It’s no doubt that getting approved for disability is hard. The SSA uses a rigorous process to evaluate every applicant to make sure that they qualify for the benefits that they applied for. So, what are the phases of the disability process?
The SSA has divided its rigorous evaluation process into four phases to evaluate each case. These are (1) Initial Application; (2) Request for Reconsideration; (3) Hearing; (4) Appeals Council and Beyond.
Keep reading below for more information.
What are the Phases of the Disability Process?
The four phases of the disability process are discussed in this section.
Phase 1: Initial Application
To receive disability benefits, the first step is to file an application for SSDI with the Social Security Administration. This can be done by going to the local SSA office and filing an application in-person, making a call over the phone, or through the internet at the SSA website.
After the application is filed with the SSA, it goes to your state’s division of Disability Determination Services, or DDS. The purpose of the DDS is to determine whether an applicant is actually entitled to receive SSDI benefits.
While filing the application, you will be required to provide information about your medical condition and how it impairs your daily activities. The SSA might send you to an internist to confirm the medical evidence and further evaluate your medical condition. They might also get the opinion of a third party, such as your friends and family, about your health conditions.
Once all of this evidence is gathered, the SSA will make a decision as to whether or not you are qualified to receive benefits. If it finds you to be qualified, you will start receiving benefits. If not, you will receive a notice of denial. You will then have to file an appeal to challenge this decision.
Phase 2: Reconsideration
As mentioned previously, if you want to fight the decision of the SSA, you will have to file an appeal. This process is known as a Request for Reconsideration. It is a necessary step to take if you want to get a hearing from a judge.
This claim will be evaluated through the same procedure used for the initial application for SSDI. However, the decision is made by a different set of people. Unfortunately, only 10% of the appeals at this stage are approved, so be prepared to file the next appeal.
Step 3: Hearing
If your appeal was denied at the previous stage, don’t worry, because you still have the option to request a hearing before an Administrative Law Judge (ALJ).
The judge will review all of the medical evidence in your case file before making a new decision regarding your legal matter. There will be a hearing where you can explain your to the judge how your condition limits you and how that impacts your life.
The court can consult with medical and employment professionals to get an idea of what you’re capable of doing considering your disabilities.
If it becomes necessary, you will also be able to call witnesses to testify on your behalf. The judge’s ruling will be handed down in writing. At the hearing phase, a majority of the cases that were rejected in earlier stages are found to be valid.
Step 4: Appeals Council and Beyond
Even if an ALJ rules against you, you may still file an appeal. You are afforded the opportunity to file an appeal with the Appeals Council of the Social Security Administration regarding your case.
Even though you will not have the right to a hearing, you have the chance to send a written request to the Appeals Council urging that they either approve your claim or offer you an additional hearing on the grounds that the administrative law judge made a legal or obvious error in their decision.
In the event that the Appeals Council rejects your claim, you have the right to file a complaint against the Social Security Administration in federal court, requesting either a reversal of the decision or a fresh hearing on the matter.
While you wait for the results of your appeal, you might also be given the option of submitting a new claim.
How Do You Know If You Will Be Approved for Disability?
There are a few telltale signs that your disability benefits will be approved. Keep reading below for more information.
You Have Paid Enough Social Security Taxes
To begin with, in order to be eligible for Social Security Administration benefits, you need to have accumulated a sufficient number of work credits.
Work that results in the payment of social security taxes can count towards the maximum annual allotment of four work credits. To be eligible for disability benefits from Social Security, you are required to have accumulated at least 40 work credits during your lifetime.
It is also required that twenty of these have been earned within the past ten years. However, younger workers with fewer years of experience may also be eligible.
You can’t qualify for Social Security Disability Insurance if you don’t have enough work credits (SSDI). However, you will still have the opportunity to submit an application for Supplemental Security Income (SSI).
You Submitted Sufficient Medical Evidence
No overstatements can be made about the significance of medical evidence in disability claims. The SSA will examine it to determine if your disability claims have merit. Inadequate medical documentation of your injuries or sickness, or insufficient medical proof overall, increases the likelihood that your disability benefits application will be denied.
It can be difficult to decide what medical evidence to provide. You need only submit the “relevant” ones to your case. For example, if your handicap is shoulder-related, you can skip the dental record submission.
Obtaining the required medical evidence is less of a hassle when you have a disability lawyer on your side. Experience has taught them what the SSA is looking for and how to present it in the best light possible. They can also communicate with your doctors to gather the necessary medical evidence.
Your Condition is Listed in the Blue Book
To be clear, this is by no means a guarantee that you will receive disability benefits. However, it is quite useful.
You see, the Social Security Administration’s (SSA) blue book provides guidance on what conditions are regarded as disabling enough to qualify for disability benefits. You have a good shot at collecting benefits if your condition is included.
The SSA, however, reviews each claim separately. Keep in mind that people have different pain thresholds. The medical condition’s severity varies from person to person as well. Even though a fractured ankle may not keep one person from doing their everyday activities, it can seriously limit the mobility of others.
The Social Security Administration will determine if your health condition limits your ability to work. Your claim could be accepted if they determine that it significantly reduces your earning potential.
