The First Level Of Appeal: Reconsideration
A reconsideration is an administrative review of your claim. A new claims examiner will check to ensure the initial determination was made following Social Security procedures.
When the Social Security Administration mails you an initial determination denying your benefits, you’ll have 60 days to request a reconsideration. You can expect to wait three to six months for your reconsideration to be completed. In 2021, the average length of time for a reconsideration was 147 days. Unfortunately, the most common result of reconsideration is another denial.
Filing A Hearing Request
The Hearing is the second level of appeal when an SSI/SSDI application is denied.
Termination Of Abd Assistance Following Ssi/ssdi Denial
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Social Security Disability Criteria
The Social Security Administration doesnt just make up its disability criteria as it goes along. Instead, it compares diagnoses, courses of treatment, and prognoses against its listing of impairments for adults aged 18 and over. Often described as the blue book, the list lays out the criteria for disabling conditions.
Criteria for Social Security Disability Conditions:
- Musculoskeletal, including: loss of function as a result of a major dysfunction of joints disorders of the spine amputation reconstructive surgery of a major weight-bearing joint certain fractures burns.
- Cardiovascular system, including: chronic heart failure recurrent arrhythmias symptomatic congenital heart disease heart transplant ischemic heart disease aneurysm of aorta or major branches peripheral arterial disease.
- Neurological, including: epilepsy benign brain tumors cerebral palsy multiple sclerosis post-polio syndrome amyotrophic lateral sclerosis Parkinsonian syndrome traumatic brain injury.
- Mental disorders, including: neurocognitive disorders schizophrenia and similar psychotic disorders depressive, bipolar, and related disorders personality and impulse-control disorders autism spectrum disorders eating disorders trauma- and stressor-related disorders.
In all, SSA tracks 14 varieties of disorders that can sideline workers for a year or more. Length of time is a key decider of whether a claimant will be eligible for SSDI.
How Long Does An Ssi Denial Appeal Take
The length of time for the SSI denial appeal can vary, but the Reconsideration Review should be performed within six months. Some cases only take about three months, depending on how many cases have been filed at the time. The ALJ level often takes up to one year. If your case gets up to the Appeals Council or Federal Review level, expect about six months per level.
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How Long Will I Wait For A Social Security Disability Hearing
If you disagree with a decision by the Social Security Administration on a claim for disability benefits, you have the right to appeal. In most cases, that will involve a hearing before an administrative law judge , but it can be a long, arduous process involving multiple steps.
Cases heard by ALJs in October 2022 took nearly 13 months on average to reach that stage, counting from the date the hearing application was filed, according to SSA data. Thats a national figure depending on which of Social Securitys 168 regional hearing offices handles your case, it can take several months longer or be several months quicker.
And thats just counting the time from a request for a hearing to the proceeding itself. An ALJ hearing is the second step in a disability appeal, and it can take several months to get to that phase.
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In most circumstances you must first ask for a reconsideration by your states Disability Determination Services, the same office that handled your initial application. A different disability examiner and medical team takes a fresh look at your claim and any additional evidence you want to present, such as recent medical treatment or exams. You have 60 days after an initial denial to file for reconsideration.
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How Much You Will Receive
The amount of your monthly SSDI benefit is based on your lifetime average earnings covered by Social Security.
If you don’t already have an estimate, you can get your Social Security Statement online with your personal mySocial Security account or use our Benefit Calculators to determine how much you could get if you became disabled right now.
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How Do I Get An Attorney
For SSI and Social Security Disability claims, contact the nearest Idaho Legal Aid Services office listed on the back of this pamphlet, or the National Organization of Social Security Claimant’s Representatives, 1-800-431-2804, or the Idaho State Bar, 334-4500, to receive a referral.
This page is for information only. If you have questions about your disability claim, contact an attorney.
Contact A Professional Relations Officer
DDD’s Professional Relations Officers serve as points of contact regarding Social Security disability programs in Ohio. They provide presentations to health professionals about how medical information is used to evaluate disabilities, recruit health professionals to become consultative examination providers, assist consultants in using SSAs Electronic Records Express , and much more.
DDD is actively seeking Ohio-licensed psychiatrists, clinical psychologists, and psychiatric nurse practitioners in Ohio to conduct independent psychological exams of Social Security disability claimants. Opportunities exist throughout Ohio with a significant need in Northwest Ohio. Please contact ANY of the Professional Relations Officers to learn more.
