The Social Security Appeals Process

Legal Article

The Social Security Appeals Process

While millions of Americans depend on social security to cover their most essential expenses, the first time most people apply for Social Security or Social Security Disability Insurance (SSDI), they are denied these benefits. However, if individuals appeal these partial or full benefit denials, the chance of reversing the initial decision is highly likely. While one can likely reverse the Social Security Administrations (SSA) initial ruling, navigating the social security appeals process is extremely difficult without the help of a lawyer.

If your Social Security or SSDI claim was denied, below are the four ways you can appeal this ruling and how an attorney can help.

Appealing Your Social Security Decision

Once you receive the denial of benefits from the SSA, you can file a request for reconsideration. If this initial request fails, there are a few more steps you can take to overturn your case. Below is a list of the various levels of appeals after the SSA denies your disability benefits.

Request for Reconsideration

Request for reconsideration is the first step to take after your claim’s initial denial. Additionally, a request for reconsideration is also used when the SSA terminates benefits after a continuing disability review.

Reconsideration of Original Claim

When you submit a request for reconsideration, the SSA does a complete review of your claim. Furthermore, this review is done at the Disability Determination Services level. However, an examiner and medical consultant that were not part of the initial decision will review the case. While almost always a good idea to appeal the initial denial, the Disability Determination Services only grants benefits in 10 – 15 percent of claims that they look through.

If the Disability Determination Services denies your benefits, you can seek a hearing by an Administrative Law Judge.

Reconsideration of Continuing Disability Claim

Even when you start receiving Social Security or SSDI, your case will be examined through a continuing disability review (CDR). Through this review, the SSA may decide to end your benefits at any time for reasons including:

  • your failure to cooperate in the CDR process, or
  • a determination that your condition has improved and you can now work.

If your benefits were taken away from you for either of the two reasons above, you must request a reconsideration of a CDR before a disability hearing officer. A new examiner and medical consultant will review your case and have the opportunity to reinstate benefits before your hearing begins. However, if the new examiner and medical consultant agree that you should not be on Social Security or SSDI, you can request a hearing with an Administrative Law Judge.

Administrative Law Judge (ALJ) Hearing

In certain circumstances, the SSA will deny requests for reconsideration. If this occurs, you have 60 days from the receipt of your denial to request a hearing before an administrative law judge. A social security disability hearing is an informal meeting with an ALJ. Furthermore, an ALJ will review your claims, ask you for additional information, and potentially overrule the initial decision. When appealing your social security ruling, an attorney is especially useful. The reason for this is that an attorney is familiar with the legal processes associated with this case. Additionally, an attorney understands the documentation necessary to overrule the decision. Finally, they can layout arguments meant to convince the ALJ that you should receive financial assistance. From national statistics, ALJ reverses almost half of the cases they see. This means that 50 percent of disability applicants that take the case to an ALJ will start receiving benefits.

Appeals Council

If the ALJ does not overturn the SSA ruling, you can request that the appeals council review your case. However, the appeals council only randomly selects cases for review. Thus, they can grant, deny, or dismiss your request for review before you ever get a hearing. The appeals council is able to dismiss your case without review unless it falls under one of the following distinctions:

  • substantial evidence does not support the ALJ decision, or
  • an abuse of discretion (for example, your hearing was cut short) or an error of law (for example, a claimant was not permitted to cross-examine a witness) by the ALJ, or
  • a broad policy or procedural issue is raised by the case (such as the ALJ not notifying a claimant that an expert witness would be present at the hearing).

Furthermore, if you request a dismissal or file your claim late, the appeals council may dismiss your claim without review. There are two main perspectives the appeals council will take when deciding to review an ALJ case. The first perspective is when the council looks for a flaw in the ALJs decision. In other random hearings, the appeals council can remand the case that requires another ALJ to review the case.

In most cases, the only reason to push your case to an appeals council is to exhaust all of the SSA appeals processes. However, you must go through each of these appeals in order to sue the SSA in federal court.

Federal Court Review

Once you have exhausted the other appeals options, you can choose to file a lawsuit in the U.S. District Court. While the other appeals scenarios are better with the help of a lawyer, this process requires you to enlist a lawyer. When dealing with SSA cases, federal judges hear disability cases without juries. In most cases, the federal judge will review the case only for legal issues. However, in other scenarios, federal judges rule on factual questions as well. The federal judges very rarely reverse the ALJ or appeals councils’ decisions. However, in about half of the SSA cases that federal judges hear, they remand the cases back to the SSA.

The most common reason for federal judges to remand cases is that the SSA did not consider the doctor’s opinion sufficiently, did not consider the pain or symptoms that the applicant experiences, or did not contact treating doctors for assessments of abilities. While suing the SSA can help you attain the benefits you are seeking, this process is both expensive and time-consuming.   

Contact Our DC Law Office for More Information

Finally, for more on the social security appeals process, contact us at 202-803-5676. You can also directly schedule a consultation with one of our skilled attorneys. Additionally, for general information regarding social security law, check out our blog.