If your disability case is initially denied, it may leave you feeling defeated. However, there are several steps you can take to appeal a decision by the Social Security Administration (SSA) that doesn’t go in your favor.
A denial puts you in the company of many others who apply for disability benefits—estimates show that the SSA denies between 60 and 70 percent of applications at the initial claim.
A majority of those who apply must go through an appeals process to further pursue benefits.
Yet, those who go through the first stage of appeal face an even higher percentage of unfavorable outcomes.
Appeals often go through multiple stages and hearings.
From the SSA’s perspective, a denial can come for many reasons, such as their assessment of the severity of your condition, your ability to work, your income, or insufficient medical documentation.
However, that doesn’t mean you shouldn’t appeal. Most disability case decisions for SSI or SSDI benefits must be appealed to reach a favorable outcome.
In many cases, consulting an experienced disability attorney can help. The right lawyer will be able to guide you through each step and act as an advocate on your behalf.
We will discuss this, as well as all the steps after a denial, below.
First, let’s take a look at your claim denial.
A claim denial notice will include details about your case, which can act as a road map for how to approach your appeal process. For instance, if you were denied based on a specific lack of medical evidence, providing this evidence would become a crucial component of future appeals.
The SSA should send you a claim denial notice that includes:
- The condition or disability that was under consideration
- A list of your medical records and related documents
- An explanation of why you were denied
A denial may also include a technical rationale that discusses the SSA’s detailed assessment of medical considerations and your ability to perform certain types of work tasks, referred to as “residual functional capacity” (RFC).
If your notice doesn’t include this rationale, you should request it, as well as your entire disability file, by calling your local Social Security field office.
Once you receive a claim denial notice, you typically have 60 days to appeal.
Disability Case Appeal, Step 1: Reconsideration
Once your initial application for benefits is denied, you can immediately request a medical reconsideration or nonmedical reconsideration online.
These online applications can also be used to request a hearing with an administrative law judge (ALJ) in the next step, discussed below.
This is essentially a request for a second review by someone who didn’t make a determination in your initial claim. It includes any evidence you’ve already submitted, plus any new evidence you send them.
Since this reconsideration also comes through the SSA, your chances of winning a reconsideration are low. It’s estimated that nearly 90 percent of people are denied during this stage of the appeals process.
The status of this, and future appeals, can be checked via your my Social Security account.
Disability Case Appeal, Step 2: Hearing by an Administrative Law Judge
Typically, this hearing will take place before an administrative law judge who has no prior connection to your disability case.
There may be some minimal travel involved to attend this hearing, as it will usually take place within a 75-mile radius of where you live.
However, if traveling is a hardship, you can also request an online hearing.
You will be sent a confirmation package that explains the hearing process. It also includes a form for you to opt out of a potential video (VTC) hearing, if you prefer an in-person hearing.
This stage of your appeal gives you perhaps the greatest chance of winning your benefits. As opposed to other levels of appeal, Administrative Law Judge hearings see nearly 50 percent of claimants win their cases.
Unfortunately, it can take anywhere from six months to several years for a hearing, although agreeing to a potential VTC hearing may reduce that wait time.
Disability Case Appeal, Step 3: The Appeals Council and Federal Court
You may request an appeal by the Appeals Council online.
However, unlike earlier stages of your appeal, the Appeals Council can outright deny your request if it feels your hearing decision was supported by the evidence, in accordance with Social Security law and regulations.
If they review your claim, they may do so themselves or send it to an Administrative Law Judge who hasn’t yet reviewed your claim.
If the Appeals Council doesn’t rule in your favor, you must take your case to federal court within 60 days of the decision.
You can request a federal hearing by calling 1-800-772-1213 (TTY 1-800-325-0778) or contacting your local Social Security field office.
At this level, a federal district court judge will rule on your claim. This can be a lengthy process and may include a filing fee, though in some cases this fee can be waived.
This is the highest level of appeal possible for your disability case.
How an Attorney Can Help with your Disability Case
An attorney experienced in disability law will be able to help you during each step of your case appeals process, as well as your initial application.
Filing a claim can be a journey that is long, complicated, and at times, discouraging. Your attorney can act as an advocate on your behalf, communicating with the SSA and helping you build a strategy to maximize your chances of winning your benefits.
Whether you succeed at each stage of appeals depends on navigating the expectations of the SSA, as well as local and possibly federal judges, and having current knowledge of laws and regulations. Although there’s never a guarantee, your attorney can use their knowledge of these subjects to guide you toward a favorable outcome.
An initial consultation with disability attorneys at Affleck & Gordon is completely free.
Depending on your case, you may not have to pay a legal fee until the conclusion of your case. If this is true for you, the fee is limited to 25% of the past-due benefits you are awarded, up to a maximum of $6,000. Note that the attorney will be paid only out of your past-due benefits, or “back pay.” If no back benefits are awarded, the attorney will not receive a fee.
If your Supplemental Security Income claim or your Social Security Disability Insurance claim has been denied, or you’re thinking about filing and don’t know where to start, Affleck & Gordon can help. We’ve been helping people in Georgia just like you for over 45 years. Sign up for a free case evaluation here, or call us (404) 990-3945.