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Policy: Entitlements

Those denied disability benefits offered long road of appeals

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Local,DC,Maryland,Virginia,Matt Connolly,Entitlements

The Social Security Administration uses a five-question process to determine whether applicants qualify for disability benefits.

The administration asks that applicants say whether they're working, whether or not their condition is "severe," whether their condition can be found on the administration's extensive list of disabilities, if they can do the same work they did previously and if they can do any other type of work.

"If we decide you cannot do the work you did before, we consider your remaining ability to do other work considering your age, education and work experience," said Social Security Administration spokeswoman Terri Lewis. "We assess these factors with your capacity to work to determine if you can be expected to adjust to other work that exists in the national economy."

If an applicant meets those requirements, he or she is transferred to a disability determination service office in his state. Doctors and disability specialists working with the state agency contact doctors and medical institutions where the applicant was treated for details on the condition. The agency uses that information to make a decision.

In 2012, 35 percent of applicants were approved for benefits. That percentage has dropped almost every year for more than a decade as the number of applications soars -- 1999 was the last year in which a majority of applicants were accepted.

Applicants can appeal the decision within 60 days. The first step is reconsideration -- a Social Security Administration official who did not participate in the original process will review prior files plus any new evidence. If the applicant disagrees with that decision, he can request a hearing with an administrative law judge.

If the applicant has no luck at the hearing, he can go further by requesting a review by the Social Security's Appeals Council. Finally, if the council also denies the request, the applicant can file a lawsuit in a federal district court.

While reconsideration can take just a few months, applicants who keep appealing often must wait more than a year for a final decision. Filing a lawsuit will stretch the process even longer. - Matt Connolly

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