Process

Filing a claim with the Social Security Administration is a confusing and frustrating process. Many do not know if they are eligible or where to begin to make a claim. This is where Janice H. Whitehead & Associates can help. Our office of experienced staff will guide you through our proven process to determine what disability program is best suited for your situation, file a claim on your behalf and, if necessary, help with an appeal.

Programs

The Social Security Administration (SSA) has two main programs to assist those who are disabled according to the terms of the Social Security Disability Act. Those programs are Social Security Disability (SSD) and Supplemental Security Income (SSI). Each program has a different set of eligibility criteria, but both are required to find that the person has a disability that prevents them from doing “any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” The key difference between SSD and SSI is age and work history. Those who have worked recently and earned enough “credits” can generally apply for SSD. While those with little to no work history and children can apply for SSI.

Claims

The claims process is the same for each program. There are five steps.

  1. The SSA determines if you are working at the SGA level, which is an annual level of income that allows one to support themselves. Those whom the SSA determined are at or above this level are denied regardless of their claimed disability.
  2. If the SSA determines you are under the SGA, medical documentation is reviewed to substantiate your claim.
  3. SSA uses this medical documentation to determine if your disability meets the impairment level required for compensation.
  4. SSA assesses all past work history to determine if you could now perform them at or above SGA level or if another type of work could be performed with your current condition to meet or exceed SGA.
  5. The final step is for the SSA to determine if you can perform any type of work considering your condition, work history, age and anything else that may affect your ability to work.  Obviously, those who are determined to be unable to sufficiently provide for themselves are approved. Others are denied and may begin the appeals process.
Appeals

If your initial claim is denied, you have the right to appeal the decision. Appeals can go all the way to Federal Court of Appeals, but we can only assist through Appeals Council.

  1. The first step after the initial denial is Reconsideration. New medical evidence and additional documentation is reviewed by a different Social Security Administrator. Process generally takes 4 months.
  2. If your reconsideration is denied, you may request a hearing before an Administrative Law Judge (ALJ). Due to Covid 19, hearings are being held by phone or video via Microsoft Teams. This step is the only part of the appeals process that requires a meeting with a Judge and takes about an hour. The judge will take testimony from you, medical and mental health professionals, family, former employers and your representative into consideration along with information in your file. The decision is issued in writing 90 days after the hearing. Approvals begin receiving compensation in two to four months while denials can proceed to the next step.
  3. If we feel the ALJ mistakenly denied your claim, we will submit it to the Appeals Council who can overturn the Judge’s decision.
  4. If you are denied at Appeals Council, you may appeal to Federal Court. However, you will need an attorney at this level. We will be happy to make a recommendation if required.

For more information about this process, you may visit the SSA website or review their claims video series.