When you apply for Social Security disability benefits, how long can you expect to wait before you get a decision approving your case?
There are actually two answers to this question – one that you will find encouraging and the other that will not make you happy at all.
Some people apply, then get an approval within four to six months. Others apply but are denied, then appeal twice before appearing before a judge. They may not see the first dollar for two to three years. Here’s what you need to know.
Meet a Listing for a Fast Approval
Currently about one-third of disability applicants are approved within four to six months after they apply. What types of cases fall into this “early approval” category?
Almost all of these early approval cases are listing level cases. These are people with medical conditions that meet one of SSA’s listed impairments. You can read more about this listings at my website MeetaListing.com but to simplify, a listed impairment is a medical condition so severe that SSA will assume that you cannot work.
If you look at Social Security’s “Blue Book of Listings” you will see that they have divided the human body into fourteen (14) body systems:
Listing 1 – Musculoskeletal System
Listing 2- Special Senses and Speech
Listing 3 – Respiratory Disorders
Listing 4 – Cardiovascular System
Listing 5 – Digestive System
Listing 6 – Genitourinary Disorders
Listing 7 – Hematological Disorders
Listing 8 – Skin Disorders
Listing 9 – Endocrine Disorders
Listing 10 – Congenitial Disorders that Affect Multiple Body Systems
Listing 11 – Neurological Disorders
Listing 12 – Mental Disorders
Listing 13 – Cancer
Listing 14 – Immune System Disorders
Within each of these Listings, you will find subsections that describe specific injuries or diseases.
- For example, under Listing 1 (musculoskeletal system), there is Listing 1.03 – Reconstructive surgery or surgical arthrodesis of a major weight- bearing joint , with inability to ambulate effectively, as defined in 1.00B2b , and return to effective ambulation did not occur, or is not expected to occur, within 12 months of onset. This listing would apply, for example, to a person who underwent a hip replacement surgery that did work and now the person cannot walk for more than a few feet at a time.
- At listing 5.07 Social Security identifies Short bowel syndrome (SBS), due to surgical resection of more than one-half of the small intestine, with dependence on daily parenteral nutrition via a central venous catheter. This would apply to a person who had one-half or more of his small intestine removed and must get nutrition through a feeding tube.
- The Listings also include people whose diseases are included in the “compassionate allowance” list of diseases that are terminal or that create symptoms so severe that no one with these diagnoses could every hope to work. These include conditions like ALS, inoperable breast cancer, early onset Alzheimer’s Disease and many others.
Social Security has intentionally made it very difficult to meet a listing. Generally speaking you must have a firm diagnosis of a very serious medical condition, diagnostic test results that meet the specific requirements set forth in the listing and solid written support from your long time treating physicians (usually a specialist).
Many people look at the listing and are convinced that they meet one of these listings. And they very well might. But unless the Social Security decision maker (called the Adjudicator) agrees, they will not be approved early.
In some instances the adjudicator is not able to obtain all of your medical records fast enough, so they don’t have enough information to issue an approval. In other cases the medical consultant working for Social Security who reviews the records can’t read the doctor’s handwriting or does not have enough time to read through all of the records.
The medical records and test results need to be crystal clear for an adjudicator and SSA’s in house medical consultant to find that your case meets a listing. As noted earlier about one-third of applications are approved. These early approvals are issued within four to six months. But this also means that two-third are denied.
What if I Do Not Meet a Listing or if My Application is Denied?
If your application for benefits is denied, that does not mean that you will never be approved. It just means that you will have to wait months or years for a decision.
If you are denied by the adjudicator, you will get a form letter stating the reasons for your denial and the list of reports used to make that decision. Most people get very frustrated when they read this denial notice because they disagree with the conclusion and they may see that some of their medical records were never received and considered.
If you are denied, you should not give up. You should appeal by filing a Form SSA-561 Request for Reconsideration within 60 days from the date you receive the denial. You may decide that it makes sense to hire a lawyer to file your appeal.
