If you were denied benefits when applying for Social Security Disability Insurance (SSDI) or Supplemental Security Insurance (SSI), don’t give up. There are still plenty of doors open for you to appeal the decision and be awarded benefits.
The Social Security Administration (SSA) rejects about 65 percent of first-time applicants and expects them to appeal. SSA provides a four-step process for appeals – Reconsideration; Hearing; Appeals Council; and District Court – where you may present additional evidence, witnesses and updated medical records to resolve your case.
If you are successful at any step along the way, your benefits will start immediately and there is no need to go any further in the appeals process. Unfortunately, only about 10 percent of appeals are approved at the Reconsideration level, but the numbers do improve as you move through the process.
The appeals process can be a daunting task if you are unprepared. The rules and paperwork involved can be very confusing for someone not familiar with the system. Frustration is common while the process plays out, usually taking anywhere from five months to two years or longer.
Individuals can, and sometimes do, represent themselves at the various stages in the appeals process, but it is wise to have an advocate or legal representative assist you. They can help compile the paperwork and document the evidence needed to persuade decision-makers that your case is valid. If your appeal reaches the final stage, District Court, you must have an attorney to represent you.
Some of the information you should have available when appealing at any level includes:
- Your Social Security number, address and phone number.
- Medical records, including any changes in treatment or conditions, name, address and phone number of facilities or hospitals, dates you were treated, changes in medications, who prescribed them and if there are side effects.
- The Notice of Decision or Notice of Reconsideration from Social Security.
- Name, address and phone number of your lawyer or legal advocate, if you have one.
Steps in the Appeal Process
Once you have all of your information together, you can begin your appeal. Here is a look at what you can expect at the various levels of the process:
Reconsideration is the first step in the appeals process. You must complete a Request for Reconsideration form and an Appeal Disability Report to start the procedure. Both forms are available online. They must be submitted either online or to the local Social Security office within 60 days of when you received the letter telling you that you were denied benefits. SSA assigns the case to the Disability Determination Services office in your area, where it will be reviewed. You will be notified by mail whether your appeal was granted or denied.
Some states skip the Reconsideration step and move directly to a Hearing. They include: Alabama, Alaska, parts of California, Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York and Pennsylvania.
If you were denied at Reconsideration, you may request a Hearing before an Administrative Law Judge (ALJ) to appeal your case a second time. This is the where the highest percentage (75 percent) of appeals are granted. The paperwork to request a Hearing is available online and can be submitted online or to your local SSA office. Your request is sent to the Office of Disability Adjudication and Review. If you prefer a face-to-face meeting with the judge, an appointment will be made. It is best to submit all your medical records to the judge before the hearing date so they can be reviewed. The ALJ will notify you of his or her decision by letter.
Appeals Council Review
If you are denied again, you can complete a Request for Review of Decision/Order of Administrative Law Judge that must be submitted to your local SSA office. Your case will be sent to the Office of Disability Adjudication and Review. You must be able to explain how the ALJ erred in his/her decision. You will be notified by letter of the decision.
If you are denied again, you must hire an attorney and have him or her file a case against the Social Security Administration in District Court. You must file within 60 days of receiving the rejection from the Appeals Council Review. Your lawyer will start by filing a brief that explains your position. The SSA will respond with a brief that justifies denying you benefits. Your lawyer will respond, and in some cases, the judge will ask for oral arguments. The judge will make a decision and notifies you by mail.
Why You Need a Legal Advocate
Many factors are involved in the final decision to award or deny benefits. Your chances of succeeding at any of the levels depend primarily on the quality and thoroughness of the documentation you can present. A legal advocate can help you make your case.
Another factor is where you file, and who judges your case. An investigation by the U.S. Senate in 2012 revealed that approval rates in the appeals process varied from 99 percent by a judge in Texas to just 5 percent by a judge one state away, in Oklahoma.
There also is the matter of caseloads to consider. There are approximately 1,500 judges for SSDI appeals, and they decide over 800,000 cases a year. That is an average of more than 500 cases per judge, which means they hear a lot of stories. You want to be sure your story is told and documented well, to give you the best opportunity for a positive result. A legal advocate can help you tell your story.
One other consideration on using legal representation: An attorney can’t collect a fee unless you are awarded benefits. In other words, that attorney won’t get paid unless you win your appeal.