What Appealing A Denied Claim Looks Like
If you take nothing else away from reading this page, understand this: a denied claim for Social Security Disability Insurance (SSDI) benefits is not the end of the road. In fact, it’s the beginning — and a common beginning at that. Nearly 70% of initial claims for SSDI benefits are denied.
There are four different stages in responding to a notice of denial. Success at any of these means your claim has been approved and you do not need to move to the next step.
1. Request For Reconsideration
In this initial stage of the appeal, you simply request that your application be reviewed again, this time by Disability Determination Services (DDS). It will be reviewed by a medical consultant and an examiner who were not part of the initial review. Only 5% to 10% of claims that are reviewed at this stage are approved.
2. Request For A Hearing
If your request for reconsideration results in a denied claim, the next step is to request a hearing before an administrative law judge (ALJ). This request must be submitted within 60 days of receipt of the denial. ALJ hearings are usually held in small conference rooms, though some are held via video conference. The judge, an attorney who works for the SSA, will ask the injured party about their medical condition and treatment.
If you have hired an attorney, he or she can speak to the judge on your behalf at this hearing and ask questions of you that you have been prepared to answer. There may also be medical professionals who serve as expert witnesses. The judge will ask these witnesses questions and your lawyer may ask questions of them as well.
The judge typically rules on your claim within four weeks, and you receive that notice by mail. If the judge approves your claim – and this occurs more than 50% of the time at this stage – you will begin to receive benefits.
3. Appeals Council
If you lose your disability hearing, you can request to have the appeals council review your case. This also must be done within 60 days of receiving notice of losing your hearing. The appeals council does not review all cases it receives, and it will not be reviewing the merits of your claim. Rather, it reviews the ALJ hearing to determine if there was an abuse of discretion, if the ALJ decision is not supported by evidence, or if actions by the ALJ raise a policy or procedural concern. The appeals council stage does not result in many reversals of denials. Instead, it is mostly a bridge to the fourth stage of appeal.
4. Federal Court Review
The final stage in the appeals process is filing a lawsuit in U.S. District Court. These cases are heard without a jury. Federal judges are supposed to review the case only for legal errors, but they frequently rule on factual aspects of the case as well. Here again, the rate of reversal at this level is low. However, they do send back a high percentage of cases to SSA for further review.
Put An Experienced Lawyer In Your Corner
Having a disability attorney who is familiar with the appeal process on your side is an important advantage. Statistics show that those who enlist the help of an attorney when appealing a denied disability claim have a higher chance of being successful.