The disability decision letter

by Tim Moore, Disability Representative in North Carolina

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How long does it take to get a disability approval decision letter?

How long it takes to get a decision letter, for an approval or otherwise, can depend on the level your claim is at. For example, is it a new application or an appeal? A decision letter can absolutely take longer if Social Security has trouble getting your medical records or identifying your past work. In most cases, an answer on a disability claim takes 90-120 days.

(Read if you live in North Carolina)

Things that cause you to wait longer for a decision letter

It can take longer if you miss appointments for consultative medical exams or you do not contact the disability examiner after they have tried to reach out to you (for this last reason, always make sure Social Security has your current address and phone number). If you have a disability representative, of course, that person can assist in these areas because Social Security is required to keep them up to date on your case, and because the representative’s job will be to win your case.

How long the decision letter takes can depend on the level of your claim

Obviously, the wait time for a decision letter from Social Security varies based on the case in question. And it depends on what level the case is at. If a person has only just filed their initial claim, or application for disability, then they can expect an answer on their claim within the standard 90 to 120 days of case processing. The first appeal, the request for reconsideration, however, is usually quicker and you will usually get an answer in under 60 days, sometimes under 30 days. If you have had a disability hearing, sometimes the judge can get the decision letter out to you in a matter of weeks.

Why do Social Security decisions take this long?

Mainly, it takes this amount of time due to 1. how many claims disability examiners (the individuals who make decisions on claims that have not gotten to the hearing level yet) have in their caseload and 2. how long it takes the disability examiner to gather the claimant’s medical records as well as all the necessary information about their work history, or school performance if they are a child.

If Social Security has trouble getting your records

If the disability examiner has trouble gathering your records, you can be assured it will take longer to get a decision letter. This is why it is important, when you apply for disability, to supply full and complete information about your medical treatment sources. If you fail to list the correct names of medical practices, or wrong addresses, it will slow the process down. Likewise, you want to supply accurate information about your work history, including correct descriptions of your jobs and the duties performed. Finally, if you are scheduled to go to a Social Security medical exam, do not miss your appointment. Missed appointments can add weeks of processing time to your case.

If you get denied for disability and file a reconsideration appeal (as most do), you can generally expect to receive a faster decision letter. Usually within 60 days, but often within 30 days. This is because the reconsideration appeal is a near-repeat of the application and most of the “pieces”, i.e. medical evidence and other evidence, has already been gathered.

If your case is at the hearing level and you have already had your hearing, it is very indeterminate as to when you will get a decision letter. It may be weeks or months before the hearing office notifies you. If you had a disability lawyer for the hearing, that person can check the status of your claim.

A little about the disability system

There are two disability programs under which one may be approved for disability: Social Security Disability (SSD) and Supplemental Security Income (SSI). You don’t have to worry about which to apply for; Social Security will handle that. In order to qualify for either disability program, the applicant must be able to demonstrate that, due to their physical or mental impairment, they are unable to earn the substantial gainful activity (SGA) amount each month (the current SGA limit).

However, those who have not worked enough to collect SSD (this program is available only to those who have worked and thus paid a certain dollar amount into the system over the years) must also be able to prove that they own assets with a total value of no more than $2,000 to qualify for SSI (not counting one car and one place of residence).

When someone applies for disability, their application is immediately evaluated by the Social Security office to see if they qualify for disability in either program. Depending upon his or her work history and total assets, an applicant may qualify for SSD, SSI, or both (this is called a concurrent disability claim).

However, regardless of which disability program the applicant is eligible to collect benefits from, the burden of proof regarding medical documentation is the same.

Most disability claims (about 70 percent) are denied at the initial application level, and most first appeals are unsuccessful as well (over 80%). However, if you are approved for SSD or SSI at either of these levels, you can expect to receive a notice of approval within a few days. Sometimes there is a bit of delay, particularly if matters such as workmans’ compensation, manual benefit computations, or capability development need to be factored into the decision.

Collecting disability benefits

To collect either SSD or SSI, there must be solid medical evidence in the form of medical records from a licensed physician or psychologist, indicating 1) the patient has a severe impairment that is expected to endure for no less than 12 months, and 2) the impairment prevents him from being able to earn the SGA at any job he has performed in the past 15 years or any other job that someone with his work skills, education, etc., could switch to.

How many appeals are needed?

The majority of disability applicants who are approved for disability must appeal not once, but twice. The second appeal is a hearing before an administrative law judge (ALJ), and it is at this level that most claims are approved. If an ALJ grants your claim for disability, it generally takes a bit longer to receive a decision letter from Social Security. This is because the judge must write his or her decision before the claim can be processed at the payment center.

In addition, all claims granted either solely or concurrently under the SSI program are sent back to the local Social Security office for a final review called the PERC review. The PERC review is a final check to be sure that the disability applicant still meets the financial requirements for SSI, or, if the claim is concurrent, that the applicant is eligible to receive SSI during the mandatory 5-month waiting period that applies to those who collect SSD.