After the hearing, the ALJ evaluates the evidence in the case and issues a written decision. In evaluating the case, the ALJ must follow a five-step sequence:
1. Is the claimant working? If the claimant is engaging in “substantial gainful activity,” which is often determined by average monthly income from work, the ALJ will find the claimant not entitled to benefits. Exception: If the claimant was unable to work for 12 or more consecutive months due to his or her impairments but has returned to work by the time of the hearing, the claimant may be eligible for a “closed period” of benefits – that is, a lump-sum payment of benefits for the period the claimant could not work.
2. Does the claimant have a severe impairment? A severe impairment has more than a minimal effect on the claimant’s ability to do basic work activities such as see, hear, speak, lift, carry, sit, stand, walk, concentrate, maintain a pace, or interact with others. If a claimant has a severe impairment, the ALJ goes to step 3 of the process, if not, the ALJ will find the claimant not entitled to benefits.
3. Do the claimant’s impairments meet or equal a Listing? Social Security has set standards, called the Listing of Impairments, by which it rates certain impairments. If the claimant’s impairments meet or equal a Listing, the ALJ will find the claimant disabled, if not, the ALJ will go to step 4 of the process.
4. Can the claimant return to his or her past relevant work (PRW)? PRW is generally work done in the past 15 years. The ALJ determines whether the 1 claimant can return to any PRW given the limitations imposed by his or her impairments. It is up to the ALJ to determine what limitations are supported by the record in each claimant’s case. If the ALJ find the claimant can return to PRW, the ALJ will deny the case; if the ALJ finds the claimant can’t return to PRW, the ALJ will go to step 5 of the process.
5. Is there any other work available in the economy that the claimant can still do? To find a claimant not disabled, the ALJ must find that there are jobs the claimant can do. If there are no jobs the claimant can do, he or she is disabled. Even if there are possible jobs the claimant can do, some claimants can, based upon their age (generally 50 and above), “grid out,” that is, be found disabled based upon SSA criteria known as “the grids.” If the claimant does not grid out and the ALJ finds there are other jobs the claimant can do, the ALJ will find that claimant not disabled.
If you disagree with the decision made by the appeals council or the second ALJ, you can file a lawsuit to your federal district court in order to get your denied disability insurance claim reversed.
The federal court is best to contact if you believe that there has been an legal mistake in your case. If you believe that there has been a factual mishap in your case, the federal court may turn your denied disability insurance claim over.
The federal court can either reverse your case or send your denied disability insurance claim back to an ALJ for another review.
70% of people are denied disability insurance at this stage.
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If you are denied disability insurance and your request for reconsideration is also denied, you have 60 days from the second denial to request a hearing with an administrative law judge (ALJ). This judge will have had nothing to do with your case beforehand.
Although you may not have a hearing for some time, when the hearing does come around witnesses will be present. The administrative law judge and you will have the opportunity to question the witnesses. Witnesses can be doctors, coworkers, or any other person that can vogue for your case.
At this point in the appeals process, 62% of cases are approved.
You must file your appeal application within 60 days of having your disability insurance claim denied. The count to 60 starts five days after the postmark on the denial letter that you receive in the mail. Click here to access the Request for Reconsideration application
After you send in your request for reconsideration, your case will be reviewed by a person that had nothing to do with your original claim. All old evidence, and any new evidence that you submit, will be looked at.
When you appeal your denied disability insurance claim through a request for reconsideration, be aware that few negative decisions are reversed at this point in the process. This does not mean you should give up! It typically takes 3-6 months to receive a decision.
The appeals council can deny your request for review of a denied disability insurance claim if it agrees with the ALJ’s decision.
The appeals council can either make a decision pertaining to your denied disability insurance claim or it can send the case back to an ALJ.
Only 3% of appeals are reversed at this stage.
Schneider, Kerr & Robichaux
The first step in the process is applying for benefits, and there are three basic ways of applying:
1. you can apply in person at your local Social Security field office;
2. you can apply by telephone; and
3. you can apply on line.
It typically takes 3-6 months to hear a decision.