“What is taking so long?” The Levels of Adjudication Explained

Anyone who has applied for Social Security benefits has probably wondered why it takes so long for the Social Security Administration to make a decision. A claimant’s first impression is that Social Security just doesn’t care about their disabling conditions or their situation. This is not the case. Rather, evaluating a disability claim requires a lot of work, time and care in order for the right decision to be made.

Initial Application

After you complete your application at your local Social Security office, a claims representative will request medical records from all of the treating sources your provided. Because oftentimes it will take a doctor’s office or hospital a month or more to fulfill the request, some of the wait time comes from Social Security waiting for your records to arrive so that they may be reviewed. Reading through these documents, which sometimes can be hundreds of pages, is also a time-consuming process.

In the meantime, you may be asked to complete forms regarding your daily activities, symptoms, or past work history. Completing these forms to the best of your ability and returning them to Social Security before any deadline they may give you helps the evaluation process move more smoothly.

You may also be asked to attend a physical or mental exam, where you will be evaluated by a doctor employed by Social Security. After the appointment is completed, the doctor who examined you must take the time to write a report, which is subsequently sent to Social Security to be reviewed and considered along with your medical records and any forms you completed.

Typically, this initial process takes 3 to 6 months, but sometimes longer in more complicated cases.

Reconsideration

If your initial application is denied, you may file an appeal called the Request for Reconsideration. Afterwards, Social Security will do just that: they reconsider their first determination, alongside any new medical evidence, forms you complete, or further exams you may be sent to.

When you appeal the first decision, you are asked to fill out form SSA-3441. This form asks you if there have been any changes in your condition, any new conditions, and for more information about your treating sources and how recently you may have treated with them. As in the initial application, Social Security will request any updated medical records that may exist. You may be asked for clarification in some of your answers.  It is important that Social Security is aware of any new treatment.

As with the initial application, reconsideration of the first determination also takes approximately 3 to 6 months, depending on your claim’s circumstances.

Hearing

Once all of the evidence is reviewed alongside the initial determination, and you are denied again at the Reconsideration level, you may request a hearing in front of an Administrative Law Judge (ALJ). You will be asked to complete another SSA-3441 when you appeal, however, updated or missing medical evidence must be provided either by the claimant or the claimant’s representative to be added to the file.

At this stage of your claim, the file that has been created for you thus far in the determination process is organized and exhibited in preparation for a hearing. Once the hearing staff has prepared your file, either you or you and your representative will be asked to attend a hearing. By law, you will be notified at least 20 days prior to the hearing date so that you can make suitable arrangements to attend.

In the past, the wait time for a hearing in the state of Ohio was at least two years! Fortunately, with the opening of a new national hearing center in St. Louis, Missouri as well as new hearing offices opened in the state of Ohio, that wait time has been greatly reduced. However, the exact wait time still varies from claim to claim, as some people may have more complicated claims than others that require extra time to prepare.

Conclusion

When you are unable to work and you have no income, you want answers fast so you can be certain of your future. Fortunately, the Social Security Administration understands the plight of the disabled person and will make every effort to make a timely determination for you, but it cannot happen overnight. Understanding the process helps a claimant make sense of all the time he or she must wait for an answer. The wait can be daunting, to be sure, but taking an active role in making sure Social Security gets all the information they need in a timely manner, such as completing forms accurately and attending state-sponsored exams, is the best course of action for a claimant.

 Written by Anna Westfall & Attorney Andrew November