Applying for Social Security Disability benefits can be a complicated affair. Most people think they submit an application for disability benefits, the social security administration will review and approve the application, and then they will start receiving a monthly check. In a perfect world that is exactly how the process will play out. However, we do not live in a perfect world. There are a lot of factors that go into determining if you meet social security’s definition of disability. The analysis process is long and cumbersome. This article will go over the steps you should expect throughout the disability process.
The first step is submitting your application. The application requires information surrounding your work history going back fifteen years, a list of your medical conditions, a list of your doctors you have been treating with recently, and finally a list of your medications. After your application is processed, SSA will transfer your case to DDS or disability determination services. This is an organization SSA contracts with to do a medical analysis of your case. While your case is with DDS they will request your medical records and require you to fill out multiple questionnaires documenting your conditions. This process takes an average of 3-5 months. Once DDS has made a decision your claim will be sent back to the local SSA office to process. If your case is approved, SSA will work on getting your monthly benefits started. But if you are like the other 70% of applicants, you will be denied at the first step.
If you are denied, the next step is appealing your denial. You will be requesting a reconsideration. Essentially you are saying to SSA you got it wrong and I need you to re-look at my claim. This process will follow the same steps as the initial claim and will take another 3-5 months. Your odds of being approved at this stage drop drastically with only 15% of initial denials being overturned.
If you are denied again, the third step is requesting a hearing before an administrative law judge. More often than not, your claim for disability will require a hearing so as to explain to a judge what is actually going on. Up until this point, SSA has made a determination based simply upon what is in your medical records and how you have filled out the forms. A hearing is an opportunity to discuss with the Judge face to face the struggles you go through on a daily basis. As you can imagine, the approval rating at the hearing stage increases with a national average of 45%. The downfall of requesting a hearing is that it takes approximately 16-18 months to receive a hearing date. This time frame is a huge disappointment especially since you have already been waiting a year in most cases. On average, it can take 2-3 years before receiving a final resolution of your disability claim.
If you are approved at the hearing stage, SSA will then begin processing your payments and working on your back benefits. One thing to note is that while this process does take a significant amount of time if approved you will be eligible for retroactive benefits, sometimes going back to your disability date. The furthest back you could possibly receive retroactive benefits is 12 months prior to your filing date. This is the reason it is so important to start the disability process as soon as you believe you are disabled. However, just because SSA can pay 12 months prior to the filing date does not mean you were disabled at that time. IF your disability date is around the same time as your filing date then your retroactive benefits will only go back to your disability date. If your disability date is three years prior to your filing date you will only be eligible for retroactive benefits going back twelve months prior to the filing date.
The other benefit SSA will work on if you are approved is whether you qualify for Medicare health insurance. Medicare will apply two years after you are first eligible to receive disability benefits. If you do not qualify for Medicare right away you will want to apply for Medicaid, which is a state-run health insurance program. Medicaid typically does not provide the same level of health insurance as Medicare but it is certainly something to help carry you through until you are eligible for Medicare.
If you have an attorney or representative assisting you with your case they will be paid out of your retroactive benefits. The general agreement which SSA will approve limits your representative fee to 25% of back benefits up to a maximum of $6,000. SSA needs to approve the fee agreement between yourself and your representative. If they approve of the agreement, SSA will handle paying your representative, which will come out of your retroactive benefits check.
If you have children under the age of 18 that you care for they will be entitled to additional benefits from your account. Depending on the state you live in, if you owe child support your back benefits may automatically be sued to pay that amount first.
One thing to keep in mind at the resolution of your case is that an approval of disability benefits does not mean SSA will consider you permanently disabled. SSA may do a review of your claim periodically to ensure you are still disabled. These reviews can occur 12 months after you are first found disabled or even five years later. When SSA reviews your case they will request copies of your current medical records. As long as your medical records show you are still suffering from conditions affecting your functional capacity then your benefits will continue. For this reason, I stress you must continue to receive medical treatment after your approval. If you do not seek continued treatment, SSA will have a solid reason to take away your disability benefits meaning you would have to start the process all over again, waiting another 2-3 years.
The disability process can be confusing no matter what stage in the process you are at. Having a representative will ensure you understand everything that is going on at every step. Call me at LaBovick Law Group and I would be happy to explain the process and expectations.
