As part of the application process, the patient will be interviewed to gather basic demographic information.
The patient will receive a packet of forms asking for the names of treating physicians and a separate form to be completed by someone who can report on the daily activities of the patient. Another form seeks information about the patient’s work history, job duties, and pay scales.
Third-party agencies employ physicians and psychologists who review the medical information and, on the basis of that review, render a decision as to whether the patient qualifies for benefits. As part of that review, the patient may be asked to see a consultant who will conduct an examination.
›› Level Two: Reconsideration
If the initial disability application is denied, the patient may choose to file an appeal. Usually, the patient must present new objective information testifying to disability and loss of function.
›› Level Three: Hearing Before an Administrative Law Judge
If the reconsideration appeal is denied, the patients must generally obtain the services of an attorney in order to pursue their claims. An attorney can review all pertinent medical/psychiatric information and advise the patient regarding the need for additional evidence in order to strengthen the case.
An attorney will represent the patient before the Administrative Law Judge (ALJ) and state the reasons why the patient should receive benefits. This is true for both SSDI and SSI. The judge may ask the patient about his or her disability and why he or she cannot work. There may also be a medical and/or a vocational expert present to provide testimony. Having an attorney present may protect the rights of the patient, especially when disputing the testimony of expert witnesses. The judge may also take into consideration a patient’s prior criminal record.
Because of the backlog in most jurisdictions, it may take as long as two years from the filing of the application before the claimant has a hearing before an ALJ. The waiting time for a decision can be shortened in cases that are supported by strong medical and/or vocational evidence.
An attorney can ask that a decision be issued on the record without the necessity of a hearing if the evidence supporting a favorable decision is strong. This request is made in writing and is usually supported by a brief explaining why an “on-the-record” decision is warranted. When the medical evidence shows that the claimant’s condition meets one or more of the Listings of Adult Impairments, it is more likely that an on-the-record decision will be awarded. Space does not permit an adequate discussion of the listings here. Healthcare professionals may wish to review the medical listings online at http://ssa.gov/disability/professionals/bluebook/listing-impairments.htm.
