Benefits received for Supplemental Security Income (SSI) require approval of an application based on a series of medical determinations against existing legal requirements. Applications not approved, or those approved but for an amount the applicant deems insufficient, remain subject to review, at the applicant’s request, by a system of administrative appeals created by the Social Security Administration (SSA).
The first review of an individual’s application, known as an initial determination, refers to written findings by the SSA regarding legal or factual issues on an applicant’s eligibility for SSI and the amount of payment, including overpayment. The term also applies to any subsequent determination about eligibility or payment amount.
Four possible appeals follow the first initial determination in the following sequence:
- Reconsideration: This must be submitted within 60 days of the written notice of initial determination. Different standards apply, depending on whether the applicant seeks a non-medical initial determination or that concerning a medical disability.
- Hearing: Applicants have 60 days within which to request a hearing before a judge. The applicant may choose to have a judge review only the evidence contained within the file. Expert witnesses may testify.
- Appeals Council: Sixty days from determination at the hearing, an applicant may seek review by a council and submit new evidence for review. The decision can have three outcomes: fully favorable to the applicant, return all or part of the case to a judge for further hearings (a remand) or not remand.
- Federal Court: Within 60 days, an applicant must file an action in U.S. District Court. The court will review evidence and the final Agency decision. The court may remand the case to the agency or may direct the Agency to either dismiss the case or award benefits.
Cases involving Supplemental Security Income range from the straightforward to the complex. Legal and medical reviewers can conflict about how to interpret data and requirements. Attorneys who understand how to navigate the process as well as the substance of the law can offer guidance.