Understanding the 2018 FY SSA Waterfall Chart

Legally Reviewed and Edited by: Terry Cochran

The SSA Waterfall Chart is an excellent point of reference for both citizens and social security lawyers. The yearly report provides information on the approvals and denials in the different stages of the Social Security Benefits application process.

Initial Level

The majority (65%) of claims were denied, and only 35% were approved.

What happens during the initial level?

• Filling out application
• Complete a work history report
• Fill out a disability report
• Attend a consultative exam

After all these steps have been completed, the SSA will assess your file and make their first decision. If you are part of the small group that receives an approval during this stage, you will usually have to wait between one and two months before you receive your first benefits check. If you were denied, you can request to be reconsidered and move onto the next stage.

Reconsiderations

The reconsiderations level garnered even fewer approvals than the previous level, with 87% of cases being denied. Just over 10% of claims were approved in this stage in 2018.

What happens during reconsiderations?

• Submit a Request for Reconsideration
• Re-submit disability report with any new information
• A new examiner will make the final decision

Administrative Law Judge Hearing

Of the 562,452 claims present in this stage in 2018, the majority of 45% were approved. 35% were denied, and 21% were dismissed. The hearing stage is historically the most “successful” for applicants. Cases are dismissed if the appeal was not filed within the 60-day limit.

If you are worried about filing paperwork on time, it may be to your benefit to immediately hire a social security benefits lawyer to take over the process for you. An experienced attorney can also take over submitting new and convincing evidence of your disability leading up to the hearing.

Whether or not you have a lawyer fighting for your case, you should consider bringing along a vocational expert witness to your hearing who can assess the extent of your disability and whether or not there exists employment opportunity in light of your disability.

What happens during the hearing?

• A judge will question you, and if applicable, your witness
• A judge will provide a written decision following a thorough study of the evidence

A hearing can take place in-person or by video teleconference. However, keep in mind that due to the varying volume of claims in this stage, it could take some time before your hearing is scheduled.

In case of a denial, your case will move onto the appeals council.

Appeals Council

Only 1% of claims were allowed, 4% were dismissed, 10% remanded (returned to an Administrative Law Judge for further review), and 85% denied.

Exactly like after the reconsideration level, you will have 60 days to file your request to have your claim reviewed by the Appeals Council after receiving the judge’s verdict. You do not have to appear in front of the Appeals Council.

What happens during the appeals stage?

• You or your representative files the request
• Appeals Council accepts or denies the request to review
• If accepted, they will review your claim and make a final decision

Federal Court Decisions

In the final stage of the claims process, only 2% of cases ended with the claimant receiving benefits. Eight percent of claims were dismissed, 48% remanded, and 42% denied.

Again, if you are denied in the previous stage, you have 60 days to file the civil action in the district court nearest you.

The statistics harvested during the last calendar year of Social Security claims are largely reflective of the general process. Most people will see a denial within the initial, reconsideration, and appeal council stages. Denials are a common part of the social security benefits process. If you or a loved one has attempted to go through the process alone and it ended with a dismissal, contact a social security lawyer near you.

Cochran, Kroll, & Associates, P.C. has some of the top social security disability lawyers in Michigan. If you would like to receive a free consultation, contact us at 866-MICH-LAW.

Disclaimer : The information provided is general and not for legal advice. The blogs are not intended to provide legal counsel and no attorney-client relationship is created nor intended.