Many Social Security disability claims are denied after an initial application. This is true of both Social Security Disability insurance claims and Supplemental Security Income applications. The Social Security Administration (SSA) might deny your claim for several reasons. Some of these are for medical reasons, and others are more administrative. Regardless of the reason for your denial, you are entitled to appeal that decision. If you decide to move forward with an appeal, there are several things you can do to significantly improve your chances of success. Keep reading as we tell you everything you need to do to win your SSI appeal.
Social Security Disability Appeals Process
Before you learn what you need to do to win your appeal, it helps tremendously to understand the disability appeals process. The process is basically the same no matter what type of disability benefits you apply for, so this same process applies to both SSI and SSDI benefits. The process involves several steps, and your claim can be approved at any step of the process. As long as your claim is denied, you can attempt to appeal the claim to the next level. There are four main levels of appeal, and here they are.
— Request For Reconsideration
The first step in the appeals process is the request for reconsideration. Some states allow you to skip this step, but others require this step before you can move to the hearing stage. You can request a reconsideration online, and this step in the process allows for a new review of your case. The reconsideration will be handled by someone not involved with the initial determination of your claim. Your claim will be reviewed again from scratch, and a new representative will review all the evidence used in your original claim. If any new evidence has been included, this new evidence will also be reviewed. If your reconsideration request is unsuccessful, you can move on to the next step in the process.
— Hearing By Administrative Law Judge
The hearing level is typically the time when a claimant will hire a disability attorney. Some states allow a disability hearing as the first level of appeal, while other states require you to go through the reconsideration stage first. The hearing level involves requesting an administrative law judge (ALJ) to hear the appeal of your disability application. You must request this hearing within 60 days of receiving the reconsideration decision, and the hearing request can be completed online.
First, you should know that it might take nine months or longer to get a hearing scheduled. The backlog of cases waiting to be heard is quite large, and these administrative law judges spend almost all of their time hearing disability cases. When the hearing arrives, you will present your case to the judge. If you have a disability lawyer, your lawyer will help you present your case.
You can expect the judge to ask you questions about your medical condition and your ability to perform work. In addition, the judge will review all the evidence in your case file. Finally, the judge will typically rely on expert testimony from a vocational expert to assist in determining the severity of your medical condition. In most cases, you can expect a decision from the judge within 30 days of the hearing. About half of cases that make it to a hearing are won by the claimant. However, if your appeal is denied, you may move on to the next step.
— Appeals Council
The next step in the appeals process is a request to the Social Security Appeals Council. You can make this request in writing or online. There is one important distinction to be made at this level of appeal. The Appeals Council is not required to hear your case. You should know that you are requesting the council to hear your appeal, although they will not always grant your request. If the judge followed all applicable laws, then your request is likely to be denied.
If the council notices that the law was misapplied, they will likely hear your appeal. The council may take a couple of actions after hearing your appeal. They could choose to grant your disability benefits, or they could order a new hearing with a different judge. If you are dissatisfied with the council’s decision, you have one last option to appeal your case.
— Federal Court
Finally, you may appeal your disability case to a federal court. You would need to ask the Federal District Court in your area to hear the case; however, very few cases make it to this step. The request to the court must be made in writing, and an attorney is almost always required at this step. The process of appealing your case to federal court is expensive and time-consuming, so less than 5% of all disability claims end up in federal court. However, about one-third of claims that make it to federal court are won by the claimant.
How To File Your SSI Appeal
If your SSI claim was denied, you are likely wondering how to file an appeal. The process for filing an appeal is not that difficult, but there are certain rules that must be followed. Failure to follow the rules can result in your claim being denied, regardless of whether or not you should have qualified for SSI payments. Here is how to file your SSI appeal.
First, you should file your request for reconsideration within 60 days of receiving your initial determination. The Social Security Administration assumes the receipt will occur five days after the date on the notice. You can make the request for reconsideration online through the appeals page on the Social Security website. You may also complete a paper request and mail it to your local Social Security office.
A hearing with an administrative law judge must be requested within 60 days of your reconsideration decision. If reconsideration is not required in your state, the request must be made within 60 days of the initial determination. Again, this request may be made online or by completing the paper request. Likewise, a request for the Appeals Council to hear your appeal may be made online.
Finally, taking your case to federal court requires a little more effort. Your request must be filed with the federal court following all federal rules of procedure. Usually, this process requires hiring an attorney, and a filing fee of several hundred dollars will be required.
Tips For Winning Your SSI Appeal
Now that you know how to file your appeal, it is time to learn what you need to do to win your appeal. Simply filing an appeal is not very likely to get your case approved. There are other things you need to do to make sure you have the best chance of winning your case. Here is what you need to do.
— File Your Appeal On Time
One crucial step to winning your appeal is to make sure it is filed on time. Most steps in the appeals process allow 60 days for the filing of an appeal to the next level. However, you should consult the Social Security Administration’s rules or a disability lawyer in your area for specifics about your case. Failure to file your appeal on time can get your case dismissed immediately. Even if you are successful on the merits of your evidence, you will not get your claim approved on appeal if you file your request after the deadline.
The Social Security Administration has deadlines in place for a reason, and these rules are strictly followed during the disability process. Similarly, federal court rules require your appeal to be filed in a timely manner, and you can almost guarantee that you will lose your appeal if it is not filed on time.
— Submit The Required Documents
The next tip for winning your appeal is to make sure you submit all the required documents. In addition to your notice of appeal, some steps in the process also require additional documentation. For example, a reconsideration request specifically requires Form SSA-561. You also need to include a Reconsideration Disability Report that will show any new evidence associated with your claim.
