Social Security Disability Insurance: Are Your Employees Still Waiting?
By Phil Bruen
VP, Group Life and Disability Products
MetLife
Less than half of the Social Security Disability Insurance (SSDI) claims submitted this year will be approved, and that number keeps decreasing year over year.1 With over one million claims awaiting an Administrative Law Judge (ALJ) hearing, knowing the basics of the SSDI process can help you and your employees navigate through more effectively. The SSDI determination process has three basic levels.
1. Initial
Most claims are initially processed in a local office where the staff makes the initial disability determination.
2. Reconsideration
Reconsideration is the first step of the appeals process for a claimant who is dissatisfied with the initial claim determination. This step involves a thorough review of the initial claim along with any new evidence available. A reconsideration determination is made by an entirely new team including an examiner and medical consultant. A request for reconsideration must be filed within 60 days after the date the notice of the initial determination is received by the claimant.
3. Hearing
If the claimant is still not satisfied with the reconsideration determination, the next step is to request a hearing before an ALJ. The claimant generally has 60 days after receiving notice of the decision to request an appeal. It is very important that any additional evidence is submitted as soon as possible for the Administrative Law Judge to consider. After the hearing, the ALJ will issue a written decision to the claimant. If the claimant is still not satisfied with the decision, a request for review with Social Security’s Appeals Council may be filed. In addition, an on-the-record review (OTR) process may be requested. An on-the- record decision is a favorable ruling by an ALJ that is made prior to a hearing by the SSA. It is made if there is sufficient documentation supporting the decision provided before the hearing.
The Long Wait
Wait times at the hearing level continue to increase despite fewer filings entering the system. At the hearing level, the average wait time was projected to be 605 days by October 2017.2 Additionally, the wait time for providing the notice of decision after a hearing has nearly doubled since 2012 and was up to 48 days in 2016. The 2016 CARES Plan (Compassionate And Responsive Service) laid out strategies to mitigate the growing Social Security backlog, but it relies on adequate funding to hire Administrative Law Judges and staff. The program goal is to bring down the hearing wait time from the current 605 days to 270 days by fiscal year 2020.
Help Is Available
Many long-term disability (LTD) insurance carriers include Social Security advocacy to help speed up the SSDI process. If customers don’t have an LTD program in place, several qualified Social Security advocate services and attorney groups are available to help navigate the SSDI process. Given recent award volume and rate trends from the Social Security Administration, it is even more important to have expert representation up front. Experts help claimants understand the process and represent claimants at critical hearings. It is recommended that employees who may meet the criteria for an award discuss their application with a qualified Social Security vendor or attorney group. Disabled employees whose disease or condition meet the criteria of the Social Security Administration’s Compassionate Allowances program should also file as soon as possible.
References
- SSDI applications, awards, and percent of applications awarded, retrieved from https://www.ssa.gov/oact/STATS/dibStat.html#f1
- National average SSDI processing time, chart page 10, retrieved from https://www.ssa.gov/budget/FY18Files/2018BO.pdf
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