If you have found this article, you likely received an unfavorable decision from the Social Security Administration in your disability benefits claim – either a total denial or a partially favorable determination that changes the award date for benefits and reduces your back pay.
Fortunately, the Social Security Act and its regulations allow you to appeal a decision that you disagree with. Appeal is the official term for requesting a review of Social Security’s determination on your claim.
Indeed, Social Security calls the levels of review available to you the administrative review process.
Having to appeal the Social Security Administration’s denial is common. You may have to appeal an SSA denial four times before the SSA changes the decision and awards disability benefits.
This article explains the appeal process for Social Security disability and how to request a review of the SSA determination in your case. I recommend you click the links to learn more about the specific disability appeal stage you are interested in. And then check out my article on how to win an SSDI appeal for more tips.
Read on to learn more about appealing a disability benefits decision.
If you have questions about the process, call (804) 251-1620 or (757) 810-5614 or complete this form to contact one of the nation’s top disability attorneys.
Attorneys (me included) and disability claimants often complain that Social Security’s administrative review process has too many steps.
For example, you may have to go through all four disability benefit appeal levels described below before the SSA allows your claim.
Each level of the appeal process requires you to request administrative review by a deadline; otherwise, you must start over if you cannot show good cause for failing to request a review in time. You may be able to show good cause for filing a late appeal if one of the following applies: you were seriously ill and your illness prevented you from requesting review; the SSA gave you incorrect or incomplete information; you did not receive notice of the initial denial; or there was a death in your immediate family.
Your disagreement with a decision at one level requires you to appeal your claim to the next appeal level.
Completing and filing a Request for Reconsideration is the first step in the appeal process.
You request a reconsideration when you disagree with the SSA’s initial determination in your disability claim.
Last year, Social Security denied 61 percent of the initial applications it reviewed, prompting approximately 468,880 claimants to request reconsideration.
If you disagree with the SSA’s reconsideration decision, you may request a hearing with an administrative law judge.
Although the ALJ hearing is the third step in Social Security’s administrative review, it is your first opportunity to testify in person and argue your case to the SSA.
Last year, the Social Security Administration decided 246,399 disability benefit claims at this appeal level.
If you disagree with the ALJ’s written decision in your case, you may ask the Appeals Council to review the action.
The AC has two options after receiving the appeal.
First, the AC can grant your request for review, reversing the ALJ’s decision or remanding the case to the ALJ with instructions.
Second, the AC can dismiss your request.
The AC decision is the Social Security Administration’s final decision. It is binding unless you take advantage of the fourth opportunity to appeal an unfavorable disability benefits decision.
Last year, the Appeals Council denied or dismissed approximately 86 percent of the 49,080 ALJ decisions it reviewed.
Although the Appeals Council review decision is the last step in Social Security’s administrative review process, you can continue with your claim.
The next step is to appeal the SSA’s determination by filing a civil action with the United States District Court that has personal jurisdiction over you.
You may have success at the federal court level.
Last year, federal courts vacated (set aside the SSA’s decision) and remanded (sent back for the presentation of more evidence) approximately 61% of the 15,710 Social Security cases they decided. Remand is generally appropriate when the ALJ fails to follow the law, or the denial decision lacks substantial evidence to support it.
Our law firm routinely handles disability appeals in federal court and we have obtained numerous remands that led to a benefits allowance.
Maybe not.
For example, many of the disabled adults and children seeking SSI that my law firm represents obtain Social Security benefits at the hearing level and can avoid the Appeals Council and federal district court levels.
At each stage of the administrative review process, you have 60 days from receiving the written decision you disagree with to submit an appeal in writing.
The Social Security Administration assumes that you receive notice of a determination five days after the date on the notice unless you show the SSA that you received it later.
I understand that you may receive the SSA’s decision more than five days after the SSA mails it, especially if you regularly have problems with mail service in your area. Therefore, tell your attorney as soon as you receive the denial. Also, document the date you received the letter, keeping a copy of the envelope. You may need it if you submit an untimely appeal and must show good cause to keep your claim open.
So, you have decided to appeal a Social Security denial.
Now, you need guidance on how to proceed with the appeal.
You have several options:
Yes.
Social Security’s administrative review process is informal and non-adversarial compared to civil litigation (including personal injury lawsuits) and workers compensation cases.
For example, other legal disputes and claims usually have discovery deadlines. If you produce information or helpful evidence after you submit your case or the pretrial discovery deadline, the court may exclude it.
In contrast, you may present new information, medical records, adult function reports, or doctor disability letters at each step of the Social Security appeal process.
No matter what appeal method you choose, I recommend having this information close to you when submitting the request for a review:
Submitting this information with your Social Security appeal increases the chance of changing the denial decision.
If you received a disability denial and want to know if you should request a review of the determination, call my firm at 804-251-1620 or 757-810-5614 or complete our online form.
We are here to help at each Social Security administrative review stage.