Disability Appeals

Brass ScalesIf you have been denied SSD or SSI, you still have the right to make an appeal. In fact, you have the right to make several appeals if necessary. While many applicants get approved based on their initial applications, many others receive benefits only after going through the appeals process, so don’t give up.

There are time limitations on every step in the appeals process. In general, if you disagree with a decision you will want to request the next level of appeal as soon as possible.

Step 1: Reconsideration

If you disagree with the initial determination regarding your eligibility for benefits or if the SSA changes your benefit amount and you disagree, you can appeal through reconsideration.

How: Request reconsideration by sending SSA a signed note with your Social Security number stating that you wish to appeal the decision. Or, complete Form SSA-561 (Request for Reconsideration) or Form SSA-789 (Disability Cessation Appeal).

When: Make the request within 60 days of the date you receive the written notice of initial determination. If you request reconsideration within 10 days, any payment being made to you will continue until a determination is made, providing your income and resources do not exceed SSA’s limits.

Reconsideration will take approximately 90 days to complete.

Step 2: Administrative Law Judge (ALJ) Hearing

If you disagree with the reconsideration determination, request a hearing before an ALJ. You may review your file, submit new evidence and present your own testimony at the hearing. The judge may also want you to have additional medical exams and tests completed.

Because these hearings are done in-person, it is important that you attend or you may lose your appeal rights and benefits. If you cannot make the hearing, contact the judge as soon as possible before the hearing and explain why.

How: Either write to the SSA and requesting an ALJ hearing or complete Form HA-501 (Request for Hearing).

When: Make the request within 60 days after you receive the notice of reconsideration.

AJL hearing will take approximately 530 days to complete.

Step 3: Appeals Council

If you disagree with the judge’s decision, you may request an Appeals Council review but the Appeals Council will select which cases it wishes to hear. You may also submit new evidence here.

How: Either write to the SSA and requesting an Appeals Council review or complete Form HA-520 (Request for Review of Hearing Decision/Order).

When: Make the request within 60 days after you get the hearing decision.

Appeals council will take approximately 220 days to complete.

Step 4: U.S. District Court

If you disagree with the Appeals Council, you may file a civil action with the U.S. District Court in your area.

The court will decide whether to overrule the SSA’s decision by granting you benefits, or, more often, by remanding the case (sending it back) to the ALJ for reconsideration. The SSA will no longer be able to help you at this level.

Federal court will take approximately 540 days to complete.

All necessary forms can be found at the SSA’s website.

 


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Real Life

"It took over three years for me to get approved, which included two denials and required that I get a lawyer. BUT... the process could have been much smoother and likely would have been much shorter had I been more organized and less distracted or had someone to help me.

Records from some doctors were missing. Others were old and did not reflect new findings. And I didn't review my case file to make sure that all was in order before filing my appeals.

My best advice is to call for assistance first thing."

Social Security Disability Assistance

It is highly recommended that you have an attorney or other representation throughout the entire appeals process.

Caring Voice Coalition

1-888-267-1440

Caring Voice Coalition offers free disability assistance to PH patients.

If you decide to hire a lawyer, they are only allowed to charge you $5,300 or 25% of any retroactive benefit you receive if you win (whichever is less) and nothing if you lose.

Visit National Organization of Social Security Claimants’ Representatives for a listing of attorney referrals.

Helpful Disability Resources

SSA.gov is the official U.S. Government site for the Social Security Administration.

Social Security Handbook on the Web includes the provisions of the Social Security Act, regulations issued under the Act, and precedential case decisions (rulings). It is a readable, easy to understand resource for the very complex Social Security programs and services.

Caring Voice Coalition has free programs to help patients with insurance reimbursement, financial assistance, patient support services, public advocacy, and the SSD application and appeals process.

Advocacy for Patients with Chronic Illnesses provides information, advice and advocacy regarding retrieval of medical information, obtaining and keeping health insurance, obtaining coverage for your treatment, applying for SSD and asserting your rights. Also publishes a Know Your Rights handbook.

National Organization of Social Security Claimants’ Representatives (NOSSCR) is an association of over 3,900 attorneys and other advocates who represent Social Security and Supplemental Security Income claimants.

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The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

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