The SSDI Process
Social Security Disability Insurance (SSDI) is an employee payroll tax-funded federal insurance program. Its purpose is to provide income to people unable to work because of a disability. Depending on their age, an individual may qualify for SSDI benefits if they have worked and paid into the program for five of the last 10 years. You must also have been disabled before reaching full-retirement age (65-67) and must meet Social Security's definition of disability. Click here to read about the advantages in filing for SSDI beyond monthly income.
Allsup guides applicants through the disability decision process. With guidance from Your Allsup team and through empower, our convenient online tool, all forms are completed accurately and submitted in a timely manner. It is important to provide medical updates to Your Allsup team related to new doctors, hospitals, and conditions throughout the process so evidence can be considered as soon as possible. Allsup also needs to know if you receive a decision or any other correspondence from SSA. We regularly follow-up with SSA to obtain status and to ensure they have all necessary information. You may contact Your Allsup Team at (800) 405-8339 or click here if you have any questions.
There are four levels in the Social Security Administration's (SSA) review and award system, plus an additional level that that reaches the Federal District Court (FDC). Few applicants will pass through all five levels:
- Once Allsup receives your initial representation forms, a Social Security disability application can be submitted. Cases are assigned to a Disability Determination Service (DDS) office. These offices are state agencies that make the medical decision for the federal program. Allsup will assist with completing questionnaires, submitting vocational documentation, and providing medical updates. DDS may request that you attend a consultative exam (CE) if there isn't enough medical evidence to make a decision. The DDS examiner may send questionnaires to your spouse, family members or neighbors. Please encourage them to complete these and return them directly to the DDS examiner.
- It takes an average of four to six months to receive a decision at the initial level. Because Allsup's process is efficient and its professionals are so familiar with the Social Security process, you have a 53% better chance of receiving benefits at the initial application level. This rate is higher than the SSA standard of 33%
- If the initial disability application is denied, Allsup will file a reconsideration or first appeal. The case will again be assigned to DDS for a second review of the medical criteria. The reconsideration process is the same as the initial level, however cases are generally assigned to a different DDS examiner.
- The average waiting period at level two is 3 to 5 months. We maintain a 23% award rate compared to the SSA award rate of 12%.
- *Note: In certain states, the reconsideration level has historically been skipped. SSA has begun to reinstate the reconsideration level nationwide. As of 4/20/2019, the remaining states that skip the reconsideration level are Alabama, Alaska, Michigan, and Missouri, with plans to re-implement to all states by 3/31/2020.
- If the reconsideration is denied, Your Allsup team will file for a hearing before an administrative law judge (ALJ) and assign your case to a senior associate. The case will be handled by the Office of Hearings Operations (OHO). If a hearing is required, the associate briefs the customer on the hearing procedures and appears with the claimant before the judge.
- Allsup will follow-up with OHO every 60-70 days to obtain status and provide any additional information as needed while a case waits for a hearing to be scheduled. OHO usually processes cases in the order received.
- About 20 days prior to your scheduled hearing, you will receive a notice indicating the date, time and place of your hearing. The ALJ usually holds the hearing within 75 miles of your home. If the ALJ schedules a hearing, you should make every attempt to attend due to the backlog of cases waiting for a hearing.
- After your hearing, the ALJ reviews all evidence and issues a written decision. In some cases, your representative may ask for a decision on-the-record, which means the ALJ reviews your claim and makes a decision without a hearing.
- The SSA estimates the average time spent at Level Three is 605 days (about 18 months). Our award rate for customers who appeal at Level Three is 76% compared to the SSA award rate of just 46%.
- If the hearing ends in a denial, Allsup will review the case again and may submit an appeal, along with any additional medical information and a written brief, to the Appeals Council. The Appeals Council reviews the hearing decision to determine if it was rendered properly according to the law. Only 1 percent of third appeals result in a favorable decision for the applicant. The SSA estimates the average time to receive a decision at Level Four is 364 days (about 12 months).
- The final level in the appeal process is the federal court system. Less than 1% of all claims reach this level. Approximately 70% of these appeals are denied with a small amount receiving a decision in FDC that resulted in an award. The remainder of those are remanded or sent back to the hearing level for an additional hearing.
Allsup does not charge a fee unless it obtains your SSDI benefits. The SSA governs the fee. Typically, under the SSA's fee agreement approval process, we receive 25 percent of the retroactive award, not to exceed $6,000. If you do not receive a retroactive award amount, your fee could be much less. All future monthly benefit payments go directly to you.
Award: If your claim is awarded, the general guidelines regarding when to expect payment, including retroactive payments (if applicable), are two to four weeks for claims awarded at levels one and two, and one to three months for claims awarded at levels three and four. These time frames represent an average or general guideline - specific time frames may be shorter or longer.
How much you receive is determined by a complicated formula using the amount of your past earnings that have been subjected to FICA taxes. The average monthly benefit for an individual is $1,234 in 2019. However, your monthly award is dictated by your lifetime earnings so for many people their award could be much higher. You also may access your Social Security statement online, which will include an estimate of the amount of benefits you may receive.
Continuing Disability Review: Your eligibility for SSDI benefits is subject to review at certain intervals after benefits are first awarded. These intervals are based on if your condition is expected to improve. These reviews are usually at one, three, five or seven years. For example, if medical improvement is expected, a "CDR" (Continuing Disability Review) date of one year is established at the time your benefits are awarded.
You may be able to suspend a CDR by participating in the SSA’s Ticket to Work program, and Allsup Employment Services can help.