The process of making a claim can be difficult and confusing. On this page, we try to explain the process as simply is possible to help you navigate this journey.
The claims process is comprised of three stages:
(1) Initial Application,
(2) Request for Reconsideration, and
(3) Request for Hearing before an Administrative Law Judge.
After these three stages, there is a possibility that your case will go to the Appeals Council and eventually to Federal Court. However, the majority of cases stay in these three stages.
At the Initial Application stage you will spend a significant amount of time filling out forms. The disability application asks you for general information including, but not limited to marital status, family status, income earned for the last few years, medical providers, dates of visits, tests performed, current medications, and work history for the last 15 years. The Social Security Administration (SSA) wants a complete picture of what’s happening with you medically and vocationally. Once the entire application is completed, it will be submitted to the Utah Department of Disability Services (DDS). DDS will collect your medical records, send you more forms to complete, and begin reviewing your file as a whole. You will receive a response within 30 to 60 days. Approximately 66% of applicants are denied at this stage. Don’t give up if you are denied because you will be given a chance to appeal by filing a Request for Reconsideration.
Request for Reconsideration
The Request for Reconsideration is a one-form request. As part of the request, you will be asked to provide updated information about your medical condition, health care providers, and work history. The Utah DDS will update your medical records and take another look at your file. Within 30 to 60 days of the request, you will receive an answer. About 66% of people are denied again. If you are denied again, you are given another chance to appeal by filing a Request for a Hearing before an Administrative Law Judge (ALJ).
Hearing Before Administrative Law Judge
At the Request for a Hearing stage, your claim finally gets out of DDS and goes to the Office of Disability Adjudication and Review (ODAR). Unfortunately in Utah, you might wait 12 to 16 months before being granted a hearing. There is nothing you can do to speed up the process, unless you qualify for a dire need expedite (loss of access to food, medical care, or shelter). The good news is that you have the greatest chance of being awarded benefits during the Hearing Stage.
A few months before the intended date, you will be contacted to schedule your hearing. During the waiting period, your job is to continue seeking treatment. Once the date of the hearing arrives, you will walk into a room with your attorney, a judge, and a Vocational Evaluator (VE). The VE is a vocational (jobs) expert who will review your file and offer testimony about whether you could return to your past level of work or to a job in the national economy that would accommodate your disability.
The judge will usually begin the hearing by asking you a series of questions. He will ask about your work history, and medical history, and he will ask you to explain how your conditions keep you from performing basic work-related activities. Once the judge asks his questions and allows your attorney to question you, he will ask the VE a series of questions. The first will most likely be whether you can return to the lightest job held in the last 15 years. Based on your current restrictions and limitations the VE will render an opinion considering your testimony, your lightest job description, and the exertional requirements given in the Dictionary of Occupational Titles (DOT). If the VE says you can return to one of your previous jobs, your claim will be denied. The judge will proceed to his next question if the VE says you cannot return to a previous job.
The next question will most likely be hypothetical. It will center on a person with your restrictions, limitations, age, education, and work skills. The judge will ask whether there is a job in the national economy that this hypothetical person (you) can do. The VE will then offer his opinion. You win if he says there is not a job in the entire national economy you can do. If he says there is a job you could perform, he will list the job(s). At this point you or your attorney can cross examine the VE. You must show what restrictions exist (that were not considered in the hypothetical) that prevent you from doing the specific jobs the VE has listed. The restrictions and limitations you add must be found in your medical records. Unfortunately the suggested additions are often not detailed enough in the records for the judge to add them to the hypothetical. You will lose your case if you still cannot prove your inability to work, despite all of your additional information.
Right now you may be thinking, “It’s impossible. The cards are stacked against me, I can’t win.” I admit the process is difficult. It is designed to be difficult. At my law firm, we are aware that the process of accessing disability benefits is intimidating and complex. Fortunately, we guide our clients through the entire process. We work with your doctors to make sure the medical records clearly and accurately document your conditions and resulting limitations. We help you make sense out of the forms and prepare you for what you need in order to adequately complete them. We prepare you for the hearing, and the questions the judge will ask you, and manage the VE section of the hearing. Our goal is to help you move past denial and receive you the benefits you deserve.
For years, millions of working Americans have paid into the Social Security fund in order to enjoy the benefits of coverage for retirement and catastrophic injury. The SSA guards the fund for people who can prove they deserve it. Part of showing you deserve it is learning the rules and how to communicate with the SSA.