How The Social Security Disability Process Works

Just because your claim was denied at first, do not despair. Although most claims get denied initially, your chances go up significantly if you stick with it. In fact, most claims that make it to a hearing get approved. Persistence pays off.

1. Applying for Disability Benefits

You apply for disability benefits when you become disabled.

• You can apply online at www.socialsecurity.gov; or
• You can call Social Security’s toll-free number (800) 772-1213 and set up an appointment.
• You can do this yourself, but I suggest you let me handle the initial application for you.

2. After The Application Is Completed

Once you complete the application, your file goes to your local Social Security Field Office. The Field Office determines non-medical issues, like if your name matches your Social Security Number, whether you have worked enough to qualify, and other things of that nature.

If everything checks out, then Social Security farms your file out to the State of California’s Disability Determination Service Division (“DDSD”). This state agency makes the initial decision on whether you are disabled.

• DDSD will try to order medical records from the doctors and hospitals you remembered to tell them about. They are doing that because they are trying to verify:
  • What your medical condition is;
  • When it began;
  • How it limits you;
  • What your tests show; and
  • What treatments you received.
• DDSD might also try to ask your doctors about your ability to do work-related activities, such as walking, sitting, lifting, carrying, and remembering instructions. Doctors do not decide if you are disabled. That is a legal question, not a medical question. However, the answer to that legal question relies heavily on the medical evidence.
• It may come as a shock, but is unlikely that your doctor will answer DDSD’s questions for any number of reasons. As a result, DDSD will often send you to a doctor who will examine you. You will be amazed at how fast these doctors can do a physical exam.
• DDSD will send you many questionnaires to fill out about pain, what you do during the day, etc. Try to be thorough, to the point, and not argumentative.
• The key point through all of this is to remember the following basic truth: Besides yourself, NO ONE cares as much about your case as much as your attorney does. Not the doctors, not DDSD, not Social Security, not even the judges. They mean well, but they have neither the ethical obligations nor financial incentives to the degree that your lawyer has.
• Generally, you have to work the Initial Application hard if you want to win it at this stage. It requires follow-up, follow-up, and more follow-up on records requests and such.

3. The DDSD Makes A Decision

DDSD makes a decision with whatever information they have. They mail you a decision letter. You will often get your money very quickly if the decision is favorable. I have to give them credit; once Social Security decides to “turn on the money hose”; it is amazing how quick it will show up in your bank account. If DDSD denies your claim, do not give up.

4. The First Appeal

It usually makes more sense to file a Request for Reconsideration than a new application. This is the first appeal. DDSD rarely grants one of these because there is usually no additional evidence to submit. It seems almost like DDSD simply hands your file off to a different examiner to see if your first examiner made any big mistakes in denying your claim. The main goal of this step for me is to get it over with and file …

5. A Request for Hearing

This is where an attorney can really earn his pay. If you go to a disability hearing in front of a Social Security Administration Administrative Law Judge without a lawyer, you are making a mistake. Not only will you submit additional evidence, but also, for the first time, a real live human being (the judge) will get a chance to ask you questions and hear your story. You can also call witnesses who will support your claim.

6. Appealing Your Claim to the Appeals Council

If you lose at the hearing level, you can file an appeal with the Appeals Council. This mysterious body will either affirm the judge’s decision, remand the case back to the judge for further proceedings, or reverse the judge’s decision. Appeals at this level have a higher success rate when there is an error of law.

7. Federal Court

If you lose at the Appeals Council, then you have to file an action in the Federal court system. These are successful often enough that it is usually better to appeal than file a new claim.