updated November 2016
Social Security Disability (SSD) and Supplemental Security Income (SSI) are programs that provide benefits to people who are unable to work because of physical and/or mental impairments. SSD is based on your work history, meaning you need to have worked and made enough income over a certain period of time in order to be eligible to file this application. For example, if you have not worked at a job in the last 10 or 15 years, you most likely will not be eligible to file an SSD application. On the other hand, an SSI application is based on financial need for food and shelter. You do not need to have worked before to file for SSI. SSI has income and asset limits. For example, a single person with more than $2,000 in assets will not be eligible for SSI payments. You may be able to file both an SSD and an SSI application.
HOW DO I FILE AN APPLICATION WITH SOCIAL SECURITY?
You can file for disability online at the Social Security website, www.ssa.gov, or go to your local district office and file an application in person. The Social Security website has a link to locate your local office and all you need to do is put in your zip code. You can call your local district office to get more information. You can call the national Social Security hotline at 1-800-772-1213 for more information if you do not have access to a computer (you can try your local library for internet access).
WHAT HAPPENS AFTER I FILE MY APPLICATION(S)?
When you file your application(s), Social Security requests your medical records and in most instances they will have you see one or more doctors in an Independent Medical Exam (IME). Try to keep your appointment for the IME or failure to do so may result in an unfavorable decision in your case. Once that happens, a representative at the Social Security office reviews your file to see if you qualify for disability under the Social Security Regulations.
WHAT HAPPENS IF SOCIAL SECURITY DENIES MY APPLICATION(S)?
If you are found not disabled after filing your application(s), and you still feel that you are disabled, you should file a Request for Hearing by Administrative Law Judge (ALJ) (the form can be found at http://www.ssa.gov/online/ha-501.pdf) or you can call the local Social Security office and tell them you want to file the Request for a Hearing. You have to file this hearing request within 65 days of the date on the denial letter otherwise your case is over.
WHAT IF I MISS THE 65-DAY DEADLINE TO FILE A REQUEST FOR A HEARING?
If you have a really good reason why you missed the 65 day deadline, you have to tell Social Security in writing. Examples of circumstances where good cause may exist include, but are not limited to, the following situations:
- You were seriously ill and were prevented from contacting SSA by phone, in person, in writing, or through a friend, relative, or other person;
- There was a death or serious illness in your immediate family; pertinent records were destroyed or damaged by fire or other accidental cause;
- You were actively seeking evidence to support your claim, and your search, though diligent, was not completed before the time period expired;
- You requested additional information concerning SSA’s determination within the time limit. (After receiving the information, the individual has 60 days to request a reconsideration or hearing. The individual has 30 days after receipt of such information to request AC review or file a civil action);
- You were furnished confusing, incorrect, or incomplete information or were otherwise misled by a representative of SSA or CMS about your right to request reconsideration, a hearing before an Administrative Law Judge, AC review, or to begin a civil action;
- You did not understand the requirement to file timely or were not able (mentally or physically) to file timely;
- A notice of the determination or decision was never received (e.g., SSA used incorrect address or claimant moved);
- You transmitted the appeal request to another government agency in good faith within the time limit and the request did not reach SSA until after the time period had expired;
- You thought your representative had filed the appeal (good cause applies to you despite whether you are still represented or represented by a different person); or
- Unusual or unavoidable circumstances exist, which demonstrate that you could not reasonably be expected to have been aware of the need to file timely, or such circumstances prevented you from filing timely.
WHAT HAPPENS IF YOU CANNOT SHOW GOOD CAUSE?
If good cause is not shown, you will have to begin the application process over again. It is very important that you make every effort to file the request for hearing within 65 days of your denial.
WHAT HAPPENS AFTER I FILE MY REQUEST FOR A HEARING?
Shortly after you request your hearing you will receive a notice confirming that you requested a hearing. It can take about 12 months from the time you file your request for a hearing with Social Security to get a hearing date but it may be less. This is due to a backlog of cases already pending at Social Security.
WHAT DO I DO WHILE I AM WAITING FOR A HEARING DATE?
Medical evidence is very important in being able to prove that you have severe conditions and that they are limiting. Therefore, if you are having any problems, talk to your doctor about it and have the doctor document everything. You should also see specialists if needed to show the extent of your condition. If you need to miss any appointments, reschedule them right away. If you do not show up to your appointments and the doctors note that down, it may not help your case. Also, if you are in any mental health treatment, tell your counselor/psychiatrist if you are having any problems at all and make sure everything is written down. If you feel you do have a mental condition but are not receiving any formal counseling for it, it is recommended that you try some counseling. The judges want to see if you have tried available treatment to see if it makes you feel better or not. Make sure that you always take your medication as stated by the doctors and follow recommended treatment if at all possible.
If your doctor supports your claim that you are disabled, it is helpful to have the doctor specifically state what your limitations are. If the doctor generally says they believe you are disabled, this is not enough. Such a broad statement is not given much weight by a judge as it is the job of Social Security to make that specific finding.
