SSDI Determination Process

Familiarizing yourself with the different stages of the SSDI determination process is important, as each phase requires specific information and has particular timelines.

Below is a breakdown of each stage and what applicants should expect.

Initial Application Review

The SSDI application process begins when you submit your application to the Social Security Administration (SSA), either online, by phone, or at a local field office.

This stage involves collecting personal details, work history, and medical records.

The primary purpose of the initial review is to determine if the applicant meets the basic SSDI criteria.

During this stage, the key requirements and actions include:

• Applicants must demonstrate a medically determinable impairment that prevents them from performing their past relevant work or any other type of work.
• The SSA checks if the applicant has earned enough work credits based on their employment history.
• DDS reviews the medical evidence provided, such as doctor’s reports, imaging studies, and lab results.
• If the medical evidence is insufficient, DDS may request additional records or send the applicant for a consultative examination.

Many applications are denied at this stage, but denials can be appealed, which brings applicants to the reconsideration phase.

Reconsideration Phase

If the initial SSDI application is denied, applicants have the right to request reconsideration.

This phase entails a thorough review of the application by a different examiner at DDS.

The reconsideration focuses on whether the initial decision was correct and whether any new information affects the outcome.

Key steps involved during the reconsideration phase include:

• Applicants can submit updated medical records or additional information during this phase.
• A new application is not required for reconsideration; the original case is reopened for further review.
• DDS may consult with additional medical experts to ensure all relevant evidence has been reviewed.

Like the initial review, the reconsideration phase frequently results in denials.

If denied again, applicants can request a hearing with an administrative law judge (ALJ).

Hearing with an Administrative Law Judge (ALJ)

The ALJ hearing is a key step in the SSDI determination process.

During this phase, an independent judge reviews the case and listens to testimony from the applicant and, in some instances, medical or vocational experts.

The hearing provides applicants with an opportunity to explain their limitations and present any new evidence that may support their claim.

At this stage, some important considerations are:

• Applicants may have legal representation during the ALJ hearing.
• The judge evaluates whether the applicant’s impairments meet the SSA’s criteria for a medically determinable impairment and whether those impairments prevent them from engaging in substantial gainful activity.
• In many cases, the ALJ may consult a medical or psychological consultant to clarify the severity of the applicant’s condition.
• Applicants can present new documentation, including updated medical records and reports from treating physicians.

While many applicants are approved at the ALJ stage, decisions can take several months.

If denied, applicants can still pursue further review through the Appeals Council.

Appeals Council and Federal Court Review

If the ALJ denies an SSDI claim, the applicant may request a review by the Social Security Appeals Council.

The Council examines whether the ALJ followed proper procedures and correctly applied the law.

While the Appeals Council may uphold or reverse the ALJ’s decision, it can also remand the case for another hearing.

Key aspects of the Appeals Council and Federal Court Review process include:

• The Appeals Council does not conduct a new hearing but instead reviews the case file and the ALJ’s decision.
• If the Appeals Council upholds the denial, applicants can take their case to federal court.
• Appeals to federal court focus on errors in applying the law, rather than disputing the facts of the case.

Although the federal court process can take significant time, it represents an important final opportunity for those seeking a favorable outcome.

Throughout this process, legal support can help applicants navigate the SSDI system and ensure that their claims are well-prepared.

Once an applicant is approved for SSDI, Disability Determination Services (DDS) decides the type and duration of benefits, depending on the applicant’s condition, prognosis, and the supporting medical evidence provided.

Determining Short-term SSDI Benefits

Short-term benefits are typically awarded to individuals whose disabilities are expected to improve.

DDS regularly reviews these cases to evaluate whether the individual’s medical condition has improved enough to allow them to return to work.

Important factors to note about short-term SSDI benefits include:

• Short-term benefits are for those with temporary disabilities that prevent them from working for a limited time.
• DDS conducts periodic medical reviews to assess continued eligibility for benefits.
• Benefits may be adjusted based on the applicant’s medical progress or work ability.

The primary purpose of these reviews is to assess if the individual can return to work or if further benefits are necessary.

Determining Long-term SSDI Benefits

Long-term SSDI benefits are provided to individuals with conditions that are expected to last indefinitely.

These benefits continue as long as the applicant is unable to work and meets the SSA’s eligibility requirements.

Key aspects of long-term SSDI benefits include:

• Long-term SSDI benefits are awarded for severe or permanent disabilities that are expected to end in death.
• DDS may perform occasional medical reviews to ensure the condition still qualifies the individual for SSDI.
• Applicants with permanent impairments may receive benefits for life, provided they continue to meet SSA criteria.

The amount of SSDI benefits is determined by the applicant’s prior work history and earnings, with a maximum monthly benefit set by the SSA.

Managing the SSDI determination process can be overwhelming, especially given the number of legal and medical details involved.

Whether you’re submitting your initial application, appealing a denial, or preparing for a hearing with an administrative law judge, TruLaw offers professional guidance and support at every stage.

Our team is experienced in disability determination and can help you gather the necessary medical evidence to support your claim.

At TruLaw, we focus on providing clients with comprehensive assistance throughout the entire social security disability process.

From completing applications to representing clients in hearings, we are dedicated to ensuring that you receive the disability benefits to which you are entitled.

We also assist with supplemental security income, a program designed to help individuals with limited income who are disabled, blind, or aged 65 and older.

The application for social security disability benefits requires a detailed understanding of SSA requirements and substantial documentation.

Our legal team has extensive experience with social security disability programs, ensuring that your case is handled with care and attention.

Should your application be denied, we will guide you through each level of the appeals process, providing representation at hearings and beyond if needed.

Trust TruLaw to assist you in securing your social security disability benefits.

We are committed to helping you obtain the support you need, ensuring your claim is handled with precision and care.

By partnering with TruLaw, you can improve your chances of a successful disability determination.

Contact us today to schedule a consultation and find out how we can help you obtain the benefits you need to support yourself and your family.