The vast majority of people who apply for Social Security Disability Insurance (SSDI) get a rejection. Luckily, applicants can challenge the Social Security Administration’s (SSA) decision through their appeals process.
To file a successful appeal with the SSA, it is important to file for an appeal as soon as possible, submit all the necessary paperwork, draft an effective appeal letter, provide new medical evidence, and maybe even consider hiring a qualified disability lawyer to represent you.
Continue reading for more tips on how you can file a successful appeal.
Eligibility Criteria for SSDI
The Social Security Administration has a strict definition of disability that must be met in order to qualify for SSDI. Applicants need to:
- Not be capable of engaging in significant gainful activity
- Not be capable of working in their former or a different occupation as a result of their medical condition
- be terminally ill or have a disability that has or will keep them from working for at least a year
Furthermore, applicants must have worked in a Social Security-covered job for a sufficient amount of time within the preceding 10 years. This means they must have paid Social Security taxes while employed.
Why Does Social Security Reject Applications?
Your claim for Social Security Disability Insurance may have been disapproved for a variety of reasons, including errors in the paperwork you submitted, a lack of sufficient medical evidence, or missing a critical filing deadline.
It is also possible that the Social Security Administration will decide that an applicant’s condition is not severe or disabling enough to warrant SSDI benefits. Even though these are the most common reasons why the Social Security Administration rejects claims, there are also others, including the following:
- Failure to cooperate with the SSA
- Ignoring medical advice or failing to show up for appointments
- Having a physical impairment that occurred while committing a crime
- Making false claims to receive Social Security Disability Insurance
- Being physically or mentally impaired as a result of substance abuse
It’s possible to still qualify for SSDI benefits even if your initial claim is denied. You can file as many appeals as necessary to get the SSDI benefits you need and deserve. You can appeal the decision made by the Social Security Administration with the help of a Social Security Disability advocate, help from the SSA, or a SSDI lawyer.
Levels of Appeal
There are four main stages of the appeals process if your application is denied.
Request for Reconsideration
To begin an appeal, you must submit a Request for Reconsideration. By doing this, you are requesting that your claim be carefully reviewed once more. This is done by a reviewer who has not been involved with the review of your initial claim. The reviewer will read through all of the evidence you submitted, both new and old.
This appeal can be submitted, and the status of your request for reconsideration can be checked online. If you’d rather not file your application online, you can do so by phone or in person at a nearby Social Security Administration office.
Unfortunately, a large number of these requests for reconsideration are also rejected; as a result, it may be a good option to seek help from a Social Security disability lawyer who can assist you in this process.
Administrative Law Judge Hearing
If your request for reconsideration is denied and you do not agree with the decision, you have the right to an Administrative Law Judge (ALJ) hearing. It is conducted by an administrative law judge who did not participate in the reconsideration review or application process.
You can also check the outcome of your hearing by visiting the SSA’s website. Disability hearings can take hundreds of days to schedule, and then you’ll probably wait another 45–90 days for a decision after the hearing itself.
Hearing decisions may go one of three ways:
A Fully Favorable hearing decision means that the judge who heard your case ruled in your favor and that you are entitled to disability benefits, and agreed with your disability beginning on the date you claimed it began.
In a Partially Favorable hearing decision, the judge who heard your case rules in your favor on some of the issues raised in your claim for disability benefits but made modifications to other parts of your claim.
For example, the judge could have approved your claim for only a “closed period” of benefits rather than continuing disability benefits, or the judge could have approved your claim for a date later than the one you specified to be the onset of your disability.
An Unfavorable hearing decision means the judge who heard your case did not agree with you and did not grant you disability benefits.
Appeals Council Review
After the hearing, if you are still not approved for benefits, you have the option of requesting a review from the Appeals Council of the SSA. This can be done in person, via mail, or over the internet on the Social Security Administration’s website. You’ll need to provide the following information in order to request this review:
- SSA’s official letter of decision
- The full name, phone number, and mailing address of your legal counsel, if you have one
- Additional documentation for your application, such as forms, legal documents, and statements in writing
The Appeals Council will consider each and every request, but they reserve the right to reject it if they feel that the decision that was reached at your hearing was appropriate and in accordance with the law.
If they decide to look into your claim, they will either make a decision on it themselves or send it to an administrative law judge.
Review By Federal Court
The final option is to file a civil suit in the federal district court if the Appeals Council either refuses to review your case or finds that you do not qualify for benefits. Unlike the rest of the Social Security disability appeals process, this cannot be filed electronically.
