About Retiring

If an individual applies for Social Security disability insurance and is denied there is an appeals process they can through in order for reconsideration of their application.

If an individual wishes to appeal the Social Security Administration’s decision regarding their application for disability insurance they can do so, however they must make their request in writing within 60 days from the date they received Social Security’s denial letter. The Social Security Administration assumes that the individual receives their letter five days after the date posted on the letter, unless an individual can show them they received it later. There are generally three or four levels of appeals; the first being reconsideration, second is a hearing by and administrative law judge, third is a review by appeals council and lastly is a federal court review. When the Social Security Administration sends an individual their letter about their decision on their claim they give them instructions on how to appeal the decision.

The first level of appeals is reconsideration. Reconsideration is a complete review of the individual’s application by someone who didn’t take place in the first decision. The individual at the Social Security Administration reviewing the application will look at any evidence submitted when the original application was sent in and also any new evidence. Most of reconsideration reviews are done without the individual present, however if the individual is appealing a decision that they are no longer eligible for disability insurance because their condition has improved, they can meet with a Social Security representative to explain to them why they believe they still have a disability.

The second level of appeals is a hearing by an administrative law judge. If an individual disagrees with the reconsideration decision, they may ask for a hearing. The administrative law judge conducting the hearing is one who had no part in the first decision or the reconsideration decision in the individual’s case. The hearing is held usually within 75 miles of the individual’s home, and the administrative judge notifies the individual of the time and place of the hearing. The individual and their representative (if they have one) may come to the hearing to explain their case to the judge in person; they may look at the information in their file and give any new information that they have. In order for the administrative law judge to make his/her decision they will question the individual and their witnesses they bring to the hearing. Other witnesses such as medical and vocational experts may also give the judge information at the hearing. The individual or representative then also may question the witnesses. It is usually to the individuals advantage if they attend their hearing, however if they chose not to do so they must notify the Social Security Administration in writing that they don’t want to attend. In some situations they hearing may be held as a video conference rather than in person. The individual will be notified ahead of time if this is the case. A video conference is often more convenient for the individual, it also is usually faster to schedule a video conference than an in-person hearing. Lastly the video conference may also make it closer to their home so it would make it easier for the individual to have witnesses and others accompany them. Unless the administrative law judge believes that the individual presence is needed to decide the case he or she will make their decision based on all the information in the individual’s case and that’s including any new information. Lastly when the administrative law judge has reached their decision the individual will be sent a letter and a copy of the administrative law judge’s decision.

The third level of appeal in denial of Social Security disability benefits is an appeals council. This level of appeal happens when the individual doesn’t agree with the hearing’s decision they make ask for a review by the Social Security’s Appeals Council. The Appeals Council looks at all requests for review, they can however deny a request if they believe that the decision of the hearing was correct. If the Appeals Council decides to review the individual’s case it will either decide the individuals case itself or it will return it to an administrative law judge for further review. If the Appeals Council denies the individuals request for a review they will send the individual a letter explaining the denial, if the Appeals Council makes a decision on the case the individual will be sent a copy of the Appeals Council’s decision, and lastly if the Appeals Council returns the case to an administrative law judge for further review the individual will receive a letter and a copy of the order for further review from the Appeals Council.

The last level of appeals is federal court. If the individual disagrees with the decision of the Appeals Council or the Appeals Council denied request for a review of their case, the individual may file a law suit in a federal district court. The letter that the Social Security Administration sends to the individual explaining about the Appeals Council’s action will also have information regarding how to ask a court to look at the individual’s case.

An individual may still be eligible to receive disability insurance while the Social Security Administration makes a decision on their appeal if, the individual is appealing a decision that they can no longer get Social Security disability benefits because their medical condition is not disabling or, if the individual is appealing the Social Security Administration’s decision that they are no longer eligible for SSI payments or that their SSI payments may be reduced or suspended. If the individual wishes to continue receiving benefits they must notify the Social Security Administration within ten days of receiving the administration’s letter. If the individuals appeal is turned down they might be required to pay back any money they were not eligible to receive.

An individual appealing a Social Security disability denial has the right to have a representative help them in their appeals process. The Social Security Administration offers free help with the appeals process however the individual may also opt to have a lawyer, a friend or someone else to help them. The Social Security Administration will work with the individuals representative in all the steps to appeal, the representative can act for the individual in most Social Security matters and will also receive copies of any decisions made about the individuals claim. The representative however cannot collect any fees from the individual without prior permission of the Social Security Administration. Rules about representation can be found on the Social Security Administration’s website. http://www.ssa.gov/pubs/10075.html

In order to contact the Social Security Administration for further information regarding a denial of disability insurance their website at www.ssa.gov is a very useful resource of information they also have a number of things the individual can do online. The individual can also contact the Social Security Administration directly by calling them at 1-800-772-1213.