Why Is My Disability Claim Taking So Long? The Levels of Adjudication Explained

Originally Published April 10, 2015. Last Revised April 6, 2022.

Anyone who’s applied for Social Security disability benefits has probably wondered why it takes so long for Social Security to make a decision on their case. While it’s easy to chalk this wait up to red tape and a lack of care on the government’s part, this isn’t (usually!) the case. Rather, evaluating a disability claim requires a lot of time and attention in order for the right decision to be made. Here is a brief description of the levels of review at Social Security and the wait time associated with each level of review.

Initial Review

After you complete your application for disability benefits, your case is assigned to a Claims Adjudicator at Social Security. The Claims Adjudicator is the Social Security employee charged with deciding whether to grant or deny your application for benefits. The Claims Adjudicator, with the assistance of your lawyer, will work to gather all of your medical records from your various doctors. Because it often takes a doctor’s office or hospital a month or more to fulfill a request for records, some of the wait time comes from Social Security waiting for your records to arrive so that they can be reviewed. Reading through these documents, which are often thousands of pages, is a time-consuming process that requires great attention to detail.

While the Claims Adjudicator awaits your medical records, you will be asked to complete forms regarding your daily activities, medical symptoms, functional limitations, and past work history, if any. These forms are your first opportunity to explain to the Claims Adjudicator how your health problems affect your ability to simply get through the day let alone hold down a full-time job. Completing these forms to the best of your ability and returning them to Social Security in a timely fashion will help Social Security reach the proper decision on your application in a timely fashion.

The Claims Adjudicator may also ask you to attend a one-time physical or mental consultative examination at the government’s expense. At a consultative examination, a doctor employed by Social Security will evaluate your condition. After this appointment is completed, the doctor who examined you must take the time to write a report, which is subsequently sent to Social Security to be reviewed and considered along with your medical records and any forms you completed.

It usually takes the Claims Adjudicator 3 to 6 months to complete their Initial Review.

Reconsideration Review

If your disability application is denied after the Initial Review, then you have the right to file an appeal – called a Request for Reconsideration – within 60 days of the date of your initial denial letter. Once your appeal is filed, your case will be assigned to a different Claims Adjudicator and Social Security will reconsider their first determination, alongside any new medical evidence, forms you complete, or further exams you may be sent to.

When you file your appeal, you are asked to fill out form SSA-3441. This form asks you if there have been any changes in your condition, any new conditions, and for more information about your treating sources and how recently you may have treated with them. The new Claims Adjudicator will again work alongside your lawyer to gather any and all recent medical records.

Similar to Initial Review, it usually takes the Claims Adjudicator 3 to 6 months to complete their Reconsideration Review.

Attending a Disability Hearing

If your disability application is denied after Reconsideration Review, then you have the right to file a second appeal – called a Request for Hearing before an Administrative Law Judge – within 60 days of the date of your reconsideration denial letter. You will be asked to complete another SSA-3441 when you appeal, and any and all new medical evidence will be added to your file.

At the hearing level of review, the staff at the disability court – officially called The Office of Hearings Operations or OHO – will organize and exhibit all of the evidence in your file in preparation for a disability hearing. Once your file is exhibited, your case will be randomly assigned to an Administrative Law Judge or ALJ (the official name for a disability judge) who will schedule a disability hearing to discuss your application for benefits. By law, you will be given at least 75 days’ notice of the date and time of your hearing. Traditionally, disability hearings took place in-person at your local OHO; however, with the onset of the COVID pandemic Social Security has shifted its focus to holding disability hearings via phone or video. You will have the opportunity to testify, call your own witnesses, and question any witness at your disability hearing.

Currently, it takes between 6 to 10 months after you file your appeal for a disability hearing to be scheduled.

Conclusion

When you’re unable to work and you have no income, you want answers fast so you can be certain of your future. Fortunately, Social Security understands the plight of the disabled person and will make every effort to make a timely determination for you, but it’s not an overnight process. Understanding the process can help you make sense of the sometimes lengthy wait. The wait can be daunting, but taking an active role in making sure Social Security gets all the information they need in a timely manner, such as completing forms accurately and attending scheduled consultative exams, is the best way to ensure your application is decided ASAP.

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