Tag Archives: SSA appeals process

Appeal a decision or start over?

Posted on by

Q: If an application for Social Security disability benefits is not approved, is it better to appeal that decision or to file a new application?  

A: It is usually better to appeal the decision rather than start over, if you disagree with the decision received on a Social Security application. Among other reasons, using the appeal process keeps an application open and still pending, including the possibility of retroactive payments.  

Most Social Security decisions can be appealed. Four levels of appeal exist. If not satisfied with the decision at one level, appeal can be made to the next.  

If you intend to file an appeal, do so quickly. Strict timeframes, usually 60 days, exist during which you can file an appeal. With few exceptions, the last decision becomes final if timeframes are not met. Do not wait. Additional evidence can be submitted afterwards. Stay within the timeframes. 

Be sure you understand the decision. For example, is the disability denial because you did not have enough work at the right time or because the medical definition of disability was not met? This tells you the issue to be appealed, if desired.  

If the issue is medical denial, Social Security disability decisions can be appealed online. Details are at http://www.socialsecurity.gov/pgm/disability.htm.  

More about the Social Security appeals process is in “Your Right to Question the Decision Made on Your Claim” (publication 05-10058) available at www.socialsecurity.gov/pubs/10058.html, by calling the SSA national number, 1-800-772-1213 (TTY 1-800-325-0778) or by contacting any SSA office. 

Are disability decisions reviewed?

Posted on by

Q: Are Social Security disability decisions ever reviewed to see if the person remains disabled? 

A: Yes. In general, benefits continue as long as a person remains disabled. Under Social Security law, all disability cases must be reviewed to make sure that people receiving benefits continue to meet disability requirements.  

Benefits continue unless there is strong proof that a person’s impairment has medically improved and that he or she is able to return to work. How often a case is reviewed depends on the severity of the impairment and the likelihood of improvement. The frequency can range from 6 months to 7 years. 

Here are approximate guidelines for medical reviews:

Improvement expected - If medical improvement can be predicted when benefits start, the first review will be 6 to 18 months later.

Improvement possible – If medical improvement is possible but cannot be predicted, the case will be reviewed about every 3 years.

Improvement not expected – if medical improvement is not likely, the case will be reviewed about once every 5 to 7 years. 

As part of a medical review, the disabled beneficiary is asked to provide information about any medical treatment he or she has received and any work he or she might have done. An evaluation team, which includes a disability examiner and a doctor, then requests the individual’s medical records and carefully reviews the case file. Depending on the review decision, benefits either continue or end. The person can file an appeal if he or she disagrees with the determination.  

More information is on the Social Security website, www.socialsecurity.gov. See the “Your Continuing Eligibility” section of the Social Security Disability Planner.

Medical reviews are not the only type of review to determine if benefits should continue. For example, many work incentives exist to help people return to gainful employment. If working while receiving Social Security disability, reviews are completed to see if earnings have reached a level where benefits might be affected. It is possible for disability benefits to eventually end because of ongoing work activity even though the person has not medically recovered. Different from medical reviews, routine Supplemental Security Income (SSI) reviews show if people continue to meet income and resource requirements. 

Did You Know? According to the 2011 Annual Statistical Report on the Social Security Disability Insurance Program, in December 2011 just over 9.8 million people received Social Security disability benefits as disabled workers, disabled widow(er)s, or disabled adult children. The majority (87.5 percent) were disabled workers, 10 percent were disabled adult children, and 2.6 percent were disabled widow(er)s.

 

SSA testimony before House of Representatives about disability appeals

Posted on by

Michael J. Astrue, Commissioner of Social Security, testified about the Social Security disability appeals process before the House of Representatives, Committee on Ways and Means, Subcommittee on Social Security on June 27, 2012. 

Commissioner Astrue provided an overview of the appeals process, updated members of the Subcommittee on Social Security Administration efforts and progress towards eliminating the hearings backlog, and discussed the President’s fiscal year (FY) 2013 funding request.  

Hearings are conducted by an Administrative Law Judge (ALJ). Other than receiving hearing requests, local SSA offices are not largely involved in the hearing process. The following portions of the Commissioner’s testimony refer mainly to Hearings Offices, not local offices. 

