You are about to enter the twilight zone. The Social Security Administration (SSA) is a government organization,
ergo, more waiting and frustration is in store for you. Knowing what to expect and what forms are required will
help eliminate a great deal of frustration and will cut down on the time required to receive your benefits.
(Authors Note: Before you begin the process I advise you to obtain and submit a Form SSA-7050 (Request for Social
Security Earnings Information). As part of your initial application packet you will be required to fill out two
documents that require work history for the past 15 years. Obtaining the information from the SSA insures that
you do not submit incorrect data and also serves as a reminder of your work record in case you no longer have
that information available in your own files. You may be required to pay as much as $50 for this information).
The SSA Internet web page is located at www.ssa.gov where you can download blank forms and find up-to-date information
rulings and regulations. The SSA falls under CFR (Code of Federal Regulation) 20 (Employee Benefits), Chapter III.
07-21. Qualifying for Benefits. Be aware that you are not eligible for SS payments until you have been out of work
for at least 6 months and if you win your case in the first round it may take another three months before you begin
receiving any payments. However, according to SSA publication 05-10029, dated May 2011, "Your monthly disability
benefit is based on your average lifetime earnings. Your first Social Security disability benefits will be paid
for the sixth full month after the date your disability began". Here is an example: If the state agency decides
your disability began on January 15, your first disability benefit will be paid for the month of July. Social
Security benefits are paid in the month following the month for which they are due, so you will receive your
July benefit in August.
They use a five-step process to decide if you are disabled.
1. Are you working?
If you are working and your earnings average more than a certain amount each month, we generally will not consider
The amount changes each year. For the current figure, see the annual Update (Publication No. 05-10003).
If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your
2. Is your medical condition "severe"?
For the state agency to decide that you are disabled, your medical condition must significantly limit your ability
to do basic work activities-such as walking, sitting and remembering-for at least one year. If your medical condition
is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state
agency goes on to step three.
3. Is your medical condition on the List of Impairments?
The state agency has a List of Impairments that describes medical conditions that are considered so severe that they
automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions)
is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list.
If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide
that you are disabled. If it does not, the state agency goes on to step four.
4. Can you do the work you did before?
At this step, the state agency decides if your medical condition prevents you from being able to do the work you
did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency
goes on to step five.
5. Can you do any other type of work?
If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work.
It evaluates your medical condition, your age, education, past work experience and any skills you may have that could
be used to do other work. If you cannot do other work, the state agency will decide that you are disabled. If you can
do other work, the state agency will decide that you are not disabled.
If you disagree with a decision made on your claim, you can appeal it. The steps you can take are explained in The
Appeals Process (Publication No. 05-10041), which is available from Social Security.
You have the right to be represented by an attorney or other qualified person of your choice when you do business
with Social Security. More information is in Your Right To Representation(Publication No. 05-10075), which is also
available from Social Security.
(Authors note: For your protection, in most situations, your representative cannot charge or collect a fee from you
without first getting written approval from the SSA. However, your representative may accept money from you in
advance as long as it is held in a trust or escrow account. If you and your representative have a written fee
agreement, your representative may ask the SSA to approve it any time before we decide your claim. Usually, the
SSA will approve the agreement and tell you in writing how much your representative may charge as long as:
" You both signed the agreement;
" Your claim was approved and resulted in past-due benefits; and
" The fee you agreed on is no more than 25 percent of past-due benefits or $6,000, whichever is less.
If we do not approve the fee agreement, we will notify you and your representative in writing) .
07-22. Loss of benefits. Your benefits can be discontinued by the SSA if your medical condition improves of if you
work at a "substantial" level. Currently the SSA considers earnings of $750 or more a month "substantial". I is
possible to earn more than $750 a month and retain your benefits under certain "work incentives", which will be
explained in the booklet you will receive along your first disability check.
07-23. Filing your claim. To get started you must:
a. Call 1-800-772-1213. You will normally be asked if you wish to go to the nearest SSA office for an interview or if
you prefer to file your claim by telephone. Save yourself time and aggravation and take the phone interview (if they do
not offer this option, ask for it). The representative I spoke with told me the time and date I would be called (27 days
out) and said that I would receive a reminder in the mail. The representative also informed me that I would need an
ORIGINAL copy of my DD 214 and birth certificate.
Authors Note: I did not receive a reminder in the mail, so make your calendar just in case. Also be advised that the
call can come anytime within an hours time, thirty minutes prior to or after, the agreed upon time.
b. Accomplish the claim interview. The phone interview will take approximately 30 minutes. Most of the interview will
consist of questions about your work history with emphasis on unusual changes in your work habits (sharp increases or
decreases in income). You will be asked if you were ever self employed, or if you are currently drawing Workman's Comp.,
and if you have ever received a print-out of your SS contributions (they will offer to send you one if you say no).
