SSDI and SSI are federal programs, but a Colorado applicant’s medical eligibility may initially be reviewed by Colorado Disability Determination Services, the state agency that makes disability determinations for the Social Security Administration. Later stages of an appeal might involve federal Social Security offices, an Administrative Law Judge, or the Appeals Council.
The Initial Application
The process begins with an application. Applicants are asked to provide information about their medical conditions, doctors, medications, treatment, education, work history, and daily activities. The forms can be time-consuming, especially when someone has seen several providers or held different jobs. Clear and complete information makes it easier for the reviewer to understand how the condition affects the applicant. Missing treatment sources, vague job descriptions, or incomplete explanations of daily limitations may leave important questions unanswered. Providing specific information about symptoms, treatment, daily activities, and work-related restrictions may help the reviewer understand the claim more fully.
Reconsideration
If the initial claim is denied, the applicant can request reconsideration. A different disability examiner reviews the file and may consider updated medical records, treatment information, or other relevant evidence.
Applicants generally have 60 days after receiving a decision to request reconsideration. Because missing the deadline can affect the ability to continue the same claim, the denial notice should be reviewed carefully.
The notice may also help identify whether the claim was denied because of the medical evidence, SSDI work-credit requirements, SSI financial rules, or another issue that may need attention during the appeal. The notice should also provide instructions for requesting the next level of review.
An Administrative Law Judge Hearing
If reconsideration also ends in a denial, the applicant may request a hearing before an Administrative Law Judge (ALJ). This stage gives the applicant a chance to answer questions directly and explain how symptoms affect daily life and the ability to work. The judge may also hear from a vocational expert and, in some cases, a medical expert. Depending on the available procedures and the circumstances of the claim, the hearing may take place in person, by video, or by telephone.
Appeals Council and Federal Court Review
If the ALJ denies the claim, the applicant may be able to ask the Social Security Appeals Council to review the decision. The Council may decline review, issue its own decision, or send the matter back for additional proceedings.
Some claims may later move into federal court. At that point, the focus is generally on whether the correct legal standards were used and whether the decision was properly supported by the administrative record.
