The Social Security Appeal Process

If an initial claim for Supplemental security income (SSI) or Social Security Disability Benefits is denied, applicants can challenge that decision.

Although appealing social security denial can take months or even years, there’s a higher chance of succeeding if done correctly.

According to the Social Security report, among people who received their benefits between 2010 and 2020, a third of the applicants accepted were those whose application was initially turned down.

Do I Need to Appeal?

After receiving a denial letter from the Social Security Administration, many applicants feel discouraged and give up on disability benefits. But before giving up, know it’s essential to file an appeal. Here’s why:

Most Initial Disability Applications are Denied

70% of initial disability benefits applications in the United States are denied. This doesn’t mean that the denied applications are all wrong. Applicants are usually rejected at first unless they have a very clear-cut case.

Most applications are denied because the SSA needs more proof or information to approve the benefits.

This may be due to a lack of enough medical records. Therefore, the initial application requires applicants to provide a list of medical providers and their contact info to confirm the medical records.

Suppose the application does not contain the unique contact information of these providers. In that case, it’d be difficult for SSA to understand the disability’s effects on the applicant.

One of the most critical aspects of confirmation from SSA is to see that the applicant is actively receiving treatment for their condition.

The Disability Appeal Option was Introduced for a Reason

As mentioned earlier, most initial disability applications are usually denied. That’s not weird; this is why there’s an option to appeal the SSA decision.

The SSA appeal is a process that involves having a new SSA staff review a disability claim and possibly make a new decision.

What is the Appeal Process Like?

As stated earlier, most initial disability applications are usually denied. There are different stages of the appeal process, and it’s important to know how to win a Social Security disability hearing before commencing these processes.

Reconsideration

The state-level Social Security agencies, known as the Disability Determination Services (DDS), review the medical eligibility for disability benefits.

When a claim is rejected, the next step is to ask the Social Security Administration (SSA) for reconsideration. Applicants can file for reconsideration online or by completing a form and sending it to their local Social Security office.

During the reconsideration process, a medical team and an examiner from the state DDS are involved. This initial review looks at the claim from a fresh point of view.

This is an opportunity to provide additional evidence (like other medical treatment and examination records) and point out evidence DDS may have omitted during the initial review. Of course, the examiner may request additional information.

The reconsideration decision may, on average, take 147 days, according to SSA. 1 out of 8 reconsideration requests got approved in 2019.

Requesting a Hearing BEFORE an Administrative Law Judge

If the reconsideration process doesn’t work, request a hearing from the administrative law judge (ALJ), who will review the case’s evidence and hear the testimony from both the claimant and the expert witness.

To request an ALJ hearing, complete a form through the online appeal system.

Keep in mind that it may take a while to receive a date.

Disability hearings usually last for an hour, except when there are multiple witnesses. However, receiving their final decision can take anywhere from a few weeks to a few months.

Appeal Council

If the administrative law judge’s decision is against you, request a review from the Appeal council. You can file an Appeal council review online or fill out a form for social security.

A panel of Appeals Council members will review the judge’s decision, evidence, and any added information.

If the case involves oral argument, the panel will consist of three claimant members. In the case of a simple case record review, only two members are involved. The council can reverse, uphold, or modify the ALJ’s decision or order ALJ to hold a new hearing and make a new decision.

Federal Courts

The federal court is the claimant’s last hope. If the Appeal Council’s decision is turned against you, file a suit in the U.S. District Court.

This court can challenge any unfavorable ruling.

The SSA’s Hearing and Appeals site contains more information about this process.

Remember that each stage of the appeal process requires you to request an appeal within 60 days from the date of an unfavorable decision.

How to Write a Letter of Appeal

That said, here’s how to write a letter of appeal. Before writing the letter, understand why your claim was denied. This can be accessible in the decision notice.

Put the Name and Claim Number at the Top

Although the SSA appeal form already bears the name and details of the claimant, the attached letter may mistakenly get separated from the form. Having the name and claim number written in the upper area of the letter will help the SSA staff know which document goes with which letter.

Identify any Oversight or Mistake

If you discover any wrong info or mistake from the SSA verdict, point it out in the letter. Be specific, and print out the exact line and paragraph where the administrators made the mistake.

Add Missing Medical Information

If the initial claim was denied because of inadequate medical information, include it in the letter and be prepared to back it up with proper evidence.

Attach Medical Records and Evidence

Attach the proper evidence that backs up every claim for a more convincing appeal. Evidence can include:

• Medical records indicating the severity of your medical condition.
• Recent medical evidence from the doctor proves that the condition has worsened.
• Written evidence from your doctor proving your disability and limitations.
• Recent medical tests proving the severity of the condition.

And every necessary document to support the claim.

Be Straightforward

The SSA works on thousands of appeals, so it’s essential to get the points across as briefly as possible and avoid information that does not relate to the appeal.

Be Detailed

Although the letter should be brief, it must be as detailed as possible. Doing this makes the appeal more convincing if it is backed up with quality details.

Who Determines Whether I’ll Receive Aid, and How is it Determined?

The SSA determines whether or not you’ll receive a benefit. The Social Security Administration federally administers social security insurance benefits.

Social Security benefits pay disability benefits to U.S. citizens who have worked long hours and have medical conditions that have stopped them from working for at least 12 months. This is a crucial point to understand when learning how to apply for SSI.

What Might Automatically Disqualify Me from Social Security?

Just because you have a severe medical condition doesn’t make you automatically qualify for disability benefits.

However, some things may automatically disqualify someone from becoming eligible for disability benefits.

They could be if your medical condition lasts for less than 12 months, your condition isn’t listed on the SSA blue book list of eligible medical conditions, you’re making money above the SSA’s requirement for disability benefits, etc.

How to Increase Chances of Appeal Acceptance

There are several ways to increase your chance of a possible acceptance. You can:

File an appeal on time: The Social Security Administration communicates the application denial in a letter. There’s a 60-day automaton for the applicant to file an appeal. Therefore, it’s essential to submit the appeal on time.

Write an effective appeal letter: Explain why yours is a good cause, and why the SSA’s denial of your application was not the right decision.

Provide additional medical evidence: Try to submit additional documentation and evidence to give sufficient medical reason when filing for disability consideration.

We’re Here to Help!

We understand the process of appealing an SSI/SSDI decision and have handled similar cases. Our experts help you know what additional medical evidence is required to strengthen the appeal process. If you’re looking for more benefits, don’t hesitate to get in touch.