The SSA representative informed me that it would take about 90 days to receive a determination and that I could
appeal that determination if I did not agree with it. She also said that I would receive a packet containing a
medical questionnaire and a list of any documents I would need to send in. If you are not able to provide an
original copy of your birth certificate and DD 214 that would be OK but the process would take longer as the
SSA would need to send for those documents and then wait for them to arrive before the claim could be further
processed. The representative said the disability claim evaluation would be done by a :local state agency" and
told me the approximate amount that I would receive if my claim was approved and asked if I had a bank account
available for automatic deposit.
Authors Note: Approximately two weeks after I applied for benefits I received a letter from the "Department of Public
Human Services, Disability Determination Services, my home state. A representative from that office informed me that
they would process the medical portion of the disability application (this would be the local state agency the SSA
spoke of). The letter informed me that the process would take between 60-120 days, that my doctors would be contacted
along with past employers, schools and other sources. The letter also said that I might be contacted and that if I had
additional treatment to contact them with that information or any information that I might have left off of my original
07-24. Filing out the forms. One day after the phone interview I received an envelope full of forms and other documents.
It may take you several hours to complete the requested information. Here is what I found in the envelope:
a. Stamped return envelope.
b. Cover letter. This letter requested I mail them ORIGINAL copies of my birth certificate and DD Form 214 and asked
that this be done in 10 days. There is no claim number listed. Always reference your Social Security Number when dealing
with the SSA. Authors Note: When they ask for your DD 214 they really mean ALL of your DD 214's.
c. Letter SG-SSA-16. This was a three page document more or less containing the information covered in the telephone
interview. Make certain the information presented is accurate or make corrections and initial where appropriate. You
will also find several items you will be agreeing to when you sign the letter such as a change in your medical condition
and your work status. You will need to sign and date this letter. (Authors Note: This form may no longer be in use.)
d. Form SSA-3369-BK (Work History Report)
e. Form SSA-3368-BK. Disability Report-Adult). Both of the above SSA Forms are tedious and will require patience to
complete properly. Get someone to assist you if necessary, but no not submit incomplete or inadequate information.
f. Form SSA 827 (Authorization for Source to Release Information to the Social Security Administration SSA). Do not
do anything to these forms except sign them and have them witnessed. IMPORTANT - Have the form witnessed by a "competent
adult", which the SSA states can be a spouse or social worker. Have them witnessed even if they do not ask for it.
Make extra copies of the originals as you may need them again later in the process.
g. Personal Data Questionnaire. This is a local questionnaire included in the packet for the benefit of the Department
of Public Health and Unman Services in your home state. You may or may not receive this questionnaire.
Make copies of everything before you mail them in. You may wish to send the packet back by Registered mail but if you do
you will not be able to use the self - addressed, stamped envelope provided. Two weeks after I submitted my claim I
received a letter of acknowledgement and the return of the original documents I had submitted with the application.
07-25. First Denial. Approximately 48 days after I submitted my claim I received a letter informing me that my claim had
been denied. The letter was some 4 pages long and listed the material used to decide my case. The letter informed me that
I must submit my appeal on a Form SSA-561-U2 (Request for Reconsideration), which they did not provide, however, a
pamphlet enclosed with my denial letter says you may also submit a signed letter requesting an appeal.
Authors Note: IMPORTANT. You can save yourself another couple of weeks by submitting a Form SSA-3441-BK (Reconsideration
Disability Report) along with the Form SSA-561 and half dozen SIGNED AND WITNESSED Forms SSA-827. The SSA did not
informed me about the SSA-341-BK in my letter of denial but if you go to the SSA web site and then the "Forms" area
you will find the following statement. "If you determine you need to complete an SSA-561 and you disability claim
was denied because we determined you do not meet our medical, or vocational requirements you need to complete the
SSA-3441. If you are uncertain whether this is the appropriate form, review the letter you received. It will tell
you why they denied your application."
07-26. Second Denial. Approximately 84 days after I submitted my appeal and 132 days after my initial application
I received my second benefits denial. The "Notice of Reconsideration" said the following:
"Upon receipt of your request for reconsideration we had your claim independently reviewed by a physician and
disability examiner in the State agency which works with us in making disability determinations. The evidence
in you case has been thoroughly evaluated; this includes the medical evidence and the additional information
received since the original decision. We find that the previous determination denying your claim was proper
under the law". It further stated "you state that you are disabled due to PTSD. Your medical reports show
you have some limitations from your PTSD and depression. However, your condition does not qualify you for
benefits at this time. We understand you have mental problems but we find you still are able to do unskilled
types of work. We expect your condition will improve. We have determined that your condition is not severe
enough to keep you from working. We considered the medical and other information, your age, education,
training, and work experience in determining how your condition affected your ability to work. We understand
your condition concerns you and you may not have the ability to to your past work. However, we find you
retain the ability to do other types of work."
