Americans seeking Social Security disability benefits must navigate a complex application process, and the majority of applicants are unfortunately denied. With denial rates so high across the country, applicants should be familiar with the Social Security appeals process. Unfortunately, most people will have to go through one or more appeals to obtain their benefits. By appealing your disability denial, you can increase your chances of approval and get the financial assistance you need.
- Request for Reconsideration
- Hearing by Administrative Law Judge
- Appeals Council Review
- Federal Court Review
When going through the appeal process, you must perform each step in order before moving on to the next. Each level must be initiated within a specific time frame (usually 60 days), and for most steps, you’ll need to provide additional documentation or medical evidence to support your disability claim. Additionally, many people choose to retain legal help since the appeals process can be time-consuming, and having legal counsel on your side can lessen your burden and will usually shorten the time you have to wait between stages.
There are two main disability benefits programs that are run through the Social Security Administration (SSA): Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). These two programs currently provide monthly cash benefits to over eight million Americans, though only a little over 35% of applications are approved after an initial claim is submitted. However, after accounting for those that go through the appeals process, the final rate of acceptance jumps to over 50%. There are several reasons why your initial claim could be denied due to the SSA’s comprehensive eligibility guidelines.
To better understand the reasons for your Social Security disability benefits denial, it helps to know the basic criteria for qualifying. Disability insurance is reserved for those with severe impairments that are expected to last over 12 months or end in death, and prevent them from engaging in substantial gainful activity (SGA). Applicants must also have paid into the Social Security system by acquiring a certain number of work credits in their working life. A typical worker earns four credits per year of employment, and an applicant needs 20 credits, or to have worked five out of the last 10 years. It is strongly recommended that you double-check your eligibility before submitting your application to ensure you meet the basic criteria. Once your application is received, it will be reviewed by your state’s disability determination agency to see if it meets federal criteria.
The most common reason applicants are denied benefits is because they were judged able to perform another kind of work (other than their occupation before they became disabled) and earn over the SGA limits. Of the final SSDI decisions, over 41% of applicants were denied for this reason. Per SSDI guidelines, even if you’re not able to continue your previous line of work, if you are found to be able to transition into another line of work, you will be denied benefits.
The SSA uses many factors to determine this such as your age, level of disability, prior education, transferable skill set, prior work experience, and your likelihood of adjusting to a new job. If they find you likely canperform another kind of work, they are required to list at least three alternative jobs that match your existing skill set. Like any Social Security disability denial, you can contest their determination.
The second most common reason for denial is that your disability is not severe enough. Roughly 24% of denied applications fall into this category. The SSA consults a reference called the “blue book” that lists all impairments that have been pre-authorized to receive an SSDI benefit. However, it’s not enough to simply have your disability listed here – you also have to meet the listed criteria for severity which must be supported with medical evidence.
Each condition comes with a description of symptoms and a listing of test results and diagnoses that are needed to rate your disability severe enough. Many applicants falsely believe that just because their condition is listed, they will automatically be approved. The blue book is available online to anyone, and it’s recommended you consult the listing that pertains to you along with your doctor to determine if you meet the criteria.
Applicants are also denied if the SSA believes they are still able to perform their previous line of work despite their disability, or if their disability is not expected to last 12 months. There may be other reasons as well, such as they don’t have enough work credits or their application was incomplete.
If you received a denial letter after your initial application, it’s almost always in your best interest to start a Social Security disability appeal. Each level of the appeals process gets more complex and time-consuming as you move on, so you may consider getting a Social Security disability attorney to help.
This is the most straightforward stage of the appeals process. Within 60 days of receiving your denial letter, you can request reconsideration. Reconsideration simply means that someone at Disability Determination Services (DDS) will perform a complete review of your application to see if an error was made. The representative that completes this review must be different from the original reviewer. You are also allowed to submit more information during this review process if your application was incomplete or if you were denied due to lack of evidence, though this is not required. This stage of appeals typically takes four to 12 weeks to receive a decision.
The form you use to request reconsideration depends on the reason for your denial. If you were denied for medical reasons, you must submit Form SSA-561 (Request for Reconsideration), Form SSA-3441 (Disability Report – Appeal), and Form SSA-827 (Authorization to Disclose Information to the Social Security Administration). If you were denied for a non-medical reason, you only need to submit Form SSA-561. These forms can be printed, filled out, and mailed to the SSA, or it can also be done entirely online.
