How does the Social Security Disability Appeal Process work?

If your initial disability claim has been denied, you have the right to disagree with the decision. You do this by filing a reconsideration appeal, a.k.a. a request for reconsideration. You can file your reconsideration appeal by completing appeal paperwork and returning the forms to your local Social Security office. Or you can go online and file your reconsideration.

To initiate your first appeal, you must complete a request for reconsideration form (form SSA 561), appeal disability report form (form SSA 3441), and sign a medical release form (form SSA 827). These disability forms must be completed for both the paper and online appeal process. You have sixty-five days from the date on your denial notice--usually stamped in the upper right hand corner of your notice--to get your reconsideration appeal submitted to your local Social Security office.

Determining the appeal at Disability Determination Services

Once the local Social Security office has your reconsideration appeal, it will be electronically sent to a state disability agency that is responsible for making disability determinations for the Social Security Administration. Some state have one centralized disability agency to make their disability determinations, while others has more than one. In most states, the agency is referred to as DDS, or disability determination services. (Though some states have chosen to title their state disability agency with a different name, the Social Security Act which established both the Social Security Disability and SSI programs actually uses the term "disability determination services").

At DDS, the same process that was employed to make a decision on your application for disability will be used to render a determination on your reconsideration appeal; meaning that your medical evidence will be reviewed, along with information regarding your work history. If the claim involves children filing for disability, school records, teacher questionaires, and reports of IQ and academic testing will substitute for information regarding the work history.

For adults, the disability examiner's goal will be to determine if the person can return to work activity--either at a job that is part of their past work or at a job that they have not previously done but could be expected to do based on their education and skills, assuming those skills are transferrable to other work.

For children, the disability examiner will review both medical and academic records to determine if the child is able to perform what SSA refers to as age-appropriate activities.

The Reconsideration process

The process for the reconsideration is practically identical to the process used for the disability application. The chief differences are A) a different disability examiner handles the case and B) the case decision is usually made significantly faster because most of the medical records and other evidence will already have been gathered at the earlier application phase (see How long does it take to be approved for SSI or Social Security Disability?).

In some instances, a claimant will need to be sent to a CE, or consultative examination that may involve a physical examination or psychological or psychiatric testing. And, in other cases, if the claimant has been recently seen by their doctor, or has been seen by a new physician, the reconsideration examiner will need to request these records.

However, as a general rule, reconsideration decisions occur much faster than decisions on initial claims. Even discounting for medical evidence, other aspects of the case will have been developed at the disability application level that will enable the case to proceed much more quickly at the reconsideration level.

Unfortunately, the rate of approval on reconsideration appeals is even lower than on initial claims. This is hardly surprising since the disability criteria used to make your reconsideration appeal decision is the same as the criteria used to make your initial disability decision. Unless the initial disability examiner made an error, or you present new and substantial medical evidence with your reconsideration, there is usually little chance of your initial disability determination decision being overturned. As previously stated, if you receive a denial notice, you have the same sixty-five days to disagree with your reconsideration appeal decision.

The Disability Hearing Level Appeal

Most claimants, of course, will be denied on the reconsideration. You appeal your reconsideration denial with a request for a hearing before an administrative law judge.

To submit the request, you must complete a hearing appeal request (form SSA 501) and an appeal disability report form (form SSA 3441). Again, you have the option of completing your appeal online, or by returning the correct paper work to your local Social Security office within the appeal period.

As with the reconsideration appeal, after you submit the appeal paperwork, you will receive a notice of acknowlegement which will inform you that your appeal has been received. If you do not receive this notice within several weeks of sending in your appeal, you will probably wish to contact the Social Security office to verify their receipt of your appeal.

It is not unusual for paperwork to get lost or not be properly matched with the correct file. Doing a status call on your appeal submission can resolve an issue before it actually becomes an issue...for example, only learning months later that SSA never received the appeal that you sent in and that, since your appeal time period has elapsed, you must now start over with a new disability application.

Once your disability hearing request is submitted, it could be months before you are scheduled for an administrative law judge hearing. When you are, however, you will receive a letter informing you of the date of your disability hearing, along with the location and the name of the ALJ, or administrative law judge who will be hearing your case.

Most hearings are conducted at the hearing office, officially known as ODAR, or the office of disability adjudication and review. However, due to distance, some hearings may be conducted at satellite locations to make it more convenient for the claimant. Other times, again due to distance, the hearing office may choose to conduct a video hearing. Note: The claimant always has the right to an in-person hearing and, therefore, can reject a video hearing in favor of a standard hearing.

Holding the Disability Hearing

Social Security Disability hearings are generally more informal than other hearings; however you will still appear before a judge. Consequently, you should arrive on time and dress accordingly. Most ALJs operate on a tight schedule, holding multiple hearings per day and scheduling them back-to-back with little time in between. If you arrive late, you may forfeit your haering opportunity and be forced to reschedule, which may take weeks or even months depending on the backlog of cases.

During the hearing, the judge will most likely ask questions about your disabling condition, or possibly your work activity prior to becoming disabled, or even regarding your ability to do ordinary things (activities of daily living). Always answer questions honestly and thoroughly.

If you are appearing with a disability representative or a disability attorney, you may be surprised to see that your attorney has little to say. This is because many judges will have reviewed the case materials and evidence submitted by your representative. In other instances, your attorney may direct questions to you, or may pose hypothetical scenarios to any expert witnesses that have appeared at your hearing at the discretion of the judge. The way the hearing proceeds, of course, depends entirely on the judge.

Cases at the disability hearing level are usually won at least forty percent of the time when the claimant is not represented. Statistics indicate that hearings are won more than sixty percent of the time when representation is present.

Even if your disability hearing is denied, you can file an appeal to an Appeals Council that is responsible for reviewing the decisions of administrative law judges. However, you would have to determine if you should file this appeal or not. In times past, Social Security allowed you to file an Appeals Council review appeal and a new initial disability claim simultaneously; however that is not the case anymore.

Most Appeals Council reviews are denied; very few are remanded back to the judge for another look, and still fewer are approved for disability benefits. Many claimants choose to file a new disability claim at this juncture; however for others, filing a new disability claim may not be advantageous. If you have a representative, they can most often help you determine what path you should take after considering the merits of your disability case.

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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