07-27. Appeals. Authors Note: If you need to submit an appeal, and you almost assuredly will, you will have to "update"
your claim file at each level. I make this statement now because you will need to keep tack of anything that happens
that might concern your claim. If you have any change in medication, visit a doctor or hospital or are treated for
anything related to your claim you will have to note this on required forms between each appeal. Get in the habit
of noting these things in the beginning of the process.
Types of appeals:
Reconsideration - This is accomplished at the same SS office where you initially applied for benefits but by a
different person that the one who made the initial decision.
(General Information on Filing your Request for Reconsideration . You may, and should request the SSA send you
copies of any reports submitted by your doctors and the state agency staff psychiatrist. I requested this information
and received copies of the VA treatment interviews they evaluated and the following statement made by their
contracted staff psychiatrist:
"The claimant is a 55 Y/O man who has been diagnosed as having PTSD and depression. While concentration and
pace are slightly variable these appear to be adequate for the timely completion of simple tasks without the
need for inordinate supervision. The claimant will do best at work where had need not deal with the general
public and where he need have no more than brief and superficial contact with coworkers and supervisors. He
should be capable of at least unskilled work."
This "expert" medical determination by the SSA contracted psychiatrist was made not from a personal interview
but two short write-ups done by my VA doctor.)
Review by the Appeals Council - This is a SSA council which will make a decision based on the material presented
or return your claim to the administrative law judge for further review.
Authors note: In 1997 32% of the appeals submitted were allowed to go forward and 68% were denied without getting
to the "Reconsideration" stage.
07-28. Filing Appeals on Time or Proving Cause for Being Tardy. Let me take a moment here and emphasize the importance
of filing your appeals on time (within 60 days). If you do not file your appeal on time you may still file another
application, BUT you may lose some benefits, or not qualify for any benefits. This is because you are starting
all over again. The following pertains to the 60 day appeals filing requirement…. "Our rules in 20 CFR (Code of Federal
Regulation) sections 404.909(a), 404.933(b), 416.1409 (a), and 416.1433 (b) provide that a request for reconsideration
and a request for hearing before an Administrative Law Judge (ALG) must be filed within 60 days after the date of
receipt by the claimant of the notice of determination being appealed. However, the regulations also provide that
a claimant can request that the 60 day time period for filing a request for review be extended if the claimant
can show good cause for missing the deadline. The request for an extension of time must be in writing and must
give the reason why the request for review was not filed timely.
When the claimant fails to timely request reconsideration for an ALJ hearing, The Agency applies the criteria in
section 404.911 or section 416.1411, as appropriate, in determining whether good cause for missing the deadline
Section 404.911 (a) states:
"In determining whether you have shown that you had good cause for missing a deadline to request review we consider-
1. What circumstances kept you from making the request on time;
2. Whether our action misled you;
3. Whether you did not understand the requirements of the Act resulting from amendments to the Act, other legislation,
or court decisions; and
4. Whether you had any physical, mental, educational, or linguistic limitations (including any lack of facility with
the English language) which prevented you from filing a timely request or from understanding or knowing about the need
to file a timely request for review."
Hearing by Administrative Law Judge - this appeal is accomplished by an administrative law judge (this is a judge who
presides over public hearings involving the promulgation (to post in public) regulations and decides contested cases
and appellate cases) within 75 miles of your home. You may request not to attend this hearing in person, however,
this is not advisable unless you have a representative present.
If you do not agree with the reconsideration determination we made on your claim, you may file a request for hearing
before an Administrative Law Judge (ALJ). To request a hearing, you may use this form or write a letter.
If you are not sure this is the form you should use, the Notice of Reconsideration (reconsideration determination)
will tell you that to appeal our determination you should request a hearing before an ALJ. If the notice does not say
this, or if you still are not sure this is the form you should complete, call 1-800-772-1213 or your local Social
Security office and they will help you to complete the right appeal form.
If you are requesting a hearing on the denial of a claim for disability benefits, you must complete and sign additional
forms. These forms are the HA-501, Request for Hearing by Administrative Law Judge, HA-4486, Claimant's Statement When
Request for Hearing is Filed and the Issue is Disability, SSA-3441, Disability Report - Appeal, and SSA-827,
Authorization to Disclose Information to SSA. You should also complete an HA-4631, Claimant's Recent Medical
Treatment, and an HA-4632, Claimant's Medications. If you have worked since you filed your application for
disability benefits, complete an HA-4633, Claimant's Work Background.
You may also need to complete a form SSA-1696, Appointment of Representative, if you are appointing a representative.
Your representative should also sign the SSA-1696 before you send it to us.
You must file your appeal within 60 days from the date you got the reconsideration determination. We assume you got
the reconsideration determination within 5 days of the date shown on that notice unless you can show us you did not
get it within the 5-day period.
