There are four stages for SSDI and SSI applications: Initial, Reconsideration, Hearing, and Appeals Council. These steps are the same for both SSI and SSDI applicants.
Stage #1: Initial
When your first apply for disability benefits, you complete an Initial application. This can be filed at your local Social Security office, over the phone or online. Rarely, your application will be approved at the Initial stage. More likely, your application will be denied and three options remain: do nothing, file a new Initial claim, or file a Request for Reconsideration (recommended).
Stage #2: Request for Reconsideration
If your Initial application is denied, you have 60 days from the date of denial to file a Request for Reconsideration (Recon). At this stage, your claim is reviewed again by Social Security. If your Recon claim is approved, you will receive disability benefits. If not, three options remain: do nothing, file a new Initial claim, or file a Request for Hearing (recommended).
Stage #3: Hearing
When your Request for Reconsideration is denied, you again have 60 days from the date of your most recent denial to file a Request for Hearing. You have the greatest chance of being approved at this stage. The hearing takes place before an Administrative Law Judge (ALJ) and claimants will receive a Notice of Hearing approximately 30 days before the hearing date.
The hearing usually takes place at your local Office of Disability Adjudication and Review (ODAR). While legal representation is not required for the hearing, it is highly recommended. A qualified disability attorney/advocate can present and defend your case in the most favorable manner. Going to a hearing without adequate representation is not a good idea.
Step #4: Appeals Council
You will usually receive a decision from the ALJ within a few months after your hearing. If your claim is approved you will receive both a Notice of Decision and a Notice of Award. If your claim is denied, you can appeal the decision before the Appeals Council. However, the Appeals Council frequently upholds the decision of the ALJ. At this point, you may wish to seek the assistance of a qualified disability attorney/advocate and file a new Initial claim.
What Happens When an Application is Pending
The disability application process can be a long and difficult. During that procedure, SSA will do various things to gather and process information related to social security disability insurance (SSDI) or supplemental security income (SSI) claims.
If your application is still pending the SSA may be still reviewing your medical records. That includes treatment records, tests, diagnostic scans, notes, and any other records held by any person or facility treating that person. Records can be obtained by the Administration from physicians, hospitals, physical therapists, counselors, social workers, and others. These records are the raw data that the SSA uses to make disability decisions.
In some situations, especially if there is a gap in the medical records or the Administrative wants a medical opinion, a claimant may be sent to a Consultative Examination. These are examinations conducted by licensed professionals, who then provide opinions on the claimant's illness. A claimant may be granted a Consultative Examination for any ailment (i.e. physician, mental, speech). The examinations are usually held near the claimant's home and do not last long. Refusing to participate may result in benefit denial.
Social security will periodically ask a claimant details about their medical problems, work status, and daily living, both when they apply and throughout the procedure. Many of these questions are included in a single document called the Adult Disability Report. Other forms and surveys are also used by the SSA. A person may be required to complete one or more Adult Disability Reports for any particular claim.
During the application procedure and while waiting for a decision, a claimant or their representative can always send new records, comments, and other information that the SSA should take into account.
It is just as critical, if not more important, to ensure that the Administration receives the information it seeks. Failure to answer may result in benefit refusal at any point. If you have any questions about a social security claim or the application procedure, you should speak with an attorney in the area who can help you.