Basics of Social Security Disability Appeals
Social Security disability insurance applications don't always go the way the applicant anticipates. Indeed, most claims are initially denied. This doesn't mean you aren't disabled, however, and the Social Security Administration (SSA) has a long appeals process where you can challenge a negative decision. If your benefits are denied, modified, terminated, or less than you deserve, you have the right to appeal the SSA's decision.
There are four levels of appeal in the SSA appeals process, each with its own rules and procedures:
- Hearing before an Administrative Law Judge (ALJ),
- Review by the SSA Appeals Council, and
- Filing a claim in federal court.
Your Right to Representation
When appealing, you can represent yourself if you so desire. Many people do. The SSA offers free assistance to those who represent themselves during the appeals process.
However, given how important disability support can be, the SSA guarantees your right to representation. You can also choose to have someone, be it an attorney, expert or family member, represent your interests at every step of the process, from the initial claim to federal court.
If you choose to have a representative, you'll have to file a form notifying the SSA of this choice. Your representative will also have to file a request for written approval from the SSA if they intend to charge you for their services. Often, representation costs nothing upfront; fees are paid from the recouped benefits.
If you're seeking a reconsideration, ALJ hearing, or review by the Appeals Council, strict deadlines apply. In each step of the process, you have 60 days to file for further review. The clock starts the day you receive notice of the SSA's decisions, which Social Security usually assumes is five days after the decision is made. Filing late can result in a dismissal of your appeal and leave you without any recourse.
The first step in a Social Security Disability appeal is a request for reconsideration. During the reconsideration process, a person who didn't participate in the original decision will reevaluate an application for benefits. The reconsideration examines evidence available during the initial application, as well as any new evidence that you may have.
You're not required to be present at a reconsideration, but if you've had your disability revoked you may want to appear and speak with an SSA representative in order to explain why you believe you're still disabled.
Administrative Law Judge (ALJ) Hearing
If the reconsideration isn't successful, you can request a hearing before an administrative law judge. If you request a hearing, it's in your best interests to attend. You don't necessarily have to show up to the hearing in person; the SSA allows for appearances by video conference under certain circumstances. If travel is difficult, the SSA may cover your costs.
Before the hearing, the SSA may ask for more information or clarification. Submit all information requested and any evidence that you would like the ALJ to consider as soon as it becomes available. At the hearing, the ALJ will question you and any witnesses you present. Expert witnesses in medicine or occupational issues may also give testimony. If, after reviewing the evidence, the ALJ issues an unfavorable decision, you can continue the appeals process by requesting a review by the SSA Appeals Council.
Appeals Council Review
If you disagree with the ALJ's decision, the next step is review by the Appeals Council. The Appeals Council considers every request it receives, but doesn't always grant review. If the Council feels that the ALJ made the right decision, it may decline your request.
If the Council does decide to hear your case, it can either decide the issues itself or refer the matter back to an ALJ for a resolution. If the Council declines to review your case, or if you disagree with its decision, the next step in the appeals process occurs in federal district court.
Federal District Court Review
The last way to challenge a decision of the SSA is by filing a civil lawsuit in federal court. The district court judge will hear the evidence in the case in order to determine whether the circumstances meet the requirement for overturning the SSA's decision. A judge will reverse the decision if he or she finds it "arbitrary and capricious." The evidence must show that the SSA's decision was not based on fact or was inherently unreasonable.
Getting Legal Help
Disability benefits can be an invaluable form of support when injury or illness prevents you from working. If you've had a disability claim denied or have questions about what benefits you're entitled to, consider calling a qualified disability lawyer to discuss your options.