There are a vast number of people who get denied disability benefits the first time they apply. As such, many of them are forced to reapply or appeal the Social Security Administration’s (SSA) decision. But is it better to appeal or reapply?
It is generally suggested that you appeal the SSA’s decision instead of reapplying from scratch. This is because reapplying usually results in the same outcome as when the SSA finds that you previously applied for disability benefits.
Keep reading below as we discuss in more detail whether you should appeal or reapply for disability benefits.
Why Was My Disability Application Rejected?
If the SSA denies your claim for disability benefits, they are required by law to provide you with a written explanation of their decision.
A small percentage of applications are turned down on the basis of “technical denials,” which might arise from issues such as an applicant having an excessive amount of assets (if applying for Supplemental Security Income, or SSI) or not having worked long enough (if applying for Social Security Disability Insurance, or SSDI). Other possible causes of technical denials are:
- Fraudulent activity.
- Not keeping the Social Security Administration up-to-date on your current contact details.
- Having a criminal record (depending on the situation)
A large proportion of applications are turned down due to the health-related criterion. A medical denial from the Social Security Administration indicates that the agency has determined that you are not sufficiently disabled and, therefore, do not qualify for financial assistance.
Getting denied for medical reasons can be upsetting. If you and your doctor both recognize that you have a health issue, the Social Security Administration should be able to see it, right? But there could be a variety of reasons why they didn’t.
The Social Security Administration may deny your disability benefits on the grounds that you failed to provide adequate proof of the seriousness of your condition, that your symptoms would subside if you complied with your doctor’s advice, or that your condition is too short-term to meet the 12-month duration criteria.
The SSA Appeals Process: Step-by-Step
In this section, we’ll describe how the appeals process works.
1. Reconsideration
Disability Determination Services (DDS) are Social Security offices in each state that assess applicants’ medical qualifications for disability benefits. If the Social Security Administration denies your claim, you can appeal the decision.
You can submit a request for reconsideration either online or by mailing in a completed copy of forms SSA-561, SSA-3441, and SSA-827 to your local Social Security Administration office.
The reconsideration process involves a new evaluation of your claim by a DDS examiner and a team of physicians in your state who didn’t participate in the previous evaluation.
You can supply DDS with new data, including medical documents from more recent exams or treatments, and draw their attention to pieces of information they might have missed the first time around.
It’s possible that the examiners will make their own requests for more information.
Recent SSA statistics show that, on average, it takes 147 days to receive a reconsideration judgment and that only around 1 in 9 requests for reconsideration result in benefit awards.
2. ALJ Hearing
You may request a hearing with an administrative law judge (ALJ) if DDS refuses to overturn its decision. The ALJ will analyze the material in your case and hear testimony from you and any expert witnesses.
To request a hearing, either submit Form HA-501 or use the online appeal system. Your hearing can take place either in person, over the phone, or through an online video feed.
It may take some time to schedule a hearing: There were 168 regional Social Security hearing offices across the country in October 2022, with average waiting periods ranging from 8 months to 24 months.
Depending on the number of witnesses, a disability hearing could last more than an hour. After that, it may take a few weeks to a few months for the ALJ’s written decision.
According to data provided by the Social Security Administration, the rate of approval for applicants after the hearing stage fell from over 75 percent in the middle of the 2000s to just under 50 percent in the middle of the 2010s, but it has moved up to approximately 57 percent in the past few years.
3. Appeals Council
If an ALJ rules against you, you can appeal to SSA’s Appeals Council for a second opinion. To request a review by the Appeals Council, either fill out and submit Form HA-520 or go online to Social Security’s website.
A three-person panel from the Appeals Council will review the judge’s decision, the supporting evidence, and any new material you provide. If the claimant opts for oral argument, the panel will consist of three members; if the council is merely analyzing the case record, the panel will consist of two members.
If they can’t come to an agreement, a third person is brought in to decide. The council has the power to sustain, alter, or overturn the ALJ’s judgment or to request a fresh hearing and decision from the court.
After receiving an appeal in 2016, the most recent year for which data are currently available, the Council’s decision-making process typically took roughly a year, on average, from the time it received the appeal until it issued a ruling.
4. The Federal Courts
Your final option is a federal court review for SSDI appeals. If the Appeals Council rejects your appeal, you can take legal action in federal district court. If you don’t like the outcome, you can appeal to the next level of court in the United States.
Social Security will give instructions on how to proceed after an Appeals Council decision in the letter they send you.
Is It Better to Appeal or Reapply for Disability?
We’ll go through some of the reasons why appealing a denial from the Social Security Administration is preferable to starting over with a new application if you disagree with the agency’s decision.
There are, however, cases where a fresh application is required.
Back Payments
The “protective filing date” is the date you inform the Social Security Administration of your intention to apply for disability payments.
