Basics of Social Security Disability Appeals
Social Security Disability (SSD) applications dont always go the way the applicant anticipates. The Social Security Administration (SSA) may decline an application or set the benefits at a lower level than the applicant had hoped for. The SSA might also modify an existing benefits arrangement, either revoking benefits or reducing the amount of the benefits.
When the SSA makes any decision affecting an individuals access to SSD benefits, however, that individual has the right to challenge the decision and enter the SSA appeals process.
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 SSA decisions, 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.
You can also choose to have someone represent your interests at every step of the Social Security Disability appeals process. The SSA can even help you if you cant find an attorney or if you cant afford one.
If you choose to have a representative, you will 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.
The first step in a Social Security Disability appeal is a request for reconsideration. This stage is fairly self-explanatory: upon application, a person who did not participate in the original SSD decision will reconsider an application for benefits. The reconsideration takes all evidence available during the initial application into account, as well as any new evidence that the applicant may have.
The SSA generally does not require an applicant to make a personal appearance during reconsideration. If an individual has had their disability benefits revoked because the SSA has determined that their medical condition has improved, however, individuals can speak with an SSA representative in order to explain why they believe they are still disabled.
Administrative Law Judge (ALJ) Hearing
If the reconsideration decision doesnt meet an individuals expectations, they can request a hearing before an administrative law judge. Petitioners have 60 days from the time they receive notice of the SSAs reconsideration decision to file a request for an ALJ hearing. The SSA presumes that petitioners received the notice of the decision 5 days after it was sent, unless the petitioner can show that they received it later.
If a petitioner does not file an appeal within those 60 days, the ALJ may dismiss the appeal. This could mean that you wont have access to any further steps in the appeal process, so be sure to meet the deadlines in your case. If you wait until the deadline has passed, it is possible that you can get an extension by explaining the reasons for missing the filing deadline, but this is by no means certain.
You dont necessarily have to show up to the hearing in person; the SSA allows for appearances by video conference under certain circumstances.
Whether you appear in person or via video conference, it is in your best interest to attend the ALJ hearing. It isnt mandatory, but if you absolutely cant attend you must inform the SSA of your reasons for not attending in writing as soon as possible.
Sometimes, however, the ALJ will decide that a petitioner must attend a hearing, even though they had requested not to be present. If this occurs, you should definitely attend the hearing. Failure to attend a hearing without a good reason could result in the dismissal of your request for a hearing.
Depending on the reasons you have for missing the hearing, the SSA may be able to accommodate you by moving the time or place of the hearing or scheduling a video conference.
The SSA can sometimes pay for expenses incurred traveling to ALJ hearings. For instance, the SSA might pay for the cost of a bus ticket or the expenses for driving a car. The ALJ must approve all payments unless the expenses were unexpected and unavoidable.
If you need an advance payment for travel costs, let the ALJ know as soon as possible. You will need to keep all travel receipts and return any money in excess of what you were forced to spend.
Before the hearing, the SSA may ask for more information or for clarification about certain aspects of your application. It is very important that you submit all evidence that you would like the ALJ to consider as soon as it becomes available. Even if evidence comes to light after your initial submission to the ALJ, send it as soon as possible in order to ensure that the ALJ can consider it when making a determination in your case.
At the hearing, the ALJ will question the applicant, as well as any witnesses they present. Expert witnesses in medicine or occupational issue may also give testimony to the ALJ. The ALJ will weigh the evidence and make what they find to be an appropriate benefits decision.
Once the ALJ has reached a decision, they will issue a written decision explaining the ruling or dismissal order. If the ALJ issues an unfavorable decision, you can continue the appeals process by requesting a review by the SSA Appeals Council.
Appeals Council Review
Similar to the ALJ hearing, petitioners have 60 days to file an appeal with the SSA Appeals Council, which begins to run five days after the SSA sends the petitioner the notice of the decision. The Appeals Council may reject an application for review received after the 60 days are up, unless the petitioner has a good reason for the delay. Petitioners must file a written request to extend the time limit; the Appeals Council will not consider verbal requests.
The Appeals Council considers every request for review that it receives, but does not grant review in every instance. If the Council feels that the ALJ made the right decision, it may decline a 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 (and final) 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 action in federal court. Once your case is filed, the Federal Rules of Civil Procedure will govern your case, rather than the procedures laid out by the SSA.
The district court judge will hear the evidence in the case in order to determine whether the circumstances meet the requirement for overturning the SSAs decision. Judges apply the arbitrary and capricious standard to Social Security Disability cases. In other words, judges will only overturn an SSD decision if the evidence shows that the decision was not based on fact or was inherently unreasonable.
This standard tends to favor the SSA over petitioners, so be sure to examine whether or not you truly have a case before opting to file a civil claim in federal court.
If you choose to file a claim in federal court and the district court judge renders an unfavorable decision in your case, you can still utilize the normal federal appeals process to keep your case alive. This would involve filing a request for an appeal with the appropriate federal appellate court.
FindLaws Federal Courts section has additional information that can assist with this process.