Once you’ve filed your initial application, your case will go to what we call the initial level. If you win at this level, great. If not, you’ll appeal. In most states the case will then be reconsidered and then if it’s denied again you can appeal to the hearing level. In a few states, they skip the reconsideration phase and go straight to the hearing level. If you win at the initial level, you can win quickly. If the case goes all the way to a hearing, the case might take over two years so you definitely want to win at the initial level, but if you don’t win you want the case to move through the initial level as quickly as possible so you can get in line for hearing so your goal at this level is to cooperate as much as possible to keep the case moving.
At the initial and reconsideration level, the federal government and your state government work together on the case. The local social security office will forward your application to an office in your state. The agency is called different things in different states – DDS, DAS, etc. Within that office, your case will be assigned to an adjudicator who will collect things like medical records and send you forms to fill out. The adjudicator also might set up medical evaluations if necessary. The adjudicator will also probably not answer the phone when you call unless you get the unicorn that is the responsive adjudicator. Even though adjudicators aren’t always helpful and you might get frustrated, you need to continue to cooperate and check in at least every six weeks to make sure your case is still pending.
When you filed your application for Social Security Disability you included a list of your doctors. The adjudicator will start requesting those records immediately. However, if you go somewhere new, the adjudicator won’t know about that doctor unless you tell him/her. Further, if the adjudicator is having trouble getting records you will want to do what you can to help him/her get records. Social Security won’t make a decision until your adjudicator has all of your records so help speed up this process by cooperating.
Your adjudicator will also send you forms to fill out. One of those forms is a “function report.” The “function report” is your opportunity to explain how your health conditions affect you. Take you time on this and be as detailed as possible but do not exaggerate. The last thing you want to do is kill your credibility. More importantly, get it back quickly because, again, you do not want to delay the process. You will also probably get a job history form so you can list your job duties for the last fifteen years.
The adjudicator might set you up for an appointment with one of their doctors. Sometimes these reports are surprisingly helpful to your case. More often, they say absolutely nothing. However, if you miss an appointment, your case will be delayed so it can be rescheduled. I’ve seen cases drag on for years because the claimant just kept skipping appointments. Do not skip your appointment. I understand people have trouble getting a ride or get sick before an appointment but you should do everything you can to make the appointment when it’s scheduled.
You can also send in information to the adjudicator. If you get a questionnaire from your doctor that helps explain your disability, call the adjudicator and ask for a barcode to send the report. The adjudicator can send you a barcode that will automatically file anything you submit if you attach it as a cover sheet to a fax.
Finally, you need to monitor your case. If you get denied, you only have 60 days to appeal. Mail gets lost. Family members throw out important mail. You don’t want to miss the appeal deadline because you assumed it was still pending. If your adjudicator never answers, you can try calling the main number for the state agency to check the status. You can also call your local social security office. The local office will know if the case has been denied.
Again, the primary focus at this stage is to keep the case moving and not miss any appeal deadlines. At this level, you have some control over how quickly your case moves so keep it moving by cooperating at every step. Fill forms out immediately and send them back. Go to appointments. Call the adjudicator back if he/she calls you. Be the most helpful person you can be. Hopefully, you’ll win right away. If not, you can at least do your part to speed the case along. If you win at the initial level, you can stop reading. If not, you’ll need to move on to the next section.