Denied. Now What?

The most common time frame people are given for the amount of time it would take for their Social Security Disability applications to be processed is 90-120 days.  However, this value is often far more optimistic than the average of 261 days it took for the average appeal to complete in 2009, and would only be relevant for the 30-40% of the applicants whose initial applications are approved.  The average time for appeals to be processed by the Social Security Appeals Council is 6 months~2 years 1.

As mentioned on the main page of this website, 60-70% of initial applications are denied for Social Security benefits 2.  A letter will be mailed to you once a decision has been made on your claim. Once denied, there are 4 levels of appeals that are available to the applicants to dispute the initial determinations 3.  The hearing by the Administrative Law Judges and the review by the Appeals Council are directed by Social Security Association’s Office of Disability Adjudication and Review 4.

There are few “determinations” that are done in the Initial Determinations, including whether or not you are eligible, the amount the SSI payment will be, and whether or not if you were overpaid, the amount of overpayment, and whether or not you must repay it.  When you file for an appeal, Social Security will evaluate the entire determination or decision, including parts that were in your favor 5.

Levels of Appeals 6

  • Reconsideration: Complete review of claim of originally and newly submitted evidence by a new Social Security representative
  • Hearing: 7 A hearing by an Administrative Law Judge who had no part in the original or reconsideration decision
  • Review: 8 The Social Security Appeals Council may deny the request (if it believes the judge was correct in his decision), or decides to review by returning the claim to an Administrative Law Judge or decide on the case itself
  • Federal Court Review: Law suit filed in the Federal District Court

If your initial claim was denied, you must request an appeal within 60 days of the receipt of the denial letter, which can be done online 9.  Reconsideration, hearings, and reviews can also be requested through the local Social Security field offices 10.

You can call 1-800-772-1213 (TTY: 1-800-325-0778) for assistance by an SSA Telephone Representative 11.  Social Security can help you navigate Reconsideration ~ Appeals Council Review, but cannot help you file a law suit.

Reconsideration

If your initial claim was denied, you can file an appeal for Reconsideration, which is a complete review of your claim by someone who was uninvolved with the first decision.  You are free to submit new evidence.

You must fill out Form SSA-561: Request for Reconsideration or Form SSA-789: Request for Reconsideration – Disability Cessation, or write to Social Security within 60 days of receiving your initial determination notice in order to request for reconsideration 12. Most reconsideration do not require you to be present, as they will only be reviewing your files.

Hearing

If you do not agree with the decision reached from the Reconsideration, you can request a Hearing by an Administrative Law Judge (ALJ) 13.  There is a Hearing Office Locator for Office of Disability Adjudication and Review (ODAR).  ODAR holds hearings and issues decisions, and its headquarter is in Falls Church, Virginia 14.  As of 2012, there are 10 regional offices, 168 hearing offices (with 6 satellite offices), 5 national hearing centers, and 1 national case assistance center 15.

Within 60 days of receiving the Notice of Reconsideration, you must submit Form HA-501: Request for Hearing by Administrative Law Judge, as well as SSA-3441, Disability Report – Appeal and SSA-827, Authorization to Disclose Information to SSA.  At this point, you may also want to appoint a Representative to help you in your case.

It is not mandatory that you attend the Hearing, but it is highly recommended.  You must also submit an explanation in writing, explaining why you will not be attending as soon as possible 16.  In most cases, the Hearing will occur within 75 miles from your house.  However, it is possible to request a Video Hearing, which may be more convenient for you and your witnesses, as there may be Video Hearing locations closer to your home 17.

Once you request a hearing with the ALJ, you must submit any new evidence you want him to consider within 10 days of filing the request.  In Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut, you must do so no later than 5 days before the scheduled hearing 18.

Appeals Council Review

If you do not agree with the decision reached by the Administrative Law Judge, you can request for a review with the Social Security Appeals Council 19.  The headquarter of the Appeals Council is in Falls Church, Virginia, and it has additional offices in Baltimore, Maryland and Crystal City, Virginia.

You must file your appeal within 60 days after the receipt of the hearing decision, and to do so, you must write a letter, or fill out HA-520: Request for Review of Decision/Order of Administrative Law Judge Form.  The Appeals Council will look at your case and will grant, deny, or dismiss your request for review.  If it decides to grant your request for a review, it will either return it to ALJ for further action, or decide on your case within the Council.

Federal Court Review

If the Appeals Council denies your request for a review, or you do not agree with the decision it made, you can file a Civil Action Law Suit with the U.S. District Court in your area.  Social Security cannot provide you aid, so it recommends that you contact a lawyer or legal aid group.  You must file an action with a U.S. District Court within 60 days after receiving the notice of the Appeals Council 20.

Having Help

You can handle the whole appeals process with only the free help from Social Security, or you can have a Representative help you.  A Representative can be a lawyer, friend, or family member, and he can act in your place in most Social Security related issues.  They will also receive copies of all of the decisions related to your claims 21.  Even if you have a Representative, it is usually to your advantage to attend the hearings and meetings in person.

If you hire an attorney, he cannot charge or collect fees from you without first obtaining written approval from Social Security by filing a Fee Agreement or a Fee Petition.  He may only charge you the fee Social Security authorizes.  If your Representative charges or collects a fee (or overcharges) without Social Security’s authorization, he may be suspended or disqualified from representing in future Social Security related cases, and may even face criminal prosecution.  If you file a claim to the Federal Court, your attorney can request a reasonable fee for his services without authorizations from Social Security.  However, the fee cannot exceed 25% of all past-due benefits that result from the court’s decision, and he cannot charge any additional fees for services before the court 22.

You can have more than one Representative, but the Representatives cannot be someone who has been suspended or disqualified from representing before SSA.  Some organizations may be able to provide you free legal services if you qualify, or help you find a Representative.  Your local Social Security office has a list of organizations that can help you find a Representative for your case 23.

Once you appoint a representative, you must notify Social Security in writing as quickly as possible by filling out and mailing Form SSA-1969-U4: Appointment of Representative.  You must provide the name of the individual, sign your name, and if the Representative is not an attorney, he must also sign the form 24.

Important Forms

Reconsideration

Hearing by Administrative Law Judge

Review by Appeals Council

Appointing a Representative

Important Links