The Social Security Disability Application and Appeals Process

Living with medical problems or mental illness can be difficult. Life for the disabled is challenging. When a person feels unable to work due to a physical or mental impairment and chooses to apply for Social Security Disability benefits, a myriad of medical, psychiatric, psychological, legal, social, cultural and financial forces conspire. Below is information about the process.

Determining Disability

To render a disability determination, the Social Security Administration employs a well known five step sequential analysis.

  • Step 1 of the sequential analysis is the question: are you working? If a claimant is working and earning at a level of “substantial gainful activity,” s/he is, by definition, not disabled.
  • At Step 2 of the sequential analysis, if the claimant is not working, a decision is then made as to whether the claimant has a “severe impairment.” This is essentially a de minimus standard to weed out frivolous claims.
  • At Step 3, a determination is made as to whether the claimant meets or equals in severity a listed impairment. If s/he does, the claimant will be found disabled.
  • After Step 3, but prior to Step 4, a determination as to the claimant’s “residual functional capacity” is made. Once “residual functional capacity” is established, at Step 4 a determination is made as to whether the claimant can return to her/his “past relevant work.” If the claimant can return to her/his “past relevant work,” unless a GRID rule applies, s/he will be found not disabled.
  • If it is determined at Step 4 that the claimant cannot return to her/his “past relevant work,” at Step 5 a determination is made as to whether the claimant retains the “residual functional capacity” to perform any other type of work which exists in significant numbers in the regional or national economies.(See 20 CFR 404.1520).

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LEARN HOW TO GET YOUR SOCIAL SECURITY BENEFITS

Initial Social Security Disability Application

After Social Security personnel complete the application process, the “initial” application is sent to Disability Determination Services (DDS), a state agency under contract with the federal government to make Disability determinations. The DDS claims examiner assembles the claimant’s medical records and any other medical evidence of disability, and the case is sent to a DDS reviewing physician for a disability determination. The claim is then sent back to the local Social Security District Office for the issuance of a Notice of Initial Determination.

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Social Security Disability Appeals Process

Reconsideration

If denied, the claimant has the right to file a “Request for Reconsideration,” at which time the file will be returned to DDS to a new claims examiner for additional development of the medical record, if necessary, and for a second disability determination by the DDS reviewing physicians. The file is then again sent back to the Social Security local District Office for issuance of a “Notice of Reconsideration.”

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Hearing

If denied again at the reconsideration level, the claimant has the right to Request a Hearing before an Administrative Law Judge at the Office of Hearings and Appeals. The average delay from the filing of a Request for Hearing to the scheduling of the hearing varies but currently is approximately sixteen (16) to eighteen (18) months at the Providence Office of Hearings and Appeals. At the hearing, the ALJ often employs the services of medical and vocational experts to provide expert opinion evidence as to the claimant’s medical condition, residual functional capacity, and ability to work, including statistical data regarding the existence and incidence of jobs the claimant could perform, despite his/her impairment. After the hearing is held, the average processing time for the issuance of a decision is anywhere from one to six months.

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Appeals Council

If the ALJ issues an Unfavorable Decision, the claimant can file a Request for Review with the Appeals Council. The Appeals Council is located in Falls Church, Virginia and handles Requests for Review of Unfavorable Decisions (at the hearing level) for the entire country. With rare exception, the Request for Review entails a written Memorandum of Law, alleging factual and/or legal errors.

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District Court

If the Appeals Council affirms the ALJ’s Unfavorable Decision, the claimant has the right to file a complaint for relief in the United States District Court (USDC) for the district in which s/he resides.

Experienced Social Security Disability Lawyers

Please fill out a contact form or call our Rhode Island office at 401-274-7400 for more information or a free legal consultation with a Social Security Disability lawyer.

The law firm of Marasco & Nesselbush, LLC, represents individuals and families in matters of personal injury (including auto accidents), Social Security Disability, and medical malpractice. Our attorneys serve clients throughout Rhode Island at offices in Providence, Woonsocket, Warwick, and Wakefield. Our firm represents residents of Providence, Kent, Bristol, Newport and Washington Counties, as well as clients in Massachusetts and Connecticut. We always stand ready, willing, and able to help; feel free to call us today.

Social Security Disability Timeline

View our visual representation of the steps involved in applying for and appealing SSD benefits.

Social security disability timeline infographic

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Helpful Numbers For SSD Applicants

Rhode Island Social Security Offices
Newport SSA – 866-253-5607
Pawtucket SSA – 866-931-7079
Providence SSA – 877-335-4113
Warwick SSA – 866-964-2038
Woonsocket SSA – 877-229-3542

Massachusetts Social Security Offices

Attleboro SSA – 888-655-6469
Boston ODAR – 888-870-7573
Brockton SSA – 888-717-1524
Cambridge SSA – 800-772-1213
Lawrence SSA – 877-669-3127
New Bedford SSA – 866-964-7413
Taunton SSA – 877-505-4546
Worcester SSA – 866-331-9069

Connecticut Social Security Offices
New Haven SSA – 866-331-5281
New London SSA – 866-931-0157
Norwich SSA – 888-482-3170
Willimantic SSA – 877-405-0488

Other Helpful Numbers

RI Department of Human Services
DHS Offices by Program
DHS InfoLine: 401-462-5300

DHS Long Term Care Office
Building #55, Howard Avenue
Cranston, RI 02920
tel. 462-5182; 462-2400

Newport Regional Family Center
110 Enterprise Center
Middletown, RI 02842
tel. 851-2100 or 1-800-675-9397
fax 851-2105

South County Regional Family Center (Stedman Center)
4808 Tower Hill Rd., Suite G1
Wakefield, RI 02879
tel. 782-4300 or 1-800-862-0222
fax 782-4316

Office of Rehabilitation Services
40 Fountain Street
Providence, RI 02903
tel. 421-7005 ; TTY 421-7016; Spanish 272-8090

Pawtucket DHS
24 Commerce Street
Pawtucket, RI 02860
tel. 721-6600 or 1-800-984-8989
fax 721-6659

Providence Regional Family Center
206 Elmwood Avenue
Providence, RI 02907
tel. 415-8200

RI Veterans Home
480 Metacom Avenue
Bristol, RI 02809
tel. 253-8000 ext. 695

RI Veterans Memorial Cemetary
301 South County Trail
Exeter, Rhode Island 02822
tel. (401) 268-3088

Warwick DHS
195 Buttonwoods Avenue
Warwick, RI 02886
tel. 736-1400
fax 736-1442 or 736-1443

Woonsocket DHS
450 Clinton Street
Woonsocket, RI 02895
tel. 235-6200
fax 235-6237