In certain circumstances, applications for social security disability and SSI claims can be denied by the SSA. The applicant, however, has the right to appeal this decision. The disability appeals process has 4 different stages: reconsideration, hearing, Appeals council and court. Each of these stages is explained in more detail below.
A reconsideration is the first level of appeal offered to applicants for SSDI or SSI. It is a request to have the initial application reviewed by a claims examiner with the goal of having the decision that was made reversed. The process involves review by a medical professional or examiner that was not a party to the initial application made.
In most cases, however, reconsiderations are normally denied (only 5-10% are accepted), therefore making this step more of a formality in order to get to a hearing in front of a judge (the second level of appeal). A reconsideration request should be filed within 60 days of the denial of the initial application.
A hearing before an administrative law judge (ALJ) is the second level of appeal in a disability application. An ALJ is an attorney who is an official of the SSA and works within their disability review office. During this step, the judge will reconsider your application, factoring in any new medical evidence or details in your application that may have been overlooked. The judge will ask you questions, and may choose to have a Vocational and/or Medical Expert at your hearing.
This is the stage that has the highest chance for your appeal to be accepted because the judge takes a second look at your application and you have the opportunity to appear in-person and plead your case (about 67% of appeals are granted benefits at this stage). The downside, however, is the amount of time that it takes to get a hearing date. Requests for a hearing should also be made within 60 days of the denial of a reconsideration.
If a hearing by the ALJ results in a denial of your application, you have available to you the third level of appeal, which is a review by the Appeals Council of an ALJ. The appeals council is made up of a team of appeals judges and officers, which reviews the judges’ decision for either technical errors or failures to consider certain important components of the application.
The appeals court selects the cases at random that it will review. They normally look for technical errors or missed considerations by the ALJ. Technical errors include factors such as mistakes in considering time missed at work by the applicant, or mistakes in age categorization. Misconsiderations by the judge involve overlooking certain medical evidence or economic conditions of the applicant.
After reviewing the application, the appeals council can overturn the judge’s decision and approve your application, order the case to be heard again due to a fault in the judge’s ruling, or uphold the judge’s decision and deny your application.
The appeals council often turns away many appeals without reviewing them if they cannot readily identify technical or procedural errors. In fact, only about 2-3% of appeals stand a chance to win at this level. This option is therefore often used as a required prerequisite step for getting to the final level of appeal; which is presenting a case before the federal district court
If your appeal has been denied by the appeals council, you have the option to file a case with the federal district court. These courts are responsible for hearing civil and criminal cases and are part of the US federal court system. At this level, your application is considered outside of the court systems within the SSA. You will most likely be required to have an attorney represent you, so you should be prepared to look for social security attorneys in your vicinity.
At the federal court, the judge reviews the case for any important factors that may have been overlooked (such as the importance of doctor reports or symptoms such as pain and suffering) as well as checking for administrative errors.
Your chances of winning the case at this level are considerable – however, the process is expensive and time-consuming. Indeed, less than 1% of claims reach this level because of the reluctance of attorneys to pursue this option (owing to the time and resources involved).
To sum up, your SSDI and SSI applications are subject to an appeal if they are denied. It is, therefore, important to well prepare your appeals at each stage in order to increase your chances of having your disability benefits granted within a minimal amount of time.
In preparation for your appeal, the advocates at DEF can help. With over 100 years of combined experience, we know how to navigate the SSA’s appeals process and we can help you prove your disability case. Let our team of experts help you get the benefits that you deserve.