When you are first denied for your Social Security benefits, many thoughts are likely running through your head: how could they deny me? Should I continue to fight for my benefits? Should I try to return to work? While all of these are valid questions, they are not easy questions to answer. Often, I find that Claimants do not know what the appeals process actually entails, and therefore, they are afraid of it.
When you are denied Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, the first thing you need to do is to look at the reason for the denial. If it is a medical reason (i.e., you are not disabled under the rules of the Social Security Administration), you can appeal that decision right away. If it is a non-medical decision (i.e., you have too many assets for SSI, or you do not have enough quarters for SSDI), that decision is a bit tougher to appeal. This article focuses on what to do if you receive a medical denial.
After receiving your first medical denial, you have sixty-five days from the date of the letter to file a Request for Reconsideration. The Request for Reconsideration can be filed on your own, or with the help of an attorney, and explains to Social Security (SSA) why you disagree with their decision, and why you believe you are disabled. The SSA then reviews your file again, pulls any additional medical records, and makes another decision. If the decision approves your benefits, then your claim ends there and you have won. If the SSA once again denies your claim for benefits, you may appeal again (within 65 days from the date of the letter) and request a hearing before an Administrative Law Judge.
Currently, in Jacksonville, Orange Park, St. Augustine, and surrounding areas, the wait for a hearing is two years from the date you request the hearing. Therefore, it is important to request the hearing as soon as practicable after you know you have been denied at the reconsideration level.
While your request for hearing is pending, it is important for you to continue seeing all of your doctors and medical professionals and maintain a stream of evidence for your ongoing case.
Once your request for hearing is granted and you appear before the Administrative Law Judge, you (and your attorney, if you have one) are responsible for proving your disability case and explaining why the lower decisions were wrong.
If you are approved at the hearing level, congratulations! If your case was once again denied, you are able to file an appeal up to the Appeals Council, who will review your entire case once again, along with the ALJ’s decision, to determine whether there were mistakes made along the way. If the Appeals Council finds mistakes were made, they will send the case back down for another hearing. If the Appeals Council does not think mistakes were made, they will deny your request for review.
If the Appeals Council denies your request for review, your only recourse is to file a claim in Federal Court.
The appeals process with Social Security is nothing to be afraid of, but it can certainly be helpful to have an attorney at your side, explaining everything to you along the way.