No matter how much thought, time and effort you’ve put into preparing your initial application for Social Security Disability benefits, don’t be surprised if it’s denied by the Social Security Administration. Over 70% of them are.
To help you decide what to do next, we’ll explain why most initial applications are denied, how you might deal with the denial, and the sequence of options the SSA offers to applicants who wish to contest their denial.
The SSA wants to provide SSD financial aid to every deserving applicant, regardless of age (if under 65), disability, location or anything else. But for several reasons—the huge number of applicants annually, the SSDI’s constantly eroding financial condition, the need to prevent fraud, and the agency’s desire to judge every application in the same, impartial way—eligibility requirements are strict and are followed “to the letter” nationwide.
Even so, the SSA realizes that those involved are “only human,” and human error is possible at any stage of the eligibility evaluation process. Possible, too, are other medical or non-medical reasons for a turn-down, but many can be dealt with once you know what action to take. That’s why, if you’ve been denied benefits, but believe you qualify for them and you know you need them, don’t give up. Challenge the decision — either by yourself or with the help of a law firm with SSD experience.
Important: If you wish to appeal, you must make your request in writing within 60 days from the date you receive the SSA’s letter of denial. Do so even if you have only some, but not all, of the new required information.
In recent years, the SSA has been improving the process of filing a disability claim—or filing an appeal if it’s denied—by implementing the Disability Service Improvement (DSI) process.
Its objective is to enhance the current disability determination process by:
– Helping to make the right decision as early in the process as possible
– Provide for consistent decision-making nationally and at all steps
– Improve the documentation
– Ensure that decisions follow SSA policy
– Enhance the quality and availability of medical and vocational expertise that the SSA employees need to help make accurate and timely decisions.
Depending on where you live, there are three or four levels of appeal.
In most states there are four levels — Reconsideration, Hearing, Appeal and Federal court review. In other states where the Disability Service Improvement program has already begun, there are three levels:
- Hearing by an administrative law judge (ALJ)
- Review by the Appeals Council
- Federal court review — for those applicants living in Alabama, Alaska, parts of southern California, Colorado, Connecticut, Louisiana, Michigan, Missouri, New Hampshire, New York, Pennsylvania. [The DSI process will be expanded nationally on a gradual basis, so check to find out if your state has eliminated the Reconsideration level.
Reconsideration. This is a thorough and independent review of your case, based on the evidence you submitted for the initial determination plus any further evidence you submit in connection with the reconsideration. It’s made by a member of the SSA staff who has been trained in handling reconsiderations and who was not involved in the initial decision you’re appealing. Most reconsiderations involve a review of your files without the need for you to be present.
You must file Form SSA-561-U2: Request for Reconsideration within 60 days after receiving the notice of denial. However, if you miss the deadline, you can still request a reconsideration if you include a written statement of “good cause” containing one or more good reasons for missing it. For example: A severe disability, particularly mental illness, which prevented you from contacting the SSA; the loss of important records, due to fire or theft; your incarceration; illiteracy; inability to understand or read English; or non-receipt of a decision due to homelessness or hospitalization.
Regardless of when you send it, you should present any new evidence you have that may prove the original determination was incorrect. You’ll need to use and sign two other forms: SSA-3441-F6 — Reconsideration Disability Report and SSA-827 — Authorization to Disclose Information to SSA.
Hearing. If you disagree with the reconsideration decision, you may ask for a hearing, to be conducted by an administrative law judge (ALJ) who had no part in the original decision or in the reconsideration of your case. The hearing is usually held within 75 miles (or longer in some states) of the applicant’s home. You will be notified of the time and place of the hearing.
Before the hearing, you may be asked to submit more evidence and to clarify information about your claim. You may look at the information in your file and give any new information.
At the hearing, the ALJ will question you and any witnesses you bring with. Other witnesses—e.g., medical or vocational experts—also may provide relevant information, and you’re allowed to question them.
In certain situations, your hearing may be via a video conference rather than in person; if so, you’ll be notified ahead of time. A video hearing may be more convenient for you. Often, it can be scheduled faster than an in-person appearance and/or it may be held closer to your home, making it easier for you to have witnesses or have other people accompany you. Either way, in-person or by video, it is usually to your advantage to attend the hearing in order to explain your case and answer any questions.
If you’re unable to attend a hearing or don’t wish to do so, you must tell the SSA why, in writing, ASAP. Unless the ALJ believes your presence is necessary to decide your case and requires you to attend, you won’t have to go. Or the SSA may be able to change the time or place of your hearing.
After the hearing, the ALJ will make a decision based on all the information in your case, including any new information provided. You’ll be sent a letter with a copy of the judge’s decision. If it’s another denial, and you’re sure you’re eligible for SSD benefits, then you can ask for an Appeal.
Appeal. At last count, the SSA’s Appeals Council consists of about 70 administrative appeals judges, 56 appeals officers, and several hundred support personnel. The Council may grant, deny, or dismiss a request for review. If it grants the request for review, it will look at the entire decision, not just the part you disagree with. “If our decision was wrong,” the court promises, “we will change it.” It will either decide the case or return (“remand”) it to an ALJ for a new decision.
But don’t expect a quick decision by the Council. Between October 2010 and September 2011 (the SSA’s fiscal year), it processed 126,992 requests for review, and the average processing time was 360 days! [If you assume each request was seen by a judge — not only by an appeals officer or a staff member — that’s an average of 1,814 cases per judge per year. If each judge worked 250 eight-hour weekdays per year, that’s an average of 7.26 requests per day, or close to one per hour. With its financial status the way it is, don’t expect the SSA to hire a lot more judges in the near future.]
Federal court review. This is the last level of the appeals process. It’s actually a civil lawsuit you would file within 60 days of a denial — in a federal district court in your state — against the SSA, and you’ll need to have a qualified attorney represent you. The SSA will provide the district court with all the documents and evidence they relied upon in determining your eligibility for SSD benefits. Afterwards, the court will notify you and/or your attorney in writing of their decision.
If the court decides against you, there’s nothing more you can do, unless you can come up with new and relevant medical or non-medical evidence (e.g., your disability gets much worse) or, perhaps, your medical condition (whether physical or mental) is added to the SSA’s Listing of Impairments or newly qualifies for a Compassionate Allowance. These are conditions that are so severe that they obviously qualify and meet the SSA’s standards of disability.
For those living in the states listed above (or to be added later), DSI allows individuals who are clearly disabled to have favorable determinations made within 20 calendar days (if at all possible) after the date when their state’s Disability Determination Service (DDS) receives the claim or appeal.