Will I Have to Appear Before a Judge to Win my Case?

The Social Security decision-making process is unwieldy and time-consuming.  When you first file (your initial application), your case is opened by an office  called the Disability Adjudication Section (the D.A.S.) which is part of the  State, not Federal, government. The D.A.S. adjudicator will interview you and  request medical records from your physicians. After about 3 months, the  adjudicator will issue a decision.

It has been my experience that D.A.S. adjudicators are often overworked and  unable to spend the time necessary to develop your case file. In addition, by  law, adjudicators have specific guidelines that they must follow when evaluating  your case. For this reason, many deserving cases are denied at the initial stage  because records were simply not returned by doctors or because a medical record  does not contain language discussing work activity limitations. Although Social  Security is working to change the D.A.S. position, most claimants never have the  opportunity to speak with the adjudicator deciding their case, and most  adjudicators are too busy to spend as much time as they might want to analyze  each case.

The D.A.S. adjudicator's decision denying your case is mailed to you in a  letter that briefly explains why you were denied. This letter also advises you  that you have 60 days to appeal, although the appeal forms are not mailed to  you. If you follow-up with Social Security, you (usually) will be provided with  an appeal form called a Request for Reconsideration and a 6 page Reconsideration  Disability report. As you might imagine, many claimants fail to appeal, and  those that do often find the lengthy paperwork difficult to complete.

If you complete your Reconsideration paperwork, it is sent back to the D.A.S.  where another adjudicator reviews your file. It has been my experienced - and  this is backed up by Social Security statistics - that very few cases are  reversed at Reconsideration. The Reconsideration process takes about three to  four months.

If your case is denied at Reconsideration, the Adjudicator's decision denying  your case will be mailed to you with a brief explanation and a notice that you  can appeal by requesting a hearing within 60 days. Again, no hearing request  paperwork is enclosed, although it will be sent to you if you ask.

If you request a hearing, you will receive an acknowledgment and a letter  advising you that you can expect to wait about a year. During this year, your  file will be transferred from the D.A.S. to the Social Security hearing office  called the Office of Hearings and Appeals (the O.H.A.). After about a year, you  may receive a notice from the Judge to whom your case is assigned advising you  that your file is being worked up. Thereafter, you will receive a hearing notice  setting the time and place for your hearing.

I get involved in cases at all levels of this process, although most of my  clients hire me after receiving their initial denial. Many clients feel more  comfortable having my firm complete and submit the appeal paperwork within the  60 day deadline. In addition, as noted above, I make sure that your medical  record, including recent treatment, is sent to the Adjudicator or the Judge at  the correct address prior to the hearing. Most importantly, I identify a  strategy to win your case and obtain forms, letters or other documents from  physicians and others to prove your case.

Obviously, not all cases need to be heard by a Judge. It has been my  experience, however, that many seriously ill claimants will not be approved at  the initial or reconsideration adjudication level.

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