There is no clear-cut answer to this question, because each person’s disability claim, whether it is filed under the Social Security Disability or SSI disability program, has it own unique set of medical facts. Some individuals with severe physical or mental conditions may be allowed at the initial or reconsideration levels (reconsideration is the first level of appeal). Admittedly, this would not be the majority of cases.
Situations allowing for faster decisions
For instance, if an individual has a disabling condition, of a physical or mental nature that a) fits the criteria of a QDD (quick disability decision) decision case, b) is a condition that is on the compassionate allowance list, c) is a terminal condition, or d) the severity of their condition satisfies the criteria of a Social Security impairment listing. they are fairly likely to qualify and be awarded benefits in a short space of time.
Approvals under one of these conditions--with the exception of being awarded on the basis of a disability listing, which often occurs at all levels of the system--will nearly always take place at the initial claim, or disability application, level. This is because disability examiners at the various DDS (disability determination services) agencies in the nation have been increasingly trained to identify cases that meet QDD, compassionate allowance, or terminal illness criteria.
The time required for most decisions
When cases do not fit into one of these scenarios, disability decisions are usually rendered in 90-120 days. This is, of course, a processing goal of the Social Security Administration and perhaps an accurate reflection of the time involved for the majority of claims. Some claims will receive a disability decision much sooner, while other cases may take six months or longer.
What determines how fast an initial, or disability application decision may be made? As this site repeatedly states, the time required for a decision is largely a function of how long it takes a disability examiner to get the claimant's medical records gathered. There is a certain amount of time required for the examiner to actually review the records after they are obtained, very often in combination with information regarding the claimant's work activity. However, for the most part, the single largest delay is. the time it takes to acquire the records.
This is exactly why, when an examiner has difficulty obtaining the records a case may drag on for months, or make it necessary for a Social Security medical exam to be scheduled (these exams are usually scheduled when the examiner cannot locate evidence that addresses a specific medical condition. or the evidence in the file consists of old medical records).
Submitting medical records yourself
Very often, of course, such delays can be avoided by supplying fairly detailed information when filing for disability. In some cases, individuals who submit their medical records when they file a claim at a Social Security office can avoid months of processing time.
However, claimants who submit their own copies of their records should be sure to include:
A) Recent medical records. Social Security will need records not older than 90 days in order to approve a disability claim.
B) Records that go as far back as the time they became disabled. Older records are necessary to document a claimant's onset date which can affect the amount of back pay they are eligible to receive and when their eligibility for medicare may begin.
Note: Claimants who are approved for title II Social Security Disability benefits may receive medicare, while individuals who are approved for title 16 SSI may receive medicaid.
Being denied lengthens the process
In the majority of cases, though, a claim will be denied at the disability application level, forcing the claimant to pursue their case through the Social Security Administration's appeal process.
Because the appeal process is usually dependent on filing two separate appeals (the request for reconsideration appeal, and, secondly, the request for hearing before an administrative law), it is difficulty to predict how low long it will ultimately take a claimant to win their benefits.
Reconsideration appeals can often take 60 days or less, and--assuming that the reconsideration is denied and a hearing must be requested, which is usually the case--the time required to request a hearing, have it scheduled, and then receive an answer from a judge may take well over a year.
Added to this amount of time is the amount of time that is expended in the initial disability application phase and the total process can easily stretch out to two years, start to finish.
For most claimants, winning disability benefits will involve having to pursue their Social Security
or SSI claims to a hearing before an administrative law judge. This is the level of the system where, typically, it would be best to have representation. Fortunately, it also the level where claimants will generally have their best chance of being approved.
Approval rates on disability claims at the various levels
Statistics do vary in different states. However, on a national average basis, one-third of initial claims, or disability applications, are approved. This means that seventy percent are likewise turned down. For those who choose to appeal and file a request for reconsideration, the rate of denial will be even higher, approaching 85 percent in many states.
The high rate of denial on a reconsideration is not surprising when one considers several facts: the reconsideration process is identical to the initial claim process; the reconsideration appeal is handled by the same agency (DDS, or disability determination services), only this time by a different disability claims examiner; the reconsideration appeal usually occurs very shortly after the initial claim has been denied, i.e. not much has usually changed in terms of the medical evidence.
The approval rates and denial rates at the first two levels are markedly different from the disability hearing level where unrepresented claimants will have, on average, a forty percent chance of being approved and represented claimants may win as much 62 percent of the time.
At the hearing level, of course, both the claimant and their disability attorney, or non-attorney disability representative, will both appear before an administrative law judge after having presented medical evidence aside from that which was gathered by the social security administration at prior levels.
Note: Because over a year's time will usually pass between the first appeal (the reconsideration), and the second appeal (the hearing), it is absolutely necessary that new records be obtained and submitted to the judge.
Additionally, cases are made much stronger when the claimant's representative will have obtained a strong supporting physician statement from the claimant's treating physician, or physicans if the claimant has more than one. Disability judges are significantly more likely to give evidentiary weight to such statements while disability examiners at the first two levels often do not.
All this said, your initial disability claim, ie. disability application, usually takes about 90-120 days to process. Initial claims can potentially take much longer, especially if consultative medical exams--paid for by social security--are scheduled (especially if they are scheduled and missed), or if the claimant has undergone recent heart or eye surgery, or has had a stroke. In those cases, social security will defer a decision on the case for three months to allow time to properly assess the individual's recovery.
For the most part, however, the majority of disability applications will be decided in under 120 days, with approximately 30 percent of claimants meeting the qualifications for disability.
Reconsideration appeals tend to proceed much more quickly. This is because the reconsideration is essentially just a repeat of the initial claim, except that most of the medical evidence has already been gathered and is recent enough to be used by the reconsideration-level disability examiner. Reconsiderations usually take 60 days or less.
In the case of adisability application or a request for reconsideration, the longest delay will usually be attributable to how long it takes the examiner to get the claimant's medical records (again, why it is so important to supply detailed information regarding one's medical history).
For those who are denied at the first two levels and have to have an administrative law judge hearing, the process may take many more months. In the case of a hearing, however, the wait is not simply for a decision from a disability judge. The primary wait involving a hearing actually concerns the scheduling of a hearing date, which is dependent on how backlogged a particular hearing office is.
This part of the process can take a year or more in many parts of the country. On the bright side, the social security administration is actively working to reduce the wait time for a hearing. In prior years, the wait often exceeded two years for hearing offices in certain parts of the country.
As you can see, the disability process can, and often is, a lengthy process, and you may not get Social Security benefits or SSI the first time you file, meaning on your initial claim.
However, statistically, those who appeal their claims following a denial will typically stand a very good chance of eventually qualifying for disability, usually at the hearing level before a federal judge.
Return to: Social Security Disability Resource Center . or read answers to Questions