Social Security Disability Insurance: the ALJ hearing

Social Security Disability Insurance provides disability insurance benefits to people who are disabled from working and otherwise qualify for this federal program. It is not uncommon for the initial application for SSDI to be denied by the Social Security Administration, the agency that administers the program.

The appeals process

When a claim for SSDI is denied, the applicant may request reconsideration, which is essentially a paper review of the first decision. If the claim is again denied at reconsideration, the next step of review is to ask for a hearing before an administrative law judge or ALJ, who is an employee of the SSA. ALJ hearings are similar to court hearings, but are conducted by the agency.

The ALJ hearing

The ALJ hearing is less formal than court and the rules of procedure and evidence are more relaxed. However, the hearing will be recorded.

Hearings are conducted in hearing offices or in more remote locations that the ALJs travel to for the convenience of the claimants. Sometimes it is possible to request travel expenses from the SSA if the hearing is more than 75 miles from the claimant's home. Another alternative is to hold it via video teleconference.

At the hearing stage, all of the medical and other paper evidence will be reviewed by the ALJ and new or updated evidence may be submitted. New evidence submitted to the ALJ before the hearing may allow him or her to decide the case favorably, making a hearing unnecessary.

Witness testimony

If the hearing goes forward, the ALJ will have the claimant testify about his or her disability, its symptoms and the limitations it causes. The ALJ may ask questions and if the claimant has an attorney, he or she will also examine the claimant to bring out important information that the ALJ may not.

Other witnesses can include family members or friends who have observed the functional limitations caused by the claimant's disability. Sometimes the ALJ will call a medical expert to testify about the medical records or the claimant's conditions, or a vocational expert to talk about how the claimant's disability may limit him or her in work activities and whether significant numbers of jobs exist in the community that the claimant could do considering the disability and other relevant factors like age, education and vocational experience.

The claimant's lawyer can be particularly important if an independent expert is called because the lawyer will ask appropriate questions of the experts, including whether the expert is qualified to express an opinion in the case and whether he or she is considering all aspects of the claimant's condition and other relevant factors.

Next steps

The ALJ will issue a written decision based on the testimony and the written record. If the decision still does not grant benefits, the claimant may appeal to the SSA Appeals Council. If the Appeals Council still denies the claim, that denial is considered the final decision of the agency and may be appealed for review to the local U.S. District Court and through the federal court appeals process.

Legal counsel

It is always a good idea to consult with an experienced SSDI attorney for representation before the SSA because the lawyer will know the procedures, deadlines and intricacies of the applicable laws, as well as how to develop the medical record and present the claim favorably for the claimant. Legal representatives in SSDI claims do not charge legal fees; rather, attorney's fees are collected from past-due benefit awards if the claim is successful, or sometimes from the SSA directly.