Social Security Disability Resource Center

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.








  • Index of Social Security Disability SSI Questions and Answers

  • 56 Answers to Social Security Disability SSI Questions







  • SSDRC Homepage:

    Social Security Disability and SSI Resource Center



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    Social Security Disability and SSI Back Pay Benefits

    Social Security Disability SSI and whether or not you can work

    How long does it take for Social Security Disability or SSI?

    Social Security Disability SSI Awards and Award Notices




    Tips, Mistakes, How to Qualify, and How to Win Disability

    Tips and Advice for Social Security Disability and SSI Claims

    Common Mistakes to avoid after being denied for Disability

    Disability Qualifications and How to Qualify for Disability Benefits

    Winning Social Security Disability or SSI, How to Win




    Denials, Appeals, and Getting a Disability Lawyer or Representative

    What you should know about Social Security Disability and SSI Denials

    Social Security Disability and SSI Appeal Process - How to file appeals

    Questions about Disability Lawyers and Hiring a Disability Attorney




    Various Types of Benefits including SSI, Mental, and Child benefits

    SSI Disability Benefits, Questions and Answers

    Social Security and SSI based on Mental Disability

    Social Security Disability or SSI Benefits for Children

    Disability Benefits through Social Security




    Information to start with regarding Disability Claims

    An Overview of Social Security Disability and SSI

    What is considered a Disabling condition by Social Security?

    The Disability Requirements to be eligible for SSD and SSI Benefits




    Filing for Social Security Disability or SSI Benefits

    Social Security Disability and SSI Applications

    Social Security Disability SSI List of Conditions and Impairments

    Social Security Disability SSI: Medical Evidence and Records

    Filing your claim for disability benefits

    Eligibility for receiving disability benefits




    Resources on this site

    Social Security Disability, SSI Terms and Definitions

    Previously answered questions regarding SSD and SSI



    The SSDRC Disability Blog




    For Individuals living in North Carolina

    Disability in North Carolina

    North Carolina Disability Lawyer

    Getting disability in North Carolina








    Related pages:

    The Levels Of The Social Security Disability and SSI Application and Appeal Process
    How does the Social Security Disability Appeal Process work?
    Is it better to appeal or file a new claim if your disability is denied?
    How Long Are You Given To Appeal Your Social Security Disability Denial?
    How Long Does a Social Security Disability or SSI Appeal Take?
    Will I be approved for disability on my appeal?
    What Happens If I Miss My Social Security Disability Appeal Date?
    How Do I Find Out How My Disability Appeal Is Going?
    Can You Work While You Appeal Your Social Security Disability Decision?
    How Long Does It Take To Get SSDI If You Have To Appeal?
    If Your Disability Benefits Are Stopped Can You Get Them While You Appeal?
    Winning a Social Security Disability Appeal or SSI Appeal



    Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

    Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI


    These pages answer some of the most basic questions for individuals who are considering filing a claim.

    How to file for disability SSD, SSDI, SSI
    How to Apply for Disability - What medical conditions can you apply and qualify for?
    Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
    What happens if I file a disability application and it is denied by a disability examiner or Judge?
    How to Prove you are disabled and qualify to win disability benefits
    How do you prove your disability case if you have a mental condition or impairment?
    Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
    Disability Criteria - Eligibility For Social Security and SSI Disability