If you receive a denial for your Social Security disability claim, you have the option to appeal the decision. It’s important to understand the appeals process to give yourself the best chance of success in overturning the denial.
4 Levels of the Appeals Process
- Request for Reconsideration
- Hearing by Administrative Law Judge
- Appeals Council Review
- Federal Court Review
The Social Security appeals process is made up of four levels, each with its own set of rules, forms, and deadlines. Familiarizing yourself with each level can help you prepare for your hearing.
Why Was My Disability Claim Denied?
When applying for Social Security disability benefits, there are several reasons why your claim might be denied. These reasons can be categorized into medical and non-medical factors.
Medical reasons for claim denial often include insufficient evidence of a disabling condition or a condition that is not severe enough to last 12 months or more. Failure to follow a prescribed treatment plan or a disability resulting from drug or alcohol abuse can also result in claim denial.
Non-medical factors can also lead to a claim denial, such as application errors, fraud attempts, or earning too much money. It’s important to note that there is a monthly income limit for disability recipients, which is updated annually.
The biggest non-medical reason for claim denial is a lack of communication. It’s crucial to keep your contact information up-to-date with the Social Security Administration throughout the process. Failure to do so can result in denied claims simply because the SSA cannot reach applicants.
4 Levels of the Appeal Process
If you disagree with the SSA’s decision on your claim for disability benefits, you have the right to appeal. The appeals process for Social Security disability has four levels, each with specific rules and timelines. Knowing what to expect at each level can help you prepare and create a stronger case for your appeal.
1. Request for Reconsideration
The first step in the Social Security disability appeal process is to submit a request for reconsideration. After your initial claim is reviewed and denied, someone who was not part of your initial review will perform a second review of your case.
Your denial letter will specify why your claim was denied. During the reconsideration stage, the reviewer will evaluate any new evidence that you provide along with your initial claim. If you have new evidence that may help get your claim approved, you can submit it along with your reconsideration request.
All claimants, including those living outside of the U.S., can request a reconsideration online. You must submit your appeal request within 60 days of your claim denial.
If you prefer not to file your reconsideration request online, you can download the appropriate forms and submit them to the SSA via mail, fax, or in person. The forms required for submission depend on the reason for your claim denial.
Denial for Medical Reasons
- Form SSA-561, Request for Reconsideration
- Form SSA-3441 Disability Report – Appeal
- Form SSA-827, Authorization to Disclose Information to the Social Security Administration
Denial for Non-Medical Reasons
- Form SSA-561, Request for Reconsideration
Each form contains instructions to complete and submit to your local Social Security office. You can download the above forms from SSA.gov.
2. Hearing by Administrative Law Judge
If your disability claim is still denied after the reconsideration request, you can move on to the next step of the appeals process, which is a hearing by an Administrative Law Judge (ALJ). The ALJ who will oversee your hearing did not previously review your case.
Hearings can be conducted in person or through video conferencing. The location of the hearing is typically within 75 miles of your residence. If you prefer to have a video hearing, you can attend through the Microsoft Teams app on your computer, tablet, or smartphone. If you have a representative helping you, they must agree to attend through video as well.
During the hearing, you and any witnesses will be asked to take an oath affirming that you will provide truthful testimony. You can explain your case, and any witnesses you bring can provide supporting testimony. The judge will ask you and your witnesses questions, as well as any medical experts present. You can also ask questions of the judge.
You must file your disability hearing request within 60 days of receiving the reconsideration decision.
Complete the following forms to make your written request:
- HA-501, Request For Hearing By Administrative Law Judge
- SSA-341, Disability Report – Appeal
- SSA-827, Authorization to Disclose Information to SSA
- SSA-1696, Appointment of Representative (only if using a Representative)
Submit these forms to your local SSA office and any new evidence to include with your disability case. You can download all the above forms on SSA.gov.
3. Appeals Council Review
If you are still dissatisfied with the decision made in your disability case, the next step is to request a review by the Social Security Appeals Council. The council will review your request to determine whether the decision aligns with Social Security laws and regulations.
The council may take one of three actions:
- Deny your request for review
- Review your case and make a decision
- Return your case to the Administrative Law Judge for further review
You can submit new evidence for the council to consider. If you need more time to gather documents, you can request an extension to avoid missing any deadlines. If you don’t have any new evidence, the council will review your current claim and previous decisions.
Make sure to file your request for review of the hearing decision by the Appeals Council within 60 days of the hearing decision.
If you don’t want to use the online method, you can print and mail Form HA-520 (Request for Review of Hearing Decision/Order.
Send the above form to:
Appeals Council, SSA/OARO
5107 Leesburg Pike
Falls Church, VA 22041-3255
4. Federal Court Review
If you want to appeal the decision made by the Appeals Council, or if they denied your request for a hearing review, your final step in the appeals process is filing a civil suit in a Federal district court.
You can file a civil suit in the district court of the U.S. in the judicial district where you live or have your principal place of business. If you do not live or work in a U.S. judicial district, you must file in the United States District Court for the District of Columbia.
Your denial letter will give you further instructions, including the requirement to send copies of the filed complaint and the issued summons to the Social Security Administration. Send these documents by certified or registered mail for increased security and tracking to the SSA’s Office of the General Counsel in the area you filed the suit.
There is no form to submit at this level. To use this level of appeal, an attorney needs to file a civil suit for you through Federal Court.
Should you hire a disability attorney?
Getting legal advice early in the appeals process can be very beneficial. A Social Security disability attorney can offer a free consultation to assess the likelihood of your claim being approved and assist you in assembling a strong initial claim. This is particularly helpful as the application process can be complex and time-consuming, and having legal guidance can make it less stressful. An experienced attorney may even be able to maximize your disability back pay.
If your claim is denied, the help of a disability attorney becomes even more important. With numerous appeals decisions made by the SSA each year, denials are common. Having an expert on your side to make persuasive arguments on your behalf can significantly increase your chances of success. A disability attorney can prepare you for potential questioning by the judge during your hearing and can cross-examine experts brought in by the ALJ.
How are Social Security disability attorneys compensated?
Most often, Social Security disability attorneys do not require an upfront payment for their services. They are paid a federally regulated amount of 25% of your back pay or $6,000, whichever is less.
What is the difference between a disability attorney and a disability advocate?
Although a disability advocate has passed a certification exam showing proficiency in disability matters, they are not required to have a law degree. It is important to note that a disability attorney is not the same as a disability advocate. While disability advocates can assist you during the appeals process through the hearing level, only a licensed attorney can represent you in a civil suit in Federal court. Many disability advocates are also attorneys. A disability attorney has more trial experience and is more well versed in legal precedence that can help get your case approved.
Your Right to Appeal
Appealing a denied Social Security disability claim is a right that you have. To increase your chances of success, you should address any reasons for the denial and provide thorough documentation. Meeting the 60-day appeal deadline is crucial, and if you need more time, contact your local Social Security office promptly.
The first appeal stage is reconsideration, where your case is reviewed by officials who were not involved in your initial claim. If you disagree with their decision, you can move to the hearing stage.
At the hearing, you can present your case in person and have witnesses speak on your behalf before an Administrative Law Judge.
If your claim is denied at the hearing level, the Appeals Council can review it again. If it is still denied, you can file a civil claim in a Federal district court.
Throughout the process, you can submit new medical records or administrative documents for review. Staying in contact with your local Social Security office is essential. Hiring a Social Security disability attorney can significantly improve your chances of approval. They can help at the initial claims process stage and represent you at hearings, preparing persuasive arguments to get your claim approved. Don’t wait until your claim is denied to seek help.