You Make Less Than the SGA Amount
The Social Security Administration uses Substantial Gainful Activity (SGA) as a measure of your ability to work. It’s more likely that your benefits application will be approved if you return to work and earn an amount that is less than the monthly SGA. The SGA may change yearly due to inflation, so the SGA for the year prior may not be applicable in the year you are filing.
You Cannot Go Back to Work
Your ability to work is considered one of the criteria for assessing your disability status. The SSA will determine if you can perform alternative types of work if they determine you cannot return to your previous line of work due to your disability. They will consider your experience, age, and level of education.
It’s likely that you’ll be accepted if they conclude that you either don’t have the abilities necessary to do any other work or that you’re too old to acquire an unfamiliar skill.
The Social Security Administration will evaluate your ability to learn new skills and your Residual Functional Capacity (RFC). This represents your ability to keep working despite poor health. If you are unable to stand, walk, or run for an extended period at work, it’s reasonable to assume that you also won’t be able to do heavy work like pushing or lifting.
In general, the likelihood of receiving social security payments decreases in relation to the amount of labor one can perform.
Your Disability Has or is Expected to Last 12 Months
This is a prerequisite for receiving Social Security Disability Insurance, which means there’s really no way to avoid it. You won’t be eligible for disability payments if your injuries won’t prevent you from working in the future, and you’re predicted to make a full recovery within a few months.
Nonetheless, if your income is below the limit, you are still eligible to apply for SSI.
You are 50 Years Old
The Social Security Administration uses the “grid rules” method to determine if a person is disabled and is over a certain age. The system is based on the premise that older workers who lack specialized skills have a challenging time breaking into the labor market.
This is why those 50 or older and disabled have a better chance of being granted benefits under the current system.
What Should I Expect After the Approval of Benefits?
In this section, we will briefly discuss what you should expect after approval of benefits. Keep reading below!
Notice of Decision
You probably filed for a hearing before an administrative law judge if the Social Security Administration (SSA) rejected your disability claim after your original application and reconsideration.
A letter with the verdict will be sent to you in such a situation. The ALJ’s ruling and the SSA’s subsequent implementation of that ruling (which is communicated in the notice of decision) are made clear in this letter.
Positive verdicts can either be 100% successful or 50% successful. When you receive either of these results, you have been granted benefits. All that differs is how you define the beginning of your disability.
If the ALJ rules in your favor, it suggests that the date you claimed your disability began is correct. The date you ceased working is usually considered the “onset date” for disability purposes.
In a ruling that was not entirely favorable, the ALJ determined that your date of disability onset occurred after the date you provided on your application.
Notification of Award
If your disability claim is approved by the Social Security Administration or an administrative law judge, you should get a notice of award within one to three months. However, this time frame might vary widely depending on the caseload of your local SSA field office.
Most of the basic issues that people have about their disability payments are addressed in the notice of award, such as:
- Date of disability onset
- The amount of disability compensation received
- The first month of benefit eligibility
- The total amount of back disability benefits you are owed (this will be paid in one lump sum payment)
- When you can anticipate receiving your back disability pay
- When your continuing disability status is reviewed next
If you get a notice of award and you believe you are entitled to more money than what was awarded (either in terms of disability back pay or in terms of your monthly benefit amount), you can file an appeal. The notice of award describes how to file an appeal.
Your regular monthly payments will remain unchanged while your appeal is being processed. The Social Security Administration may change payment amounts if the appeal is upheld.
Pre-Effectuation Review Conference
Pre-effectuation Review Conferences (PERCs) are mandatory if you receive both SSI and SSDI from Social Security. You can maintain your SSI financial eligibility with the help of a PERC. If you are simply receiving SSDI benefits, a PERC is not necessary.
Continuing Disability Review
Everyone receiving Social Security Disability Insurance must undergo periodic Continuing Disability Reviews (CDRs). Even though they may seem alarming, there is usually nothing to worry about. The Social Security Administration (SSA) will use your CDR results to evaluate whether your handicap continues to prevent you from working.
After a CDR, more than 90% of those receiving SSDI are granted approval to continue receiving payments.
When the Social Security Administration (SSA) decides that you are eligible for SSDI, you will be placed in one of three medical categories. Classes are assigned according to the character and extent of your disability and the prognosis for your condition. Your case’s CDR frequency is based on the category you were assigned to. This includes:
- Estimated Medical Progress: Every 6-18 Months.
- Potential Medical Progress: Every 3 Years.
- Medical Improvement Not Expected: Once every seven years, but never more than once every five years.
Benefit Offsets
Under certain circumstances, such as if you were awarded worker’s compensation following a workplace accident, your award is subject to offset. While SSA staff should be programmed to account for offsets automatically, mistakes sometimes happen. Perhaps you forgot to notify the SSA that you received additional benefits subject to offset.
To ensure you receive the correct amount, verify with the SSA that they have properly offset your benefits award. In the event that you don’t, you’ll have to fork over the cash difference between your benefit award and what you would have gotten if the offset had been applied correctly.
Conclusion
When applying for social security disability, it’s important to understand the process used by the SSA to evaluate your case. Understanding the phases of the disability process helps you be more prepared for the next steps you are supposed to take.