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Do You Need An Attorney
If you are denied disability benefits and feel that you are disabled, you should see an attorney. Idaho Legal Aid Services, Inc. represents hundreds of claimants for SSI disability. Your chances of winning an SSI appeal are much better if you have an attorney.
Here are 10 good reasons for getting an attorney:
What Is The Social Security Decision
The SSA has two disability programs: Supplemental Security Income and Social Security Disability Insurance. The SSI program is for people who have little to no income and financial resources available to pay the cost of food, shelter, and other basic needs. The SSDI program is for people who paid Social Security taxes on income earned through at a job or through self-employment for a long enough duration to qualify for benefits under the program.
When you apply for either SSI or SSDI, the application is received by a Social Security field office that reviews it to verify non-medical eligibility, such as income and resources of SSI applicants and employment history of SSDI applicants. The applications then go to a Disability Determination Service office, which is an agency in each state funded by the federal government.
The Disability Determination Service office that receives your application reviews it to determine if you meet the medical criteria to qualify for either SSI or SSDI. It does this by using your medical records and, if necessary, by arranging for a consultative examination, which can be performed by the physician who treated you or by an independent health care professional. The DDS staff then decides whether to approve or deny the claim. This is known as the initial disability determination.
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Level : Appeals Council Review
The third level of your disability appeal is to request a review by the Social Security Appeals Council. At this stage, you will not receive a new hearing. Rather, the Appeals Council will review all the lower decisions and decide whether to reverse the previous decision and approve your claim, let the ALJs ruling stand, or they may deny your request of review and remand the case back to an ALJ to review it again.
Like the other three steps, this request must be initiated within 60 days of receiving your denial. It can take anywhere from six months to two years to complete this stage of the Social Security disability appeals process.
Required Social Security Appeal Form
The best way to request a review is by using the SSAs online service, AC iAppeal Online, but you can also fill out form HA-520 and send it to the SSA. You should also include any new evidence with this request or inform the Appeals Council that you and your representative will be providing new evidence.
Level : Hearing By Administrative Law Judge
If your reconsideration review was denied, the second level of the appeals process is to request a Social Security disability hearing with an administrative law judge . This must be initiated within 60 days of your prior reconsideration denial. These hearings are occasionally held at a physical location, but can also be conducted via video conference which is becoming more common. Video conferences typically can be scheduled sooner and make it easier for the claimant to bring witnesses to testify on their behalf.
During your administrative law judge hearing, youll be able to present your case to a judge who had no role in the previous two decisions and will therefore give their impartial judgment. You may be asked to bring or choose to bring additional documentation and witnesses to support your case, and many people opt to have a legal representative with them as well. Unfortunately, it can take several months or over a year to get a disability hearing scheduled, making it important you make the request as soon as possible.
Required Social Security Appeal Form
If you receive a denial from your reconsideration, there will be instructions on your letter for how to start the next level of appeals. To request a hearing, you must fill out and submit forms HA-501 , SSA-3441 , and SSA-827 .
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How Can You Expedite Your Claim
Make certain that you have proper identification when you make your claim: Birth Certificate, Social Security Card, Driver’s License, etc.
Take time to go over your work history and try to list all of your employers for the last 15 years. Company names, addresses where you worked, supervisors’ names, and any documentation on how much you were paid will all be helpful.
Know the date that you stopped working due to your impairment. Know the date that your work changed due to your impairment if that is different from the date when you finally quit. Explain any special working conditions that may have been provided by your employer to keep you on the job.
Write down the names, addresses, and telephone numbers of any medical source you have seen. The DDS may have trouble identifying the right doctor if you only state “Dr. Smith in Denver,” so it would be most efficient if you would provide accurate names, addresses, and telephone numbers.
If your doctor has given you any written instructions that limit your activities, have a copy placed in your file. The date the restriction started and the date it might end are very important to your decision.
It is also helpful to ask your doctor to write a medical source statement about the facts of your medical condition and how your impairments limit your physical and/or mental functional capacity.
Administrative Appeals Process
Benefit Decisions You Can Appeal
You can appeal a decision about:
- 30 hours free childcare scheme
- Attendance Allowance
- Child Support or Child Maintenance
- Compensation Recovery Unit
- Employment and Support Allowance
- Funeral Expenses Payment
- Winter Fuel Payment
- Vaccine Damage Payment
Check any letters youve received about your benefit if you do not know the exact name.
