Four Steps to Filing Your Social Security Disability Appeal

disability appeal

Appealing your denied Social Security disability (SSDI) or Supplemental Security Income (SSI) benefits claim can be frustrating. Since each state’s disability appeal process varies, you may wish to speak to a Social Security advocate or attorney first. An experienced legal representative in your area can give you the best chance of winning benefits from your disability appeal. If you decide to file your own disability appeal with the Social Security Administration (SSA), follow these four steps.

Disability Appeal Step 1: Request for Reconsideration

For most states, submitting a request for reconsideration form (SSA-561) will be the first step to file your disability appeal. This step applies whether your initial application was denied or your benefits were terminated after a continuing disability review (CDR). Any request for reconsideration forms must be submitted within 60 days of your disability claim’s denial by the SSA. If you happen to live in a state that doesn’t require this first step, then skip to the disability hearing stage (Step 2).

Step 1A: Filing A Disability Appeal After the SSA Denied Your Initial Application

Always keep your denial notice from the SSA, since it includes information about your right to file a disability appeal. Find the paragraph that explains why your medical condition doesn’t meet the SSA standards required to receive disability benefits. (You may be asked for this information later on.)

Filing a request for reconsideration always triggers a complete review of your Social Security disability claim paperwork by the SSA. In some cases, your state’s Disability Determination Services (DDS) will review your claim alongside a medical consultant and examiner. However, these will be completely new claim examiners and medical consultants performing your new claim review. This means staff that wasn’t involved in your initial denial will be handling your claim’s reconsideration request. Typically, DDS grants disability benefits to 5-10% of the reconsideration requests they receive.

It’s possible that your claim will be denied again. If so, you’ll receive another denial notice along with an explanation that’s similar to the first one you received. If this happens, move on to the next step in filing your disability appeal and request a hearing.

Step 1B: Filing A Disability Appeal After the SSA Stopped Your Monthly Benefits

The SSA doesn’t assume that you are permanently disabled after approving your initial application for disability benefits. After you start receiving monthly Social Security disability insurance (SSDI) income, expect the SSA to periodically review your disability status. The SSA typically conducts reviews every three or seven years, depending on the timeframe set during your initial claim determination. The SSA may halt your monthly benefits because your medical condition improved, meaning you’re now able to start working again. Failing to cooperate with the continuing disability review (CDR) process may also cause your monthly disability benefits to end.

To appeal your termination of continuing benefits, visit a disability hearing officer in your area and request a reconsideration within 60 days. At this point, you’re technically skipping ahead to Step 2 in the disability appeal process. However, you’ll automatically get a second review by a different DDS or SSA medical consultant and examiner. These representatives have the power to reverse any prior decision to end your monthly disability benefits. If your case is considered “borderline,” you will usually win your disability appeal and keep receiving monthly benefits. But if your appeal is denied, you must move on to Step 2.

Important: To keep getting your previously approved monthly SSDI payments, file your disability appeal within 10 days of receiving your notice.

Disability Appeal Step 2: Request an Administrative Law Judge (ALJ) Hearing

If the reconsideration process fails, request a hearing before an ALJ within 60 days of receiving your denial. Request your hearing as soon as you possibly can, because the SSA is very strict about following disability appeal timelines.

An ALJ is an attorney who works for the SSA’s Office of Disability Adjudication and Review (ODAR). The ALJ must uphold or overturn prior decisions to deny or end monthly disability benefits. Some ALJs also hold hearings that don’t involve Social Security disability issues. For the most part, however, they focus on either upholding or overturning decisions made by the SSA. According to the SSA’s quarterly disposition data, as of March 2017, ALJs grant benefits in about 57% of claims decisions. And of course, some ALJs have a higher number of favorable disability claim decisions than others. Do not skip this step if the SSA denies your claim — it may be your best chance to overturn it!

Disability Appeal Step 3: Request Appeals Council Review

If the ALJ does not grant you benefits, the next step is to request a review by the Appeals Council. This step in the disability appeal process can be quite confusing, and many review requests at this stage are unsuccessful. Because the Appeals Council randomly selects cases for review, your case may not get chosen at all. And if it does, they have the power to grant, deny, or dismiss your request for disability benefits.

If you file your request for an Appeals Council review more than 60 days after denial of your reconsideration, you may be immediately denied. The only instances where they may consider reviewing your case themselves is if:

  • They find an abuse of discretion (for example, your hearing was cut short)
  • The ALJ’s decision was not supported by substantial evidence
  • Your claim raises a broad policy or procedural issue (for example, if the ALJ notifies you that an expert witness will be present at your hearing)

For the most part, the Appeals Council looks for a flawed ALJ decision before granting your claim’s review. In those situations, you still have a very small chance of winning disability benefits from the Appeals Council’s review.

Disability Appeal Step 4: Request a Federal Court Review

Your fourth and final disability appeal option is to sue the SSA in federal district court. Federal judges will hear disability cases without juries and mainly look for legal errors in your application and review process. District court judges reverse denials in less than a third of all appeals cases, but it’s also your last option. It can be an expensive and time-consuming process that still may not get your denial overturned in court. As a result, some attorneys are not willing to sue the SSA.

We’ve summarized every step in the appeals process for you here in our helpful infographic:

Infographic: Four Steps to Filing Your Disability Appeal

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