Readers interested in the Social Security and Supplemental Security Income disability process will find his full testimony informative. Starting with an overview of the SSA appeals process, Commissioner Astrue quickly progressed to a discussion of the hearing level, providing a history of hearings workload growth and past agency efforts to meet that workload. He then emphasized the current hearings backlog reduction plan, complete with actions taken, workload numbers, processing times and results. In part, he stated: 

“This plan has worked. Average processing time, which stood at 532 days in August 2008, steadily declined for more than three years, reaching its lowest point of 340 days in October 2011. …  

… Fifteen offices have hit our goal of 270 days or less, and many others are getting close. While our goal is to reach an average processing time of 270 days by the end of next fiscal year, that number depends on our ability to timely hire judges and support staff. 

These numbers are even more impressive because we have given priority to the oldest cases, which are generally the most complex and time-consuming. Five years ago, we defined an aged case as one waiting over 1,000 days for a decision. At that time, 63,000 people waited over 1,000 days for a hearing, and some people waited as long as 1,400 days, which is a moral outrage. Since 2007, we have decided over 600,000 of the oldest cases. Each year we lower the threshold for aged cases to ensure that we continue to eliminate the oldest cases first. We ended FY 2011 with virtually no cases over 775 days old. Through the steady efforts of our employees, we now define an aged case as one that is 725 days or older, and we have already completed over 90 percent of them. Next year, our management goal is to raise the bar on ourselves again by focusing on completing all cases over 675 days old.

This emphasis on eliminating aged cases increases average processing times, so we also look ahead to see how long people in the queue have been waiting for a hearing. At the beginning of FY 2007, the number was 324 days. That number today is just 208 days, a 36 percent decrease, and we are hopeful that figure will drop again next year. Also, at the beginning of FY 2007, nearly 40 percent of pending hearing requests were older than one year. We reduced this figure to 14 percent at the end of May 2012. …

Read his full testimony at http://www.socialsecurity.gov/legislation/testimony_062712.html.

Social Security Testimony Before Congress

Posted on by

Michael J. Astrue, Commissioner of Social Security, testified before Congress on May 17, 2012, about agency accomplishments and the resources needed to continue providing outstanding public service.

The first two portions of his testimony, Overview and Our Services and Accomplishments, and the ending Conclusions are included here in full. You can read his complete testimony at http://www.socialsecurity.gov/legislation/testimony_051712.html. 

Easy to read, a lot of behind-the-scenes information is in the testimony.  Other topics discussed by Commissioner Astrue include Social Security disability claim processing, service delivery in local field offices and the national toll-free number (800-772-1213 / TTY 800-325-0778), online services, budgets and agency staff levels.  

I encourage you to look at the full testimony and hope you find interesting.

Statement of Michael J. Astrue,
Commissioner,
Social Security Administration
before the Senate Finance Committee
May 17, 2012

Chairman Baucus, Ranking Member Hatch, and Members of the Committee: 

Thank you for the opportunity to discuss issues related to our ability to provide quality service and value to the American public. I will try to be very clear about the service the American people and Congress can expect, which is highly dependent on future funding levels. 

Before I begin, let me express my gratitude to you, Mr. Chairman and the Ranking Member, for signing the letter to the Budget Committee urging support for the President’s FY 2013 funding request for the Social Security Administration (SSA), including full funding for our program integrity efforts authorized by the Budget Control Act (BCA).

Overview

Congress has expected us to manage our workloads successfully, with limited resources. In every fiscal year (FY) from 1994 through 2007, Congress appropriated less than the President requested. The agency did the best it could to meet expectations, but for the past 20 years, our workloads steadily increased. Requests for our core services have increased as the population grows, and baby boomers age and pass through their disability-prone years before retiring.

To the extent that limited resources allowed, the agency hired and trained staff for these increased workloads and used technology to make traditional work processes more efficient. Even with these new and unavoidable demands, our innovative and proactive employees maintained high service levels for some time. 

Inevitably, though, increasing workloads combined with declining budgets damaged service delivery. Even with consistent year-over-year increases in employee productivity, our reduced staff could not keep up with the rising workloads. Throughout most of the past decade, the average time claimants waited for a disability hearing decision rose steadily, and in many locations, average wait times for a hearing exceeded 800, and even 900, days. Sadly, some claimants waited as long as 1,400 days—nearly four years—for a decision. We also dramatically cut the amount of program integrity work we did during these years despite the long-term harm to the trust funds. 

After the Senate confirmed me as Commissioner, I made the case that we needed to move in new directions and that Congress needed to provide the funding to support that shift. For FYs 2008- 2010, Congress provided funding at or above the requested level and in 2009, as part of the American Recovery and Reinvestment Act, provided us with additional funds to tackle our surging retirement and disability applications. This funding allowed us to reverse many negative trends, significantly improve service and stewardship efforts, and absorb huge increases in workloads due to the worst economic downturn since the Great Depression. We have dramatically lowered the average wait for a hearing decision, reversed the disturbing trend in program integrity work, and improved services agency-wide. We made remarkable progress. 

