Disability Determinations: Initial Reviews vs. Appeal Hearings

Submitted by Shane on Thu, 03/22/2012 - 15:19

The processes involved in initial reviews for Social Security Disability Insurance (SSDI) benefits vary significantly in some ways from those that take place at an appeal hearing officiated by an administrative law judge (ALJ). There are also some aspects of the review process and appeal hearing procedure which are quite similar. Following you’ll find information on both the similarities and differences to help you understand what to expect from each stage of the disability determination process.

Who Reviews Your Case

After you submit your initial application, it is reviewed by the Disability Determination Services (DDS) office which handles Social Security Disability claims for your region. If your application is initially denied, you can request a reconsideration of your case, but it is still the DDS that reviews and makes a determination during the second review as well.

Only upon filing an appeal and appearing in court in front of an ALJ is your case reviewed by someone other than the DDS. At an appeal hearing, it is the ALJ that makes the determination on your eligibility.

Regardless of who is reviewing your application for SSDI, the same basic criteria apply. You must have a long term or permanently disabling condition which significantly affects your ability to work and/or perform everyday functions.

How Your Case is Presented

During the initial and reconsideration reviews conducted by the DDS, your case file is the only information examined. The DDS staff will not meet with you or ask you any questions. Essentially, if the information does not appear in your case file, it will not be considered at this stage.

During an appeal hearing, you will be expected to appear in court and testify on the details of your case. The judge has your case file as well and will take the information within it into consideration when making a determination on your eligibility. He or she will also take into account your testimony at the hearing and any and all observations gained through interacting with you during the proceedings.

Witnesses are also allowed to testify at a disability hearing, which means you have the ability to further support your claim by having a spouse, medical practitioner or someone else speak on the subject of how your disability affects your daily life. You can also have legal representation present at the hearing, ensuring your interests are always covered. In other words, the detailed presentation of your specific disability case is significantly more thorough during an appeal hearing than it is during reviews conducted by the DDS.

Once again however, the same criteria for eligibility applies whether it’s the DDS and the ALJ reviewing your case, meaning they look at your disability using the same SSA guidelines. The essential difference then comes from the degree of detail available to each on the subject of your disability, and indeed, as a result of their exposure (or lack thereof) to you as an individual.

How a Decision is Made

Because the DDS has only paperwork to review in making a determination on your eligibility, their decisions are often much more formulaic in nature. They typically apply the same limitations to all individuals with a specific diagnosis, even though the manner in which a condition affects one individual can be quite different from how it affects the next.

Because an ALJ has the ability to see and speak with you, and to ask probing questions about how your condition affects your everyday life, he or she is often privy to a more personalized picture of your disability. The judge can get a better idea of the extent of your disability and the specific effects it has for you. This can make it more likely you’ll be found eligible for disability benefits during a hearing, though of course, the same eligibility requirements still apply as they always do throughout all SSA disability processes.

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