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Appeals Process

You have the right to appeal any decision the Social Security Administration (SSA) makes in regards to your eligibility for Social Security Disability Insurance Benefits (DIB) or Supplemental Security Income (SSI) payments. If SSA concludes that you do not fit the prerequisites for Social Security DIB or SSI or that you are being paid too much, you are entitled to file an appeal. SSA strives to make certain that every decision regarding your Social Security DIB or SSI claim is accurate. SSA diligently analyzes your case prior to confirming your eligibility or entitled benefits. When SSA finalizes your claim, they will send you a letter rationalizing why they made the decision they did. If you disagree with the decision, you can dispute it, and SSA will inspect your case again. During an appeal, SSA will take a look at the initial decision, even the sections that were in your favor, and reverse it assuming the original was a mistake.

If you choose to appeal, a written request must be submitted within 60 days from the day you receive the letter of denial. You will be granted a five-day grace period to account for the mail delay unless you have proof that it arrived even later. If you need assistance with your appeal, contact the local Social Security office.

Typically, there are four levels of appeal including:

1. Reconsideration
2. Hearing before an administrative law judge
3. Appeals Council review
4. Federal Court review

When you receive a letter of denial, it will be stated within the letter how to appeal the decision.

When someone who was not involved in the first decision thoroughly reviews your claim, it is known as reconsideration. All original evidence is combined with any new evidence and reviewed by an unbiased representative. At the conclusion of the hearing, you will receive a letter with a duplicate of the administrative law judge’s decision. In most reconsideration cases, your files will be reviewed without your presence required. However, when you appeal a decision in which disability benefits no longer apply due to an improvement in health, you can meet face to face with a Social Security representative and plead your case, stating that a disability still exists.

If the reconsideration decision is not in your favor, consider requesting a hearing. An administrative law judge with no prior connection to your case, whether it is the first decision or reconsideration, will hold the hearing. The hearing is normally staged within a 75-mile radius of your home, and the judge will alert you as to exactly where the hearing will be and when it will take place. If you have legal representation, your counsel may accompany you to the hearing and plead your case in person. The administrative law judge will interrogate you and any witnesses there on your behalf; additional witnesses, like medical or vocational experts, can also attend the hearing to provide insight. You and your attorney may also have the opportunity to question witnesses. It is generally advantageous to show up at the hearing, but it is not mandatory. If you choose not to attend, you must notify SSA in a written document. Under unique circumstances, your hearing may be conducted via video conference instead of in person. SSA will inform you in advance if this happens. Video hearings offer convenience, and they can also be set up much more efficiently. Video hearing centers may also be closer in proximity than normal facilities. This might also increase the odds of key witnesses joining the conference on your behalf. Unless the judge decides your absence is detrimental to the decision-making process, the case will be settled based on old and new data. After the hearing wraps up, SSA provides you with a letter and copy of the judge’s verdict.

If the outcome of the hearing is not to your liking, you can demand another review by the Social Security Appeals Council. SSA will be glad to assist you in this matter. The Appeals Council considers all requests for review, but it reserves the right to deny a request if it sides with the judge’s decision at the hearing. If the Appeals Council chooses to take on your case, it will either finish the case off itself or hand it over to and administrative law judge for further review. If the Appeals Council turns down your request to assess your case, you will get a letter in the mail detailing the denial. On the other hand, if the council decides to review the case and make an independent decision, SSA will send you a copy of the decision. If the Appeals Council sends the case back to an administrative law judge, you will receive a letter in along with a copy of the order from SSA.

If you still are unhappy with the Appeals Council’s final decision, or if the Appeals Council has refused your case, there is always the option of filing a lawsuit in a federal district court. The letter from SSA regarding the Appeals Council’s course of action instructs you how to bring your case to court.