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What is a Social Security Request for Reconsideration?

By   /  March 3, 2016  /  252 Comments

Learn how to appeal a denied disability claim with a Social Security Request for Reconsideration and how a lawyer can help you win.

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Watch the Video: "What is a Social Security Request for Reconsideration?"

Filing Your Social Security Request for Reconsideration

If your initial disability claim is denied, the first appeal you can file is a Social Security Request for Reconsideration. When you file a Request for Reconsideration, you will be asked to complete a reconsideration request form and to provide information about any changes in your health and any work you have done since you filed your claim. You will also be asked the reasons why you think the denial determination is wrong. This means that you will need to understand why Social Security denied your initial claim, so that you can effectively prove your case and be approved.

Refuting Social Security’s Reasons for Denial

Sometimes a person’s claim is denied because Social Security says the disability won’t last for twelve months. In that case, a reconsideration claiming that disability will continue for twelve months can result in an approval simply because, by the time the reconsideration is processed, twelve months will have passed and current medical information will show that disability continues.

At other times, how DDS arrived at their decision is not as clear. You have the right to obtain a copy of, and review, your claim file, including the determination memos. Social Security can, however, at its discretion, decline to release your medical records and doctor’s reports, including any consultative examination reports, directly to you. They will, however, release them to an attorney who represents you or, in some cases, to your physician. It could be helpful to have a lawyer who is experienced with Social Security Disability review your claim file to determine what is needed to win the appeal. See our article “How Can a Social Security Disability Lawyer Help Me Get Social Security Benefits?” for more information on how an attorney can help your case.

Sixty-day Deadline to Appeal

There is a time limit for filing a Social Security Request for Reconsideration. You must file your appeal within sixty days of receiving your denial letter. Social Security allows five days from the date on the letter for delivery. This means that Social Security must receive your reconsideration request within sixty-five days of the date on the denial letter. Filing the appeal on time is very important because if you fail to do so, you will most likely lose your right to appeal. It is only very rarely that Social Security allows a late appeal, and then only because the claimant couldn’t respond sooner because of very severe limitations, such as an extended hospital or nursing home stay.

The Reconsideration Review and Appealing Again

Physicians and claims examiners at the Disability Determination Services who were not involved with your initial claim will review your Request for Reconsideration. If your disability claim is denied at the reconsideration appeals level, you can appeal again by requesting a hearing. For more information about the Social Security disability appeals process in general and hearings in particular, please see our articles “I Was Denied Social Security Disability. What Can I Do?” and “What is a Social Security Disability Hearing, and What Can I Expect When I Request a Disability Hearing?”

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  • Published: 7 months ago on March 3, 2016
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  • Last Modified: March 4, 2016 @ 4:02 pm
  • Filed Under: Appeals

252 Comments

  1. Scott Dyben says:

    Hi Kay,

    I filed for SSD in June 2015. After filling out and returning a number of forms, I began to receive requests for details on my work history. Ms. K. Evans from Indianapolis, IN. is my case representative and I have been in contact with her thru written responses, verbal response over the phone at her request and several messages left on her Voicemail. In each case I gave detailed info on my work history.

    Then the letters began to arrive that I had 10 days to respond to the work history requests or the possibility of denial could result. I called a couple more times and she did not respond to my messages asking her to call me back and confirm the dates and times I wrote down clearly giving this information. I just received a letter of denial claiming those in charge of the review had no information regarding my work history to evaluate my claim for Disability.

    I immediately went Online and filled out the form for reconsideration, again giving all details of my work history. Is Ms. Evans willfully ignoring the fact that I contacted her several times?

    As an Honorably discharged US Army veteran at nearly 55 years of age, I only recently became so financially destitute so as to qualify for full coverage from the VA. My medical exams and test results, along with Physical and Occupational Therapy are well documented. This began in April 2015 and continues till this day. Why did she do this to me ?

    Sgt. Scott T. Dyben

    • Kay Derochie says:

      Dear Scott,

      Clearly, some lack of coordination has occurred. If the person you were communicating with was in the local office and not in the Disabilty Determination Services (DDS) that might account for it. Also, verbal versus written communication could be the issue. Form SSA-3369 is how work information is usually captured. A printable copy of this form can be obtained at https://www.ssa.gov/forms/ssa-3369.pdf. I suggest that you review it to see if the work information you provided for the appeal addressed everything asked for on the form. If not, I suggest completing the form and submitting it’ even if part of the information duplicates what you previously submitted.

