The Social Security Disability Appeals Process

The Social Security Disability Appeals Process

My SSDI claim was denied, now what do I do?

67% percent of claims for disability benefits are denied when initially submitted.

Applications for SSDI can be denied for a number of reasons – filling out a form incorrectly, incomplete medical documentation, not enough work history, not keeping up with prescribed medical treatments. After being denied, many people just give up all together or maybe reapply again at a later date. Neither of these choices is wise. Denial of your initial application does not mean you are not disabled. Re-applying will only delay the process and chances are you will be denied again.

You should strongly consider filing an appeal.

Half the applicants who appeal their denial are approved for benefits in the future.

You will have 60 days to request an appeal after receiving your denial letter.

The request must be in writing. An applicant may also call the Social Security administration and request an appeal form (Form SSA-561). The fastest and perhaps easiest way to appeal a case is by filing online at www.socialsecurity.gov/disability/appeal. If you have gone past your 60 days, do not worry; you can still file a “Request for Reconsideration” but you will need to submit a written statement describing a good cause for filing late. If you do not have a good reason, you can file a new claim immediately, but this will significantly impact your possible approval timeline.

1. Request for Reconsideration.

The first step you need to take is to submit a Request for Reconsideration within 60 days of receiving the denial notice.

In this step an applicant simply asks the Social Security Administration to completely review their case again. This review is performed at Disability Determination Services (DDS) by a medical consultant and examiner who had no part in reviewing the initial claim. Only 10-15% of all requests for reconsideration are awarded benefits, but there is a chance for approval. Fresh eyes on your case can make a difference. If your claim is denied again, you will receive another letter like the first denial notice stating why the claim was denied. A denial at this level is not unlikely and you will most likely need to move to the next level of appeal, which is requesting a hearing before an Administrative Law Judge.

2. Hearing before an Administrative Law Judge (ALJ).

If your Request for Reconsideration is denied, you may request a hearing before an ALJ, but you must do it within 60 days of receiving the denial notice.

Administrative Law Judges are attorneys who work for the Social Security Administration Office of Hearings and Operations. They review SSDI cases and either uphold or overturn decisions to deny SSDI benefits or terminate disability benefits. This step is your best chance to win your claim as approximately 50% of applicants who take their cases to an ALJ win approval on appeal and begin receiving SSDI benefits. This opportunity is not to be taken lightly, and you will need to appear at the hearing either in person, via videoconference, or telephone to present your case to the ALJ. Understanding exactly what the court is looking for, and presenting your claim in a favorable light can be very challenging, and being represented by a dedicated disability advocate would be an advantageous choice for anyone at this level of appeal. You certainly don’t need to hire our attorneys, but you should strongly consider finding someone to help you at this point. This is your best chance to secure the financial assistance you are seeking.

3. Appeals Council.

If your claim gets denied at the ALJ hearing, you can request that the Appeals Council review their case.

The primary duty of the Appeals Council is not to assess the merits of an individual’s disability claim, but rather to examine the ALJ’s decision for any legal or procedural mistakes and determine if there was enough evidence to support the judgment. The Appeals Council can also dismiss a case if an applicant files late, requests a dismissal of their claim, or dies. You have 60 days from the date of the ALJ’s decision to submit a request for review by the Appeals Council. You must file the request in writing using Form-HA520.

It typically takes the Appeals Council a long time to evaluate a case; the average period being 345 days.

If your claim gets denied by the Appeals Council, you will then have 60 days to file an appeal in U.S. District Court.

4. Federal Court Review.

The final step in the appeal process is filing suit in U.S. District Court.

If you are not already represented by an attorney at this point, you certainly need to obtain legal counsel for a suit in U.S. District Court. Federal judges hear SSDI cases without juries. The responsibility of the federal judge is to review a case for legal errors, but judges can rule on certain factual questions. Very few decisions by ALJs or the Appeals Council are reversed at the district court level. Instead, many federal judges remand (or send back) cases to the Social Security Administration, stating that the SA did not consider a doctor’s opinion sufficiently, or an applicant’s pain or other symptoms, or the agency should have requested assessments from treating doctors. Though there is a fair chance of winning a case at this level, lawsuits are expensive and time consuming. Not all disability attorneys are willing to go to court and less than 1% of SSDI applicants pursue their claims that far.

Can I appeal the decision if the Social Security Administration terminates my benefits?

The SSA will periodically review individuals currently receiving disability benefits in order to verify their continued disability status and eligibility for SSDI. This is known as a continuing disability review or CDR. Social Security may decide to terminate your benefits if it finds that your condition has improved to the point that you are capable of working. It may also terminate your benefits if you fail to cooperate with the review process. If they decide to terminate your benefits, you can appeal the decision by requesting a Reconsideration of Continuing Disability Review at a hearing before a disability hearing officer (DHO). Your case will once again be reviewed by the Disability Determination Services (DDS) before it is sent to the DHO. DHOs are permitted to form their own opinions about your physical and mental condition and there is a chance that they will reverse the termination of your benefits. If your claim is still denied, the next step would be to once again, request a hearing before an ALJ.

Will my disability benefits continue while I appeal?

In some circumstances you may ask Social Security to continue paying benefits while they review your case; for example, when a claimant appeals a decision that they are no longer eligible for SSDI benefits. If you want benefits to continue, you must contact the Social Security Administration within 10 days of receiving Social Security’s letter stating that your benefits are terminated. Note that in the event your appeal is denied, you will have to pay back any money you were not eligible to receive.

When should I contact a disability attorney?

It’s never too early to contact a disability attorney. An experienced disability attorney can evaluate your case and help you file your claim, gather medical evidence, and obtain medical tests and necessary documents. They will know what is required at each step of the process, keep track of deadlines and be able to present your case in the best possible light. Additionally, a disability attorney can help determine if you are eligible for a fast-track decision. Under certain circumstances, such as a terminal illness or extreme poverty, Social Security will shorten the claim processing time.

Appealing an SSDI case can be a long, frustrating process but can potentially be a very worthwhile effort to obtain the financial assistance you rightfully deserve.