1. Initial Determinations.

(This is the first step, but don’t expect to win at this stage. In 2011, 55% of all claims in New Jersey were denied at the Initial Determination stage.)

An applicant for Social Security benefits must file an application. Presently, all new applications for disability benefits must be filed online through the Social Security Administration (SSA) website, at www.ssa.gov. Applicants can also get help in filing an initial claim for benefits at any local SSA office.

Usually, it takes the agency about six (6) months to process an Initial Determination. During that time, SSA has the responsibility to develop the record. To do so, the agency starts the process by gathering medical records. As necessary, applicants are also sent to consultative medical and/or psychological examinations conducted by appropriate specialists. At times, vocational consultants are assigned to perform residual cognitive capacity evaluations of an applicant’s physical and mental impairments. Applicable questionnaires are completed by the applicant, and by those familiar with the applicant’s situation.

SSA reviews all medical evidence to determine if the applicant has any medically determinable impairments which could support a determination that the applicant is disabled under the SSA law. Opinions of treating physicians are given greater weight than opinions of examining physicians. Opinions of those who merely reviewed medical records are given the least weight.

Once SSA has considered all the evidence in the record and a decision on the application is made by the agency, a Notice of Initial Determination is mailed to the applicant.

2. Reconsiderations.

(Applicants have less chance to prevail at the Reconsideration stage than they do at the Initial Determination stage. 85% of all claims in New Jersey were denied at Reconsideration.)

The first level in the internal agency appeals process is called a Request for Reconsideration. All reconsideration requests must be filed online. A reconsideration request must be filed within 60 days of the date the Notice of Initial Determination is received by the applicant, but a late appeal can be filed for “good cause shown.”

At the reconsideration stage, all evidence in the file is given a “fresh look” by the agency, and the applicant can submit any additional evidence he or she may have available, or can obtain from independent sources. The additional evidence may include medical records, opinion reports and affidavits from witnesses.

Reconsideration is a paper review only, and no personal appearance is necessary.

It usually takes the agency about 6 months to process an application through the Reconsideration stage.

3. Hearings Before Administrative Law Judge.

(Applicants have the best chance of prevailing at the Hearing stage of the appeals process.)

Applicants dissatisfied with the Reconsideration decision have 60 days to file for a hearing before an administrative law judge (ALJ). Requests for hearing must be filed online. The process at the Hearing stage takes about 1 year.

Generally, SSA does not develop the claim further at this stage unless the applicant specifically asks that agency to do so. However, the ALJ can ask an independent vocational expert or medical expert to testify at the hearing. Hearings typically take about an hour to complete. In addition, an applicant can submit further evidence at any time, can testify at the hearing and, if necessary, present witnesses. No attorney represents the SSA at the hearing.

The ALJ issues an opinion on the issues raised in the appeal some weeks or months after the hearing, which gets mailed to the applicant and to his or her legal counsel.

4. Appeals Council Review.

Applicants dissatisfied with the ALJ decision can file an appeal within 60 days, called a Request for Review by the Appeals Council. Like the reconsideration stage, the Appeals Counsel Review is a paper review only, and no personal appearance is permitted. To prevail, the applicant must show that the ALJ decision was the result of material mistakes of law and/or fact.

5. Federal District Court.

Claims which are not approved through the agency’s internal administrative law process must filed within 60 days in federal district court