Why is My Disability Claim Taking So Long?

Why is My Disability Claims Taking So Long?
By Pitt Dickey

One of the most common questions disability claimants ask is “When will the Social Security Administration make a decision in my case?” First the good news, the Social Security Administration (SSA) is making a conscious effort to speed up the procedure. The bad news is that the system is not going to get any quicker in the foreseeable future. Both the applicants and the SSA itself frequently are frustrated by the substantial time lags. This column will look at the process and give some observations about the time frames in disability claims. There are essentially two ways that Disability Insurance Benefits claims are approved: either fairly quickly at the initial decision level or pretty slowly after waiting for a hearing before an Administrative Law Judge.

The test that the SSA must apply to award Disability Insurance Benefits is essentially this: does the applicant have a medical condition which can be expected to last at least twelve months (or result in death prior to the 12 months) which not only prevents the applicant from performing the work he has done in the past, but also from doing any type of work that exists in the American economy?

The application process begins by the person contacting the local District Office of the Social Security Administration to obtain the application forms. These forms can be picked up at the District Office located at 111 Lamon Street in Fayetteville or they can be mailed by the SSA to the applicant by calling the District office at 910-486-4325. The SSA can then set up a telephone interview with the applicant to go obtain additional information from the person seeking disability benefits.

The SSA contacts the claimant’s medical providers such as doctors, hospitals, physical therapists to obtain the person’s medical records. These medical records are then sent to Raleigh to the Disability Determination office which will make a decision as to whether the applicant is qualified for disability benefits. It can take 3 to 4 months to get a decision on this initial level. If the case is approved at the initial level, the SSA will pay the claim. The applicant will receive the benefits within a few weeks of the favorable decision. This is the short route for disability benefits.

The longer route occurs if the applicant is denied benefits at the initial decision level. If a denial occurs at the initial level then in most cases the applicant is going to have to have his case heard by an Administrative Law Judge after one more administrative review and denial. After the initial denial the person has 60 days to request a Reconsideration of the initial denial. An applicant denied at the initial level should immediately contact the SSA and request the forms for the Reconsideration request. There is no advantage in waiting the full 60 days as most claims are denied at the Reconsideration level.

In my experience it typically takes the Raleigh Disability Determination Office about 2 to 3 months to deny the claim at the Reconsideration level. It is important not to get discouraged and let a claim be dismissed by not appealing on time. If the applicant waits until after the 60 days have elapsed he will have to start the process all over again.

After being denied twice many people will consider retaining an attorney to assist them in their hearing before the Judge. It is not necessary to have an attorney but disability law is complex and an applicant’s opportunity to obtain disability benefits is usually enhanced by having an attorney.

All claims from Cumberland County have their hearings in Raleigh at the Office of Hearings and Appeals. It is necessary for claimants from Cumberland County to travel to Raleigh for these hearings. Claimants who live in Robeson County have their hearings in Lumberton before an Administrative Law Judge from the Charlotte Office of Hearings and Appeals.

Recently the Chief Administrative Law Judge from the Raleigh office sent out a memo to attorneys practicing in the Raleigh office. The delay in setting hearings in the Raleigh office is due a tremendous increase in the number of appeals of denials of Reconsideration decisions. In October 2000, there were 2534 cases pending before the Raleigh Office of Hearings and Appeals. In December 2002 there were over 6500 cases pending in Raleigh. Cumberland County appeals were assigned to the Raleigh Office in December 2000. Prior to that date Cumberland County cases were assigned to the Charleston, South Carolina Office of Hearings and the appeals were heard in Fayetteville.

Appeals from Cumberland County have added about 90 new cases per month to the Raleigh Hearing’s office. Several years ago the national Social Security Administration reorganized the system with something called HPI which was supposed to speed up the processing of cases. It had the opposite effect and has greatly slowed down getting cases heard. A number of Hearing Office employees have left their jobs and there has been a hiring freeze imposed which makes the processing of cases even more difficult.

Essentially what the Hearing Office does is to prepare cases for hearing by the Administrative Law Judges. This involves organizing the files and making exhibits for the Judges to review. The Judge’s hold the actual hearings but are limited in setting the cases for hearings until the Hearing Office staff has worked up the files and marked the exhibits. Based on my own experience with Cumberland County cases, it takes about a year to get to a hearing after the hearing is requested after the Reconsideration denial.

The Chief Administrative Law Judge’s memo in Raleigh requested the filing of Motions for On the Record decisions in disability cases. If such a motion is granted by the Judge, it is not necessary to have a hearing. The granting of such a motion can save months of time waiting for a hearing date. The SSA is doing what it can to recover from the nationally imposed HPI administrative reorganization that has created massive delays across the United States in SSA disability hearings.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years.