Some of you must go through four appeal levels (three administrative stages plus filing a lawsuit in federal district court) before the Social Security Administration (SSA) allows your disability claim.
This article answers questions about the first appeal stage in the administrative review process – asking the SSA to reconsider a decision it made on your initial application for Social Security Disability Insurance (SSDI) benefits or Supplemental Security Income (SSI).
It aims to explain your options when dissatisfied with the SSA’s determination on your disability application.
Keep reading to learn more about Social Security law.
And don’t hesitate to call me if you want help from a top-rated disability attorney: (804) 251-1620 or (757) 810-5614. My law firm wants to help you get the money and medical coverage you need to improve your quality of life.
The SSA defines reconsideration as follows:
A reconsideration is a complete review of your claim by someone who did not take part in the first determination. We will look at all the evidence used in the first determination, plus any new evidence that we obtain or that you submit.
The Social Security Administration will send you a letter explaining its decision on your disability claim.
Under the Social Security Act (42 U.S. Code Section 405(b)(1)), any decision denying a disability application in whole or in part must contain a statement of the case discussing the evidence and why the SSA denied the claim.
This denial letter will include boilerplate (generic) language, as found in every letter denying disability benefits. However, at least one paragraph should explain the SSA’s findings about your medical condition. These statements provide clues about why Social Security denied your claim.
If you disagree with the SSA’s decision, you can (and usually should) ask the SSA to look at your case again (i.e., reconsider the facts and law).
The time limit for requesting reconsideration of SSA’s initial decision on your disability application is 60 days from the date you received the decision.
But mail delivery times vary. And there could be a significant delay between the date the SSA sends the unfavorable decision and when you receive it.
Therefore, the Social Security Administration has created a presumption that disability claimants receive mailed decisions within five days of the decision date.
So in effect, you have 65 days to file a request to reconsider the initial disability determination.
20 Code of Federal Regulations Section 404.909 explains how to request reconsideration of an initial determination.
You must submit a written request for an appeal using either the paper-based appeals process or SSA’s electronic system.
You may submit a written request for reconsideration by mail or in person at one of Social Security’s local field offices.
Although the SSA’s rules do not require you to use a specific form to request reconsideration, I recommend using Form SSA-561, entitled “Request for Reconsideration.”
This form asks for the following information:
In addition, I recommend submitting an updated Form SSA-3441-BK, entitled “Disability Report-Appeal,” when requesting reconsideration of the initial decision. This form asks about the following:
You may submit a written request for reconsideration using the SSA’s electronic appeal option.
To do so, visit this web page and follow the prompts.
The Social Security Administration contracts with Disability Determination Services (DDS), an agency of the state government, to process and decide your Social Security disability claim at the initial and reconsideration stages.
When DDS has your initial application, a disability examiner (like an insurance claim adjuster) and a medical doctor employed by the state agency review your case and make a medical decision. Then the SSA adopts this finding.
If you request reconsideration of this initial decision, your case returns to DDS, where a different group than the one that issued the unfavorable determination will make the reconsideration decision.
Yes, I recommend building and developing your case while waiting for a decision at the reconsideration stage and then submitting this evidence to DDS and the SSA.
Although DDS and the SSA deny most claims at the reconsideration level, some get approved.
Therefore, you should do everything you can to strengthen your disability claim.
You have several options to increase your likelihood of success at the reconsideration and hearing levels, such as the following:
In addition, beware that the SSA may hire private investigators to conduct surveillance (to see if you are faking your disability) or ask you to attend a consultative examination (CE).
If the SSA schedules a CE, I recommend taking a family member or friend with you to witness what occurs. Unfavorable CE reports run rampant; you may need this person’s hearing testimony to attack the report’s contents.
Further, write down everything you remember about the CE examination when you leave the office. And send a copy to your attorney or, if unrepresented, to the SSA. This will serve as real-time (contemporaneous) evidence of why an unfavorable CE cannot be trusted.
Unfortunately, the SSA awards a low percentage of disability claims at the reconsideration level. So instead, you will likely get the same result you received at the initial stage.
In Fiscal Year 2022, for example, disability applicants requested reconsiderations in 459,925 cases.
But the SSA allowed benefits on reconsideration in only 15% of those cases.
These statistics and anecdotal reports of few clients receiving favorable determinations on reconsideration are why many disability lawyers find the reconsideration stage a waste of time. However, you must request reconsideration and complete this stage to get a hearing before a judge, where the success rate increases.
Patience goes a long way when your case is at the reconsideration level.
On average, you will likely have to wait three to six months for a decision. But unfortunately, I have seen the length of time claims stay pending with DDS for reconsideration grow since the COVID-19 Pandemic.
I recommend following up with DDS and the SSA once per month to ask for a status report.
Missing the deadline for submitting a request for reconsideration may force you to start over with the application process, costing you months of benefits and several hours of wasted time.
But there is a way to overcome a late disability appeal: showing good cause for extending the time limit.
The SSA will find you have good cause for failing to file a request for reconsideration timely if:
The SSA will review the evidence in your case and decide if you are disabled based on the preponderance of the evidence (i.e., whether the evidence shows that you are more likely than not disabled). Then it will send you a letter stating its decision.
If your case is approved, great! If not, the reconsideration denial will state the specific reasons for the determination and tell you of the right to a hearing before an administrative law judge (ALJ).
The reconsideration determination is binding unless you or your attorney request a hearing before an administrative law judge within 60 days of the date of the reconsideration denial. I recommend asking for a hearing in all cases.
Yes.
The SSA allows disability attorneys and qualified representatives to represent claimants at any stage of the administrative review process.
Requesting reconsideration is the best option in every case I have reviewed.
Submitting a new application puts your case in front of DDS again and forces you to start over, potentially costing you several months of SSDI or SSI benefits if you get approved at a later stage.
Have a question about your legal rights under the Social Security Act?
Need help getting approved for SSDI or SSI benefits?
Call me at (804) 251-1620 or (757) 810-5614. See why past clients and current colleagues have voted me one of the best disability lawyers in Virginia.