      Sincerely,
      Kay

      • Na Thomas says:

        I am in the reconsideration stage since April 2016. My denial was in February 2016 due that my chemotherapy will not last longer than 12 months. I presented my new medical evidence of my stroke March 2016 and physical therapy treatments. On August 24th I went for an Physical Exam by the SSA Doctor. He was very rude and made me feel like nothing. The doctor checked my blood pressure twice on both arms and tild me the exam is over. While sitting in the lobby waiting for my transportation he comes out and tells me I need to go to the emergency room because my pressure is sky high and could be catching another stroke. I was so weak and tired that all I could do was cry. ER help me stable my blood pressure the same night. I called the DDS Worker the nect day to tell her I went to the appointment she stated to me she knows she spoke to the doctor this morning and is just waiting for his paper decision to speed up process which cam be 4 to 5 days. I have been calling every two days to find out the decision but they keep saying its in processing. My question to you “Do you think I was approved or denied? “

        • Kay Derochie says:

          Dear Na,

          Given the complications you have had, it is possible that your appeal will be approved. If it is not, you can appeal. If an appeal is necessary, I recommend that you hire an experienced Social Security attorney. When you hire a Social Security attorney, you do not have to pay any legal fees up front and you will pay attorney fees only if you are approved for benefits. Social Security law sets the amount your attorney can charge, and the Social Security Administration pays the attorney directly from your retroactive award before they send your back pay to you.

          Sincerely,
          Kay

          • Alicia says:

            Hi Kay

            I was on SS since 09 and they currently knocked me off in Feb 2016. I suffer from Rhematoid and MPTS and currently still under MH Doctor. I’m in the appeal status now and they did not want to continue my pay because they said I missed the deadline line for returning paperwork. Can a MH case worker help to get my disability back going because I need the insurance to continue to see my Doctors. Do you think they may give it back because I have Severe physical and mental issues right now.

          • Kay Derochie says:

            Dear Alicia,

            Late appeals are sometimes accepted for good cause. I have not heard of the ten-day deadline for payment continuation to be waived, but you can always try. If your disability caused you to miss the deadline and your doctor is willing to make a statement to that effect, you might be successful if there is possibility of a good-cause exception in Social Security procedures.

            If you need help getting prescriptions, you might be able to get assistance through http://www.needymeds.com/

            Sincerely,
            Kay

          • Na Thomas says:

            Update: Still waiting for medical approval. …Call the #800 and they keep referring me to the local office…..call the local office and they stated it is in medical….My question to you Kay does it take this long for an decision after seeing the CE doctor 8/24? I keep reading the comments an notice fast responses come back denial. …I am in dire needs and completely losing it waiting on the decision.

          • Kay Derochie says:

            Dear Na,

            It can take a month or more to get a decision after a consultative examination.

            Sincerely,
            Kay

    • Annie says:

      Dear Kay,
      If I did a reconsideration on a denial! How long will it take 4 me to get an answer?

      • Kay Derochie says:

        Dear Annie,

        Reconsideration appeals usually pend from two to five months.

        Sincerely,
        Kay

        • Kelly says:

          Hi Kay, I got my reconsideration letter March 4, 2016 stating that my disability is continuing. My claim has been in the payment center and they have been working on it since May 2, 2016. I call the local office every 2-3 weeks to get the status, nothing. It has been almost 60 working days since it has been in the payment center. Any ideas as to what is going on? Or suggestions?
          Thanks
          Kelly

          • Kay Derochie says:

            Dear Kelly,

            I suggest that you call your congressperson’s office and ask them to follow up for you because it has been nearly four months since the decision to reinstate your benefits was made and you have received no payment.

            Sincerely,
            Kay

    • Paul says:

