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Different Disability Decision Process in Ten States

Updated January 1, 2003

The Social Security Administration ("SSA") began testing a new process for deciding disability claims in ten states in October 1999. The testing process continues. 

SSA calls the new process the "disability redesign prototype," and calls the ten states "prototype states." 

The ten prototype states are: Alabama, Alaska, California (Los Angeles North and West areas), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York (Brooklyn and Albany areas), and Pennsylvania.

In prototype states, claimants who receive unfavorable initial decisions from SSA may appeal directly to federal Administrative Law Judges (ALJs). The intermediate "reconsideration" appeal step* which exists in other states, no longer exists in the prototype states. 

For almost three years, until June 2002, SSA would notify claimants in prototype states if the agency was intending to deny the claim. SSA made no final decision until the claimant received this notice. This gave claimants a last chance to provide any evidence that might be missing from the SSA file, or to correct errors, and avert an unfavorable decision. Last June SSA announced that it no longer will give the warning. See the Federal Register, June 24, 2002, p. 42594

The change means that claimants in prototype states should be careful to check with their state disability determination services ("DDS") every few weeks to assure that all available medical evidence has arrived and is in their files. Specifically, they claimants should ask decision makers whether all their medical providers have provided documentation and whether the documentation is the correct kind. SSA offices can provide telephone numbers for state DDSs.

This precaution - checking with disability decision makers periodically - is advisable in all states, but especially in prototype states where there is one less opportunity to appeal unfavorable rulings.

* "Reconsideration" is a relatively fast review by the same state agency that issued the initial decision. This appeal is available in most states, but not the ten prototype states. 

[Physicians' Disability Services, Inc.]
Pds-Third Floor Publishing, LLC
Douglas M. Smith, Editor

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Last Revised Tuesday, April 13, 2004, 5:50 PM EST

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