Virginia disability lawyer explains the Social Security claims system
I have extensive experience as a Virginia disability lawyer having worked with the Social Security disability system in Virginia since 1988. I now handle disability claims for the entire Shenandoah Valley, including portions of Central and Northern Virginia as well as the panhandle of West Virginia.
I have presented many Social Security disability cases before administrative law judges in Richmond, Charlottesville, Roanoke, Baltimore, Morgantown, and Washington, D.C.
I will give you and your disability claim my best personal and professional attention. I promise to provide you:
- Straight answers.
- Honest advice.
- Experienced advocacy.
- Real help.
I often hear from my Virginia and West Virginia disability clients that they are confused by the terminology and procedure of the Social Security Administration. This 100-page website explains a lot about the Social Security system, and I will begin here by showing the general steps in the Social Security disability claim process.
How the Social Security disability claims system works in Virginia and West Virginia
There are four levels of administrative adjudication of Social Security disability claims. If you succeed at any level then your claim is accepted. Otherwise, you may go on to appeal at the next level. The levels are as follows:
- The initial determination. This is performed by a disability analyst and a doctor (or sometimes a clinical psychologist) who work for the Disability Determination Services. In Virginia this is the Virginia Disability Determination Services, with offices in Richmond, Norfolk, Fairfax, and Roanoke. In West Virginia it is the West Virginia Disability Determination Services in Charleston. The decision of the Disability Determination Services is then adopted by the Social Security Administration.
- Reconsideration. Just like the initial determination, this is performed by people who work for the Virginia or West Virginia Disability Determination Services.
- Appeal for an Administrative Law Judge hearing. This hearing is the first opportunity for a face-to-face meeting with the decision maker. The Administrative Law Judge is an employee of the Social Security Administration and he or she will take testimony about your disability.
- Review by the Appeals Council. The Appeals Council is located in Falls Church, Virginia, and it has the authority to review a decision of an Administrative Law Judge.
The difference between the initial disability decision and an appeal
There is a significant difference in the process between the initial determination of a Social Security disability claim and an appeal hearing before an Administrative Law Judge.
Both the initial claim and a request for reconsideration are evaluated by people from the Virginia or West Virginia Disability Determination Services rather than by someone from the Social Security Administration. The people on the reviewing team from the Disability Determination Services look at your claim and your medical records, but they do not take testimony and they do not meet with you. That means that the only opportunity you have to describe your disability is on your written claim form.
At this first level the approval rate is relatively low. Approximately 35% of claims are approved at the initial determination, and approximately 65% are denied. If a claim is denied, the chances of being approved at the reconsideration stage are even lower: only 15% of claims are approved on reconsideration.
In contrast to the Virginia or West Virginia Disability Determination Services determination, when you have an appeal hearing before an Administrative Law Judge you are able to appear in person (or by video teleconferencing). Also, you can bring witnesses and an attorney. Thus, unlike the state disability examiner, who is limited to the written file, the Administrative Law Judge is able to get a much more complete picture of your situation.
Another difference is that the Virginia or West Virginia Disability Determination Services teams tend to apply specific formulas to determine residual functional capacity, and as a result they treat all claimants with similar medical findings the same. Administrative Law Judges take a broader view and are more likely to conclude that a disability results in an inability to work so that a claimant is entitled to Social Security disability benefits.
Appeal beyond the Administrative Law Judge hearing
Most claims end with the Administrative Law Judge hearing. However, if the determination at that point is unfavorable it is possible to appeal further.
The first appeal is to ask for a review of the Administrative Law Judge’s decision by the Appeals Council in Falls Church, Virginia. The Appeals Council may do one of several things. First, it may decline to review the decision. Then, if it does choose to review the decision, it may affirm it, modify it, reverse it, or send it back for a second hearing with an Administrative Law Judge.
If the Appeals Council either declines to review the Administrative Law Judge decision, or review it and affirms it, then it is possible to file a civil action in the United States District Court.
I can help you through both the Virginia and West Virginia Social Security disability claim process
The rules and procedures of the Social Security administration can be complex and frustrating. Experienced and skilled assistance from a lawyer is essential.
If you are not already represented by a Virginia or West Virginia Social Security disability lawyer and want my evaluation, give me a brief description of your claim using the form to the right.
Or you may contact me at my Winchester, Virginia office:
J. David Black
Virginia and West Virginia Social Security disability lawyer
115 South Kent Street
Winchester, Virginia 22601-5051
Toll free: 1-866-538-0568