The Disability Adjudication Process:
In more than 50% of the cases, disability is obvious, and the disability claim is approved at the Initial administrative level by SSA. In those cases, you do not need an attorney to help you establish disability. For that reason, if you believe you are disabled, you should go ahead and apply for benefits. The staff at SSA are usually quite pleasant and helpful and will process the paperwork you need to apply.
If your claim is denied at the Initial level by SSA, you will need to file a Request for Reconsideration, and you should consider speaking with an attorney at this point. Reconsideration involves a review by the same agency that turned down your claim at the Initial level, but it is done by a different adjudicator and all new evidence will be considered. Approval of benefits at the Recon level occurs in approximately 15% of the cases. If your claim is denied at the Recon level, you need to file a Request for Hearing. At this level of appeal, the assistance of a lawyer is beneficial. You will appear before an Administrative Law Judge (ALJ) from the Office of Disability Adjudication & Review (ODAR), who will hear your testimony about your symptoms and limitations. Your attorney can help you develop the medical evidence, prepare you for your hearing, and be there with you to ensure that all the relevant information is in the record. Every person is different, every ALJ is different, and every hearing has different issues depending on the medical evidence and the other relevant facts. Vocational experts and medical experts are often called to give testimony by the ALJ. Your lawyer will cross examine these experts when their testimony is adverse to your claim, and try to create the strongest possible record in your case so that the ALJ will enter a decision allowing benefits. If benefits are denied, the record made at the hearing will provide the basis for any further appeal.
Most of our clients win their cases at the Hearing level.
If your claim is denied by an ALJ after a hearing, there are other levels of appeal. The last level of administrative appeal is a Request for Review with the Appeals Council, which is located in Falls Church, Virginia. This does not involve a hearing, but focuses on the ALJ’s application of the law to the facts of your case. It is highly recommended that you have a lawyer help you with this level of appeal, although unless the lawyer was involved at the hearing level his or her effectiveness at the Appeals Council level will be reduced. This is because the record will have already been developed, and it is hard to undo what has already been done.
If the Appeals Council declines review, you can file a Complaint in Federal District Court, and have the SSA’s decision reviewed by a District Court Judge. If the District Court upholds the SSA’s decision, you have the right to appeal to the Ninth Circuit Court of Appeals. We do appeal work at the Federal District Court level, both for our existing clients and for other claimants whose attorneys limit their practice to administrative work.