You May Be Eligible Even If You Have Been Denied Before! Don’t Give Up!
You have at least five chances to win your claim for Social Security benefits, and you should not give up until you have at least gone through the levels of appeal with an attorney experienced in Social Security disability claims by your side.
Stage One- Initial Application.
In order to receive Social Security benefits, you must first apply. Most people begin the application process by calling the Social Security Administration at 1-800-772-1213 or applying on-line at www.ssa.gov . Once you contact Social Security, you have established a protective filing date for your application for benefits. You will then be scheduled for an interview with a claims representative at a local Social Security office. If you are unable to go to your local Social Security office, you can have a telephone interview. If you apply on-line, you should review your application carefully before submission. If our office represents you at the initial application stage, we will use the re-entry code you are given on-line to review your application prior to submission to SSA.
When you apply for benefits, you should advise Social Security about each and every health problem that is preventing you from working. You should also tell Social Security about each and every doctor, therapist, clinic, and hospital you have been to for treatment. Make certain that you keep copies of your disability report, vocational report, and any other forms completed by Social Security representatives or by you at the time of your application for benefits.
A claims examiner at Social Security will make an initial determination as to whether or not you qualify for benefits and the State Disability Determination Section will make a medical decision on your case. You will be sent a written decision in approximately 120 days following your application. If you do not hear from Social Security within this time frame it is a good idea to call and check on the status of your claim.
Based on national averages, about 35% of initial claims are granted.For a variety of reasons, many claimants denied at the initial level do not appeal to the reconsideration level, even though they may be as likely to be entitled to benefits as those who do appeal.SSA’s statistic generally document that far less than half of claimants whose initial claims are denied go on to request reconsideration.Do not be discouraged by a denial! You should appeal a denial and continue the process.
Stage Two- Reconsideration.
If your initial application is denied, you should receive a written notice from Social Security. This notice states why Social Security denied your claim. It has been our experience that an extremely large number of valid claims are improperly denied.
If you want to continue with your claim, you must file paperwork asking for “reconsideration” of your case within 60 days after receiving a written Notice of Denial. You can and should advise Social Security about any new evidence that might benefit you. You will be sent a written decision in approximately 90 days following your application. If you do not hear from Social Security within this time frame it is a good idea to call and check on the status of your claim.
Don’t be surprised or discouraged if your claim is denied at reconsideration – very few claims are granted at this level. In FY 2009, the national reconsideration allowance rate was only 13.8 percent. However, many states were well below that rate.
Stage Three- Hearing.
If you receive a Notice of Denial – Reconsideration, you must file a request for a hearing within 60 days. Since your hearing is your best opportunity to win benefits, and because you will be appearing before a judge, it is probably wise for you to have an experienced, Social Security lawyer working on your case. Social Security’s own statistics show that claimants who have lawyers win far more often than claimants who go to hearings alone.
The wait for a hearing decision following a request for hearing is very long. Unfortunately, there are cases pending for 775 or more at the hearing level. These cases are supposed to be given priority. SSA’s goal is to achieve an average processing time for hearings of 270 days in FY 2013. In FY 2010, SSA reduced the processing time for hearings to an average of 426 days, 65 days lower than the average time for FY 2009. At its peak in August 2008, it took an average of 18 months for a hearing decision. Waits in our region are generally in excess of the national average and tend to fall in the 14-18 month range.
Based on national averages about 55% of claimants will be awarded benefits following a hearing. Patience and good representation pay off at the hearing level!!
Stage Four – Appeals Council.
If you lost at the hearing level, you can appeal your case to the “Appeals Council” and ultimately, to Federal Court. The Appeals Council accepts new and material evidence and written arguments in support of an appeal. They will only reverse or remand a hearing decision for a limited number of reasons. An experienced attorney will know how to argue on your behalf before the Appeals Council. Based on national averages only about 2% of claimants will be awarded benefits by the Appeals Council, but a larger percentage – about 23% of claimants will have their cases sent back to the judge for another hearing. The wait for a determination on review takes about 220 days based on national averages.
Stage Five – Federal Court.
Even if you lose all of your administrative appeals, you may still get benefits as a direct or indirect result of a federal court appeal. An experienced Social Security attorney should handle federal court appeals. If the decision of Social Security denying benefits contains appealable errors of law which would allow for a reversal, an appeal to federal district court may be in order. Federal Court appeals must be filed within 60 days of the receipt of the Appeals Council denial of review. The length of time for federal court cases varies widely based on the judges, briefing schedules, oral hearings and many other factors.
As a class, civil actions for Social Security disability benefits have a significant risk of loss. It is very important in an administrative hearing that the record is well documented to increase the chances of success should a federal court appeal be necessary. Federal court cases ultimately only result in payment of past due benefits to claimants about one third of the time. The Social Security Administration keeps statistics for civil litigation for benefits. Those statistics are found in various places, including in the reports of the Congressionally-created Social Security Advisory Board (SSAB) available for downloading in pdf form at http://www.ssab.gov/documents/chartbook.pdf. The SSAB’s May 2006 Report, Section XI. Federal Courts, states, “[s]ince 1995, Federal courts have reversed relatively few agency decisions. The reversal rate was about 6 percent over the entire period. However, between 1996 and 2001 the rate of cases remanded back to the agency for further action rose from 37 percent to 59 percent.” [SSAB, Disability Decision Making: Data and Materials (May 2006), at 91] In Fiscal Year 2005, federal courts found plaintiffs entitled to benefits in 5% of cases and remanded 45% of cases and denied or dismissed 50% of cases. Id. The percentage of claimants found entitled to benefits following remand has varied from about 60% of claimants in 2000 to 67% of claimants in 2004. Id. at 89 and SSAB, Disability Decision Making: Data and Materials (Jan 2001) available at http://www.ssab.gov/documents/chartbook.pdf. Therefore, claimants who go to court ultimately prevail about 33.50% (5% + (45% x 67%)) of the time. Id.