The Levels of the Social Security Disability Administration

What is the process for getting disability in Tennessee? First and foremost a claimant must file an application for disability benefits.  This can be done in a multitude of ways and I encourage the reader to visit my webpage for a video tutorial on filing an application.  Once an application is filed the case is sent to Nashville for a medical determination. The case must also meet certain requirements to be sent for a medical review.  In Nashville state employees process the case, order medical records, and sometimes schedule consultative examinations.  This first stage typically takes approximately five (5) months before SSA issues a decision. 

If a claimant is denied at the initial level then the claimant can request “reconsideration” within sixty (60) days of the initial denial notice. If a reconsideration is timely requested the case is sent back to Nashville to be reviewed by a second pair of eyes. This second stage takes approximately two – four weeks before SSA makes a decision.  The denial rate at this level is so great that many (including SSA staff) refer to this step as a rubber stamp denial. 

If a claimant is denied at the first and second stages then he can request a hearing before an Administrative Law Judge (ALJ).  The claimant may appear at this hearing and call witnesses on his behalf. Most claimants have representation at this level. Unfortunately the wait for this hearing is lengthy. As of the writing of this the average wait time from the second stage till the hearing is around twelve (12) months. 

If a claimant is unsuccessful at the hearing level then he may request a review from the Appeals Counsel within sixty (60) days from the ALJ’s decision. The Appeals Counsel will review the administrative record and can either approve, deny, or remand the case back to the ALJ. The Appeals Counsel is the final step in the SSA process. It is important to note that the Appeals Counsel can overturn even favorable decisions but such action is rarely heard of. 

Disability Defined

 What does “disability” mean for Social Security?

As a lawyer I can tell you – how something is defined can mean everything.  The term “disability” can have numerous different definitions depending on its setting. For instance, im sure many of you have heard that the military can sometimes deem someone to be disabled in percentages (ex. 35% disabled).  The definition of “disability” for Social Security purposes is defined in the Code of Federal Regulations at 42 U.S.C. § 423(d), §§ 1382c(a)(3). While the full definition is quite large its basic tenants are:

The inability to engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment 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;

This definition is important for several reasons. First off you will notice the absence of any percentages. This definition isn’t like the military’s – its either yes or no. Another aspect you may have quickly noticed is the durational requirement.  The impairment must be expected to end in death or last at least 12 months. So even the worst types of traumatic injuries may not meet the Social Security definition of disability if the condition is expected to improve within 12 months. 

*You must clearly understand the durational definition. Many people misconstrue this definition to mean that they must be out of work for 12 months before they can file for benefits. This is not the case. You do not have to be out of work for 12 months before you can file for disability under Social Security. Your condition must only be expected to last 12 months or longer. *

You will also find an absence of availability of jobs. Social Security is not meant to be an unemployment benefit. Therefore, if you cannot find a job, no jobs exist, nobody will hire you because of a criminal record, or that you have no transportation to a job will not be adequate grounds for a favorable disability decision.