Every once in a while, you should ask your doctor(s) for copies of your updated medical records and submit them to Social Security (also keep copies for yourself). This way Social Security will have your complete file when your time for a hearing comes.
HOW WILL I KNOW WHEN MY HEARING WILL TAKE PLACE?
Social Security will send you a “Notice of Hearing.” This notice will tell you when and where the hearing is; who the judge is; and whether an expert will be testifying during at the hearing. Review and keep this notice. However, you do need to mail back to Social Security the page that says you will attend the hearing. This page is attached to your hearing notice. You will receive at least 20 days notice before your actual hearing date. If you are unable to attend the hearing on the assigned date, make sure you call the office of Hearings and Appeals at Social Security and reschedule the hearing.
WHAT HAPPENS AT THE HEARING?
When you go to your hearing, it is a time for you to convince the ALJ that you are disabled. The judge will have reviewed your Social Security file but he/she is not bound by the decision made by the initial Social Security representative. In addition to you and the judge, there is a hearing assistant digitally recording the hearing. If you have any witnesses, they usually sit in the waiting room until the judge is ready for his/her testimony. You will be asked to swear under oath, meaning that you promise to give truthful testimony. Social Security will not be represented at the hearing by a lawyer. There will be no jury or spectators at the hearing. How long the hearing last depends on how complicated your case is. Generally hearings are scheduled for 45 minutes, but they can be shorter or longer.
The judge will most likely ask you questions about your background, such as how old you are, where you live, what your education is, what your previous jobs were, and what you did at those jobs. The judge may ask you about your various conditions, the doctors who are treating you, how often you go to the doctor, any medications you take, any side effects you experience, and what limitations you have. The judge may also ask you about your daily activities and why you cannot do the past work you have done or do any work at all.
Listen carefully to the questions you are asked. If you don’t understand a question, ask that it be repeated or explained. Answer the question fully and completely. If you don’t know the answer to a question, say you don’t know. If you don’t remember, say you don’t remember. Do not exaggerate your problems at the hearing. This can hurt you more than help you, especially since the judge can look at the medical records to see if your testimony matches what the doctor says. If you lie to the judge under oath, be aware that you could be prosecuted.
Don’t try to put up a brave front at the hearing. If it hurts, tell the judge that it hurts. If you can’t do something, say that you cannot. You can’t expect a fair decision from the judge unless he or she knows what’s wrong with you. If you need to stand up or walk around at your hearing, do so. Remember that if you testify that you can only sit for 15 minutes at a time and then you sit in agony for 45 minutes the judge will not believe you.
AM I ENTITLED TO HAVE A REPRESENTATIVE WITH ME AT THE HEARING?
Social Security does not have to provide you with a lawyer or other representative. However, if you want to have a representative with you at the hearing, such as a lawyer, and you do not have one at the time of the hearing, you can ask the judge to give you more time to find a representative. The judge should allow you time to find someone to represent you and the hearing will be rescheduled. Representatives can also be counselors, caseworkers, or other such professionals who are looking out for your best interest and are going to help you with your case. Friends and family members are usually not representatives. You may want a friend or family member to testify for you as a witness if they know about your conditions, but a representative should be somewhat familiar with the Social Security process to help guide you through the system. You can always waive your right to have a representative and go ahead with the hearing on your own.
WHEN WILL I GET A DECISION?
Normally you will not get a decision at the time of the hearing but will receive it in the mail after the hearing. It usually takes about 60 days to get the written decision but it may take a little bit longer if your case is complicated. If you pass the 60 day period, you can call the hearing office to check on the status of your case. Usually you will get a decision well before the 60 days is over.
A judge will not normally tell you he/she is going to find that you are not disabled at the hearing. On the rare occasion, a judge might tell you that he/she is finding you disabled. This usually happens only when the evidence is very strong and the doctor has given a specific opinion about your condition and limitations you have. Do not expect this though.
WHAT IF THE JUDGE FINDS I AM NOT DISABLED?
There are options to appeal the decision of the ALJ. Your first appeal would be to the Appeals Council which is within the Social Security Administration. You have to file this appeal within 65 days of the date on the unfavorable decision or it becomes the final decision on the case. If the Appeals Council denies your request for a review, you can then appeal to the United States District Court. Again, you have to file an action in Federal Court within 65 days of the date on the denial of your request for review from the Appeals Council otherwise the decision on your case is final. If you cannot file the action within 65 days because of a good reason, you need to ask the Appeals Council (not Federal Court or the hearings office) for an extension of time. You can also file a new application for SSD and/or SSI any time after you are found disabled but you will have to go through the whole process again.
WHAT IF THE JUDGE FINDS THAT I AM DISABLED?
Social Security will contact you to discuss payment. If you are entitled to any SSI retroactive money, be aware that the Department of Social Services may be able to collect money they paid to you for things such as rent and cash grants. Social Security will count any income you received from wages at a job as well as income from other sources, such as unemployment and workers compensation (this is not an exhaustive list) for SSI purposes.
More information about the process or to get forms can be found on Social Security’s website:
www.ssa.gov or you can contact your attorney/representative. You can also review the LifeLine entitled Social Security Disability (SSD/SSI).