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Social Security Disability Claims

Authored By: Alaska Legal Services - Anchorage LSC Funded

Social Security Disability Claims: The Administrative Process

The Administrative Process

Authored By: Alaska Legal Services - Anchorage LSC Funded
Contents
Social Security Disability Claims Link to Request for Hearing by Administrative Law Judge Social Security Disability Claims Link to Request for Hearing by Administrative Law Judge

Social Security Disability Claims

Link to Request for Hearing by Administrative Law Judge: www.ssa.gov

Social Security Disability Claims

This segment walks through the administrative process that SSA uses to handle disability claims. Although social security is a federal program, SSA contracts with the State of Alaska to evaluate initial applications for disability. This agency is called the Alaska Disability Determination Unit (DDU). It is DDU’s job to gather your existing medical records, based upon the sources you have listed when you applied. DDU may send you to a consulting physician or psychologist. DDU’s process can take months, although there are a limited number of impairments which may result in an expedited review.

Social Security has to send you a written notice to deny your application, cut you off, or lower your benefits. You have the right to appeal a decision if you think it’s wrong. In much of the US, the next step would be to ask for reconsideration.  This step is not available for initial disability claims in Alaska, but if you are already receiving disability benefits and receive a decision from SSA stating that your benefits will be reduced or terminated, you may ask for reconsideration.

In Alaska, if your claim is denied, you can ask for a hearing with an Administrative Law Judge (ALJ).  This is the most important step, because it is the one and only time that you have an opportunity to meet with a decision maker face to face.To ask for a hearing, you need to file a form called “HA-501 Request for Hearing by Administrative Law Judge” with Social Security within 60 days of the date you got your denial decision.You can get the form online OR call Social Security and have them mail you the form. Either way, you must complete the form and either mail it back SSA or drop it off in person. The 60 days starts the day after you got the decision and Social Security assumes that you got the letter 5 days after the date on the decision.  To get the form online, go to: http://www.ssa.gov/forms/ha-501.html. Or call 1-800-772-1213 (TTY 1-800-325-0778). 

If you mail the form, be sure to send it certified, return receipt requested so that you can prove SSA received it. SSA loses documents more times than you’d care to know. Likewise, if you take your hearing request form in person to SSA, make sure you get a receipt confirming the date it was received.  If you miss the deadline to file your appeal, you may still be able to file if you had a good reason for why you missed the deadline. You must fill out a Statement of Claimant form http://www.ssa.gov/online/ssa-795.pdfexplaining why you could not file the appeal on time. Either bring it or mail it to your local Social Security office. Social Security will decide if you had a good reason to file the appeal late. If you did, they will process the appeal as if you filed it on time.

The Administrative Law Judge (ALJ) Hearing

Many people don’t start looking for a lawyer to assist them until their claim has been denied and they want to file an appeal. But don’t wait for an attorney to file your request for hearing – you might miss the deadline doing that. The Social Security Administration limits the amount of fees a lawyer can charge you. Your lawyer gets paid only if you win your case and they cannot charge more than 25% of your back benefits (up to a maximum of $6,000). You will also have to pay any costs the lawyer incurs in preparing your case, such as obtaining medical records, copying charges, postage, and phone calls.  Although it would be nice if you could get a lawyer to represent you at your hearing, many people represent themselves. 

Once your appeal has been filed, it will go to a separate branch called the Office of Disability Adjudication and Review (ODAR). In Alaska, it can easily run 9 months or longer from the time you file your appeal to the actual date of your hearing. You will be notified at least 20 days before your hearing. If you plan to look for an attorney, don’t wait until you get your notice of hearing – that’s not going to be enough time for an attorney to consider your case or prepare for the hearing.  The hearing in front of the ALJ is in person. The hearing is recorded, but it is a confidential proceeding. Typically the only people present are you and the judge, and possibly a medical expert plus a vocational expert.

Medical experts are hired by SSA, but they are impartial doctors with no connection to you or your claim. Medical experts are called to testify by the ALJ and are asked to evaluate your medical records and offer an opinion as to whether your condition meets the guidelines of a Listed Impairment (discussed earlier). Additionally, a medical expert can help establish the date of onset of your disability. This is crucial in determining when benefits should have started. The date your disability began will determine the amount of retroactive benefits you should receive if the ALJ approves your claim. A vocational expert will give his or her opinion about the type of work you have done in the past, what it involved, whether you might still be able to handle any of those jobs given your current limitations, and if not, what other jobs you might now be able to perform.

When does the judge decide?

Sometimes the judge will tell you at the end of your hearing whether your claim will be approved. However, don’t expect this because it usually doesn’t happen. More typically, the judge will tell you that he or she must first carefully review your file and your testimony before deciding your case.  The decision will always be in writing and will be mailed to you sometime after the hearing. Expect it to take a month or more before you receive the decision. And make sure ODAR has your current mailing address.

The Appeals Council

If you lose your hearing, you can ask for a review by the Appeals Council in Virginia. However, you’ll need to decide whether you should reapply or appeal. It can take a long time to get a decision from the AC and under SSA rules, you cannot pursue an appeal and file a new application at the same time. You must choose one or the other. Some people choose to file a new application instead of appealing a denial. In some cases involving SSDI benefits, not appealing can result in your inability to get benefits even if you reapply. That’s because similar to an insurance policy, DIB benefits have an expiration date called the “date last insured.” What this means is that you must prove that you became disabled before your “date last insured” or you won’t be eligible for benefits.  If you believe you are still disabled and unable to work, you should file an appeal. This rule does not apply if you are only applying for SSI benefits.

If you decide to file an appeal with the Appeals Council in Virginia, you must file form “HA-520 Request for Review of Decision/Order of Administrative Law Judge” within 60 days of getting notice of the ALJ’s decision.  To get the form online go to www.ssa.govand enter “HA-520” into the search bar.  Fill it out and mail or take it to your local social security office.  When you submit your appeal, include any new reports or evidence you have. If you can’t get the evidence right away, don’t put off filing the appeal.  File the appeal first, then send the new evidence as soon as you can.

You will not get a hearing in front of the Appeals Council. The Appeals Council will review the recording of your ALJ hearing and all the papers in your file, plus any new written evidence that you send. The AC can send the case back to the ALJ for another hearing, deny your appeal, or overrule the ALJ and find you eligible. Decisions from the AC take six months to three years!

Federal Court

If your claim is denied by the Appeals Council, that is the end of the road as far as SSA is concerned. However, you still a right to appeal the decision to the Alaska Federal District Court. This can be an effective move, but it requires a very strong case. If successful, it can result in an award of benefits or a remand back to the hearing judge. Unlike appeals to the Appeals Council, you can start a new claim for disability while this is ongoing because SSA considers the case to be closed.

Ideally you would want a lawyer to present your case, but the court has prepared a do-it-yourself booklet for those who can’t afford to hire a lawyer. You can find the booklet here: http://www.akd.uscourts.gov/sites/akd/files/ProSeHandbook.pdf

Link to Request for Hearing by Administrative Law Judge: www.ssa.gov