The SSI / SSD Appeals Process 6/2010
Social Security Insurance / Social Security Disability Appeals Process:
If SSA denies your application for benefits, or decides that you are no longer eligible for benefits, or that the amount of your payments should be changed, you will receive a letter explaining their decision. If you don't agree with the decision, you can ask them to consider your case again. Many people who apply for Social Security or SSI disability are turned down when they first apply. However, some of those who were turned down are given benefits if they appeal. If you are applying for disability benefits, and are turned down, you are encouraged to ask right away for reconsideration. The next step is to immediately ask for a hearing if you are denied at reconsideration.
When and How Can I Appeal?
You must make your request in writing within 60 days from the date you receive your letter. The Social Security Administration assumes you receive the letter five days after the date on it, unless you can prove you received it later. Call your Social Security office if you need help with your appeal.
How Many Appeal Levels Are There?
There are four levels of appeal.
A reconsideration is a complete review of your claim by someone who didn't take part in the first decision. SSA will look at all the evidence submitted when the original decision was made, plus any new evidence. Most reconsiderations involve a review of your files without the need for you to be present. But when you appeal a decision that you are no longer eligible for disability benefits because your condition has improved, you have a choice of a file review or meeting with a Social Security representative to discuss your case. You can meet with a disability hearing officer and explain why you believe you still have a disability.
- Hearing by an Administrative Law Judge:
If you disagree with the reconsideration decision, you may ask for a hearing. The hearing will be conducted by an administrative law judge who had no part in the first decision or the reconsideration of your case. The hearing is usually held within 75 miles of your home. The administrative law judge will notify you of the time and place of the hearing. You and your representative, if you have one, may come to the hearing and explain your case in person. You may look at the information in your file and give new information. The administrative law judge will question you and any witnesses you bring to the hearing. You or your representative also may question the witnesses. It is usually to your advantage to attend the hearing. If you don't wish to do so, you must tell SSA in writing that you don't want to attend. Unless the administrative law judge believes your presence is needed to decide the case, he/she will make a decision based on all the information in your case, including any new information given. After the hearing, SSA will send you a letter and a copy of the administrative law judge's decision.
- Appeals Council:
If you disagree with the hearing decision, you may ask for a review by Social Security's Appeals Council. The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an administrative law judge for further review. You will receive a copy of the Appeals Council's decision or order sending it back to an administrative law judge.
- Federal Court Review
If you disagree with the Appeals Council's decision or if the Appeals Council decides not to review your case, you may file a lawsuit in a federal district court.
Will my benefits continue while my case is being appealed?
In some cases, you may ask SSA to continue paying benefits while a decision is being made on your appeal. You can ask for this continuation of benefits when:
You are appealing a decision that you are no longer eligible for Social Security disability benefits because your condition has improved; or
You are appealing a decision that you are no longer eligible for SSI payments or that your SSI payment should be reduced.
If you want your benefits to continue during the appeals process, you must tell SSA within 10 days of the date you receive the letter.
NOTE: If your appeal is turned down, you may have to pay back any money you weren't eligible to receive.
Can someone help me file an appeal?
Many people handle their own Social Security appeals with free help from SSA. You can also choose a lawyer, a friend, or someone else to help you. The person you appoint to help you is your "representative." Your representative can act for you in most Social Security matters and will receive a copy of any decisions made about your claim. Your representative cannot charge or collect a fee from you without first getting written approval from Social Security. If you want more information about having a representative, contact Social Security Administration and ask for the free fact sheet, ‘Social Security And Your Right To Representation’ (Publication No. 05-10075).
How can I get more information?
You can get recorded information 24 hours a day, including weekends and holidays, by calling the Social Security Adminstration's toll-free number. When you call, have your Social Security number handy. You also can reach Social Security via the internet.
Web site: www.socialsecurity.gov