Reconsideration appeals are rarely successful – currently around 10% of claims are approved at this stage. The reconsideration appeal will take another six months before you get a decision.
If you are denied at reconsideration, the next appeal is to request a hearing. Here, too, it is a good idea to consider hiring a lawyer to represent you. Disability lawyers handle most disability cases under a contingency fee, meaning that the lawyer only gets paid if past due benefits are awarded. This does mean, however, that a lawyer will only accept your case if he or she believes that your claim is likely to be approved.
Currently, because of the backlog of hearing requests, most people will wait twelve to eightteen months before a hearing is scheduled. Then, they may wait another two to four months for a decision and another one to two months before SSA issues payment.
Currently about 45% of claims are approved at hearings.
So, as you can see about one-third of disability applicants are approved within a few months, but those cases almost always involve very severe or life limiting medical problems. Those not approved at the initial application stage can still win, but they will wait two or more years for a decision and payment.
Why Does it Take So Long?
The reason for SSA’s long delays in processing disability claims is simple – money. Congress has not allocated enough money to SSA to hire enough people to eliminate the backlogs. SSA has also wasted millions of dollars on inefficient computer systems.
To be fair, SSA has done a good job in making the disability evaluation process paperless – this has made process run smoother. Any many SSA employees are extremely frustrated with SSA policies that limit overtime and telework.
SSA also has to deal with the realities of Congressional budget making. Some of our elected representatives are convinced that the Social Security disability system is infected with extensive fraud (statistically there is very little fraud but in a program as big as the disability system, “very little fraud” can still mean tens of millions of dollars).
Further, there are very few lobbyists employed to educate and persuade members of Congress and SSDI/SSI applicants don’t make up an organized voting block. While members of Congress are afraid to even talk about changing Social Security retirement, they have no such hesitation making disability benefits more difficult and time consuming to obtain.
What Can You do to Speed Up the Process?
Unfortunately there are not many things you or your lawyer can do to speed up the process. However, here are a few that you should consider:
- if you think that you do meet a listing, print out a copy of the specific listing and take it to your doctor. Ask your doctor to write a narrative report explaining how and why you meet that listing.
- when you apply for benefits, SSA will ask you for a list of all of the doctors, hospitals and medical provider you have seen over the past few years. Before filling out that form, get on the phone and call your medical providers to ask for the mailing address for medical records requests. Tell them that you are apply for Social Security disability and is there a person or office that should be used by Social Security adjudicators who are requesting records.
- Avoid gaps in treatment – adjudicators are much more likely to deny your case if there are gaps in treatment.
- Seek treatment from specialists – adjudicators and judges give much more weight to records and work capacity opinions from specialists than they do from family doctors.
- If you have to appeal, do so online and as soon as you can. You have 60 days to appeal. Why wait until day 55 when you could appeal the day after you receive your denial.
- If you are veteran with 100% service connected disability, your case will be expedited. While your 100% disabled status from the VA is not binding on SSA, your case will be scheduled for a hearing faster.
- SSA has a “dire need” program but there are no restrictions on who can use it. I have found that your dire need argument is more likely to be considered if you can attach evidence of a pending foreclosure, repossession or lawsuit.
- Hire a lawyer. Obviously I am a lawyer and am not entirely unbiased. However, an experienced disability lawyer can narrow the issues and understands the practical issues in presenting a case at a hearing. In my practice I often submit pre-hearing briefs detailing my argument on behalf of a client and sometimes I am able to secure an award without the necessity of a hearing.
The Reality of the Social Security Disability System
The Social Security Administration is a huge government bureaucracy that employs thousands of workers. Any agency of this size has to have procedures to process all of the requests that are submitted on a daily basis. In the disability context this means that many deserving cases will fall through the cracks so you will be rewarded by staying the course and continuing to appeal.
If we can be of assistance to you in your quest for disability benefits, please reach out.