WHAT DETERMINES HOW LONG IT TAKES TO APPROVED FOR DISABILITY?



What determines how long it will take to get disability at the application, reconsideration, or hearing level?



 
The Social Security Administration's disability evaluation process is set up to determine if an individual is totally disabled. This means that neither the title 2 Social Security Disability program nor the title 16 SSI disability program will offer offer temporary disability benefits for short-term illnesses or conditions.

Likewise, neither program will offer partial disability benefits such as the Veteran's disability program which can award 100 percent disability, but also percentage ratings.

Furthermore, though claimants qualify for disability benefits under the premise that they are totally disabled, meaning that they no longer have the ability to engage in work activity at a substantial and gainful (SGA) earnings level, SSA does not assume that the individual will be permanently disabled.

The presumption is that the individual may potentially experience medical improvement and this is why cases undergo periodic reviews every year to see if the individual still meets the requirements for receiving benefits.



What determines if you will be approved for disability?

To receive disability benefits from the Social Security Administration as a child, the medical records, and often the school records as well, must show that the individual is unable to perform age-appropriate activities in relation to their peers.

To receive disability benefits from the Social Security Administration as an adult, a person must not only be unable to do any of their past work (actually, former jobs performed within the last 15 years) but also must be unable to do any other kind of work in the general economy for which their skills, education, and training might otherwise qualify them.

The determination of whether a person can go back to their past work, or switch to some form of other work is made through a five step sequential evaluation process which Social Security uses at all levels of the system, from the disability application and reconsideration levels to the disability hearing and Appeals Council review levels, and beyond.

The odds of getting an approval can be challenging, particularly at the initial claim and reconsideration appeal levels; at the initial disability application level 30-35 percent of claims are approved; at the reconsideration appeal level approximately 15 percent of claims are approved.

Applicants who follow the disability appeals process are certainly more than likely to win their disability benefits, but the higher rate of approval does not occur at the first appeal but, rather, at the second level which is the request for hearing before an administrative law judge. Before a hearing can be requested, of course, a case must proceed through the first two levels.

How long does it take at the application or reconsideration level?

If you win your claim and receive an approval at the disability application level, this will usually occur between 30 and 120 days. Sometimes cases take longer to process based on how long it takes to gather medical records or receive reports from independent examinations scheduled by Social Security.

At times, it can take additional months simply due to how long the process sometimes naturally takes (for instance, the case may be audited for quality control) and due to the state of backlogs in the system. However, the average processing time for an initial disability claim is about one hundred days.

If you are not approved for disability benefits at the level of an initial claim, you must file a reconsideration of your initial disability denial. Reconsideration appeals take on average sixty to ninety days to receive a disability decision, though, typically they take less than 60 days.

Unfortunately, most reconsideration appeals are also denied because they are basically just a further review of your initial disability decision.

If you have no new medical information that points toward an approval or unless the previous disability examiner made a clear decisional error in rendering their initial disability decision (such as missing a piece of medical evidence or improperly applying a medical-vocational rule), the reconsideration appeal will most likely be denied.

Filing the second appeal - the request for a hearing

If your reconsideration appeal is denied, your next step is to file a request for a disability Hearing at which an ALJ, or administrative law judge will preside.

Your chances of winning benefits dramatically improve at this appeal level. National statistics indicate that more than 60 percent of represented claimants will win at a hearing.

Depending on the case, the representative being used, and the judge hearing the case, it is not unusual for up to seventy-five percent of individuals who attend their disability hearing to be approved for disability benefits.

The down side to the administrative law judge hearing is that it takes such a long time to get a hearing scheduled. The wait for a hearing was once as long as two years but even with improvements in scheduling in recent years, it can easily take a year or longer to get a hearing date.

Assuming that a claimant qualifies for disability following a hearing, how long will it take to receive benefits? Again, this varies considerably. Even if a judge indicates to a claimant and their disability attorney that the case will be approved, the notice of decision document will still need to be compiled and written.

This is typically done by decision writers at hearing offices who are often staff attorneys with their own backlog of cases. As a result, it can sometimes take several months to receive a notice of decision even if the case is slated to be approved.


About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.







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