The lawsuit would be submitted to the court in the judicial district that has jurisdiction over either your primary place of business or the location of your primary residence. There is most likely to be a cost associated with this lawsuit.
You must also provide the Social Security Administration with (via regular mail) copies of the complaint you filed and the court-issued summons.
Federal Court Review
If a claimant’s case is dismissed or denied at the level of the US District Court, the next level of appeal is to the US Circuit Court of Appeals. If the Court of Appeals does not reverse the District Court, claimants can ask the US Supreme Court to review the matter, but the Supreme Court has wide discretion over which cases it will hear, and most such requests are denied.
Should I Appeal or Reapply?
If your disability benefits application is denied, filing an appeal can protect the amount of back pay you receive.
Back pay refers to any unpaid benefits from your claim. Both SSI and SSDI use the date you applied for benefits to determine some or all of your back pay. Therefore, if approved for benefits, the sooner you apply for benefits, the more back pay you will receive in addition to your initial benefit payment.
If you decide to start the process over instead of appealing the decision, you run the risk of not receiving as much backpay since the new application date would be used. You also have to start the months-long application process over again if you don’t appeal or proceed to a hearing. You may have to wait up to a year just to hear back about your request for reconsideration.
Tips for a Successful Appeal
You can increase the likelihood of successfully winning your appeal by presenting your case in the clearest possible manner. Taking these steps will help in that process:
Consult a Lawyer
One of the best things you might be able to do to increase your chances of receiving benefits is to hire an attorney. With legal representation, you may have a three-times better chance of succeeding at your disability hearing. At the hearing stage, 83% of applicants are represented by counsel.
Having legal representation by your side can be beneficial to you at every stage of the appeals process. They will submit your paperwork during the reconsideration phase. In the event that your request for reconsideration is denied, you will have the evidence at your disposal to strengthen your case for the hearing.
Then, when the time comes for your hearing, they will act as your legal representatives in court. Your attorney will help you prepare for your hearing and will use their expertise in SSDI law to present the strongest case on your behalf.
Don’t Wait to File an Appeal
If the Social Security Administration denies your claim or approves you for fewer benefits than you deserve, you have 60 days from the date you receive the decision letter to file an appeal.
If you miss this deadline, you will lose the right to file an appeal, and you may have to start the application process from the beginning again. When you get a denial letter, call the Social Security Administration office right away so they can explain your options.
Be Clear and Truthful
At the hearing, you will also be called upon to testify. If the judge asks you questions about your health and employment prospects, the answers you give should be clear and concise if you want to improve your chances. Your attorney will prepare you for the process by outlining the types of questions you can expect.
Ask Your Doctor For A Written Opinion
Your physician is in the best position to give you an in-depth assessment of the nature and severity of your medical condition, as well as the restrictions that they place on your everyday life. You have the option of asking your physician to put this opinion in writing for you.
This letter can then be included with the other medical documentation. A doctor’s letter may help during the disability reconsideration phase of the appeal process, but it will be much more helpful during the hearing phase.
Write a Strong Appeal Letter
When filing the appropriate SSA paperwork, you’ll only have a few lines to explain why you believe the SSA’s decision was wrong.
However, you might want to provide a more in-depth analysis of why SSA’s decisions were incorrect.
This can be done by writing a powerful appeals letter and filing it together with the SSA application. You can include a note on the form stating “see the attached page” to ensure the SSA workers who receive your form also read the accompanying letter.
Provide New Medical Evidence
Your application for disability benefits will largely be decided based on the medical records and evidence you submit. If you’ve already had a disability reconsideration request turned down, the additional medical evidence and paperwork you provide could make a difference.
This supplementary evidence could prove to be the deciding factor in your favor during the reconsideration of your claim. You and your doctor can go over the reasons for the initial denial and decide together what kind of medical evidence will best support your appeal.
Submit the Right Paperwork
You must use a designated form to request a reconsideration hearing. This document is referred to as the SSA-561 Form. In addition to that, you are required to also submit a Reconsideration Disability Report. This report adds to your initial application by providing additional pertinent details.
Claimants must also submit an Authorization to Disclose Information form. This is a medical release form that grants the Social Security Administration access to your disability-related medical records.
How Long Does the SSDI Appeals Process Take?
The SSDI appeals process can take up to two years. In some cases, it takes even longer. However, it usually takes around 18 months to get to a hearing and, with competent representation, win your appeal.
Conclusion
Navigating the Social Security appeals process can be complicated for many claimants to understand. This is why it’s recommended to seek help from an advocate, the SSA, or consider hiring legal help for your case to maximize your chances of a successful appeal.
