Social Security Administration’s Process for Determining Disability

Information provided by a Tulsa Oklahoma Social Security Disability Attorney

The process for determining whether a person is eligible for social security disability benefits can be long and complicated. We have broken this process down for our clients to make it easier to understand. If you are considering filing for Tulsa SSI or social security disability benefits, please call our office to understand your options.

A. Initial Application

First a claimant must apply with the Social Security Administration for disability benefits and must explain briefly why the claimant believes he/she is disabled. The claimant may obtain a “protected filing date” by calling the Social Security office. The claimant will then be sent forms to complete, and the application date will be considered to be the date of the phone call if the forms are promptly returned. The Social Security Administration will attempt to get your medical records from treating doctors and hospitals, and you may be scheduled for a consultative examination with a doctor, psychologist or psychiatrist. After the necessary records are obtained, the Social Security Administration provides you with a decision as to whether you are disabled. Only the most obvious cases are awarded benefits after the initial application.

B. Reconsideration

If your application for benefits is denied, you may request reconsideration. This is a necessary step in the appeal process. However, many people believe this is a meaningless step. You are essentially asking the Social Security Administration to “reconsider” the previous decision. Not surprisingly, the vast majority of cases result in an identical decision upon reconsideration. The Social Security Administration has proposed that this step be eliminated.

C. Hearing before an Administrative Law Judge

After you have received a social security disability denial from the initial application and the request for reconsideration, the next step in the appeal process is to request a hearing before an Administrative Law Judge (“ALJ”). Although his title is “Judge,” the ALJ is part of the Executive branch of government, not the Judicial branch. The ALJ works for the Commissioner of Social Security. However, as with any judge, the ALJ is to make an impartial determination as to whether you are disabled. He is not to simply “rubber stamp” what the Social Security Administration has already done.

This is the stage of the process at which most claimants will be found to be disabled, if they are found to be disabled at all. As is mentioned above, only the most obvious cases are granted disability benefits from the initial application. The ALJ’s job is to review all of the records previously submitted to the Social Security Administration and to further develop the record, as necessary, by ordering additional tests or obtaining testimony from expert witnesses. A hearing is conducted, in which the claimant testifies as to the reasons the claimant believes he/she is disabled. ALJs often have a vocational expert present at the hearing to testify as to the various jobs that are available in the economy based on criteria set forth by the ALJ, and ALJs sometimes have medical experts testify as to specific medical issues.

WARNING!! Claimants are allowed to represent themselves at hearings before an ALJ, as with all stages of this administrative process. However, we believe a claimant who represents himself/herself at a hearing is at a great disadvantage, particularly in a close case. The reason for this has more to do with development of the record prior to the hearing than with what happens at the hearing. Although a good Tulsa Oklahoma social security disability attorney might be persuasive at the hearing, these cases are generally won by the work prior to the hearing, not the work at the hearing. Prior to the hearing, the disability attorney must determine the “theory” of disability, and the attorney must seek to find evidence that would support that theory. Since the ALJ must generally give more weight to the opinions of treating physicians, we work very hard prior to the hearing to get the opinion of the most significant treating physician as to a claimant’s impairments. We also work very hard to get all of the claimant’s medical records, from all of the claimant’s treating physicians and hospitals. The absence of a few records or the absence of critical information from a treating physician can doom even a very good case. Claimant’s who attempt to represent themselves simply don’t know what information is needed. Heed this warning. Don’t represent yourself!!

After the hearing, the ALJ will issue a Notice of Decision, in which he will grant or deny benefits. ALJs sometimes issue a “partially favorable” decision, in which the ALJ grants benefits for a portion of the time, but not all of the time the claimant was alleging. This might be the case where a claimant was alleging that he/she became disabled a few years ago, and the ALJ determined that he/she has only recently become disabled. Such a determination would affect the “past due” benefits, but it would generally not affect the benefits going forward (unless the claimant’s insured status expired in the interim). A partially favorable decision could also be for a “closed period,” if the ALJ determines that the claimant was disabled in the past but is no longer disabled. In such a case, the claimant would get past due benefits for the period of disability, but the claimant would not get any benefits for the period going forward. If the ALJ issues a “fully favorable” decision, he is finding that the claimant has been disabled for the entire period alleged.