      Hello,
      I initially applied for SSDI in December of 2014. I have DDD (4 level lumbar fusion in 2010), Bullous COPD, and was suffering from severe neck pains and headaches when I applied. I hired an attorney for my claim. I had just moved, so the VA was my only real medical provider. They took x-rays on 2/715 of my neck and saw 3 areas of possible nerve compromise/disc height loss, and recomended an mri follow-up. Not until late April did the VA approve an mri. By then the mri showed severe foraminal stenosis on three cervical vertabral levels. The VA said condition was normal for 55yr old man!
      I was forced into working 40 hrs a week construction to keep from being homeless (this made my condition much worse).
      I was denied SSDI on 7-8-15.
      Finally I recieved medicaid and the first neurosurgeon I saw, scheduled me for surgery 10 days later, 7-17-15.
      I had been in contact with attorney all through, and told him about mri and surgery.
      Colorado does not have a re consideration rule. So now it’s over a year later, and I found that the attorney, never submitted mri, or neurosurgeon records to SS. I obtained a list of records by inclusive dates, and it appears the attorney left out records from just before mri until just after. I think to get more $. So as I just found this out, I asked and he denied leaving out records. I asked him to request an on the record review. He said it wouldn’t help. So I brought a dire need/on the record review request to SS myself. Now after calling SS, they said (8-26-16) a decision was made and being edited, and I can call back.
      Do you think it could be approved this time?
      After the 4 level fusion, I had to go back to work 3 weeks after the surgery ( still trying to stay sheltered). Mri’s now show pseudoarthroses at all levels and further severe degeneration of cervical spine = more severe surgery.
      Do not want to pay attorney now, want to sue for incompetancy and lack of due dilligence. My pain is worse and I just am pretty much immobile.

      Thank you,

      • Kay Derochie says:

        Dear Paul,

        It is possible that your appeal will be approved, especially if you worked for a short time each time you worked after the date of disability that you claimed, less than six months each time–or better less than three months–and stopped because of your health and if the judge has medical records of your worsened condition after the last work. If you are approved, you can talk with Social Security about your reluctance to pay the attorney and the reasons and find out how to contest payment of the full fee. Sometimes fees are reduced, not cancelled, because the attorney has provided services even if they made an error.

        Sincerely,
        Kay

  2. Karen says:

    Dear Kay
    Can I ask my attorney to file a dire need in my reconsideration appeal?

    • Karen says:

      I have 2 new medications that have been up to higher doses is that new information considered in my reconsideration? also my psychiatrist is leaving going elsewhere in August. Do you think I should ask him for a statement to help my social security disability before he leaves ?would that help also I didn’t have a statement from him in my application process.

      • Kay Derochie says:

        Dear Karen,

        I’d say that getting a statement from your current psychiatrist is very important. I suggest that you discuss this with your attorney to see if he wants the statement to made on any particular form or any particular points to be addressed. Also, let your attorney know about the medication increases so that information can be submitted.

        Sincerely,
        Kay

          • Kay Derochie says:

            You are welcome, Karen.

          • Karen says:

            Hi Kay I received a MRFC form from my attorney turned it in to my psychiatrist also turned in my medications that have been up to higher doses to my attorney. I have a question? My diagnosis are generalized anxiety, ADHD, major depression and mood disorders.I received my high school records of the last two grades i was in which were 9th and 10th grade it also shows that I had an IEP also that I missed a hundred and fifty-four days between both grades and all semesters I have nothing but failing grades of Fs . Do you think this will be good to show for my appeal for my education?

          • Kay Derochie says:

            Dear Karen,

            If you can establish that you were missing school and failing classes due to your mental health, I would think that the records and the IEP would be helpful to your claim. I suggest that you show them to your attorney so the attorney can decide.

            Sincerely,
            Kay

    • Kay Derochie says:

      Dear Karen,

      Yes, you can do that if you are without or in danger of losing shelter or cannot get some needed medical care.

      Sincerely,
      Kay

  3. Julie says:

    Hi,
    My claim was denied based on 2 very ancillary medical aspects that were NOT the foundation of it (but SS paperwork collection case person said to include the whole picture). Denial letter listed what reports they had and did NOT list reports from the two professionals at core of claim. New York State does not have reconsideration (a “prototype” state). Do I have ANY recourse to address what I see as clear ERROR other than waiting a year or more for a hearing? I’m having Allsup represent me for the appeal, but would having a lawyer re: the error speed anything up or make hearing unnecessary, or is that just not an allowed route?

    Thanks very much for your help.

    • Kay Derochie says:

      Dear Julie,

      I believe that you will have to appeal, but double check with Allsup. Also get a copy of your claim file to see whether the records in question are even in file.

      Sincerely,
      Kay

      • Na Thomas says:

        My claim was denied because my illness was not to last over a 12 month span on February. I have stage 3 colon cancer that received 6 months of chemotherapy. March while receiving chemotherapy I caught a mild stroke which has left my right side of my body useless. Currently I am receiving physical therapy. Reconsideration was submitted to Social Security late March about my case. What puzzles me I keep receiving a third party questionaire for my mother. My mom passed away in April and I have told this to the worker handling my appeal but they keep coming in my mailbox biweekly. The worker received all the new medical records and physical therapy reports. So my question is how much longer will it take for a decision? Also is it some kind of scam that I keep receiving third party questionaire for my deceased mom to fill out? Is the questionaire the hold up?

