- Pulling Back the Curtain on Social Security Disability Insurance: What to Expect During the Approval Process
Pulling Back the Curtain on Social Security Disability Insurance: What to Expect During the Approval Process
Last month we introduced readers to the complex application process for Social Security Disability Insurance (SSDI) – an invaluable program that protects Americans who are unable to work due to injuries, long-term illnesses, or other medical circumstances beyond their control. With SSDI, you can receive financial support if you’ve experienced (in the words of the Social Security Administration) “a medical condition that’s expected to last at least one year or result in death.” But, as we noted in that article, your condition must be considered “severe,” meaning that it “must significantly limit your ability to do basic work activities, such as lifting, standing, walking, sitting, and remembering — for at least 12 months” to qualify for benefits.
This time, we’ll discuss what happens after you’ve applied for SSDI payments. Our goal is to let you know what to expect from the officials reviewing your file, so you can understand how long you may have to wait until your application is either approved or denied. We’ll also describe how you can check on your application status if waiting for a decision seems to be taking too long.
Establishing Expectations: This Isn’t a Speedy Process
Because Social Security Disability Insurance is funded by federal tax dollars, there are several, rigid steps that must be followed before an SSDI claim is ultimately approved or denied. While these are mostly intended to prevent fraud, verifying a claimant’s medical conditions and their severity can take some time. Expect the initial application process to take 6 months at least, which corresponds with SSA’s own reported data on average initial case processing time. It’s important to keep in mind that SSDI is a program that is purposely designed for evaluating long-term disabilities, not short-term disabilities. An example of this design philosophy can be seen in the previously mentioned year-long duration requirement of your impairments. Another example can be seen in what’s called the five-month elimination period. Between when SSA finds you disabled and when you start receiving benefits, there must be an elapsing of five months. As such, if you apply in January right after a traumatic event like a motor vehicle accident and are found to be disabled during the month of June, your benefit payments still wouldn’t start until August (the five-month period starts in February and ends at the end of July). Please note, however, that the five-month elimination period applies to SSDI benefits, not SSI benefits.
So, What Exactly Happens After I Apply?
Once you’ve gathered and submitted everything needed for a claim (basic information like your Social Security number, medical details, and documents giving medical providers permission to share your records with SSDI officials), your file will be evaluated for correct identifying information, and then sent to your home state’s Disability Determination Services (DDS) office. At this point, the approval process begins. The DDS in your state will examine the medical evidence you’ve submitted to make an “initial determination” as to whether you are considered truly disabled (or legally blind) under the law. Here’s how that happens:
- The DDS orders and reviews and verifies the details provided from your own medical sources (i.e the medical records of your primary care doctor, your specialists, or any hospitals or clinics where you’ve been treated).
- If your sources are deemed to be inadequate or insufficient, the DDS will arrange for a Consultative Evaluation (CE) to obtain any additional information that may be required to consider your claim.
- After examining all the evidence, the DDS will then make the initial determination of your eligibility for SSDI benefits. They then communicate that decision to the SSDI field office which, if you’re approved, will calculate your monthly benefits and begin sending payments.
- If your claim is denied (meaning the DDS determines you are not disabled under the terms of the law, or if the Field Office determines that you don’t meet one of the technical qualifications for filing such as a lack of work history), your file will be retained at the SSDI field office in case you decide to appeal the decision. You traditionally have 60 days from the date contained in your denial letter to file the next level of appeal, which is called reconsideration.
- At the reconsideration level, a new DDS caseworker will be assigned to your case who will order additional records and review the first caseworker’s decision for correctness. The process is intentionally similar to the initial application phase. In 2021, the average wait for a decision on a reconsideration request was 147 days. If the reconsideration gets denied, then an appeal can be filed within 60 days to have a hearing in front of an Administrative Law Judge.
- The average wait for a hearing in front of an Administrative Law Judge depends on which Office of Hearings Operations your case gets sent to. At the hearing itself, you will answer questions from the judge about your work history as well as your impairments and how they impact your daily life. The judge will also pose questions to an independent jobs expert at the hearing called a Vocational Expert to better clarify how the effect of certain limitations impact jobs available in the national economy.
- If you need assistance at any stage of this long and laborious process, please contact us so we can help you!
Who Do I Contact if the Process Seems to Be Dragging?
You can attempt to get in touch with the state’s Disability Determination Service directly. On the paperwork that you receive from DDS will be the contact number of your assigned DDS caseworker. In Michigan, there are DDS offices in Detroit, Kalamazoo, Lansing, and Traverse City. On a more local level, there are nearly 50 Social Security Disability Field Offices statewide, including locations in Ann Arbor, Detroit, Dearborn, Farmington Hills, Monroe, Livonia, Pontiac, Sterling Heights, and Wyandotte, among many others. If you run into a brick wall there (metaphorically speaking), one of our staff attorneys who’s familiar with the SSDI process may be able to help accelerate the process. One final option to consider if your case has been dragging on for too long is to contact your local Michigan congressperson as they can request Social Security to flag your case to keep them updated; this may assist you in getting the gears of bureaucracy to start turning again. You can also get in touch with us by email anytime, and we’ll offer you whatever assistance we can.
Coming Soon… Best Practices to Ensure SSDI Application Approval
By now you’ve probably gathered that getting a SSDI claim assembled, submitted, and approved isn’t an easy process. But the benefits can make a tremendous difference to your life. In an upcoming article we’ll offer step-by-step guidance to avoid common pitfalls that many applicants overlook during the application process. We’ll also discuss additional Social Security initiatives that can expedite approval, including a “compassionate allowance” program that almost automatically grants benefits to those suffering from a specific set of illnesses and conditions.
In the meantime, if you or someone you know has been denied a SSDI claim, we can help. The Social Security Administration also offers advice on your right to legal representation which we encourage you to examine. Once you’ve done so, our number is 855-MIKE-WINS (855-645-3946), or click here to instantly connect with one of our attorneys specializing in disability law.