Social Security Disability Insurance Process in California

When you have suffered a disability and cannot work in California, you and your family may suffer more if you do not bring home the paycheck you once did. Social security disability insurance (SSDI) is designed to address this problem. It helps workers who cannot work because of a disability get the assistance they need. The SSDI process, however, may seem daunting, especially for someone already dealing with health issues. 

This is general information only. The LAW OFFICE OF SHANE P. BRADLEY, APC does not represent clients for Social Security Disability Benefits.

Social Security Disability Process in California

Social Security Disability Insurance (SSDI) is a benefit available to certain people that become disabled and are unable to work. However, the process to obtain the benefits available under SSDI can be arduous, lengthy, and time-consuming. In fact, the majority of applicants are denied the first time they apply. The following is a synopsis of the major steps of the SSI process in most states. 

Filing the Initial Application

The first step to filing the initial application for SSDI benefits is to gather the necessary information that you will need to provide to the Social Security Administration (SSA). The more information you provide, the more likely they will not ask for additional information, which can delay your claim. 

• Basic Information. The SSA will want your basic information, including your: 
• Name
• Place of birth
• Name of current and former spouses (if they died or the marriage was longer than 10 years)
• Names and date of birth of your children
• Address
• Phone number
• Employment Information. You must provide the SSA your employment information, including: 
  Where you have worked for the last 15 yearsYour rate of payYour job titlesType of duties you had on the longest job you hadThe date your disability began to affect your ability to work
• Education and Training Information. You must provide your level of education and any special training you have received
• Medical Information. You must provide a list of your medical conditions; dates of examinations, treatments, and tests; names of all medications
• Additional Documentation. Additional documentation will also be needed, including your birth certificate and a W-2 if you have worked in the last 12 months

Once you have gathered the necessary information, it is time to complete the application. This is a three-part process.

1. You can complete the initial application in person at the SSA office, over the telephone, by mail, or online. Online is the preferred method.
2. The SSA will review your application at the state level. 
3. Typically, three to five months later, the SSA issues its decision. The decision can take much longer depending on the circumstances. 

Most initial applications are denied. In fact, only around twenty percent of SSA applications for disability benefits are granted initial awards. The SSA will tell you why your application has been denied. You can then appeal the decision.  

Request a Reconsideration of Denial

The next step is to file a request for reconsideration. Your claim will then be reviewed, from start to finish, by a different examiner and a decision will be made. Some districts will even consider new information at the reconsideration level. This process generally takes three to four months. 

On average, another two percent of applications are approved at this stage of the process.

Request an Administrative Law Judge Hearing

If you still receive an unfavorable decision at the reconsideration level, you have 60 days to request a hearing before an Administrative Law Judge (ALJ). It can take from 6 to 18 months for the hearing to occur, and the ALJ will not have been involved at the initial application or the reconsideration level. 

On average, another five to ten percent of applications are approved at this stage of the process.

Request a Review by SSA's Appeals Council

The next step after the ALJ hearing is an appeal before the SSA's Appeals Council. It is not guaranteed that your request for review will be granted. Even if it is granted, the SSA may decide the case on its own or remand it to the ALJ for further action. 

On average, another five to ten percent of applications are approved at this stage of the process. 

Request a Review by Federal Courts

If the Appeals Council denies your request for review, your only option is to file a civil action in a federal district court. It is the only step in the process where you must have an attorney represent you. 

It is advised, however, that you have an attorney before this step and throughout the entire process. In 2017, the U.S. Government Accountability Office released a Report to the Chairman, Subcommittee on Social Security, Committee on Ways and Means, House of Representatives, that indicated applicants represented by a lawyer throughout the SSDI benefits process were 2.9 times more likely to be awarded benefits than those applicants filing on their own.

Common Challenges to SSDI Benefits in California

There are many reasons why applications for SSDI become derailed. The following are some of the most common. 

• Income. You are permitted to earn a small amount of income while receiving SSDI benefits. Earning more than the mandated amount will result in the denial of a benefits claim. 
• Failure to cooperate with the SSA. You must take certain steps to comply with the SSA requests while the SSA is reviewing your application for benefits. Failure to do so can result in denial of a benefits claim.  
• Failure to cooperate with your physician or medical professional. It is very likely that your physician will require you to attend certain therapies and return for follow-up visits. Unless you have a valid, verifiable excuse for not doing so, you must comply to collect your benefits. 
• Failure to prove a qualifying medical condition. Not all medical conditions will qualify you for SSDI benefits. If you cannot prove that yours is a qualifying condition, then the application will be denied. In fact, 20-30% of applications are denied because their medical condition does not qualify.
• Failure to prove inability to work. It can be difficult to prove that you cannot work, but it is necessary for SSDI. Technical reasons, meaning nonmedical reasons, are the main reason applications are denied. Thirty-five to forty percent of applications result in technical denials.