        • Kay Derochie says:

          Dear Na,

          The repeat questionnaires may be due to an automated computer follow-up that the claims examiner forgot to cancel.. I suggest that you call the examiner at the Disability Determination Services again and tell him or her that you are still getting requests for the questionnaire and that you are concerned this is holding up your appeal. Ask if a realistic rough estimate can be given of when a decision will be made.

          Sincerely,
          Kay

          • Na Thomas says:

            Follow up: I visited a SSA Doctor for a CE Physical Examination on the 24th of August. The doctor was rude and made me feel like poop. He check my blood twice on both arms and told me exam was done. I sat down in the waiting area waiting for my transport when the doctor approach me and stated I need to go to the emergency room right away because my blood pressure was extremely high and could be having another stroke. All I could do was cry. Follow the doctor instructions and the ER got my pressure in stable condition. Call the DDS worker the following day to tell her I went to the appointment. She said she spoke to him this morning and is waiting on the written report in 3 to 4 business days to rush things. Call the DDS worker again on the 30th and she stated nothing yet. I keep calling the #800 number and they tell me to call the DDS worker. Do you think I was approved or denied?

          • Kay Derochie says:

            Dear Na,

            I am currently responding to your two posts of September 2. Also see my previous response to your previous post. The DDS examiner is the one who knows the status of the medical review of your claim while it pends. The examiner has to wait for the consultative examination report; and, although the doctor may have promised four or five days, he has three weeks to submit the report and then the final file review has to occur, so you could be looking at anywhere from two weeks to a month or more before you get the decision. I suggest you limit your follow ups to DDS to once every two weeks.

            Sincerely,
            Kay

    • Nona Dalaciao says:

      Hi Kay
      I apologize for using the reply button but I didn’t know how to submit a question. I first applied for disability July 2015 and was denied in December 2015 because they stated I was making substantial income. I appealed in December 2015 because my condition worsen, I lost my job, and they left some of my medical records out. I’ve had 4 brain bleeds, numbness in my left side, constant migraines, and severe carpel tunnel in both hands and it has moved up to my shoulder on the right side-all this have occurred with in this past year. Also, I’ve spoken to my examiner several times updating her. I’ve also had several failed job attempts. At the beginning of May 2016 a decision still haven’t been made I was told it left the examiner and sitting on the doctors desk and two weeks later went to another doctors desk. When I called June 1, 2016 I spoke to a lady in my examiner office who told me to call at the end of this week they should have a decision that they were tying up some loose ends. Is this normal? Do you think it could be a favorable or partial favorable decision? Thanks

      • Kay Derochie says:

        Dear Nona,

        Your claim is being looked at closely, which is good if you are disabled under Social Security law. It is less likely that something will be overlooked. When you call, you will be told whether a decision has been made, but you will won’t be told what the decision is. You will have to wait for a letter for that.

        Sincerely,
        Kay

        • Nona Dalaciao says:

          Thanks Kay

        • Nona Dalaciao says:

          Hi Kay I called today and spoke with my examiner and she stated that the decision had been made and I will get a letter in the mail in two weeks. If I go to the local office will they tell me what the decision was? or do I have to wait on the letter? is their anyway I can tell before I get the letter whether or not if it was approve or denied?

          • Kay Derochie says:

            Dear Nona,

            The local office will be notified at the same time you are, so you will have to wait for the letter.

            Sincerely,
            Kay

          • Nona Dalaciao says:

            Thanks Kay
            So that’s why when I went to the local office the decision still showed pending even though the examiner told me she had made her decision. I was thinking maybe it was a denial letter. So when the letter come it can be an approval or a denial?

          • Kay Derochie says:

            Dear Nona,

            Yes, you are correct.

            Sincerely,
            Kay

  4. Very_Confused says:

    Is it possible to be denied SSI and approved for SSDI? I received a denial letter for SSI, but was told my case was still rendering a decision on the SSDI claim. Is that even possible? If your denied for SSI ……is that an automatic denial for SSDI??

