If you've applied for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits and been denied, don't be discouraged. Social Security denies about 70% of initial disability applications. If your disability claim was denied, you should appeal, because most claims are won on appeal after being denied by Social Security.
If you fail to appeal by the appeal deadline—60 days after you receive your denial letter—you'll lose the chance to receive benefits on that application. And you might have to start a new application for benefits, which will waste time and, in some cases, can result in less back pay.
(Back pay covers the time you had to wait for Social Security to approve your disability application. For SSI, back pay goes back to the date of your application. For SSDI, it can go back even further.)
There are four levels of appeal available to you after your disability application has been denied, including:
You must work your way through each level before you can appeal to the next one. Here's how each level of the Social Security disability appeals process works.
The first step in the disability appeal process is called "reconsideration." (In the past, several states, including Colorado, Michigan, Missouri, New York, and Pennsylvania, skipped the reconsideration step, but Social Security now requires it in all states.)
To start the appeal process, you'll need to file a Request for Reconsideration (SSA-561) within 60 days after you receive your denial letter.
During a reconsideration, the Disability Determination Services (DDS) agency in your state will have a new claims examiner and medical consultant review the denial. At the reconsideration level, you can ask for an informal or a formal conference to discuss your case with a Social Security representative.
Social Security will issue a written decision on reconsideration within three or four months of your request. If Social Security denies your claim again, which is likely—only about 15% of claims are won on reconsideration—you should request an administrative hearing in front of a judge.
To request an administrative hearing, you'll need to file a Request for Hearing by Administrative Law Judge (HA-501) within 60 days of receiving your denial letter. It generally takes many months, or even a year (or more), to get your case before an administrative law judge (ALJ). And your hearing might be held in person, by video conference, or by phone.
But ALJ hearings are somewhat informal compared to court proceedings. Unlike a typical court hearing, ALJ hearings are usually held in conference rooms, and everyone sits down. Hearings are recorded, though, so that there's a record in case you want to appeal the ALJ decision.
At your disability hearing, the ALJ will review all the evidence and listen to any witnesses you want to bring. To avoid unnecessary delays, you should submit all the evidence you want the ALJ to consider as soon as possible after you request a hearing. If you submit evidence late, it might delay your case even more.
Talking to an attorney before your hearing makes sense. An experienced disability attorney can offer expertise and advice on how to get approved at the hearing. For instance, an attorney might have you submit particular medical evidence (like specific diagnostic tests) and knows how to challenge Social Security's description of your past jobs.
If you're not satisfied with the ALJ's decision in your case, you can appeal to the Appeals Council (AC). There are two types of unfavorable decisions from the ALJ that you might want to appeal:
You appeal to the AC by filing a Request for Review of Hearing Decision (HA-520).
The Appeals Council doesn't hold another hearing. Instead, the AC will either grant or deny your request for a review of the ALJ's decision. And if it grants your review, the Appeals Council won't hear new evidence—it will just review the ALJ's decision to make sure no errors were made.
For the best chance of success, you'll want to hire an attorney at this level (if you don't already have one). An experienced disability lawyer knows how to spot any errors the ALJ made and how to frame them correctly in a written argument to submit to the Appeals Council.
If the AC grants a review of your case, the Appeals Council will either "remand" (send back) the case to the ALJ for another decision or decide the outcome of your case itself. If the Appeals Council denies your request for review altogether or denies your claim, you can appeal to federal district court.
The final step in appealing a Social Security or SSI disability case is to seek a review from federal district court. You must file a complaint in federal 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 doesn't hold a trial or consider new evidence (just the evidence submitted to the ALJ).
Although you can represent yourself in federal district court, having a lawyer at this level is prudent. An attorney will be more likely to identify mistakes made in the lower appeal levels and have a better chance of success. In addition, you'll need an attorney to write a brief to submit to the federal court.
Get tips on winning your Social Security disability appeal.