Social Security Appeals Process

Have you recently suffered from a disabling injury? Did you file for a Social Security Disability Insurance (SSDI) or Supplemental Security Income Claim (SSI)? Was your application denied?

If you answered YES to all of these questions, you’re probably looking for the next step. The good news is that our attorneys at Orum Young Law have extensive experience handling clients going through the appeals procedures set by the Social Security Administration (SSA).

The SSA has established a four-stage appeals process for any individual who disagrees with their initial decision:

 

Once you file your application for SSI or SSDI at your local social security office, you can expect to receive a written notice on the initial determination. If your claim was denied, the letter will inform you how to file an appeal and until when you can do so. If you want to know the common reasons behind claim rejections, read the section discussing Common Reasons for Social Security Denials.

Since the appeals procedure is a long and complex battle, it is important to contact an experienced lawyer who will be by your side throughout the process.

STAGE 1: Request for Reconsideration

Description:

Under the first stage, claimants are given 60 days to submit an appeal. If this window is missed, the claimant will need to file a new SSDI or SSI benefits application. If an appeal was submitted beyond the window, it will still lead to an automatic rejection. An exception to this deadline is for circumstances warranting “good cause”, or where the filer can prove an exceptional event occurred which prevented him or her from filing promptly. This includes a sudden illness or being hospitalized.

A medical consultant will then be called in to review the merits of your appeal. This is normally done by double-checking that your condition is included in the SSA’s Listing of Adult and Child Impairment, or if not on the list, proven to be of equal severity as the listed disabilitie

Action Steps:

Write a letter of request detailing the reason behind your appeal.

Form/s Needed: 

  • Request for Reconsideration / Form SSA 561 – if appealing the initial determination
  • Request for Reconsideration – Disability Cessation / Form SSA 789 – if requesting continuation of benefits

Preparation Time: 60 days after receiving the notice on the decisionChances of Winning (self-representation): LOW. The first stage is a major hurdle with the SSA rejecting the majority of reconsideration requests.Chances of Winning (with a lawyer): AVERAGE. A social security disability lawyer can process the appeal faster and more accurately and will help you collect new and convincing evidence to prove that you meet the disability criteria.

STAGE 2: Request for Hearing

Description:

This is the next level in the appeals process should your request for reconsideration be denied. Hearings are done before an administrative law judge who can either award the disability benefits, send it back to the SSA for a review, or give a claim denial. Claimants are evaluated against a judge, vocational expert, or a medical expert.

Although this stage has a higher record of approval, it may take up to a year to have a final decision since the hearing would have to be scheduled.

Action Steps:

Prepare to appear and answer questions before an administrative law judge.

Form/s Needed: 

Request for Hearing by Administrative Law Judge / SSA Form HA-501

Preparation Time: 60 days from the date of denied reconsiderationChances of Winning (self-representation): AVERAGE. Nearly half of applicants who reach this stage of appeal gets approved, provided that they can provide satisfactory answers to the judge’s inquiry.Chances of Winning (with a lawyer): HIGHER THAN AVERAGE. A social security disability attorney will review your file before the hearing, look for new evidence, scout for possible witnesses to support your case, prepare you for the hearing, and may even represent you in court. If you do not want to appear at any hearing, your lawyer will help draft a letter to the administrative law judge requesting to give a decision based on all available evidence in your file.

Our Attorneys Can Help You With Your Claim

Speak with one of our attorneys today and get a free case review. Call (318) 322-6232 and find out what social security benefits you are entitled to receive.

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STAGE 3: Review by the Appeals Council

Description:

If the claimant still disagrees with the judge’s decision, this is the third level of disability review before the Appeals council. Located in Falls Church, Virginia. Unlike Stage 2, only a small percentage of appeals reaching this stage receive approval, and it may take up to a year to reach a decision. Unlike the first two steps, the purpose of this stage of the appeal is to check if the administrative law judge at Stage 2 committed any error when making the decision. Since this looks at procedural errors, those requesting on the grounds of proving disability will likely be disapproved. The council may grant, deny, or dismiss a request for review.

Action Steps:

Submit a request for review on the grounds of a possible administrative error in the previous appeal stage.

Form/s Needed: 

Request for Review of Hearing Decision/Order / SSA Form HA-520

Preparation Time: 60 days after getting the hearing decisionChances of Winning (self-representation): VERY LOW. Chances of Winning (with a lawyer): LOW. Since the purpose of this stage is to examine administrative flaws in the legal process, a  disability attorney will be of valuable service to you.

STAGE 4: Civil Action with the Federal Court

Description:

If the Appeals Council issues a denial of the request, a civil action must be filed with the U.S. district court of your area of jurisdiction. The Court may decide to send the disability case back to the Administrative Law Judge for a new hearing, award the benefits, or dismiss your case. A decision can take up to two years. The highest court that your appeal may reach is at the Ninth Circuit Court of Appeals, where you would have to wait another 2-3 years before the release of the final decision.

Action Steps:

File a civil action with the nearest District Court.

Form/s Needed: 

N/A

Preparation Time: 60 days after receiving written notice of the Appeals Council’s decisionChances of Winning (self-representation): NONEChances of Winning (with a lawyer): LOW. You will need legal aid to represent you in court during this highest stage in the appeals process.

Common Reasons for Social Security Denials

Every year, the Social Security Administration, which handles all claimants’ applications for social security benefits, receives a large volume of requests. In previous years, denial rates have gone to a high of 60% at the initial application stage. 

Since completing the initial application stage could take you anywhere between 3 and 4 months, you want to make sure that your time and efforts are not put to waste. To reduce the chances of being rejected, don’t submit a half-baked application. Make sure to do your research on the rules about social security disability benefits. 

You can visit the resources below to get acquainted with the most important information on social security disability programs.

  • Social Security Disability Insurance (SSDI) Overview
  • Supplemental Security Income (SSI) Overview

When a claim is denied, the filer will receive a written notice detailing how the SSA arrived at the decision. Here are some common grounds for rejection:

  • Insufficient proof of disability.

One of the initial criteria that the SSA judges you for is the severity of the applicant’s disability. If you can’t prove that the disability will last for more than a year, your application will almost certainly get rejected. For instance, your records must have included all details surrounding your condition and how it restricts your ability to gain any willful activity. It must also contain your treatment regimen and how your body responds to the prescribed medical course of action.

If you want to appeal the decision, you must submit additional medical records and a health professional’s opinion as to the prognosis of your condition.

  • Ineligibility for the program applied for.

Although some people may qualify for both the SSI and SSDI, these two disability programs are distinct and cater to different categories. Believing that you can apply for any of the two as long as you have a disability is a big mistake. This is why it is advisable to first consult with a disability lawyer before filing any claim for benefits.

  • Not enough work history.

This reason applies to SSDI benefit applications. Since the SSDI program has been created for disabled workers who have faithfully paid their Federal Insurance Contributions Act (FICA), deducted through their regular paycheck. 

  • A high amount of income or resources.

This reason applies to SSI claims for benefits. Since the SSI program is funded by the U.S. Treasury general funds and not your taxes, it is reserved for the population who have limited income and resources, operationally defined as having a total computation that is not more than the set limit by the SSA and your State. 

Contact An Experienced SSDI and SSI Appeals Lawyer

Attorneys at Orum Young Law have years of experience working with clients in any stage of the SSDI or SSI appeals process. We offer you the following assistance:

  • Help in processing your request for reconsideration
  • Guide throughout the appeals procedures
  • Preparation for hearings
  • Legal representation in court

If you have been denied your disability payment, a social security appeals attorney is your best resource.