    • Kay Derochie says:

      Dear Very Confused,

      Your SSI denial letter probably gives a non-medical reason for the denial–too high income or too high resources. Social Security’s non-medical requirement is having enough Social Security work credits. So, yes, it is possible to be denied SSI and approved for SSDI.

      Sincerely,
      Kay

  5. lisa washington says:

    my attorney did an otr for me. How long does it take a judge to review and otr.

    • Kay Derochie says:

      Dear Lisa,

      I am unable to predict how long it will take the judge to review your appeal and decide whether a favorable decision can be made on the record (OTR) or a hearing is needed.

      Sincerely,
      Kay

  6. Brandi says:

    My friend filed for disability because he is completely deaf. The Dr social security sent him to said for him to be able to hear and understand the noise level would have to be as loud as a jet engine. He has always worked in construction and now is a liability in that line of work because of his disability. He also is very self conscious about his disability and rarely leaves his home unless absolutely necessary. His claim was denied which has put him father in depression. He doesn’t have insurance. Is there anything he can do now to get his disability?

    • Kay Derochie says:

      Dear Brandi,

      If he was denied less than sixty days ago, he can appeal. If it has been longer, he can file a new claim. He can also get a mental health evaluation so that the depression is severe it can be considered.

      I recommend that he hire an experienced Social Security attorney to help with the appeal. When you hire a Social Security attorney, you do not have to pay any legal fees up front and you will pay attorney fees only if you are approved for benefits. Social Security law sets the amount your attorney can charge, and the Social Security Administration pays the attorney directly from your retroactive award before they send your back pay to you.

      Sincerely,
      Kay

  7. Melissa Cox says:

    Hey kay
    My husband’s case is in the reconsideration stage and it was sent to the Mississippi office and I’m in ga. Why would they send it there for in this stage
    Melissa

    • Kay Derochie says:

      Dear Melissa,

      Your husband can ask why his claim was transferred. Perhaps the office in Mississippi is more caught up in their workload and can process it faster than your husband’s Georgia office.

      Sincerely,
      Kay

  8. melissa cox says:

    Dear kay my husband is 57 and has 3 stents in his heart hep c low blood plattlets cirrohsis of the liver and diabetteted
    and received his first denial letter and now is in reconsideration stage we hsve filrd the appeal
    the first denial stated that he could sdjust to other work
    what is his chances with his age.
    thanks melidsa

    • Kay Derochie says:

      Dear Melissa,

      Your appeal has to refute his ability to work in other new occupations. If you have not already done so, I suggest that your husband hire an experienced Social Security attorney. When he hires a Social Security attorney, he does not have to pay any legal fees up front and he will pay attorney fees only if he is approved for benefits. Social Security law sets the amount his attorney can charge and the Social Security Administration pays the attorney directly from the retroactive award before they send his back pay to him.

      Sincerely,
      Kay

  9. Nancy Morgan says:

    My daughter, 45 yrs old., has been receiving Social Security Disability for 4 yrs. she has Crohn’s disease in her colon, has a fistula and Hydradinitis Supervita. Recently, she received a call that she needed to see one of their doctors ~ this after we had completed the forms they submitted requesting, basically, the same info as the original application.

    She can not work because she has diarrhea 5 to 6 times daily, the HS flares up in the groin area often and in not describe here the issues she has with the fistula.

    She went to their doctor, he had her look u/look down. Arms up/down… No physical exam at all, the doctor did inquiry about the HS and said, he could not do an exam on her, he would have to ask his report on her doctor(s)notes. She still takes oral meds and Remicade IVs every 6 weeks.

    The question… If if they deny her benefits, can we Appeal based on this doctor NOTdoing a physical exam, as it pertained to her illness that is disabling her?

    Thank you for any information you may provide ~ just in case.

    • Kay Derochie says:

      Dear Nancy,

      If your daughter receives an unfavorable decision, I suggest that she appeal and get a copy of her claim file so she can see the exact reasons and address those reasons. If the basis of the denial is the consultative physician’s report, she can tell what transpired at the exam. That said, it could be to her advantage that the consulting physician depended on her own doctor’s notes.

      If she has to appeal, it would also be helpful for her to hire an experienced Social Security attorney. When you hire a Social Security attorney, you do not have to pay any legal fees up front and you will pay attorney fees only if you are approved for benefits. Social Security law sets the amount your attorney can charge, and the Social Security Administration pays the attorney directly from your retroactive award before they send your back pay to you.

      Sincerely,
      Kay

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