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How does the SSA determine if I need to see a judge?

Social Security Disability Insurance benefits (SSDI) are awarded to claimants who have a severe health condition which does not allow them to perform substantial gainful activity and will last for at least 12 continuous months. Recently on our disability forum a user asked, “If I have applied for disability benefits how does the SSA decide I am disabled or whether or not my case needs to be heard before an administrative law judge


SSDI decision making process

This is a good question, but this is not quite how the process works. In fact, all SSDI cases are first reviewed by the appropriate local SSA field office. The field office will review the application and determine if the claimant meets the nonmedical requirements for SSDI. If not, the claim is denied. If yes, then the claim is sent to another office called the Disability Determination Services Office (DDS).

Although the DDS office is managed at the state level (and in fact may have another name other than DDS), each office is supposed to use the same disability criteria to make disability determinations.

Each DDS office reviews the medical records for each claimant, which they have obtained from the claimant’s doctors. After review, they ask a series of questions, referred to as the Five Step Sequential Evaluation process.

The goal of these questions is to determine if the claimant is working, whether their condition is severe, whether their condition meets a listing on the SSA Listing of Impairments, whether they can work their previous job, or whether they can retrain for new work.

If at any point in the sequence of questions they determine the claimant does not meet the requirements they will issue a “not disabled” decision and notify the claimant.

How does my case get to a judge?

At no time in the process does the SSA make a decision to send your case to a judge for review. In fact, this request can only be made by you, the claimant. And the decision is made only after you have received a denial from the SSA and have appealed the denial decision.

If your case is denied you have 60 days from the date of the decision to appeal the denial. In most states the first appeal step is called a reconsideration, which is another review of your case by another disability examiner.

Several states, however, have eliminated the reconsideration appeal step and allow claimants to request a hearing before an administrative law judge immediately following the first denial.

If you request an administrative hearing your SSDI file is forwarded to the appropriate Office of Disability Adjudication and Review office (ODAR). In some cases, your attorney may be able to request a review of your case without a hearing, but generally, your case is added to a long list of other cases waiting to be heard by a judge.

Unfortunately, in many parts of the country it can take up to 2 years to have your hearing scheduled before the administration law judge.

Bottom Line:

The SSA does not decide whether or not your case should be presented before a judge. You do. In fact, you make this request after your case has been denied by the Social Security Administration.

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