However, in FY 2011, while we received unprecedented new workloads, Congress cut our budget more deeply than in any year of the previous two decades. Congress also rescinded a sizable portion of our IT carryover funding, which is our best mechanism for improving productivity. With staff reductions caused by hiring freezes and attrition, our work force is contracting rapidly, field offices are consolidating, and we are struggling to maintain recent levels of service. When I leave office in 2013, the agency will have about the same number of employees that we had when I arrived in 2007, even though our workloads have increased dramatically. Since FY 2007, retirement and survivor claims have increased by 26 percent and disability claims have increased by over 31 percent. 

Before I describe the current state of our service delivery, our plans for improvement, and the difficult choices we have had to make under the current budget constraints, I want to briefly explain who we are and what we do, and our accomplishments with the funding you provided in FYs 2008 through 2010.

Our Services and Accomplishments

We have just over 80,000 Federal and State employees who serve the public through a nationwide network of about 1,500 offices. Each day almost 182,000 people visit our field offices and more than 445,000 people call us for a variety of reasons – to file claims, ask questions, and change direct deposit information. 

During FY 2011, we paid nearly 60 million people over $770 billion in benefits. Specifically, we paid $591.5 billion in Old-Age and Survivor Insurance benefits, $128 billion in Disability Insurance (DI) benefits, and $52.4 billion in Supplemental Security Income (SSI) benefits. 

We strive to make timely and accurate payments and operate efficiently and effectively. Our administrative costs are only 1.6 percent of benefit payments. We have invested in IT and efficient business practices that have kept our overall costs down and allowed our employees to be more productive.

We are proud of our record of optimizing our resources to produce results. Last year, we:

• Reduced the time it takes to get a hearing decision to the lowest point in 8 years;
• Handled a record number of benefit applications — over 4.8 million retirement
and survivors claims, nearly 3.4 million initial disability claims, and over 795,000 hearings;
• Increased our cost-effective program integrity work –1.4 million continuing disability reviews (CDR), including over 345,000 full medical CDRs, and over 2.4 million SSI non-disability redeterminations, which improves SSI payment accuracy and provides a significant return on our investment;
• Used our Compassionate Allowance and Quick Disability Determination processes to expedite medical determinations for obviously disabled individuals in over 150,000 initial disability cases;
• Achieved the best average speed of answer and busy rates on our National 800 Number ever;
• Handled nearly 63 million National 800-Number transactions;
• Issued over 16 million new and replacement Social Security cards;
• Posted 241 million annual earnings reports;
• Increased online claims — 41 percent of retirement claims and 33 percent of disability claims filed online;
• Maintained an average annual increase in employee productivity of nearly 4 percent over the last 5 years;
• Continued to use plain language principles to improve the 350 million notices we send Americans each year; and
• Balanced productivity with quality.

In addition to our core program workloads, we handle lesser-known services that drive millions of Americans to visit our field offices or call us each year. For example, in FY 2011, we issued about 1 million replacement Medicare cards, and handled nearly 1 million transactions in administering the Medicare low-income subsidy program. We handle about 2 million requests each year from claimant representatives asking for information we maintain. About 65 percent of these requests are from representatives handling Social Security cases, but 35 percent are from representatives who request our information for insurance claims or other government programs.

Furthermore, an increasing percentage of our work results from our duty to verify information for other Federal agencies. Last year, we completed 1.4 billion verifications ranging from the EVerify program to health care programs, voter registration, drivers’ licenses, and many other government programs. While most of these verifications occur cheaply and automatically, a small but significant percentage of these interactions produce an increasing number of nonmatches that strain the resources of our rapidly shrinking field operations.

In fact, if you look at our waiting rooms today, you see very few older Americans. You do see younger Americans, often with children, waiting for a document required by another agency for authentication purposes. For example, the number of people coming into an SSA office for benefit verification has increased by 46 percent since FY 2007.

 (more information is in the complete testimony)

Conclusion

Thank you for this opportunity to explain what wonderful work the men and women of the Social Security Administration are doing under enormous stress, and why we need your support to continue to serve the American people in the way that you and I expect. I am proud of the hard-earned progress we have made over the past five years. We fully recognize that we all must tighten our belts, and therefore have examined which services, though important, we must discontinue. I want to be candid with you that we will continue cut services as funding requires, even though I know these decisions are unpopular.

