The Process:
From Initial Application
through Final Appeal

Initial Application

Your first step is to apply for Social Security disability benefits at a local Social Security Administration office. An application for Social Security Disability (SSDI) can be made via telephone, mail, on-line, in person, or through your attorney or representative. Applications for Supplemental Security Income (SSI) must be made in person at a local SSA office.

Disability Determination Services (DDS)

After the local SSA office verifies some information and makes some preliminary determinations, your claim is referred to a state agency known as Disability Determination Services (DDS). Though operated by the individual states, DDS agencies are funded by the Social Security Administration. DDS initially determines whether you are disabled under Social Security’s definition of “disability.” DDS collects medical records from your health care providers and may arrange for Consultative Examinations (CEs) doctors or other health care providers hired by DDS.

When DDS has made its determination, your file returns to the local SSA office, and you are informed of the decision. More than 60% of initial applications are denied.

If Your Initial Application is Denied…

If your initial application is denied, your next step depends on whether you are an Illinois or Missouri resident.

In most states, including Illinois, the next stage after an initial denial is the Reconsideration stage.

Missouri is one of 10 states included in a pilot program designed by SSA to test methods of improving the disability determination process. In Missouri and the other pilot states, the Reconsideration stage has been eliminated.  The first appeal for applicants in these states who are denied at the Initial Application stage is a hearing before an Administrative Law Judge.

In most states, including Illinois, the next stage after an initial denial is the Reconsideration stage.

Request for Reconsideration

(*not applicable to Missouri applicants)

Upon filing your Request for Reconsideration, your file will be returned to the same Disability Determination Services office that reviewed your initial application. DDS will review its original decision using the same rules it used previously, but the review will be conducted by a different claims consultant, doctor, and vocational expert. DDS may take into account changes to your medical condition since your initial application. Around 5% to 15% of reconsiderations are granted.

Hearing Before an Administrative Law Judge

If your initial application has been denied in Missouri, or your Request for Rehearing has been denied in Illinois, the next step of the appeal process is the one that holds your highest likelihood of success: the Administrative Law Judge (ALJ) Hearing. At this stage, you case is transferred to the SSA’s Office of Adjudication and Review (ODAR) where it will be heard by an ALJ. The ALJ will make a new decision on your claim, giving little consideration to the DDS determination. The ALJ will consider the record that was before DDS, as well as any new medical evidence you’ve submitted. At the hearing, the judge will typically take your testimony as well as the testimony of vocational or medical experts. If you win at this level, and your case is not reviewed by the Appeals Council  it will be sent to local field office for payment.

Appeals Council

If you lose at the ALJ Hearing stage,  you can appeal the decision to the Appeals Council. The Appeals Council can deny your appeal, send your case back to ODAR for another hearing before the same ALJ, or enter a finding that you are disabled.

Federal Court

If you lose at the Appeals Council level,  your remaining option is to file a civil action in a United States District Court. Appeals from decisions of US District Court s are to Federal Courts of Appeal and finally, you guessed it, to the US Supreme Court.

 


Tom Lemley

Bridgepoint Law Firm, LLC

75 W. Lockwood Ave., Suite 222

St. Louis, MO 63119

TEL: 314.925.0730

FAX: 314.735.4391


The choice of a lawyer is an important decision and should not be based solely upon advertisements.

DisabilityStL.com is operated by Bridgepoint Law Firm, LLC, a St. Louis law firm serving clients in applying for and appealing denials of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefit claims throughout St. Louis City and County, including the Missouri communities of Ballwin, Brentwood, Chesterfield, Clayton, Creve Coeur, Des Peres, Glendale, Kirkwood, Ladue, Maplewood, Maryland Heights, Olivette, Richmond Heights, University City, Webster Groves, Wildwood and Town & Country, and the eastern Missouri counties of St. Charles, Franklin and Jefferson, as well as the Southern Illinois counties of Madison, St. Clair and Monroe, including the communities of East St. Louis, Belleville, Granite City, Alton, Edwardsville, Collinsville and Fairview Heights.