If your disability claim was denied, understand the social security disability appeal process and which determinations can be appealed.
Was your claim for social security disability benefits denied?
Don’t give up!
Many determinations made by the Social Security Administration can be appealed. If your claim for benefits was denied or you were told your benefits will be reduced or eliminated, chances are you can file an appeal.
Keep reading to learn more about the social security disability appeal process and how to keep fighting for the benefits you are owed.
THE SOCIAL SECURITY DISABILITY APPEAL PROCESS
Fortunately, the Social Security Administration (SSA) allows you to appeal most determinations and decisions made about whether you qualify for Supplemental Security Income (SSI) including if changes are made to the amount of your benefits. If you disagree with a decision, the SSA will look at your case again.
The SSA refers to the decisions and determinations you can appeal as “initial determinations.” There is a process in place with multiple levels of appeal to ensure decisions regarding your benefits are not made lightly.
These are the four levels of appeal:
- Administrative Law Judge Hearing
- Appeals Council Review
- Federal Court
Let’s take a look at what decisions and determinations you can appeal and what each step in the appeals process looks like up close.
INITIAL DETERMINATIONS: WHAT CAN YOU APPEAL?
The SSA calls the decisions they make that are eligible for appeal initial determinations. They include written findings about any legal or factual issue and include (but are not limited to):
- Whether or not you qualify for benefits
- The amount of your benefits
- Whether you were overpaid, by how much, and whether you must repay it
After you file your initial application for benefits, the SSA will mail you a written initial determination. While this may seem confusing, it may not be your only “initial determination.” Anytime the SSA makes a decision about your benefits or payment amount, this is also called an initial determination.
Whenever an initial determination is made, you will be sent a notice. Each time you receive an initial determination, you’ll have a chance to appeal that decision. However, you have to request an appeal in writing within 60 days of receiving your notice.
The notice you receive will contain information telling you how to appeal the decision. It’s important to file an appeal as soon as possible. If you file within 10 days of receiving your notice, you’ll continue to receive benefits at the same amount until a decision is made on your appeal.
The notice you receive will also tell you whether you are entitled to continued benefits. The SSA states that they will help you with your appeal but they also advise that you may appoint a representative to act for you during the appeals process. Now, let’s dive into the steps in the appeals process.
The first step in the appeals process is the simplest. If you disagree with a decision made in an initial determination as described above, you can request a reconsideration.
This is done by either writing to the SSA or filing out Form SSA 561 (Request for Reconsideration) or Form SSA-789 (Request for Reconsideration – Disability Cessation). You can also request a reconsideration on the SSA website.
It’s important to note that you only have 60 days from the date you receive your notice of the initial determination to request reconsideration and you must ask in writing. The SSA assumes that you’ll receive your notice 5 days after it is sent. If you request reconsideration within 10 days of receiving your notice, your payments will continue until a reconsideration decision is made as long as you continue to meet all other eligibility requirements.
Once the SSA makes a decision regarding the reconsideration, they will send you and your representative (if you have one) a notice of the new determination.
Remember that if you are being told you will no longer receive your benefits, you must file an appeal within 10 days to continue receiving your benefits until the appeal is decided. You have the right to a face-to-face hearing with a disability officer.
The SSA has improved the process of checking the status of your appeal. You can find detailed information about your appeal on their website or by speaking with an SSA employee. You can create a personal account to easily access your information on the SSA website.
THE ADMINISTRATIVE LAW JUDGE HEARING
If you don’t agree with the decision made during your reconsideration appeal, you can appeal it as well. You or your representative can request a hearing in front of an administrative law judge (ALJ).
Your or they must write to the SSA requesting a hearing or fill out Form HA-501 (Request for Hearing by Administrative Law Judge). You can file this request online. Just like when you requested a reconsideration, you have 60 days to file an appeal requesting an ALJ hearing.
You can submit any new evidence to the SSA before your hearing that you believe may affect the outcome of your case. If you are appealing a cessation of benefits, you must request in writing that your benefits continue until a decision is made on your appeal within 10 days of receiving your notice.
If you don’t want to appear at a hearing before an ALJ, you can request the ALJ make a decision without your presence. They will make their determination based on the evidence in your file.
If you do want to attend a hearing before an ALJ, you have that right. You can appear in person, by video, or by phone, depending on the circumstances. The ALJ will determine how you are to appear for your hearing. It’s vital to your case that you appear however they decide.
The SSA will provide notice of the hearing date and location at least 75 days in advance. If you can’t attend your hearing, you need to write to the judge as soon as possible explaining why you can’t attend. The SSA states this correspondence must be received no later than 5 days before the hearing or 30 days after receiving your notice of the hearing, whichever is earlier.
The hearing will be informal and will give you the opportunity to present your case and any new evidence. It is highly recommended that you have an experienced attorney representing you during this process. You and your representative will be sent a copy of the ALJ’s decision after the hearing.
THE APPEALS COUNCIL
If you disagree with the decision made by the ALJ, you have yet another opportunity to appeal. You or your representative may request an appeal of that decision by writing to the SSA and requesting an Appeals Council review.
You must complete Form HA-520 (Request for Review of Hearing Decision/Order). You can complete this form online. You have 60 days after receiving the hearing decision to request an appeal.
You may be able to submit new evidence for the Appeals Council to review. The Appeals Council will look at your case and decide whether or not to review it. They may either decide your case themselves or send it back to the ALJ for a new hearing and new decision.
You will be sent a copy of the decision made by the Appeals Council with an explanation as to their decision. If they plan to issue a decision that is not in your interest, they will send you a notice of the proposed action and allow you to respond before making a final decision.
Finally, if the Appeals Council denies your request for review or makes a decision you disagree with, you can file aa civil action with the U.S. District Court in your area. The SSA states that it cannot help you file a legal action and suggests you contact a lawyer.
You have 60 days after receiving your notice of the Appeals Council decision to file an action with the court. The District Court may send the case back to the SSA and order the ALJ to hold a new hearing and issue a new decision or direct the SSA to award benefits.
FILING A SOCIAL SECURITY DISABILITY APPEAL? YOU NEED A LAWYER
As you can see, the social security disability appeals process is complicated. There are many important deadlines and rules to be aware of. Missing one deadline could send you back to the start.
Having an attorney who is experienced with social security appeals on your side will give you the best chance of winning your case. You don’t have to do this alone. Contact us today for a free case evaluation.