You may be eligible for retroactive pay or benefits dating back to the date of your claim’s submission (or, in the case of Social Security Disability Insurance claims, no more than twelve months earlier).
During the appeals process, the protective filing date will still be in effect. A fresh claim will result in a more up-to-date protective date and less back pay in the event of a successful outcome.
Chances of Success
The majority of disability claims submitted to the Social Security Administration are initially denied. Many professionals agree that filing an appeal rather than starting the process anew can increase your likelihood of successfully obtaining disability payments.
The data from the SSA confirms this. The latest annual report on the SSDI program states that between 2016 and 2020, examiners for the Social Security Administration found sufficient medical evidence to accept around 36% of initial disability petitions.
During the same time period, benefits were granted in over fifty percent of the cases that had been appealed and went to a hearing before an administrative law judge.
As mentioned before, this is the second step in the Social Security Administration’s appeals process and the first stage in which the claimants are able to offer oral arguments and call witnesses.
Medical Condition
If your medical condition is basically the same as it was when you originally filed for benefits, a fresh claim will probably face the same fate as the previous one, except if you have obtained additional medical proof about the severity of your ailments.
It is also possible to provide such evidence in an appeal, retaining the aforementioned benefits.
However, you may want to consider reapplying if you are now seeking benefits because of an injury or illness different from the one that originally generated your claim, or because your impairment has significantly worsened since your initial application.
Deadline
When appealing a SSDI denied claim for benefits, you are given 60 days from the date of the denial to submit your appeal. You may need to reapply for the benefits you want if you missed the deadline. Keep in mind, once more, that a new claim has slim chances of success if it is nearly identical to an old one that was previously rejected.
If you miss the 60-day deadline for filing an appeal, SSA may still consider your request, but you’ll need to provide a compelling explanation.
Some examples of good reasons include personal factors that prevent you from submitting your appeal on time, including being homeless or suffering from a serious medical condition; limitations in your psychological, physical, or linguistic capabilities; getting insufficient or inaccurate data from the SSA regarding your appeal rights; or a fire or other mishap that destroyed documents that were relevant to your case.
You may also submit a request to Social Security to have your claim reopened if the deadline for filing an appeal has passed. This can be done in conjunction with filing for a new disability benefit for a similar condition. As with an appeal, your initial filing date will remain intact with a reopening.
You have the right to request a reopening of your case for any reason within the first year after the denial has been issued. After that point, the SSA will only reevaluate your claim if you can prove that the original denial was the product of fraud or an administrative error, for example, by providing fresh and relevant evidence about your condition.
You Cannot Do Both
There’s also the fact that you can’t submit a new application concurrently with an appeal. You will need to wait for the appeals council’s verdict before submitting a fresh application.
The appeals council will review any new information submitted that the ALJ did not take into account; however, that material must pertain to events that occurred before the ALJ rendered their decision.
As a result, it is often preferable to reapply, get further treatment, and collect additional information in order to bolster your case the second time around.
Therefore, when determining if you want to appeal at that point, a few things to take into consideration are as follows:
The way your medical circumstances shifted since you initially filed a claim;
- Do you have fresh proof of your conditions that is unrelated to the time frame prior to the ALJ’s decision?
- Are there new conditions that the ALJ failed to take into account in their decision?
- Have your personal circumstances shifted in such a way that you will be capable of receiving further medical care in the near future?
The “Last Insured” Date
Lastly, you should think about your “Date Last Insured,” or DLI, which depends on the day you became unemployed and sets the time frame in which your disability must start for you to be eligible for SSDI benefits. You must be found disabled prior to your DLI to be eligible for SSDI benefits.
Before determining whether or not to appeal or reapply at this point, you should discuss your options with a qualified disability expert and gain a deeper understanding of the specifics of your situation.
What is the Denial Rate for Disability Benefits?
Seventy percent or more of initial claims for social security disability are turned down. This does not imply that the majority of those requesting disability benefits are not qualified for benefits. Social Security will probably dismiss your claim unless your circumstances are particularly obvious.
The Social Security Administration might not have enough information to approve your benefits claim.
This may occur if necessary medical information is missing. For the Social Security Administration to locate your medical records, you must submit a list of the doctors who treated you and the contact details they provided on the initial application. The SSA won’t have a full picture of how your impairment impacts you until you offer specific information about these providers.
The Social Security Administration will also want evidence that you are making an effort to improve your health. The Social Security Administration may downplay the severity of your impairment if they see no evidence that you’re making an effort to improve your health.
If you do not maintain routine medical checkups, they may reject your claim.
Conclusion
In conclusion, it is generally better to appeal the SSA’s decision rather than reapply. However, if you are confused about which route is best for you, consider consulting an SSA representative, an advocate, or a disability attorney to understand the specifics of your case.
