Hearing-- https://www.ssa.gov/forms/ha-501.pdf and the information you provide is for the time interval since you filed the Request for Reconsideration.
This is the point at which most claimants decide they need to hire someone to help them with the claim. If you are seeking representation from a Social Security disability attorney, it is very important to be organized when you meet with the attorney. If you are disorganized, the merits of your claim may not be apparent to the attorney and you may not be accepted as a client.
Waiting for your Administrative Law Judge hearing to be scheduled:
Once you have filed your request for hearing your case is electronically assigned to an Office of Disability Adjudication and Review (ODAR) for your region. In Southern Illinois most cases are assigned to the Evansville, Indiana ODAR office, but some claimants will work with St. Louis, Missouri or Paducah, Kentucky offices.
Since Social Security proceedings are an administrative process, you do not have to choose an attorney who is licensed in the state where the hearing office is located. You can choose an attorney from any state to represent you on Social Security matters as long as he or she meets the agency’s requirements.
Four cases pending in the Evansville, Indiana hearing office, the current wait time is 12 to 16 months. In some instances a hearing can be expedited, but that is very rare.
Preparing for the Administrative Law Judge hearing:
The most important thing you can do between the Request for Hearing and the date of the hearing is keep track of the care you receive for your impairments, keep track of any work you perform, and communicate regularly with your Social Security disability attorney.
If you move, your case may be assigned to a new hearing office.
If you plan to return to work, your Social Security disability attorney will help you understand what that decision means for your claim.
For the cases in my office, my staff and I spend an average of 20 to 40 hours preparing the case between the request for hearing and hearing date. It is very important to develop the medical record in a timely way and to gather medical opinions as close as possible to the date of the onset of the disability.
In the final month before the hearing I spend several hours reviewing the file, meeting with the claimant, rehearsing the questions that will be asked at the hearing, and gathering the last evidence of my client’s functional limitations. This preparation and familiarity sets the stage for a favorable decision at the hearing.
Joni Beth Bailey is a Southern Illinois Social Security Disability attorney.