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DISABILITY: BOTH A FEDERAL AND STATE PROGRAM

We usually think of Social Security Disability Insurance (SSDI) as a federal program.  But, as currently practiced, it is a joint program involving both the state and federal governments.

Each of the 50 states has an office to process and make initial decisions on disability claims, whether SSDI or SSI.  These offices are generally called "the state agency," and will have official names like "The Disability Determination Service."  In Alabama, this agency is located in Birmingham.

While your case is at the "state" or "agency" level, your medical records will be ordered and interpreted.  Someone will go over your past work record to analyze your past jobs for the most recent 15-year period.  Then, the state agency will make a determination whether or not you meet the rules for a disability benefit. This "application stage" usually takes 4 to 5 months.

If you are approved, you will receive a letter stating that you qualify for disability benefits, beginning on a certain date.  If you are denied (as a majority are), you will get a letter stating the reason that you don't qualify for benefits, in state's view.

When you appeal this decision, you enter something called "the Reconsideration stage."  The same state agency, but a different person, will review your file to make sure no mistakes were made.  The denial is upheld or affirmed in about 97 percent of cases.  But you have "only begun to fight."

Next, you will appeal the state agency's decision by asking for a hearing before an administrative law judge (ALJ).  You have now moved out of the state realm and are laboring in the federal arena.  You case is shifted to the Social Security Administration's Office of Hearings Operations or OHO.  You will be scheduled for a hearing but may have to wait 6 to 12 months for an available docket.

It's important to note that you can and should update your appeal file while waiting for the hearing.  You will continue to visit doctors, and you may have new tests, imaging studies or other diagnostic procedures performed.  Copies of these records should be sent to the OHO office handling your appeal.  (If you are represented, your representative will keep your medical records updated for you).

New evidence may be submitted until 5 business days prior to your hearing.

Social Security has a unique process of determining disability cases.  They have rules and regulations that only they use. It will help you if you try to understand this process and its rules before you undertake this endeavor.

NOTE:  SOCIAL SECURITY HAS A 60-DAY DEADLINE TO FILE AN APPEAL ON ANY UNFAVORABLE DECISION.



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