How To Appeal a Social Security Disability Denial
Last updated: May 2017
Though the statistics vary somewhat from state to state, nationwide about 65% of all disability claims are denied on the first application. Luckily, receiving a denial does not mean that you will never be able to receive benefits. You can always appeal the decision of the Social Security Administration (SSA) – but you must be sure to do so within 60 days from the date of your denial notice!
Don’t Start A New Claim
If your original application for disability has been denied, the wisest course of action is to appeal your claim. If you start a brand new application, it will likely be denied for the same reason as the first application. By contrast, filing an appeal will eventually lead to a hearing with an administrative law judge (ALJ), where the odds of being approved are substantially higher. Even if you have to go through the appeals process more than once, you are still more likely to be approved for disability benefits than a claimant who files multiple initial disability claims.
File Your Appeal
To start the appeals process, the very first thing you should do is contact your local SSA office and let them know you want to initiate an appeal. This will prompt the SSA to send you the necessary forms. In most cases, the forms needed to initiate an appeal are the “Request for Reconsideration” and the “Disability Report-Appeals.” Completing this paperwork is actually fairly simple, and can even be done online.
Before you submit your forms, review everything to make sure you have included all the necessary information and any updates since your initial application. For example, if you have visited your doctor recently, started seeing a new doctor, or if your condition has worsened since your original application, all this information should be included. Make sure you get everything to the SSA within the 60-day deadline. (You are actually allowed an additional five days for mail time, but note that your appeal has to actually be received by the 65th day, not simply postmarked by that date). It is also a good idea to make a copy of anything you mail so that you will have it for your records.
Follow Up On Your Appeal
It isn’t sufficient to simply put your appeal in the mail or submit it online. Ideally, you should always contact the SSA one to two weeks after sending in your appeal to verify that your appeal was actually received. If they have no record of your appeal request, make another copy of the copy you have in your records and mail it again. Because if the SSA does not receive your appeal within the 60-day time frame, you will have no choice but to start again with a new claim, and many months of your valuable time will have been wasted.
There are some states where the reconsideration review step has been eliminated. Those states include: Alabama, Alaska, California (Los Angeles North and Los Angeles West Branches only), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania. In all other states, the first level of the appeals process is the reconsideration appeal (sometimes referred to as the “recon” appeal). Unfortunately, approval rates during this stage are quite dismal at only 10% to 15%. This is mostly due to the fact that these reconsiderations are sent back to the same state disability agency that originally denied your initial application. The good news is that even if your reconsideration appeal is denied, it is still a step in the right direction because then you can file a formal request for hearing before an administrative law judge.
Hearing With An Administrative Law Judge
The more you appeal, the greater your chances become of receiving benefits. At the hearing stage in the appeals process, things finally begin to look a bit more promising – with a national average approval rate of about 60%. There are several reasons that the odds are better for you at a hearing. For one thing, the judge presiding over the hearing may give more credence to the opinion of your treating physician. It is also the only stage in which the person making your disability determination actually gets to meet you in person, and the judge may be influenced by your symptoms, appearance, and testimony. There will also be more attention paid to your exertional and non-exertional limitations at this stage. This means that it is also a very good idea to hire legal representation before your hearing takes place.
The Importance of Legal Representation
Having appropriate legal representation can really help you win a claim at an ALJ hearing. While your lawyer can’t guarantee that you will be awarded benefits, he or she can guarantee that your case will be properly developed and prepared prior to your hearing date. A qualified social security attorney will also have a high level of familiarity and expertise with the relevant rules and regulations. They will know how to spot any errors in the SSA’s rationale for your denial, as well as which questions to ask your doctor and which types of medical documentation will be most worthwhile for your case. Disability attorneys generally get paid on contingency (i.e. only if you win), which means they also have an incentive to give your claim the best chance of winning. A social security disability lawyer’s fee is limited to 25% of the past-due benefits you are awarded, up to a maximum of $6,000. It’s important to note that the attorney will only be paid out of your past-due benefits – if no back-dated benefits are awarded the attorney will not receive a fee. (However, in some cases your disability lawyer may be able to submit a petition for payment.)
Appealing an Appeal
If your claim is still denied at the ALJ hearing, you can continue to appeal your denial. The next stage would be the Appeals Council, which has an approval rate of about 13%. If your claim is denied at that stage as well, you can still appeal the decision once again to federal court. National statistics indicate that approximately 40% of disability cases taken to the federal level are approved. So the important thing to keep in mind is that though appeals can be time-consuming, they are often your best chance for eventually receiving benefits.
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