There are four levels of administrative adjudication of Social Security claims. They are:
(1) The initial determination,
(2) Reconsideration determination,
(3) Hearing before an administrative law judge, and
(4) Review by the Appeals Council.
If a claim is denied by the Appeals Council, a case may be filed in federal court.
Initial and Reconsideration Determinations
Claims are initiated by contacting the Social Security Administration to make an appointment to file an application. Once the application is taken, the file is referred to a state disability determination service, which is an agency of the state government that has a contract with SSA for determining disability.
If you are dissatisfied with the initial determination, you may appeal. In most states, this appeal is a request for reconsideration. If you request reconsideration, a different adjudicator than the one that issued the initial determination will make the reconsideration determination.If you are dissatisfied with the reconsideration determination, you may appeal by requesting a hearing before an administrative law judge.
The Hearing
At a hearing before an ALJ, you will be given the opportunity to tell the administrative law judge how your impairments affect you. You may present additional medical evidence which may not have been generated after the initial and reconsideration denials. Also, there may be records the state agency didn't get or request which may be relevant to your claim, such as school records or VA decisions. Vocational or medical experts sometimes testify, appearing in person or by video teleconferencing. The hearing is not adversarial in nature. The hearing is recorded and testimony is taken under oath or by affirmation. After the hearing, a written decision is issued by the administrative law judge. If you are dissatisfied with the hearing determination, you may appeal by requesting a review by the Appeals Council.
Appeals Council
At the Appeals Council stage, the decision of the Administrative Law Judge will be reviewed for legal or procedural errors. The Appeals Council will not disturb the findings of fact of the ALJ unless the findings are not supported by the substantial evidence. In other words, the findings must be clearly erroneous. If the Appeals Council declines to review the ALJ decision, a claimant may appeal the case to Federal Court.
Federal Court
The Federal Court has a similar role as the Appeals Council in reviewing decisions. The Court also will only determine whether there was a procedural or legal error in the decision of the Social Security Administration. If a case is denied at the federal court level, an appeal can be taken to a Circuit Court of Appeals. Few cases are appealed to this level. Usually a case is taken to a Circuit Court of Appeals when a claimant is attempting to establish a new legal principle, or where there are conflicting legal theories amongst 2 or more District Courts.