The work we receive is not optional. At some point, we will have to handle every claim that comes to us, every change of address, every direct deposit change, every workers’ compensation change, every request for new or replacement Social Security cards. The longer it takes us to get to this work, the more it costs to do. Funding us to keep up with the work is ultimately cheaper than delaying it. It is also the moral thing to do for the American citizens who depend on our services.

No matter what Congress decides, our employees will continue to do their best to serve the public with a smile, even as that public misdirects its frustration at our frontline employees. Our employees will keep thinking of new ideas like AFI to help us better serve the taxpayer. We will also keep improving online services that are necessary to handle our ever-increasing work. I look forward to a constructive dialogue with you regarding how we can provide the best possible service and stewardship is this difficult fiscal climate.

Social Security appeals process – Appeals Council

Posted on by

Today completes the Social Security Administration appeals process series. Whether a person is applying for benefits or already receiving them, nearly all Social Security and Supplemental Security Income (SSI) claim decisions can be appealed. Disability related actions are a major area for appeals now but other topics can be at issue. Basics of the appeal process are the same for Social Security retirement, survivors and disability benefits as well as the separate Supplemental Security Income (SSI) program.  

Appeals Council Review:  the third level of appeal  

To reach this point, a person disagrees with both the original decision and the first two appeals process levels of reconsideration and hearing. If you disagree with the hearings decision of the Administrative Law Judge, you may file a request for review with the Appeals Council.  

Consistent with the other levels of appeal, stay within the timeframes provided in your decision letter if using the Social Security appeals process. The general rule is that you must make your request in writing within 60 days from the date you receive the decision letter. The assumption is that that you received the decision letter five days after the date on the letter.  

Local Social Security offices are not directly involved with cases involving a request for Appeals Council review.  Based in Falls Church, Virginia, the Appeals Council is a component of the SSA Office of Disability Adjudication and Review (ODAR), one of the largest administrative judicial systems in the world.  

The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an Administrative Law Judge for further review. When the Appeals Council reviews your case it may consider any of the issues considered by the Administrative Law Judge, including those issues that were favorably decided in your case. You receive a copy of the Appeals Council’s final action on your case. 

More about a Social Security Appeals Council review is at http://www.socialsecurity.gov/appeals/appeals_process.html.  

As the last administrative decisional level, the Appeals Council renders the Social Security Administration’s (SSA’s) final decision. If you disagree with the Appeals Council’s decision, or if the Appeals Council decides not to review your case, you would then have to go to the last level of the appeals process, filing civil suit in a federal district court.  

The entire Social Security Administration appeals process is summarized in SSA publication 05-10041, “The Appeals Process” at http://www.socialsecurity.gov/pubs/10041.html.  

Social Security appeals process – the hearing

Posted on by

Today continues the overview of the Social Security appeals process. Whether a person is applying for benefits or already receiving them, nearly all Social Security and Supplemental Security Income (SSI) claim decisions can be appealed. Disability related actions are a major area for appeals now but other topics can be at issue. Basics of the appeal process are the same for Social Security retirement, survivors and disability benefits as well as the separate Supplemental Security Income (SSI) program. 

Hearings: the second appeal level

To reach this point, the individual disagrees with both the original decision and a reconsideration decision. Reconsideration is the first level of the SSA appeals process. 

Your local Social Security office receives requests for hearings but is not directly involved with them. Instead, hearings are sent by local offices to the Social Security Administration’s (SSA) administrative appeals operation, under the Office of Disability Adjudication and Review (ODAR), one of the largest administrative judicial systems in the world. 

If the issue is medical, you can request a hearing of a Social Security disability decision online at https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp.  

Remember to stay within the timeframes provided in your decision letter if using the Social Security appeals process. The general rule is that you must make your request in writing within 60 days from the date you receive the decision letter. The assumption is that that you received the decision letter five days after the date on the letter.

Hearings are conducted by an Administrative Law Judge (ALJ) who had no part in the original decision or the reconsideration of your case. The hearing is usually held within 75 miles of your home. In some areas, opportunity exists to hold hearings by a video conference rather than in person. These can be more convenient and faster than waiting for an in-person hearing. The video conference option recently became available in Grand Forks. While I am not involved with them, these video conference hearings certainly appear to be popular and well received by people using them. 

Hearings can be completed by review of the case without you being there but it is usually to your advantage to attend the hearing, whether in person or by video conference so that you, and your representative if you have one, can explain your case. It is very common for clients to have representation for a hearing. Before the hearing, you can provide additional evidence. You can look at the existing file and provide new information.