Time to Submit New Evidence: You should submit any new evidence you want the ALJ to consider within 10 days of the
date that you file this request. If you will not be able to submit the evidence within 10 days, you must ask the ALJ
for an extension of time to submit evidence.
About the forms:
Form HA-501 (request for Hearing By Administrative Law Judge) - You can submit a letter in place of this form.
Form SSA -827 (Authorization to release medical information) - Send in 5 of these forms, signed and witnesses.
HA-4608 (Waiver of your rights to personal appearance before an Administrative Law Judge). This form is required only
if you are unable to attend the hearing.
Form HA-4631 (Claimant's Recent Medical Treatment) - IF you have not had any medical treatment since our Reconsideration
appeal submit this form anyway and check NO in section B(1).
Form HA-4632 (Claimant's Medication). This is another redundant form but fill it out anyway, making certain it is
consistent with other forms asking for information on your medications.
Form HA-4633 (Claimant's Work Background) Fill out and return ONLY if you have worked since filing your Reconsideration
I received a letter from the SSA approximately one week after I submitted my appeal to go before the Judge. Actually
it was a copy of a letter sent to my lawyer.
We will mail a Notice of Hearing to you and your client at least 20 days before the hearing to tell you its time and
The Notice of Hearing will sate the issues the ALJ plans to consider at the hearing.
Because the hearing is the time to show the ALJ that the issues should be decided in your client's favor, we need to
make sure that the file has everything you want the ALJ to consider. You and your client are responsible for submitting
needed evidence. After the ALJ reviews the evidence in the file, he or she may request more evidence to consider at
If you wish to see the evidence in your client's file, you may do so on the date of the hearing or before that date.
If you wish to see the files before that date of the hearing places call us.
07-29. Notice of the ALJ Hearing. You will receive several documents in your Notice of Hearing packet. My packet
contained the following:
a. Notice of Hearing - This document announces the place and time of the hearing. It states the issues in the case.
It may or may not state that a Vocational Expert and/or psychiatrist will be present to testify.
b. Letter to Vocational Expert - A request for the Vocational Expert to appear at the hearing.
c. Acknowledgement of Notice of Hearing - A document with your name and SSN or it asking if you will or will not be
present for the hearing. You must check the appropriate box, sign and date the form and provide your telephone #.
Mail the form to the SSA.
07-30. The ALJ Hearing. Prior to the hearing my lawyer was given the opportunity to review the files on record. There
was a ALJ, my lawyer, a transcriber and a Vocational Expert (contracted by the SSA) present. The hearing was conducted
in the following sequence:
a. The Judge started by asking me questions for about 20 minutes. He asked such questions as "can you bend and lift
items?, what do you do on a typical day? What my education was, and what my work history was for the last 10 years,
and about my last job. He was setting the table for the Vocational Expert to tell what type of work I would be
able to do.
b. The ALJ next let my lawyer ask me questions. My lawyer asked me clarification questions related to answers I
had given as the ALJ that would act in my favor.
c. The ALJ next called on the vocational Specialist to tell him what type of work I should be able to do.
d. My lawyer was next permitted to ask the vocational Specialist questions about other things I could not do
because of my disability. After my lawyer asked his questions relating to my disability he asked the Voc Specialist
"considering the disabilities I have just listed, what jobs you have listed can my client perform?" The Voc
specialist said "None".
e. The judge asked if I had anything else to add.
f. The Judge closed the hearing by telling me that I would receive a letter advising me of his decision. This
decision usually takes three to four months.
I would advise you to request a copy of the ALJ hearing as soon as possible as you may need it to file another appeal.
07-31. Third Denial. Almost four months after the ALJ hearing I received a letter with an UNFAVORABLE decision.
Authors Note: It has taken 1 year, 4 months and 5 days to reach this point in the process.
There will be a list of Exhibits attached to your Notice of Decision. Submit a request for a copy of any of these
you do not already have if you need to submit an appeal to the Appeals council.
07-32. Final Appeal. Appeals Council - You may file an appeal by submitting a SSA Form HA-520 (Request for Review
of Hearing Decision/Order). This appeal may be sent to your local SSA office, hearing office or mailed directly to
the Appeals Council (save time by sending it directly to the Appeals council. If you have a lawyer it needs to go
to him/her for signature. You have 60 days to file your appeal.
07-33. Reopening your case.
You may also "Reopen" your case within 12 months. Good cause for reopening:
1. New and material evidence is furnished.
2. A clerical error in the computation or re-computation of benefits was made; or
3. The evidence that was considered in making the determination or decision clearly shows on its face that
an error maw made.
07-34. Review of benefits. Should you eventually receive your benefits they will be reviewed as follows:
1. In 6 to 18 months if improvements is "expected".
2. In 36 months if improvement is "possible".
3. In 5 to 7 years if improvement is "not expected".
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