You might also need to provide a Form SSA-827 that allows the Social Security Administration to access your medical records. Without the right forms, your appeal cannot be processed correctly. Therefore, failure to provide the right documents will almost always get your appeal denied.
— Submit Thorough Medical Evidence
One of the biggest reasons for a denial of your claim is that the Social Security Administration does not believe you have a condition that qualifies for disability. Medical denials account for a large part of claim denials, so providing thorough medical evidence during your appeal is crucial to winning your claim. You must be able to prove that your impairment meets the definition of a disability and that it decreases your functional capacity so that you are unable to perform work. You might need to get a written statement from your doctor or provide additional test results to include in your Social Security disability benefits appeal.
— Write An Effective Appeal Letter
A well-written appeal letter can go a long way toward getting your appeal approved. Many people get the help of a Social Security disability attorney for this step. While the form required for an appeal request only contains a few lines for you to write on, you may attach additional pages. You should draft an appeals letter that clearly states why you feel the initial decision was incorrect. Include the reasons you feel the denial was in error, and reference the evidence in your file that will help prove your position. You should use your denial letter as a starting point to determine why your claim was denied. Then draft your appeals letter to explain why the denial was improper.
— Obtain Statements From Your Doctor
Your eligibility for benefits sometimes depends on an impairment or medical condition being so severe that you cannot perform any work. Although administrative law judges who work for Social Security are very good at reviewing medical records, it doesn’t hurt to give them a little help. Getting statements from your doctors about your condition can help convince the judge, and sometimes these statements are easier to understand than hundreds of pages of medical records. If your initial claim is denied, you should strongly consider getting a statement from your doctor to include with your reconsideration appeal or hearing request.
— Submit Evidence From Vocational Experts
If you appear at an ALJ hearing, there will likely be a vocational expert at the hearing. This expert works for the Social Security Administration and will provide testimony about your ability to perform certain tasks. However, you are also entitled to have your own expert testify about these facts. If you have hired a disability law firm, they will likely have a vocational expert who will evaluate you and provide their opinion of your ability to perform work. The more evidence that you can provide, the better, so make sure you do everything possible to present your full case during your appeal.
— Do Not Lie About Your Disability
Lying is never an effective strategy, and that applies to the disability application process as well. Lying on your application or during your appeal will greatly reduce your chances of success. Judges and others who review your application typically see hundreds or thousands of these applications each month. They are extremely familiar with common medical conditions and how those conditions affect you. If you lie about your condition or your ability to perform work because of that condition, the person reviewing your file is likely to be suspicious.
The best thing that you can do to increase your odds of winning is to be honest about your condition. Let the medical evidence and testimony from your doctors and vocational experts help make your case. Do not attempt to mislead the judge or outright lie about your condition. Not only will this get your appeal denied, but it’s likely to get your chances of future appeals crushed as well.
— Consult An Attorney
One of the best things you can do to increase your odds of success on appeal is to consult a Social Security disability lawyer. Claimants who have a disability lawyer typically see much higher success rates than those who do not have an attorney. This is generally true of both SSI appeals and SSDI appeals. Disability attorneys are experts on the appeals process, and they can help you understand what types of evidence you need to include with your claim. If you don’t already have an attorney, most law firms offer a free consultation so that they can help you evaluate your case at no cost.
The Bottom Line
Even though your SSI claim or SSDI claim gets denied initially, you still have a right to appeal that decision. In fact, many first-time claims are initially denied and later approved on appeal. To increase your odds of success on an appeal of a disability denial, there are some things you need to do. First, make sure you file your appeal on time and submit the required paperwork. Make sure to include plenty of medical evidence to support your claim, and consider hiring a disability lawyer. The sooner in the process you get help, the more likely you are to win your appeal.
Frequently Asked Questions
What are the chances of winning a Social Security appeal?
Your chances of winning your Social Security appeal are fairly high. Roughly half of all Social Security appeals are ultimately won by the claimant. So, you have about a 50/50 chance of winning your appeal. To improve your odds, you should make sure that you file your appeal on time, include the right paperwork, provide plenty of medical evidence, and draft a well-written appeals letter.
How many times can you appeal for SSI?
There are four levels of appeal for SSI that you can go through. You can request a reconsideration, a hearing with an administrative law judge, an appeals council review, or a federal court review. Once you have exhausted these options, you cannot appeal your SSI claim any further. In that case, you would need to start a new claim for benefits if you believe that you are entitled to them.
How long does an SSI reconsideration take?
Most reconsideration requests are completed within one to two months. However, these requests can take as long as three months in some cases. If additional medical records are required for your reconsideration, this could add time to the process. It can sometimes take weeks to obtain copies of records from your medical provider, so this could extend the amount of time it takes to process your reconsideration request. Remember that your initial application for SSI benefits could take up to twelve months to process.
What is the most common way to win an SSI appeal?
The most common way to win an SSI appeal is to provide additional medical evidence that was not included in your initial application. This additional evidence should show that your impairment prevents you from working. You can also win your appeal by providing additional evidence of your financial status or age if your claim was denied for non-medical reasons. You should first examine your denial letter to determine why your claim was denied. Use this information to determine what you need to provide on appeal to get your claim approved.
What is the difference between a hearing and a reconsideration?
A reconsideration simply means that someone new will review your application. While you are allowed to present new evidence, your claim will generally be the same as it was during the initial review. A hearing, on the other hand, allows you to present your case in person before an administrative law judge. The judge will review all the evidence in your file, and he or she will ask you questions about your claim. The hearing process is much more formal and is more like a court proceeding, whereas the reconsideration process is just a new review of your claim by a new Social Security representative.