Who Makes The Final Decision On Social Security Disability Claims?

Who decides if you are disabled? Who makes the final decision on Social Security Disability claims? That depends on your current stage in the process. Understanding the decision-making chain in Social Security Disability claims is vital for applicants navigating the system.

Initial Application

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims are primarily processed at local Social Security Administration (SSA) field offices and state agencies, often referred to as Disability Determination Services (DDS).

Examiners or claims representatives at the SSA field offices handle initial applications for disability benefits. These applications can be submitted in person, via phone, mail, or online. These applications require detailed information about the applicant’s medical conditions, treatments, and other pertinent details. In this context, the applicant is called the “claimant.”

Additionally, Social Security representatives validate “non-medical” eligibility criteria. This may include age, employment history, marital status, and Social Security coverage details. If a claimant fulfills these non-medical criteria, the local SSA office forwards their application to the DDS to evaluate the disability claim in the next stage of the benefits application process.

Disability Determination Services is a state agency responsible for obtaining medical evidence and determining whether a claimant is disabled or blind under Social Security law. The federal government fully funds the agency and its offices. DDS will first try to obtain medical records from the claimant’s doctors. If that evidence is not available or insufficient to decide, DDS will schedule a medical examination known as a consultative examination (CE) to obtain additional information about the applicant. The federal government funds this evaluation. After receiving all of the available evidence, the trained staff at DDS determine whether a claimant is disabled.

What Happens After DDS Makes a Decision?

If you are approved for disability benefits, you will receive a Notice of Award letter from the Social Security Administration. Applicants whose claims are denied will receive a Notice of Disapproved Claim instead of an award letter. You can check the status of your claim online. However, it will not indicate whether your claim for Social Security Disability benefits was approved or denied, only the status of a decision by the Social Security Administration. The best way to know if you have been approved for Social Security Disability benefits is to wait for a written notice to arrive in the mail.

Request for Reconsideration

If you have been denied Social Security Disability benefits or disagree with the start date of your disability benefits, you can file an appeal with the SSA. The Social Security Administration must receive your appeal within 60 days of the date you received the Notice of Disapproved Claim. In most cases, reconsideration is the first step in the Social Security Administration’s appeal process for individuals who disagree with the initial disability decision. Reconsideration involves a complete review of the disability case by someone who did not make the original decision. The Social Security Administration will reevaluate all evidence, plus any additional evidence submitted, and issue a new decision as to whether you qualify to receive disability benefits. You can submit a written Request for Reconsideration (Form SSA-561-U2), or you can do so online via the SSA website.

Expedited Appeals Process (EAP)

An individual may request an Expedited Appeals Process (EAP), but only after appealing a disability case, at least through the reconsideration step. EAP may be used in cases where the individual does not dispute SSA’s version of the facts in their claim. Instead, the claimant challenges the constitutionality of the law underlying the decision. The Social Security Administration and all parties to the determination must agree to use EAP.

Hearing Before an Administrative Law Judge

Generally, a hearing before an Administrative Law Judge (“ALJ”) is the next level of appeal after Social Security has made an unfavorable reconsideration determination. The ALJ will conduct a disability hearing. You and your attorney or representative attend the disability hearing and present your case in person, over the phone, or using video teleconferencing equipment. The Administrative Law Judge will evaluate all the evidence on record, including any additional evidence submitted up to 5 business days before the hearing, and will decide whether you meet the criteria to be considered disabled under the SSA’s rules. Use the Request for Review of Decision/Order of Administrative Law Judge (Form HA-520-U5) to appeal an ALJ’s decision to deny your claim for disability benefits or appeal the denial with the SSA website.

What Percentage of Disability Hearings are Approved?

In 2019, 45% of claims nationwide were approved at the disability hearing level. Approval rates for specific ALJs are also published and can be found online once an ALJ has been assigned to your Social Security Disability claim. It is also possible to receive a partially favorable decision. A partially favorable decision usually means that you have been approved for disability benefits, but the established onset date differs from the onset date alleged in your initial application for disability benefits. An attorney can help you weigh the pros and cons of appealing a partially favorable decision.

Appeals Council

If the claimant disagrees with the ALJ decision or the dismissal of a hearing request, they may ask the Appeals Council (AC) to review the action. The AC may dismiss or deny the request for review, grant the request, and either issue a decision or remand the case to an ALJ. The AC may also review an ALJ decision (within 60 days of the hearing decision or dismissal) on its motion. The AC has the final review authority for Social Security Disability claims.

Federal Court Review

The AC review completes the Social Security Disability administrative review process. If an individual is still dissatisfied, he may request judicial review by filing a civil action against the Social Security Administration in a Federal district court.

Work With a Disability Lawyer

We help disabled individuals nationwide receive the Social Security Disability Insurance benefits they deserve. If you suffer from a disabling medical condition and can no longer work, we will help you through the SSA’s initial application process. We will also help you through the SSA’s appeal process if your claims are denied. We can request a hearing before an administrative law judge if your appeal is denied.

Contact our office immediately if you have questions about the SSDI or SSI application and appeal process. You may be eligible for a free case evaluation if you cannot work and want to apply or have already received a claim denial. You can call our office at (888) 321-8131, contact us through our website using the live chat feature, or complete the Contact Us form on our website to schedule your free case evaluation. We welcome the opportunity to discuss your claim and help you obtain a favorable decision from the SSA.