consisting of a medical or psychological consultant and a lay disability examiner.
Reconsideration—Reconsiderations of initial disability determinations are also processed by the state DDS, but by a different adjudicative team than the one that made the initial decision.
Hearing—Hearings on disability cases are conducted by administrative law judges (ALJs), who are appointed by the associate commissioner for hearings and appeals. There are about 1,100 ALJs located in 144 hearings offices distributed around the country. The claimant may personally appear at the hearing and can bring witnesses. He or she may also submit new evidence and review the evidence used in the decision. The ALJ may also ask other witnesses to appear. For example, the ALJ may ask for testimony from a medical or vocational expert, and does so in about 12 and 46 percent of the hearings, respectively (SSA, 2005b). The ALJ makes the hearing decision based on the evidence and testimony presented.
Appeals Council Review—A claimant may request review of an ALJ disability decision by SSA’s Appeals Council. Administrative appeals judges (AAJs) on the appeals council will grant such a request for review only in specific circumstances. Otherwise, the ALJ’s hearing decision becomes SSA’s final administrative decision in the case.
After completing all steps of the administrative review process, if a claimant is still dissatisfied with SSA’s final decision, he or she may ask for judicial review by filing a civil lawsuit in federal district court.
For every 100 disability claims decided in FY 2005, DDSs allowed about 36 at the initial decision step. Of the remaining 64, about 22 appealed for reconsideration. DDSs approved about 3 of the 22 reconsiderations and denied about 19, almost all of whom filed a second appeal requesting a hearing before an ALJ. ALJs approved about 12 and denied about 7, 3 of whom filed a third appeal requesting review by the appeals council. The appeals council approved 1 and denied 2 (see Figure 4-1).
The process used for making a disability decision is the same, regardless of the level at which the decision is made in the administrative review process (initial, reconsideration, hearing, or appeals council review), and regardless of the specific personnel or components involved (a disability examiner/medical consultant team in a DDS, ALJ in a hearing office, or AAJ at the appeals council).
Under the Social Security Act, an individual is considered to be “disabled” for Social Security purposes if he or she is unable “to engage in