The Long Wait for Social Security Disability Hearings & Determinations
A claimant who applies for Social Security disability (“SSD”) benefits must be: (1) disabled; and (2) out of work or have earnings so modest they are not “gainful” according to the Social Security Administration (“SSA”). Claimants naturally want their applications for SSD decided quickly to mitigate the financial stress caused by their lost or diminished income.
Unfortunately, this is not true for most SSD applications. The initial application (most often done online) is decided by SSA staff and NOT by a Judge after a hearing. SSA staff reviews medical and related information and typically renders a decision within 4-6 months. That decision (most often a denial) usually has only a brief explanation of why they denied the application and often does NOT reference all relevant medical records and documents.
If the initial application is denied, the claimant’s only option is to request a hearing. The waiting period for a hearing has varied significantly in the past seven years. In 2010, a claimant waited about 15 months to appear before a Judge from the time that he requested the hearing. By 2015, his wait had grown to 19 months. Right now, he waits 23 months. Rochester is ranked 148th out of 164 hearing offices in the United States for average processing time of claims from the hearing request date until a final disposition is rendered.
On average, Judges in the Rochester Hearing Office issue 1.92 decisions per day. On average, these Judges approve 73.51% of the applications they consider. Not all hearings held in Rochester, however, occur before local Judges.
Thus, most claimants can expect to wait more than 2 years from the date they apply for benefits until the date a hearing is held. If their application is denied after the hearing, their only option is to file an appeal with the Appeals Council of SSA. Presently, there are about 112,863 appeals pending before the Appeals Council. Claimants can expect to wait an additional 1-2 years for the Appeals Council to decide their appeal.
For the most recent data regarding processing times, see http://www.ssa.gov/appeals/DataSets/01_NetStat_Report.html
As of 2016, 12.03% of appeals filed were remanded back to the hearing office for further consideration (a favorable outcome for SSD-related appeals). When remanded, the claimant will have a 2nd hearing before the same Judge that previously considered their claim to reassess benefit entitlement. Thus, it’s not uncommon for cases brought before the Appeals Council to last 4 or more years without a final resolution being made.
Do Exceptions to the Normal Waiting Periods Exist?
Yes, however, such exceptions are rare. Keep in mind, you are one of thousands of applicants who are disabled and without income. Thus, to have your claim heard before others who have been waiting longer, you must prove circumstances so significant SSA considers the exception appropriate.
Exceptions can be made for certain “critical cases” such as “TERI” cases (terminal conditions or illnesses), Compassionate Allowance cases (specific debilitating illnesses and conditions identified by Social Security), Veterans who have been classified as 100% permanently totally disabled by the Department of Veteran Affairs (“VPAT” cases), military casualty/wounded warrior cases (permanent injury sustained while on active duty after 10/01/01), dire need cases (documented loss of food, shelter or necessary medical care without ability to obtain it) and potentially violent cases (high risk of suicidal or homicidal action).
For a more complete explanation from SSA about a “dire needs” expedited hearing, see http://www.socialsecurity.gov/OP_Home/hallex/I-02/I-2-1-40.html
As to what you must do to meet their dire need criteria, SSA writes:
The claimant must allege specific, immediate circumstances: (1) lack of food (i.e., without and unable to obtain food), (2) lack of medicine or medical care (e.g., the claimant expresses that he/she needs medicine/medical care but is without and unable to obtain it; the claimant does not have any health insurance, or indicates that access to necessary medical care is restricted because of lack of resources), and/or (3) lack of shelter (e.g., shut-off of utilities such that home is uninhabitable, homelessness, expiration of shelter stay, or imminent eviction or foreclosure with no means to remedy the situation or obtain shelter).
Most critical cases require extensive documentation to prove entitlement to expedited claim processing. Moreover, you must typically ask SSA to expedite your case. They may not automatically identify your case as “critical” even if you meet the standards involved.
Having your case flagged as a critical case does not always mean that you will be approved for SSD benefits. Thus, it is important you ensure your case is fully prepared for consideration before pursuing critical case designation.
How You Can Help Us
If you believe that you may qualify for an expedited hearing because of your dire financial need, please provide us with all the relevant documentation.
If SSA finds that you MAY qualify for an expedited hearing, we will be notified. Here are the steps that must take place BEFORE a hearing will be scheduled:
SSA must make available to us the file that it has assembled for your case.
We will review and copy the pertinent parts of that file. We will assemble a list of the medical and other evidence that SSA has collected.
We will work with you to identify and collect all additional medical and other evidence. Depending on the level of cooperation from your treating professionals, this process could take 30 days or more.
Once the additional evidence has been collected, we will prepare a pre-hearing memorandum that outlines why you should prevail. Depending on the complexity of your case, and the amount of evidence, this process could take 14 days or more.
After SSA reviews our pre-hearing memorandum, they will decide whether a hearing is necessary and, if so, when that hearing will be held. There is no way to estimate how long this process could take.
There are rare occasions when SSA decides that NO hearing is necessary because a fully favorable decision can be rendered “on the record.” However, if SSA decides that a hearing is necessary, they will schedule an appropriate date with us.
Once we have a date for the hearing, and who will hear your case, we will meet in advance to prepare for the hearing..
If you have questions, please contact us.