At the hearing, the Administrative Law Judge (ALJ) will question you and any witnesses you bring. Other witnesses, such as medical or vocational experts, also may give us information at the hearing. You or your representative may question the witnesses. After the hearing, the ALJ will make a decision based on all the information in your case, including any new information you give.

 Much more detail about a Social Security hearing is at http://www.socialsecurity.gov/appeals/hearing_process.html .

 

Social Security appeals process – Reconsideration

Posted on by

Nearly all Social Security decisions can be appealed if disagreed with.  This includes requests by people applying for SSA benefits as well as by people receiving benefits. 

Last time I mentioned that it is very important to stay within the timeframes provided in your decision letter if you intend to use the Social Security appeals process. The general rule is that you must make your request in writing within 60 days from the date you receive the decision letter.  The starting assumption is that that you received the decision letter five days after the date on the letter. 

Why is staying within specific timeframes so important?  If your request arrives late, it will likely be denied for not being timely. To get the original decision reviewed, you now need to establish why your request was late. Being able to do this is not certain, creates extra work for yourself and Social Security, and is easily avoidable by following the timeframes.  Requesting review of a decision can be done even if obtaining additional evidence to support your original application will take additional time.  Make your written review request within the specific timeframe and just include the message that you will provide more evidence later. 

Reconsideration:  the first appeal level

A reconsideration is a complete review by someone who did not take part in the first decision. This independent review is a constant although specific processing steps for completing a reconsideration vary. 

The reconsideration level of appeal is usually completed without you being present. It is an independent review of the original decision plus any new evidence.  Broadly speaking, reconsideration requests involving non-medical decisions are completed within the local SSA office or another SSA component. Reconsideration requests for non-medical issues cannot be submitted online. Contact your local SSA office or SSA national toll-free number, 1-800-772-1213 (TTY 1-800-325-0778) to request the reconsideration form.  Address your appeal to the issue involved. 

Original medical issues are most likely to involve a state Disability Determination Services (DDS) and return there for reconsideration.  A Disability Determination Services (DDS) makes medical decisions on behalf of the Social Security Administration. DDS costs are paid by Social Security.  If the issue is medical, you can submit a reconsideration request of an original Social Security disability decision online at https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp.

Whether you complete the medical issue reconsideration request online or not, it goes to the DDS and seen by someone who did not take part in the first decision. As part of the reconsideration request, you update medical information for the period since completing your original application.  Include new medical providers, tests and treatments, changes in medications.  As before, you provide medical releases so that the DDS can obtain new evidence but you do not need to provide evidence yourself. 

Once received, you can accept the reconsideration decision or not. If not, the next level of appeal is to request a Hearing.  More later.

Social Security appeals process

Posted on by

Q: I know that an appeals process exists if someone disagrees with a Social Security disability decision. Can other topics be appealed?  

A: Yes. Definitely. Whether a person is applying for benefits or already receiving them, nearly all Social Security or Supplemental Security Income (SSI) claim decisions can be appealed. Disability related actions are a major area for appeals now but other topics can be at issue if the person disagrees with the Social Security decision.  

To state the obvious, Social Security wants to be sure that every Social Security or Supplemental Security Income (SSI) decision made is correct. Agency representatives carefully consider available information when making a decision. Some decisions are straightforward and rarely the subject of appeal while others are more subjective making them more open to disagreement and appeal. When a case decision is made, the person is sent a letter explaining it. If they do not agree, the decision can be appealed and Social Security will review the case decision again.  

A person’s age is rarely the subject of appeal today but this was different years ago. Just about everyone filing for Social Security benefits now had his or her birth registered with the state soon after birth. For people I worked with at the start of my career, this was not the case. Establishing the correct date of birth then could mean using documents including family bibles and religious records, school or federal census records, letters from midwives, and ship manifests. Depending on the documents original purpose, and who provided the information for it, some documents were considered accurate while others were not. Point here is that determination of the person’s age was a decision that could, and still can, be appealed.  

Whatever the reason for disagreement, four appeal levels exist with specific timeframes for filing an appeal. Following the original decision, the four levels of appeal are: Reconsideration, Hearing, Appeals Council Review and Federal Court. The first three are within different components of the Social Security Administration. The fourth, Federal Court, is not. More about each in the future.  

If using the SSA appeals process, it is very important to stay within the timeframes provided in your decision letter. It is also important to address your appeal to the facts of your case. Using Social Security disability for an example, say that the SSA decision letter states you do not have enough work to meet insured status requirements for disability. Your work record is then the main issue to focus on, not your medical condition.  

More in the future.