Navigating the process of obtaining Social Security Disability benefits can be time-consuming, confusing, and stressful — and often for individuals who experiencing the worst hardship of their lives. This is, in part, because (in order to qualify for benefits) a person must demonstrate that he or she is disabled.
Disability is defined as the “inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment . . . which can be expected to result in death or which has lasted or can be expected to last . . . not less than 12 (consecutive months).” So, even at the start of the process, a person who is disabled is expected to meet complicated legal standards.
To add insult to injury, the process is not designed for speed or simplicity. The process can generally be described as follows: First a person submits an application, which can vary depending on the type of benefit applied for. In recent years, about 66% of applications have been rejected. Fortunately, a person whose application is rejected has several options moving forward. The next step in the process is to apply for reconsideration. About 10 to 15% of reconsiderations are approved. If the application is not successful at reconsideration, the individual may apply for a hearing before an Administrative Law Judge.
Hearings before Administrative Law Judges result in approval for benefits nearly half of the time, which is why such hearings should be approached with significant care — the hearing may be an individual’s best chance at attaining benefits. Hearings involve the same legal determinations as early in the application process along with testimony from the disabled individual and likely medical and vocational experts.
In the event that a hearing results in denial, the matter may be submitted to the Appeals Council, which is an administrative body in Falls Church, Virginia. The Appeals Council makes determinations based on the record from the administrative hearing, but it will also consider new materials and evidence, as well as arguments. The Appeals Council can reverse the Administrative Law Judge’s decision, remand (send back) for further proceedings, or affirm the decision.
If the Appeals Council affirms a case, the matter may be appealed to federal court. Federal courts will review the evidence and testimony before the agency along with briefs submitted by the parties. Similar to the Appeals Council, the federal court may reverse, remand, or affirm.
At any stage of an application, having an attorney can increase chances of success and make the process easier. Fortunately for individuals needing such services, attorneys fees are contingent on the outcome of the application, and they are statutorily capped at up to 25% of the past-due benefits. Attorney’s fees do not come out of or reduce benefits moving forward. Past-due benefits may be significant, as cases often take a year or longer before they reach an Administrative Hearing. In some instances, however, an attorney may be able to expedite that process as well.