Social Security Disability Insurance Process in Virginia
Social Security Disability Insurance (SSDI) benefits are available to adults who meet the Social Security Administration’s (SSA’s) definition of disability and have earned enough work credits over their lifetime by paying into the Social Security system through payroll taxes. If you meet the SSA’s definition of disability then you can receive SSDI benefits regardless of your assets, resources, or income from other disability or retirement benefit programs. This is good news for those of you receiving workers compensation benefits, VRS payments, long term disability benefits, or a disability pension from the Veterans Administration.
There are four levels in the SSA’s administrative review process for evaluating disability claims. If your claim is denied at all four levels then you can file a lawsuit against the SSA in federal court.
This article explains the SSDI process for disability claimants in Virginia, Maryland, North Carolina, DC, and Pennsylvania – states where we represent disabled adults regularly. Read the article for additional information then contact Social Security Disability lawyer Richmond VA and Virginia Beach disability attorney Corey Pollard for answers to your questions and a free consultation.
Social Security Disability Administrative Review Process
When determining your rights under title II of the Social Security Act, which governs SSDI benefits, the SSA follows a strict administrative review process. This process applies to all adults who file a claim for disability insurance benefits.
Level One – Initial Determination on Your Application for Benefits
There is a lot of paperwork that goes into your SSDI claim. After you complete your initial Social Security Disability application, Activities of Daily Living Questionnaire, Function Report, Pain Report, Work History Report, and Authorization to Release Medical Information, the SSA will assign your claim to the Disability Determination Services (DDS) in the state where you live.
DDS makes the initial determination on your disability claim. It will review all the information you submit and request medical records from your treating health care providers for the 12-month period prior to the date you allege you became disabled through the present. This is why it’s important for you to provide detailed and complete information when you apply for benefits. If you’re vague about your work history and past job responsibilities, or leave out some health care providers, then your claim will likely be denied.
If DDS does not have enough medical information to decide your case then it will schedule you for a consultative examination with one of its doctors. This often happens when applicants do not have adequate health care coverage and therefore are unable to receive all the medical treatment they need.
After DDS obtains all the information it thinks is necessary to determine your initial application it will make a decision. Usually this takes from four to six months to complete. But if you have one of the rare medical conditions and disease that qualify for the SSA’s Compassionate Allowances program you may get a decision much sooner.
You will receive your initial determination in the mail. Remember that most initial applications for disability insurance benefits are denied. This determination is binding unless you request a reconsideration within the stated time period or the SSA decides to revise its initial determination on its own. We recommend requesting reconsideration in almost all cases.
Level Two – Reconsideration
If the SSA denies your initial disability application then you have 60 days to request a reconsideration. This is the first appeal level.
At the reconsideration level you and your attorney should review the medical and vocational documentation that the SSA used to deny to your initial application. If something is missing or you have continued to receive medical care then you need to make sure that the SSA obtains the updated information.
At this level another disability claims examiner with DDS will review your application. He or she may even be in the same office as the first person that denied your claim.
After reviewing your file DDS will send you a letter with its decision. Usually the process takes two to four months though it can take longer depending on how quickly your health care providers respond to requests for information.
The overwhelming majority of reconsideration requests are denied. If you do not request a hearing then the reconsideration denial becomes binding. We recommend requesting a hearing in almost every case.
Level Three – Hearing
If the SSA denies your initial application for benefits then you will likely need to go to a hearing before an administrative law judge (ALJ) to get the SSDI benefits you deserve. You must file a request for hearing with the SSA within 60 days of the date of your reconsideration denial.
In Virginia it takes twelve to eighteen months for a hearing to be scheduled. This is consistent with wait times at hearing offices around the country.
During the wait you should continue treating with your medical providers and continue to work with your attorney to develop the evidence in your case.
You will receive a notice of hearing in the mail roughly 75 days before the hearing is scheduled. At this time your attorney will schedule conferences with you to make sure that updated medical information is requested and to prepare you and your witnesses for hearing. You must submit additional evidence more than five days prior to hearing for it to be considered.
If you live in Central Virginia then your hearing will be held in Richmond. If you live in Hampton Roads then your hearing will be held in Norfolk or Newport News.
The ALJ is not bound by the decisions made by DDS at the initial application and reconsideration levels. He or she will make an independent decision based on the medical and vocational documents in your file and testimony from you, the vocational expert, and medical experts at hearing. The ALJ will also consider statements made by your attorney in support of your case.
We often ask the ALJ to issue an on the record decision finding that you’re disabled. But some ALJs do not like to make an on the record decision. In these cases the ALJ will issue a written decision roughly one week to eight weeks after the hearing.
Your attorney will review the written decision with you. If it’s fully favorable then the ALJ found you disabled as of the date alleged. If it’s partially favorable then the ALJ found you disabled as of some date other than the date you alleged you became disabled. And if it’s unfavorable then the ALJ denied your claim.
We experience our greatest success at the hearing level because we’re able to present your story and put a face to the case.
Level Four – Appeals Council
If the ALJ denies your SSDI claim then you have 60 days to request a review by the Appeals Council. At this level the Appeals Council will review the ALJ’s decision, the hearing recording and transcript, and the evidence in your file. Your attorney may file a disability brief that sets forth why the ALJ’s decision was incorrect.
Usually it takes from eight months to fourteen months to receive a decision at the Appeals Council level. And most cases are denied.
Before requesting review by the Appeals Council you should discuss your age and date last insured with your attorney. Sometimes filing a new application is the best decision.
Level Five – Federal Court
Requesting review by the Appeals Council is the last step in the SSA’s administrative review process. But it is not the last possible step. You may file a lawsuit against the Commissioner of the SSA in federal district court.
Few claimant file a lawsuit in federal district court. This is because the standard of review changes. Instead of deciding your case by a preponderance of the evidence the federal court will look to see if there is any evidence whatsoever to confirm your denial. For this reason we take only a handful of cases to federal court each year.
Guiding You Through the SSDI Process – Virginia Disability Lawyer Corey Pollard
No matter what step you’re at in the SSDI process, Corey Pollard is here to help.
You have a lot to gain with your SSDI claim in Virginia. Last year the average monthly benefit for a SSDI recipient was more than $1,100.00 per month. Your monthly benefit amount is determined by your past earnings. The more you made in the past the higher your monthly SSDI benefit.