Generally after a claimant files a Social Security disability claim, there are five levels of review:
1. Initial Determination: Once a claimant files a Social Security disability claim, the Social Security Administration (SSA) sends the case to a disability examiner in the state where the claimant is located. The examiner consults with a doctor, evaluates the claim, and makes the initial decision on the claim. A large majority of claims are denied at the Initial Determination level, but there are more opportunities for reversing this denial and have the claim accepted later in the process, as explained below.
2. Reconsideration: If the claim is denied, the claimant can appeal for Reconsideration. The Claimant must make his or her request in writing within 60 days from the date of receipt of the denial. At this stage, the claim is sent to a different disability examiner who did not take part in the initial determination. The new disability examiner will look at all the evidence submitted for the claim when the original decision was made, in addition to any new evidence submitted for the reconsideration.
Most reconsiderations involve a review of the files on record without the need for the claimant to be present. However, when a claimant appeals a determination that he or she is no longer eligible for disability benefits because their medical condition has improved, that claimant can meet with a Social Security representative and explain why they believe they still have a disability. Only a small percentage of claims denied at the Initial Determination are reversed at the Reconsideration Phase.
3. Administrative Hearing: If a claim is denied at reconsideration, the claimant may then request a hearing. It can take quite a long time to get a hearing (more than one year in some states), which is conducted before an Administrative Law Judge who works for the Social Security Administration. The Administrative Law Judge makes an independent decision upon the claim at the hearing; this Judge had no part in the Initial Determination or Reconsideration. The hearing is usually held within 75 miles of where the claimant lives. It is very important for claimants to attend their hearings. Claimants unable to attend in person should make arrangements for appearance by video well in advance.
Unlike regular court cases, the administrative hearing is not truly an adversarial proceeding. In other words, there is not another attorney arguing against you. The procedures are less formal than a typical court proceeding and the rules of evidence are not as strict as they are in civil court.
Before the hearing, the judge may ask the claimant for more evidence or for clarification regarding the claim. At the hearing, the judge may ask claimant questions, and also ask questions to any witnesses that are in attendance, as well as other witnesses such as a Medical Expert (ME) or Vocational Expert (VE). MEs review the records from doctors you have seen in the past and evaluate them to determine if you meet the criteria for disability, and VEs evaluate what kinds of work you can do. Your attorney can also ask you questions, and may ask questions to the VE and ME too. Your attorney might also directly answer questions asked by the judge.
At the conclusion of the hearing, the judge will either issue a decision on the spot, or the claimant will be notified of the decision in the coming months.
4. Appeals Council Review: If the administrative law judge denies a claim, a claimant may request a review by the Social Security Administration’s Appeals Council. The Appeals Council reviews the record and will deny the request if it believes the hearing decision was correct. If the Appeals Council does decide to review a claim, it will either: (1) decide the case itself and reverse the administrative law judge’s denial; (2) modify the judge’s decision; or (3) return the case to an administrative law judge for further review (called a “remand”). If the Appeals Council returns a case to an administrative law judge, the SSA will send the claimant a letter explaining the decision, along with a copy of the order.
5. Appeals to the Federal District Court and Upward: A decision not to review, or a denial by the Appeals Council is still not the end of the road. After such a denial, a claimant has the ability to appeal this claim by filing a lawsuit in Federal District Court in the district where the claimant lives. The Federal District Court then can affirm, modify or reverse the decision of the SSA, including remanding the case for a rehearing.
If the Federal District Court affirms the ruling of the SSA, further appeals may be made to the United States Circuit Court of Appeals. A Circuit Court affirmation of the decision (in other words, the Circuit Court refuses to overturn the order) leaves only the remedy of fling a writ of certiorari with the United States Supreme Court, which asks the Supreme Court to review the case. Such a writ would be granted in very rare circumstances.