ssdi-help.com | Appeals

Appeals Process for Denied Disability Claims

If your application is denied you should file an appeal. Currently, only 23% of denied claims are appealed. Once you receive a letter that denies your application you have 60 days to appeal in writing or on-line. To ensure the status of your appeal, always retain documentation of any contact with Social Security Administration.

The first three levels of appeals are administrative appeals completed by the Social Security Administration. The fourth level of appeal is in the civil legal system, the federal courts.

The four levels of appeals are

1. After your initial claim is denied, the first appeal is called reconsideration. 86% of claims are denied at this level.

3. The third and last administrative appeals is the Appeals Council. Only 2% of claims are approved, so that’s a 98% denial rate.

2. The second appeal is before an Administrative Law Judge or ALJ. This is also referred to as the ‘hearing’ level. When denied at this point you can file a second claim. Only 28% of appeals at this level are denied. The typical wait is 516 days.

3. The next and third appeal is to the Appeals Council (AC) which has a backlog of one to three years. Only 2% of claims are approved, so that’s a 98% denial rate.

4.The fourth and last appeal is at the Federal District Court.

First Level of Appeal Reconsideration

“A reconsideration is a complete review of your claim by someone who did not take part in the first decision. We will look at all the evidence submitted when the original decision was made, plus any new evidence.” (from www.socialsecurity.gov/pubs/10041.pdf)

Second Level of Appeal; -. Hearing

“If you disagree with the reconsideration decision, you may ask for a hearing. The hearing will be conducted by an administrative law judge (ALJ) who had no part in the original decision or the reconsideration of your case. The hearing is usually held within 75 miles of your home. The administrative law judge will notify you of the time and place of the hearing.

Before the hearing, we may ask you to give us more evidence and to clarify information about your claim. You may look at the information in your file and give new information.” (from www.socialsecurity.gov/pubs/10041.pdf)

Third and Last Administrative Appeal - Appeals Council

If you disagree with the hearing decision, you may ask for a review by Social Security’s Appeals Council.

The Appeals Council (AC) looks at all requests for review, there are three possible decisions that the AC can make but it may deny a request if it believes the hearing decision was correct. decide your case itself or return it to an administrative law judge for further review.

4. Federal court

“If you disagree with the Appeals Council’s decision or if the Appeals Council decides not to review your case, you may file a lawsuit in a federal district court.”

Representation at Appeals

Although you may represent yourself in any of the appeals most people retain a claims representative or a lawyer to represent them. Having said that, don’t be afraid to represent yourself if you are confident about your case. Be prepared with additional medical evidence of your disability.

The law limits the fee to 25% of your past claim amount but that fee can be increased if the judge allows it. They’re hidden fees to working with legal firms like Binder and Binder. Each doctor that completes their forms will charge hundreds of dollars plus you are liable for filing and copying fees.

There are two major organizations where you can find representatives that specialize in SSDI, they are the National Association of Disability Representatives (NADR), mostly non-attorney resources and National Organization of Social Security Claimant’s Representatives (NOSSCR). See Links below for contact information.

Appeal Statistics

Links:

SSA publication about appeals http://www.socialsecurity.gov/pubs/10041.pdf

On-line appeals application www.socialsecurity.gov/disability/appeal

Hearing level of appeal http://www.socialsecurity.gov/appeals/hearing_process.html

Appeal council appeals http://www.socialsecurity.gov/appeals/appeals_process.html

National Association of Disability Representatives, www.nadr.org

National Organization of Social Security Claimant’s Representatives www.nosscr.org