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Flow Of Cases Through The SSA Disability Process

NOTE: Social Security Administration (SSA) procedures for initial disability determination and appeals change beginning August 2006. See the topic SSA Disability Determination - New Approach for comprehensive information.

This topic provides a summary of Social Security Administration (SSA) disability application outcomes by showing and describing an outcome chart for Fiscal Year (FY) 2002 as well as an outcome chart for FY 2001 with that information. Additionally, the topic describes an extremely detailed flow chart for FY 2001 of the entire disability determination and appeal process. Contact your local Social Security Administration Office to submit a disability application.

Outcome Chart - FY 2002

The chart below is designed to give you an idea about the progression of applications through the Social Security Administration's (SSA) disability determination process. It is not based on data gathered by tracking individual cases through the process. Rather, it is based on aggregate data for all appeals in FY 2002 for Title II (Disability Insurance), Title XVI (Supplemental Security Income) and concurrent applications. Experience can vary from year to year and by application type. Additionally the numbers presented are rounded up.

The chart shows how many applications were approved out of each 100 initial claims. Approximately thirty eight percent of disability applications were approved at the first level of the process. Approximately 21 of the 62 initially denied appeal, and of those four are allowed at reconsideration. Virtually all of those denied at reconsideration appeal, and of those 12 are allowed at hearings. Finally, 5 of the 7 denied at hearings appeal, and of those 1 is allowed at Appeals Council Reviews.

Outcome Chart - FY 2001

The Fiscal Year (FY) 2001 chart below, like the FY 2002 chart above, is not based on data gathered by tracking individual cases through the process. Rather, it is based on aggregate data for all appeals in FY 2001 for Title II (Disability Insurance), Title XVI (Supplemental Security Income) and concurrent applications. Experience can vary from year to year and by application type. Additionally, the numbers presented are rounded up.

The chart shows how many applications are approved out of each 100 initial claims. Approximately forty percent of disability applications are approved at the first level of the process. Approximately 25 of the 60 initially denied appeal, and of those four are allowed at reconsideration. 19 of the 21 denied at reconsideration appeal, and of those 12 are allowed at hearings. Finally, 5 of the 7 denied at hearings appeal, and of those 1 is allowed at Appeals Council Reviews.

Flow Chart - FY 2001

A larger chart (available by clicking on this link) details the flow of an application through the Social Security disability determination process in fiscal year (FY) 2001.

Due to the extraordinary complexity and size of the chart, you will need to use the horizontal scroll bar in order to see all of it.

Taken from an applicant's point of view, the chart shows the path of a disability application from first contact with SSA through the initial claim, appeals, and district court processes. The chart presents a worst-case scenario because it presumes the application was denied at each stage. In reality, as seen in the first chart here, most claims are allowed (57 of 100), and most allowances are made at the initial level (40 out of 57 that are allowed overall for every 100 cases). Only about 5 cases out of 100 go beyond the administrative hearings level, and less than 1 per 100 enter Federal court.

Key to Symbols on Flow Chart

The detailed flow chart uses a number of symbols to indicate tasks, activities, work flow, and elapsed time. The symbols are described in this section.

The rectangular blocks represent the tasks in the initial determination and appeals processes. The color of the blocks indicates the component responsible for those tasks

SSA's field operations are shown in blue. Applicants contact a Social Security teleservice center or field office to begin the application process. A field office employee interviews the applicant and assists in gathering some of the information necessary to show that he or she meets the requirements for disability benefits. Employees in the field office also help applicants file appeals. Following a favorable disability determination, the field office completes work on the application and initiates payment.

The Disability Determination Services (DDS) are shown in green. The DDS in the home state of the applicant makes the initial disability determination. They secure medical evidence from the applicant's treating and other medical sources, and arrange for one or more consultative examinations if there is not enough evidence to make a decision. DDS employees gather information from the applicant and other sources and evaluate all the information to arrive at a disability determination. The DDS is also responsible for making the disability determination at the first appeal level—the reconsideration.

The patterned green rectangles represent quality review functions. SSA conducts reviews of some cases for consistency and accuracy.

Processing Centers are shown in purple. Some cases are sent to a Processing Center for final payment.

The beige rectangles represent Hearing Offices. The Hearing Office processes the second appeal—the hearing. The hearing is held by a Social Security Administrative Law Judge (ALJ). Some cases are decided based on information already in the file, but most are decided after a hearing before an ALJ. Additional medical evidence may be gathered and submitted by the appellant or representative.

The yellow rectangles represent the Appeals Council (AC). The AC processes the third and final administrative appeal—the Appeals Council Review. The Administrative Appeals Judge (AAJ) conducts a procedural review of the decision made by the ALJ. The AAJ does not conduct another hearing.

The gray boxes represent Federal District Courts. The Office of Appellate Operations and the Office of the General Counsel work together with a local U.S. Attorney when an applicant files a complaint in district court.

The icons connected by dotted lines show the employee position performing each type of action.

The triangles indicate delays. Some of these include mail time, medical provider response time, and the sixty-day appeal time legally available to the applicant at each step of the process.

The calendar pages along the bottom show the approximate number of days from the applicant's first contact with SSA through the end of the process charted above it. These are based on estimated average processing time for the mainstream process. Therefore, individual times may vary greatly.

The information at the top of the chart indicates the volume of cases that were considered and processed in FY 2001.

Table of Acronyms on Flow Chart

The detailed flow chart uses a number of acronyms and abbreviations to indicate personnel, offices, and events. These are described in the table below.

Also see:

SSI/DI Application Information

SSA Disability Determination Process

SSA Appeals Process

Source

Social Security Administration Office of Disability and Income Security Programs website at:
http://www.ssa.gov/disability/disability_process_welcome.htm
http://www.ssa.gov/disability/disability_process_welcome_2002.htm

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