The Social Security decision-making process is unwieldy and time-consuming. When you first file (your initial application), your case is opened by an office called the Disability Adjudication Service (called the “DAS”) which is part of the State, not Federal, government. Here is a link to the Georgia DAS web site. The DAS employs claims adjustors called adjudicators, who will evaluate your case primarily by requesting and reviewing medical records from your physicians. Generally, after about 3 to 5 months, the adjudicator will issue a decision.
Getting a Decision at the Initial Application Stage
It has been my experience that DAS adjudicators are often overworked and unable to spend the time necessary to develop your case file. In years past I have employed former adjudicators as paralegals and legal assistants in my office and they advise me that adjudicators are under constant pressure to process files as quickly as possible.
It is important to remember that adjudicators are not judges and, unlike judges they have much less discretion when it comes to approving cases. In fact, it has been my experience that unless your medical record documents a “listing level” impairment or serious activity limitations, the adjudicator will deny your claim.
Many deserving cases are denied at the initial stage because records were simply not returned by doctors or because a medical record does not contain language discussing work activity limitations. Although Social Security is working to improve the conditions of work in the adjudication offices, most claimants never have the opportunity to speak with the adjudicator deciding their case, and most adjudicators are too busy to spend as much time as they might want to analyze each case.
Denials by Adjudicators are Mailed to You – Usually Within 3 to 5 Months After Submission
The DAS adjudicator’s decision denying your case is mailed to you in a letter that briefly explains why you were denied. This letter also advises you that you have 60 days to appeal, although the appeal forms usually are not mailed to you.
If you want to appeal, you can do so online or by downloading the reconsideration forms at ssa.gov. As you might imagine, many claimants fail to appeal, and those that do often find the lengthy paperwork difficult to complete. For this reason, I find that many of my clients retain me to prepare and submit their reconsideration paperwork and to continue representation thereafter.
One added bonus – I have found that appeal paperwork filed electronically tends to result in faster decisions and faster processing when the case is moved to the hearing office. My paralegal, Kathy Presley, is comfortable and experienced with Social Security’s electronic filing procedures and we file our appeals and evidence updates electronically.
Getting a Decision at Reconsideration
If you complete your Reconsideration paperwork, it is sent back to the DAS where another adjudicator reviews your file. It has been my experienced – and this is backed up by Social Security statistics – that very few cases are reversed at Reconsideration. Your best chance at winning at recon would be if you see that compelling medical evidence was not received or considered by your adjudicator and you are able to get this evidence to the adjudicator with a cover letter that explains exactly how this evidence shows that your case meets a listing.
The Reconsideration process takes about three to four months and usually results in a denial. Social Security has been looking closely at the value of even having a reconsideration review and it is likely that this stage of the process will be eliminated at some point in the near future.
If your case is denied at Reconsideration, the Adjudicator’s decision denying your case will be mailed to you with a brief explanation and a notice that you can appeal by requesting a hearing within 60 days. I am often retained after the reconsideration denial to file the hearing request paperwork.
Getting a Decision at an Administrative Law Judge Hearing
If you request a hearing, you will receive an acknowledgment and a letter advising you that you can expect to wait about a year. During this year, your file will be transferred electronically from the DAS to the Social Security hearing office called the Office of Disability and Review (the ODAR). After about a year, you may receive a notice from the Judge to whom your case is assigned advising you that your file is being prepared for a hearing. Thereafter, you will receive a hearing notice setting the time and place for your hearing.
When to Get a Lawyer Involved
I get involved in cases at all levels of this process, although most of my clients hire me after receiving their initial denial. Many clients feel more comfortable having my firm complete and submit the appeal paperwork within the 60 day deadline. In addition, as noted above, I make sure that your medical record, including recent treatment, is sent to the Adjudicator or the Judge at the correct address prior to the hearing. Most importantly, I identify a strategy to win your case and obtain forms, letters or other documents from physicians and others to prove your case.
One thing that Social Security will not tell you – once the case leaves the State Agency adjudicator you (the claimant and your lawyer) are responsible for updating the medical record in your file. In fact, updating exhibit files is a big part of what we do for our disability clients. If you do not update your exhibit file you risk the very uncomfortable situation of appearing before a judge with a file that was last updated 2 years previously – not a good omen for success in a hearing.
Obviously, not all cases need to be heard by a Judge. It has been my experience, however, that many seriously ill claimants will not be approved at the initial or reconsideration adjudication level. As such, I advise all of my clients to prepare themselves for the likelihood that they will have to appear before a judge at a disability hearing.