The Disability reconsideration Appeal - what is it and how do you file for it?

The disability reconsideration is the first level of appeal for a denial of a Social Security Disability or SSI disability claim. A reconsideration is essentially this: the social security administration will simply take a second look at your disability claim to see if the first decision (when your disability application was denied) was correct or incorrect.

As with the application for disability, your case will be assigned to a disability examiner at the state disability processing agency. In most states, this agency is referrred as the DDS, or disability determination services agency.

Processing the Reconsideration appeal

At DDS, social security may request your medical records again, particularly if you indicate on the appeal forms that you have had new treatment with your current physician or physicians, or that you have a new source of treatment.

Of course, you may be sent to a consultative medical examination (CE for short). These exams are performed by independent doctors and psychologists and generally serve the purpose of providing recent documentation to a decision-maker on a claim if the claimant does not have recent medical records in their file ("recent", for social security purposes, means having at least some evidence that is not older than 90 days)

How long does it take to process a reconsideration appeal? Ordinarily, no longer than a disability application. Typically, a reconsideration decision on a disability claim is made faster than on a disability application and it is not unreasonable to expect a decision within eight weeks. Unfortunately, in most cases, you are even more likely to be denied on a reconsideration than on a disability application. In prior years, the average national rate of denial on a request for reconsideration was 85 percent.

Recent reporting of federal statistics indicates that it is now approximately 87 percent. Bear in mind that this is a national average and that the denial rate on a reconsideration may be higher in some states, and lower in others.

Why are reconsiderations turned down so often?

Simply because the reconsideration decision is made by the same agency (DDS) that denied the claim in the first place. The only real difference is that a different disability examiner makes the decision, usually using the exact same medical evidence, and usually within just a few weeks of the first decision--which was a denial of the claim--having been made. In most cases, given this type of setup, it would be illogical to think that any decision that was different from the first would be reached.

In cases where a claim is approved on a reconsideration appeal, it is often because the disability examiner who decided the initial claim, a.k.a. the disability application, so clearly flubbed the decision (so much so that the reconsideration-level examiner who takes a second look at the claim cannot ignore the incompetence of the decision) OR because new medical information has surfaced, such as a new diagnosis or a downgrade in the claimant's condition by the claimant's doctor or doctors.

The real reason you should file a reconsideration

Reconsideration appeals are practically doomed to fail. But that doesn't mean that they are not worth doing. First of all, a small percentage of them do get approved. This by itself makes a reconsideration worth filing. However, in most cases, the tactical value of a reconsideration is that if a person gets denied on this appeal, they can then file the next appeal which is a request for a disability hearing. And at hearings, those with representation have a substantially higher chance of being approved for disability benefits.

This is even more so if the case is properly prepared (obtaining medical record updates and submitting them to the judge, getting statements from the claimant's doctor or doctors and submitting them as well, and also being prepared to counter statements raised by expert witnesses called to the hearing by the administrative law judge). Disability hearings involving representation are typically won more than 60 percent of the time.

You may contact your local Social Security office to request your reconsideration paper work and if you have a disability lawyer you can simply contact this individual to handle your request for reconsideration.

Whether you submit a reconsideration or your attorney does, the reconsideration appeal must be submitted to social security within sixty-five days (the sixty day appeal deadline plus 5 days allowed for mailing). This means it must actually be received by the Social Security Administration, not just post marked, by the sixty-fifth day.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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