If your reconsideration review was denied, the second level of the appeals process is to request a Social Security disability hearing with an administrative law judge (ALJ). This must be initiated within 60 days of your prior reconsideration denial. These hearings (sometimes called a disability adjudication) are occasionally held at a physical location, but can also be conducted via video conference which is becoming more common. Video conferences typically can be scheduled sooner and make it easier for the claimant to bring witnesses to testify on their behalf.
During your administrative law judge hearing, you’ll be able to present your case to a judge who had no role in the previous two decisions and will therefore give their impartial judgment. You may be asked to bring or choose to bring additional documentation and witnesses to support your case, and many people opt to have a legal representative with them as well. Unfortunately, it can take several months or over a year to get a disability hearing scheduled, making it important you make the request as soon as possible.
If you receive a denial from your reconsideration, there will be instructions on your letter for how to start the next level of appeals. To request a hearing, you must fill out and submit forms HA-501 (Request for Hearing By Administrative Law Judge), SSA-3441 (Disability Report – Appeal), and SSA-827 (Authorization to Disclose Information to SSA).
If you choose to bring a representative with you, you must also fill out and submit form SSA-1696 (Appointment of Representative). Like the other steps in the appeals process, this can be done either online or by printing out forms and sending them into the SSA.
The third level of your disability appeal is to request a review by the Social Security Appeals Council. At this stage, you will not receive a new hearing. Rather, the Appeals Council will review all the lower decisions and decide whether to reverse the previous decision and approve your claim, let the ALJ’s ruling stand, or they may deny your request of review and remand (send) the case back to an ALJ to review it again.
Like the other three steps, this request must be initiated within 60 days of receiving your denial. It can take anywhere from six months to two years to complete this stage of the Social Security disability appeals process.
The best way to request a review is by using the SSA’s online service, AC iAppeal Online, but you can also fill out form HA-520 (Request for Review of Hearing Decision/Order) and send it to the SSA. You should also include any new evidence with this request or inform the Appeals Council that you and your representative will be providing new evidence.
The last level of your SSDI appeal is to file a civil lawsuit through your legal representative with a federal district court. In most cases, a district court judge will remand the case back to an ALJ or the Appeals Court to review the previous finding. On rare occasions, a judge will reverse a lower court’s decision and approve your disability benefit. This is the only level that takes your disability case outside of the SSA and moves it into the U.S. Federal Court system. Since the previous three steps can take months or years to complete, most claimants do not make it to the final stage.
There is no SSA form for this level of appeal. Instead, you’ll have to work with a Social Security disability attorney to file a civil lawsuit.
Most people can benefit from seeking legal advice during the Social Security disability process. Some may even choose to consult a disability lawyer before their initial application, though this is not required. In general, the higher you move up in the appeals process, the more helpful a disability attorney will be for you. This is especially true if you have a complicated case that requires detailed documentation and a thorough medical record to substantiate your claim. Most people choose to retain a lawyer when they get to the Appeals Council review stage since it typically requires additional evidence and a considerable amount of time.
A good disability lawyer can help you understand why your application has been denied and can work with you to gather needed documentation to increase your chances with your subsequent appeals. Lastly, per federal law, you cannot be charged by a disability lawyer or advocate unless you are ultimately approved. Even then, disability attorneys are capped at what they can charge you. If you are approved, they can only collect 25% of your disability back pay or $6,000, whichever is less.
Filing for a Social Security disability claim can prove a long and arduous road for many. It can seem all the more daunting knowing that such a low percentage of people are approved after they apply. Preparing for a denial can help provide a more realistic picture of what’s to come.
For most people, the appeals process will require you to gather additional evidence, obtain various lab tests or diagnoses from doctors, or call forth witnesses who can attest to the severity of your disability. For these reasons, many people understandably choose to hire a disability lawyer to keep them on track and offer advice on how to present your case to maximize your chances of approval. Disability programs like SSDI and SSI provide essential services to those who need them, and you should apply if you have a long-term disability that prevents you from working.