How the Social Security administration reviews SSDI benefit claims:
What is SSDI?
Social Security Disability Insurance (SSDI) is a monthly benefit for people who have worked in the past and paid Social Security taxes. It is intended to provide income to those unable to work due to a disability. To qualify for SSDI benefits you must have paid payroll taxes for 5 of the past 10 years and you must be unable to work due to a disability. Disability is defined by the Social Security office and can include both physical and mental disabilities that have or are expected to last for at least a year.
The SSDI program was established in 1954. Today, it can be difficult to obtain SSDI benefits – and this could be getting more difficult in the future. Currently 65% of applicants are denied on their initial application and the average waiting time can be more than 800 days.
Levels of Review in the Social Security Administration
- Application and Reconsideration
- Appeals Council
- Federal Court
Level One – Application and Reconsideration
You must complete the initial Social Security Disability. In most cases, your doctor must confirm both your disability and its impact on your employment. This process includes an extensive amount of paperwork and currently the wait time is between 3-6 months. About 35% of initial applications are approved. If your initial application is denied, you have 60 days to request reconsideration or first appeal by someone who did not take part in the first decision. Currently the wait time is between 2-5 months and about 87% of first appeals are denied.
Level Two – Hearing
If your reconsideration is denied, you have 60 days to appeal the decision. This moves you to the hearing or second appeal level. Your case will be heard by an administrative law judge (ALJ). This generally takes place within 75 miles of your home or by video conference and you and your representative should make every effort to attend. You may be asked for additional information and evidence and witnesses may be called for questioning. After the final decision has been made, you will be notified in writing by the ALJ. In 2010, the average waiting time was 426 days at this level and approximately 62% of these appeals were awarded to the applicant.
Level Three – Appeals Council
If you are denied at the hearing level, you have 60 days to request a review by the Appeals Council. The Council will look at all requests but it may deny a request if it believes the hearing decision was correct. The Appeals Council will also have the opportunity to return your case to an administrative law judge. In 2010, the average waiting time at this level was 345 days and only 2% of the appeals were favorable for the applicant.
Level Four – Federal Court
If you disagree with the Appeals Council’s decision, you have the option to file a lawsuit. Less than 1% of applicants appeal to the Federal District Court (FDC). Almost 70% of these cases are denied while a small percentage are awarded. The remaining cases are sent back to the hearing level for an additional hearing. For more information on SSDI, visit www.socialsecurity.gov.
Current Political Climate
With continuing unemployment problems, many more Americans have been seeking Social Security benefits. In 2010, the Social Security Administration (SSA) paid out nearly $127.7 billion in benefits to almost 10 million workers and their families. With the influx of new applicants, the SSA is facing longer delays in getting decisions than ever before.
The Social Security Board of Trustees is warning that the Disability Income Trust Fund will be exhausted in 2017 or 2018 unless legislative action is taken. For many recipients, SSDI are a financial lifeline with an average monthly benefit of $927. It is difficult to say how many bills are past due and how many families are struggling as they wait for the benefits to come in.
If you or your family is in need of SSDI benefits, contact our attorneys right away for a FREE and immediate initial consultation of your potential case.