How the Process Works

This guide is applicable to claimants who live in Missouri - other states have different processes at certain stages, such as the addition of a "reconsideration" stage

What This Guide Is About

In this Guide, Gateway tells you how the process of applying for SSI or Social Security disability (DIB) works. We explain each stage of the process, and tell you how long the process can take.

First Stage: The Application

You can apply for SSI or DIB benefits at any Social Security Administration (SSA) local office. To find out which office is nearest to your home, call SSA at 800-772-1213.

When you apply, you will speak with a “claims representative.” This worker will ask you many questions. The worker will also want details on your medical treatment, so have that information ready.

After you apply, SSA will try to get copies of your medical records. It will have its own doctors review your records and your complaints. It may also ask you to go to other doctors for an exam at its expense.

Social Security will notify you of it’s decision in writing. It normally takes SSA 90 days from the date you apply to make a decision. However, if there are problems getting medical records, or you get sent to see one of their doctors it may take several months from the date you apply to get a decision from SSA . If you are given benefits, SSA will send you a “notice of award” letter saying how much you can expect. If you are denied benefits, SSA will send you a “notice of disapproved claims.” This notice should say why SSA denied your claim.

In some cases a “reconsideration” may take place. This is only applicable to individuals whose benefits are being terminated; whose denial was based on non-medical reasons (too much income); or individuals who live in Illinois.

From the date you receive your denial, you have 60 days to appeal – to request a hearing before an Administrative Law Judge. If you are going to appeal, you should do so as soon as possible. If we are already representing you, we will help you file this appeal.

Second Stage: Hearing with ALJ

When your Request for Hearing has been filed, your case will be sent to the Office of Hearings and Appeals. Here an Administrative Law Judge (ALJ) will take a fresh look at your case.

ALJs are employed by SSA. However, ALJs are independent and are not bound by SSA’s previous decision. Therefore, they are able to take an unbiased look at your claim.

As soon as the ALJ’s staff has your file ready, your hearing will be scheduled. Unfortunately at the current time it sometimes takes 9-13 months for a hearing in St. Louis to be scheduled. Social Security is trying to catch up, so it will hopefully take less time in the future. Notice of the hearing will be mailed to you and your attorney if you have one.

At the hearing, you will answer many questions about your condition, living situation, work history, education, daily activities, and anything else the judge thinks is important. Some judges do their own questioning, and others have the lawyer, if one is present, ask questions.

Usually the only people present at the hearing are you, your lawyer, the judge, and the clerk. Sometimes the judge will ask an expert witness to testify. In some cases, you may have a witness come to testify on your behalf.

Most hearings last an hour or less. At the end of the hearing, the judge may close the record. The judge may also hold the record open to let your lawyer submit more evidence, usually medical records. Sometimes the judge will send you to a doctor for a medical exam.

Once all the evidence is in, the ALJ will decide your case. Some judges decide cases more quickly than others. There is no set time period within which a decision must be made. It could take several months after the hearing to get a decision from the ALJ. The average wait in St. Louis in 1-3 months.

You will get the ALJ’s decision in writing. If you win, SSA will let you know, usually within a few months, how much money you will be getting. If you lose, you have 60 days to appeal to the Appeals Council. If we represent you in this appeal, we will file it for you.

Beyond the Second Stage

The Appeals Council is in Virginia, and appeals to it are done on paper. If we represent you in an appeal, we send the appeal forms on your behalf. We usually also send an argument explaining why we think the ALJ’s decision was wrong. It can take 4-24 months or more to get a decision from the Appeals Council. If you lose at that level, your last appeal is to the federal courts.

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This page was last edited July 24, 2006.