Who Decides My Claim and How Long Does It Take?
Once a claim is filed, whether Title II or Title XVI, the department of vocational rehabilitation for the state in which it is filed, through its disability determination services office (DDS), will review the claim and make the initial decision. Usually DDS will obtain evidence from your doctors and other medical care providers. Sometimes they will send you to a doctor at their own expense if the medical evidence is not available or is insufficient to allow them to make a decision. At the initial level it will usually take 3to 4 months for a decision. I emphasize the word “usual” as I have seen cases where the initial decision was made in a month and others that took as long as year.
If the claim is denied you will be notified in writing and advised that if you want to appeal you have 60 days to ask for a “reconsideration”. The reconsideration review is also done by DDS but by different persons than those who made the initial decision. New medical evidence can be submitted and DDS can also refer the claimant to a doctor for evaluation just as at the initial level. This level of review can take as long or longer than the initial level based on whether new medical evidence is submitted.
If denied at the reconsideration level you again have 60 days to appeal, this time by ask ing for a hearing before an administrative law judge (ALJ) who works for the Social Security Administration in the Office of Disability Adjudication and Review (ODAR). Unfortunately, due to an extreme back log in appeals nationwide, it typically takes a year and a half from the time you request the hearing before the hearing is actually conducted.
If your claim is denied by the ALJ you can ask for review before the Appeals Council. The Appeals Council will look at the records form the hearing and can review new evidence. If the Appeals Council decides that the ALJ was correct in denying your claim, the decision of the ALJ becomes the final decision of SSA subject to court review. If the Appeals Council disagrees with the ALJ’s decision, it can modify the decision, reverse it or send it back for a new hearing.
If the decision of the Administrative Law Judge is upheld by the Appeals Council your next avenue of review is in the Federal Court system, first by filing suit in the Federal District Court for the jurisdiction in which you live. The district court can affirm, modify or reverse SSA’s decision. You can also appeal an unfavorable decision of the district court to the U.S. Court of Appeals and potentially to the U.S. Supreme Court, though appeals to these last two courts is seldom seen.
