The Social Security Disability Appeals Process
My SSDI claim was denied, now what do I do?
If your disability claim was denied you should consider filing an appeal.
Author Attorney Lloyd Bemis:
If your application for Social Security Disability Income was denied, you are not alone.
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, lack of medical evidence, failing to include important information, not keeping up with prescribed medical treatments, or earning too much money. Some people will give up pursuing their claim when their claim is first denied while others will file a new claim, but neither of these choices is a good idea. Denial of your claim does not mean you are not disabled and you should consider appealing. Half the applicants who pursue their claim on appeal are approved for benefits in the future. Re-applying will only delay the process and chances are you will be denied again.
An applicant has 60 days after receiving a notice of denial to appeal their case.
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 way to appeal a case is by filing online at www.socialsecurity.gov/disability/appeal.
There are four levels to the appeals process. Each level must be completed before continuing to the next step in the sequence.
- Request for Reconsideration
- Request for a hearing before an Administrative Law Judge (ALJ).
- Appeals Council review.
- Federal Court review.
1. Request for Reconsideration.
By submitting a Request for Reconsideration, an applicant 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. 10-15% of all requests for reconsideration are granted benefits. If a claim is denied again, the applicant will receive another letter like the first denial notice stating why the claim was denied. The next level of appeal is requesting a hearing before an Administrative Law Judge.
If you have been denied disability don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.
2. Hearing before an Administrative Law Judge (ALJ).
If an applicant’s Request for Reconsideration is denied and they want to pursue their claim, they must request a hearing before an ALJ within 60 days of receiving the denial notice.
ALJs 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. Approximately 50% of applicants who take their cases to an ALJ win approval on appeal and begin receiving SSDI benefits.
3. Appeals Council.
If an AJ does not grant a claim, the applicant can request that the Appeals Council review their case.
The Appeals Council’s responsibility is not to evaluate the merits of an applicant’s disability claim, but to review a case for legal or procedural errors in the ALJ’s decision and whether it was supported by sufficient evidence. The Appeals Council can also dismiss a case if an applicant files late, requests a dismissal of their case, or dies. An applicant has 60 days from the date of the ALJ’s decision to submit a request for review to the Appeals Court. The request must be in writing using Form-HA520.
The Appeals Council selects which cases to review and can:
- Issue a new decision, granting benefits in a case. This occurs only 3% of the time.
- Return the case to the ALJ for a new decision. The Appeals Council found a technical error in the ALJ’s decision and means you will have another hearing before the ALJ. This occurs approximately 22% of the time.
- Deny the Request for Review. The Appeals Council will not grant benefits and will not send your case back to the ALJ for another hearing.
It takes the Appeal Council a long time to evaluate a case, the average period being 345 days.
If the Appeals Council denies a case, the applicant 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 represented by an attorney, you will certainly need to obtain legal counsel at this point. Federal judges hear SSDI cases without juries. The responsibility of the federal judge is to review a case for legal errors, but many judges rule on 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 Social Security Administration 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.
What happens if the Social Security Administration terminates my benefits?
From time to time, the Social Security Administration reviews cases of claimants who are receiving disability benefits to confirm they are still disabled and qualify for SSDI. This is known as a continuing disability review or CDR. Social Security may decide to terminate a claimant’s benefits if it finds that the claimant’s condition has improved and they are now able to work, or the claimant has failed to cooperate in the CDR process. If your benefits are terminated, you may appeal the decision by requesting a Reconsideration of Continuing Disability Review at a hearing before a disability hearing officer (DHO). Your case will be reviewed a second time by a different DDS medical consultant and examiner before it is sent to the DHO. DHOs are permitted to form their own opinions about a claimant’s physical and mental condition and there is a chance that a decision to terminate benefits could be reversed. Social Security must provide evidence that your disability has improved significantly and must consider a treating doctor’s opinions as to your work-related limitations. If your claim is denied, the next step would be to request a hearing before an ALJ.
Will my disability benefits continue while I appeal?
In some circumstances an applicant may ask Social Security to continue paying their benefits while Social Security reviews their case and makes a decision. For example, when a claimant appeals a decision that they are no longer disabled, or a decision that the claimant is 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 eventually denied, you must pay back any money you were not eligible to receive.
When should I contact a disability attorney?
It’s never too early or too late to hire 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. 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.
If you have already received a denial, your chances of approval are increased significantly if you have legal representation.
At the request for reconsideration and hearing levels, an attorney can collect and submit relevant medical evidence, obtain doctors’ opinions, draft a brief to the ALJ, and prepare you for questioning by the judge. An attorney can also elicit helpful testimony from you and cross-examine vocational and medical experts, demonstrating your inability to work. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied.
Appealing an SSDI case can be a long and confusing process – but is still a very worthwhile effort.
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Lloyd Bemis has been practicing law for over 35 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Bemis obtained dual board certifications from the Texas Board of Legal Specialization. Lloyd is admitted to practice in the United States District Court – all Texas Districts and has argued before the U.S. Court of Appeals, Fifth Circuit. Mr. Bemis is a member of the Travis County Bar Association. He has been active in the American Association for Justice and is a past Director of the Capital Area Trial Lawyers Association. Mr. Bemis and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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