If you have applied for Social Security disability (SSD) benefits or SSI and been denied, don’t be discouraged. Social Security denies about 70% of initial disability applications. Disability claimants (applicants) who receive a denial should appeal their claims, because many claims are approved by a judge at the appeal hearing after having been initially denied by Social Security.
Claimants who fail to appeal by the appeal deadline will lose the chance to receive benefits on that application and may have to start a new application for benefits. A new application will waste time and, in many cases, can result in less backpay (payments that go back to the date of your application, or even further for SSDI).
In most states, the first step in the appeal process is reconsideration. Ten states have eliminated the reconsideration step; claimants in those states appeal directly to an administrative hearing (see below). The states that have eliminated reconsideration are Alabama, Alaska, California (Los Angeles North and Los Angeles West Branches only), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania. If you live in one of these states, your first step in the appeal process will be an administrative hearing.
If you live in any other state, you will need to file a Request for Reconsideration (SSA-561) within 60 days of the date on your denial letter. During a reconsideration, the Disability Determination Services agency in your state will review the decision that it made. As part of reconsideration, you can ask for an informal conference or a formal conference to talk about your case with a Social Security representative.
Social Security will issue a written decision on reconsideration within three or four month of your request. If Social Security denies your claim again, you should request an administrative hearing.
To request an administrative hearing, file a Request for Hearing by Administrative Law Judge (HA-501) within 60 days of the date on your denial letter. At this stage, you can have your case heard by an administrative law judge (ALJ). After waiting for many months or even a year for your hearing, the ALJ will review all the evidence in your case and will listen to any witnesses you want to bring. Hearings are usually held in person and are somewhat informal. Unlike a typical court hearing, ALJ hearings are usually held in conference rooms, and everyone sits down. Hearings are recorded, though, so that there is a record in case you want to appeal the ALJ decision.
As soon as possible after you request a hearing, try to submit all of the evidence that you want the ALJ to consider. If you submit evidence late, it might delay your case even more. It makes sense to talk to an attorney before you go to your hearing. A disability attorney will be able to offer advice on how you can get approved at the hearing (for instance, submit particular medical evidence or challenge Social Security's description of your past jobs).
If you get an unfavorable decision (either a denial or an approval of benefits not dating back far enough) from the ALJ, you can appeal to the Appeals Council (AC). You make an appeal to the AC by filing a Request for Review of Hearing Decision (HA-520). The Appeals Council does not hear new evidence, it just reviews the ALJ’s decision to make sure there are no errors in it. For the best chance of success, hire an attorney to help spot any errors by the ALJ and frame them correctly in a written argument to submit to the Appeals Council.
There is not another hearing at the Appeals Council level. Instead, the Appeals Council will either grant or deny your request for review of the ALJ’s decision. If it grants a review of your case, the Appeals Council will either remand (send back) the case to the ALJ for another decision or the AC will decide the outcome of your case itself. If the Appeals Council denies your request for review altogether, you can appeal to federal district court.
The final step in appealing a Social Security or SSI disability case is to seek review from the federal district court. You must file a complaint in federal district court within 60 days of the Appeals Council decision.
Like the Appeals Council, the federal district court looks at whether the ALJ made any errors. The court does not hold a trial or take any evidence other than what had already been submitted to the ALJ. Although it is possible for a claimant to represent herself in federal district court, an attorney will be more likely to identify mistakes made in the lower levels and will have a better chance of success. In addition, you will need an attorney to write a brief to submit to the federal court.