What You Need to Know


The Social Security Claims Process

The Social Security process can often be frustrating and it can take more time than you had hoped. We at Jorgensen Law want to make sure you understand the steps it takes to achieve the award that you need. If at any time you have questions about this often-complicated process, please call us at 619-282-JLAW (5529) Monday through Friday, between the hours of 8:30 am to 5pm.

Initial Application
Approval of Benefits
Denial of Benefits
Reconsideration
Hearing
Appeals Council
Federal Court Review

Initial Application

You can apply for Social Security Disability (SSDI) or Supplemental Security Income (SSI) benefits if you are disabled and cannot work, and if your disability has lasted (or is expected to last) up to 12 months. You can apply for benefits by contacting the Social Security Administration. The majority of claims receive a decision in the mail within two to four months of the most recent application.

Approval of Benefits

If you applied for SSDI benefits and are approved, your benefits begin at the sixth full month of disability. This waiting period begins with the first full month after the date the Social Security Administration decides your disability began. If you applied for SSI benefits and are approved, the benefits are paid for the first full month after the date you filed your claim, or on the date you become eligible for SSI (whichever is later).

Denial of Benefits

If your claim for Social Security benefits is denied and you believe you are disabled, you can appeal your case and have it looked at by someone else at the Social Security Administration. If you have received a letter from Social Security denying your claim, you must file an appeal within 60 days or you will lose your right to appeal.

It is very important to appeal a denial within the 60 days. If you don't appeal within the 60 days you will need to reapply, which means you start the process all over again.

Reconsideration

After your appeal is filed within 60 days of your denial of benefits, the claim is reviewed under reconsideration. Your claim will be completely reviewed by someone other than the individual who denied your benefits. All evidence, such as medical records, testimonials, work history and any new evidence will be re-evaluated and a new decision will made. An average time for this process is three to four months. If you disagree with the reconsidered decision, then you can choose to go to the next level of the appeals process, a hearing.

Hearing

If you are denied in the first two steps-the initial application and reconsideration, you must file another timely appeal within 60 days of your denial letter, seeking a request for a hearing before an Administrative Law Judge, (ALJ). The judge will listen to the facts of your case and make a disability decision. The average scheduling time for a hearing is 8 to 12 months. During this time, the Social Security Administration is preparing the claim for review by the judge.

The hearing is informal but a neat, clean appearance is recommended. If you are unsure what to wear to the hearing, please call us at 619 282-5529. However, you should refrain from wearing sweatpants, sweatshirts, shorts, t-shirts, tank tops.

During the hearing, you will be asked basic background information regarding your education, work experience and your current medical treatment. You will also be asked to explain the symptoms and limitations you have because of your medical conditions, and how they keep you from working. This information will be the basis of your hearing and should be the only information on which you should focus.

In order for an Administrative Law Judge to determine whether you are disabled, he/she will consider the following five steps in their evaluation of your case:

  1. If you are performing substantial gainful work, you are not disabled.
  2. If you are not performing substantial gainful work, your impairment(s) must be severe before you can be found to be disabled.
  3. If you are not performing substantial gainful work and you have a severe impairment(s) that has lasted, or is expected to last, for a continuous period of at least 12 months, and your impairment(s) meets or medically equals a listed impairment, you are presumed to be disabled without further inquiry.
  4. If your impairment(s) does not prevent you from doing your past relevant work, you are not disabled.
  5. Even if your impairment(s) prevents you from performing your past relevant work, if other work exists in significant numbers in the national economy that accommodates your residual functional capacity and vocational factors, you are not disabled.

You may have been told that a Vocational Expert will testify at your hearing. A Vocational Expert is an expert in the areas of work rehab, earning capacity, lost earnings and lost value of household services. A Vocational Expert is asked by the Judge to testify about your work history and how your medical problems could keep you from working. The Vocational Expert is there only to give their opinion; they do not make the decision in your case.

The Judge will not issue a decision on the day of the hearing. He/she will issue the decision after reviewing all the evidence, plus any additional evidence brought to the hearing. The court will prepare a long, written decision called a Notice of Decision. It will be issued to you and your Social Security disability lawyer at the same time. You and your lawyer will get the decision of your case at the same time so your lawyer will not know the outcome any sooner than you will.

Your lawyer cannot predict how the Judge will rule but will prepare you to the best of his ability. Typically, it takes the Judge one to two months to issue a decision. These long waits occur mostly because of the tremendous backlog of cases pending at the Hearing Office.

If you disagree with the hearing decision, you can choose to go to the next level - the Appeals Council.

Appeals Council

The average processing time for the Appeals Council is 18 to 24 months. The Appeals Council can choose to do any of the following:

  • Review your claim and make a decision
  • Choose not to review your claim
  • Send your claim back to the Administrative Law Judge for further consideration

You and your Social Security disability lawyer will receive a copy of the Appeals Council decision or a copy of the Order sending it back to the judge for further consideration.

If you disagree with the Appeals Council, or if the Appeals Council refuses to review the case, you can pursue your case in Federal Court.

Federal Court Review

If you exhaust all administrative appeals, but wish to continue pursuing your case, you may file a civil suit in Federal District Court and eventually appeal all the way to the United States Supreme Court.