D. Appeals Council

If the ALJ issues any decision other than a “fully favorable” decision, the claimant can appeal the unfavorable portion of the decision to the Appeals Council. This is accomplished by timely filing a form entitled “Request for Review” with the Appeals Council. Since the form offers very little space to argue why the ALJ erred in his decision, most attorneys attach a letter to the Request for Review, setting forth the various legal arguments that the attorney wants the Appeals Council to consider.

As is the case with the ALJ, the Appeals Council is also part of the Social Security Administration. The Appeals Council is a group of judges who oversee decisions made by the ALJs to insure that those decisions are consistent with the law. The Appeals Council is the final step in the appeal process before the Social Security Administration. If the Appeals Council issues a denial decision, that decision is considered to be the final decision of the Commissioner of Social Security. The Appeals Council also has the option of “remanding” the case to the ALJ for further development or other proceedings. The Appeals Council also can simply decide to award benefits, although such a decision is rare.

E. United States District Court

Once the claimant has been denied benefits at every step of the process through the Social Security Administration, including the Appeals Council, the claimant may file a lawsuit in United States District Court. This is a lawsuit by the claimant against the Social Security Administration for failing to follow the law in determining his/her eligibility for Social Security benefits. Although this is a lawsuit in Federal Court, there is no trial, and there is no new testimony. The Court looks solely at the records that were available to the Social Security Administration, and the Court determines if the ALJ made factual or legal errors in his decision.

With regard to “factual” determinations that were made by the ALJ, such as whether a claimant’s testimony was “credible,” the Court gives a lot of deference to the ALJ. Even if the Court would have reached a different conclusion, the Court will not reverse the ALJ’s decision with regard to such findings of “fact” as long as the record has some evidence to support those determinations. Because of this deference, Courts will often affirm an ALJ’s decision, even if the Court believes the person may actually be disabled. This does not seem fair to claimant’s, but it is simply due to the way that the law is written, requiring the Court to give deference to certain findings by the ALJ.

However, the Court does not give similar deference to “legal” errors. A “legal” error simply means that the ALJ did not follow the law. Some legal errors may be viewed by laymen as “technical” errors, but the Court does not view them as such. The Court must determine if the ALJ carefully followed the law in his decision. If the ALJ did not follow the law, the Court will remand the case to the Commissioner of Social Security for further proceedings. Sometimes, the Court will remand a case for another hearing and another decision by an ALJ, even if the Court is not convinced that the claimant is disabled. In such a case, the Court protects the claimant’s rights by insuring that the law is followed, even if the claimant ultimately does not get disability benefits.

The Court may reverse the decision of the ALJ and remand the case for payment of benefits. In such a case, the Social Security Administration simply pays benefits as awarded by the Court. However, such a decision by the Court is fairly rare. In most cases, if the claimant wins, the Court remands the case for another hearing and another decision by an ALJ. If that ALJ also issues a denial decision, that decision can then be appealed to the Appeals Council or the courts.

F. Circuit Court of Appeals

If the District Court sustains the decision of the Social Security Administration, the claimant may appeal that decision to the Circuit Court of Appeals. These are the appellate courts just below the Supreme Court of the United States, and they generally cover a multi-state area. As with the District Court, the Circuit Court can reverse and remand a case for the payment of benefits, but such a decision by the Court is rare. If the claimant wins, the Court generally will remand the case to the Commissioner of Social Security for further proceedings. Also, as with the District Court, the Circuit Court gives great deference to alleged errors by the ALJ with regard to issues of “fact,” but not to issues of “law.”

G. Supreme Court

Although a claimant can appeal a case to the Supreme Court of the United States, such appeals are very rare. This is because the Supreme Court is not required to hear such appeals, and the Supreme court will only hear an appeal in cases where there is an important issue of law that must be decided. As a practical matter, the Circuit Court of Appeals is the final step in the appeal process.