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File A Lawsuit In Federal Court
The final step in the Social Security Disability appeals process is to file a lawsuit against the SSA in federal court. This part of the appeal is very complicated, and its likely you would need the help of an experienced Social Security disability lawyer to file this lawsuit.
Again, this federal court review is not to determine whether or not youre disabled. This review is only used to determine whether the proper procedures were followed when ruling against your claim. Its difficult to win a disability case in federal court, and we do not recommend anyone pursue this step without experienced legal counsel.
If your Social Security Disability claim has been denied, our disability attorneys can help you begin the appeal process. Call RSH Legal today at 1-319-774-1542 or download our FREE legal guide on Iowa Social Security Disability Claims.
Plan For Compassionate And Responsive Service
Eliminating the hearings backlog and reducing the wait time to 270 days remains one of our agencys most critical priorities. We continue to make sustained progress towards this goal. Over the last three years, Congress has provided $290 million in special funding dedicated to reduce the hearings backlog. Through this extraordinary support, we accelerated our plan to eliminate the hearings backlog and reduce the average wait time to 270 days by the end of fiscal year 2021, one year earlier than projected in previous plans. Our progress stems from implementing improvements to the hearings business process, modernizing our information technology infrastructure, implementing important policy changes, and rallying our workforce to improve our ability to serve the public.
The 2018-2019 CARES Plan Update provides the latest information on continuing activities designed to reduce wait times and eliminate the hearings backlog. Since 2016, we hired close to 600 administrative law judges , and in FY 2018, we hired over 500 decision writers and over 170 other support staff in the hearings operation.
We have reduced the number of pending hearing requests each consecutive month since January 2017. In early March 2018, hearings pending dropped below 1 million for the first time since October 2014. As of March 2019, approximately 720,000 people were waiting for a hearing decision.
The CARES Plan remains a living document and will be modified and updated as appropriate.
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Should You Hire A Lawyer For Ssdi Appeals
Lets return to our source authority.
At 62, Windy City attorney Grossman considers himself an expert in exactly two things: arm wrestling and winning Social Security Disability appeals.
Its not a stretch to say the two require a similar skill set: Each involves overpowering an opponent determined to deny your success by outlasting you and wearing you down.
But even Grossman advises against acting hastily.
Having a lawyer for your original filing isnt necessary. Its a benefit only if you are interested in getting a head start on your almost inevitable appeal. Your disability attorney will help guide you through what documents to gather and how to make certain your application is complete and accurate.
Most people are not great historians, Grossman says. An attorney will help you assemble the right information and the correct evidence.
But initiating a claim is not where lawyers earn their keep. Your chances of succeeding at the first level by hiring an attorney improve only marginally, Grossman says. Theres no personal interface. Your application may be filled out more expertly, but he wont be making a face-to-face argument.
The Appeals Council Review Of Your Disability Claim
If you disagree with the ALJ’s decision, you can request an Appeals Council review. Again, there’s a deadline. You must file a “Request for Review of Hearing Decision” within 60 days of the date of your denial letter.
The Appeals Council will first decide if it will review your case. If it agrees to do so, the council will review the ALJ proceedings looking for errors. You won’t be able to submit new evidence, but your attorney can submit a written argument explaining the mistakes the ALJ made.
The Appeals Council could decide your case after review or send it back to the administrative law judge. You can expect to wait about a year before the Appeals Council looks at your case. If it’s sent back to the ALJ, the disability determination will take even longer.
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What Do They Mean By Disabled
The test for disability is the same for Social Security and SSI. Basically you must have a medical or mental health problem which keeps you from working full-time for at least a year. The Department of Health and Human Services, which runs the Social Security Administration, has rules and regulations which they use to define disability.
When you apply for disability, Social Security checks to see if you are working. People who work and earn over a certain amount per month are considered to be able to do “substantial gainful activity” and they are denied disability. Social Security will look at the medical condition to see if it is “severe.” A severe condition must be expected to result in death or last a year before they consider you disabled. There are 14 types of super severe conditions recognized by the Social Security Administration. If your condition matches any of the ones described in these 14 categories, you will qualify for benefits. If you have a severe impairment that does not match any of the 14 types of conditions, then the Social Security Administration will look at your age, education, and work experience to see if there is other work that you can do.