If your Social Security disability claim has been denied, you have the right to submit an appeal. Before filing an appeal, you should learn more about the appeals process to create a strong disability case that overturns the denial.
4 Levels of the Appeals Process
- Request for Reconsideration
- Hearing by Administrative Law Judge
- Appeals Council Review
- Federal Court Review
There are four levels to the Social Security appeals process. There are specific rules, forms, and timelines at each stage. Knowing what to expect at each level can make the process smoother and less stressful.
Why Was My Disability Claim Denied?
There are a few possible reasons why Social Security disability claims are denied. These reasons fall into two basic categories: medical and non-medical. If your claim was denied for medical reasons, the evidence submitted either didn’t prove that you have a disabling condition, or your condition is not considered severe enough to last 12 months or more. For example, if you cannot work due to a broken leg that will heal completely in 8-10 months, you will not qualify for Social Security disability benefits.
Another medical reason for a disability denial is when the applicant fails to follow the treatment plan. Failing to attend appointments, perform physical therapy, or take prescribed medications can result in a denied claim. If your disability results from drug or alcohol abuse, that could be another cause for claim denial.
Many non-medical factors can also cause your Social Security disability claim to be denied. Errors on applications, fraud attempts, and imprisonment can prevent claim approval. Earning too much money can cause you to be ineligible for disability benefits. There is a monthly income limit for disability recipients, updated annually. For 2022, the monthly allowable income is $1,350 per month ($2,260 for blind disability recipients).
The biggest non-medical reason for claim denial is lack of communication. Throughout the process, it’s important to keep your contact information updated with the Social Security Administration. Many claims are denied simply because the SSA cannot reach applicants.
4 Levels of the Appeal Process
If you disagree with the SSA’s decision on your claim for disability benefits, you have the right to appeal. There are four levels to the Social Security disability appeal process. It helps to become familiar with each step in the process before filing your appeal.
1. Request for Reconsideration
The first step in the disability appeal process is reconsideration. When you request reconsideration, your disability case will get a second review by someone who was not a part of your initial claim review.
The new reviewer will look at your initial claim and any new evidence you provide. Your denial letter will explain the medical or non-medical reasons your claim was denied. If you have new evidence that will help get your claim approved, you can submit it with your request for reconsideration.
All claimants, even those living outside the U.S., can request a reconsideration online. You must make your appeal request within 60 days of your claim denial.
If you don’t want to file your reconsideration request online, you can download the appropriate forms and submit them to the SSA through the mail, fax, or in person. You’ll need to submit the following forms depending on why your claim was denied.
Denial for Medical Reasons
- Form SSA-561, Request for Reconsideration
- Form SSA-3441 Disability Report – Appeal
- Form SSA-827, Authorization to Disclose Information to the Social Security Administration
Denial for Non-Medical Reasons
- Form SSA-561, Request for Reconsideration
Each form contains instructions to complete and submit to your local Social Security office. You can download the above forms from SSA.gov.
2. Hearing by Administrative Law Judge
If you disagree with the results of the reconsideration request, your next step is to attend a Social Security hearing. An Administrative Law Judge (ALJ), who did not handle your claim in any of the previous steps, will review your claim and hear testimony from you, your witnesses, and any required experts.
Hearings are held in person or through video conferences. When possible, hearing locations are within 75 miles of your home. If you select a video hearing, you will attend using the Microsoft Teams app on your computer, tablet, or smartphone. If you are using a representative to help you through the process, they must also agree to attend through video.
During the hearing, the ALJ asks you and all witnesses to take an oath that the testimony given is true. You can explain your case along with any witnesses you bring. The judge will ask questions of you, your witnesses, and any medical experts in attendance. And you will have the chance to ask questions of the judge.
You have 60 days from the reconsideration decision to file your disability hearing request. You must complete the following forms to make your written request:
- HA-501, Request For Hearing By Administrative Law Judge
- SSA-341, Disability Report – Appeal
- SSA-827, Authorization to Disclose Information to SSA
- SSA-1696, Appointment of Representative (only if using a Representative)
Submit these forms to your local SSA office and any new evidence to include with your disability case. You can download all the above forms on SSA.gov.
3. Appeals Council Review
Requesting an appeals council review is the next step if you are still unsatisfied with the results of your disability claim. The Social Security Appeals Council will review your request and determine whether the hearing decision is aligned with Social Security laws and regulations.
The appeals council will then take one of three actions:
- Deny your request for appeals council review
- Review your case and make a decision
- Return your case to the ALJ for further review
You can submit new evidence for the council to review. If you need more time to gather documents, be sure to request an extension, so you don’t miss any deadlines. If you have no new evidence, the appeals council will review your current claim and decisions made to date.
Within 60 days of the hearing decision, file your request for review of the hearing decision by the Appeals Council. The most convenient way to request a review is through the SSA’s online process AC iAppeal Online.
If you don’t want to use the online method, you can print and mail Form HA-520 (Request for Review of Hearing Decision/Order.
Send the above form to:
Appeals Council, SSA/OARO
5107 Leesburg Pike
Falls Church, VA 22041-3255
4. Federal Court Review
If you want to appeal the decision made by the Appeals Council, or if they denied your request for a hearing review, your final step in the appeals process is filing a civil suit in a Federal district court.
Where do you file a civil suit? You can file a civil suit in the district court of the U.S. in the judicial district where you live or have your principal place of business. If you do not live or work in a U.S. judicial district, you must file in the United States District Court for the District of Columbia.
Your denial letter will give you further instruction, including the requirement to send copies of the filed complaint and the issued summons to the Social Security Administration. Send these documents by certified or registered mail for increased security and tracking to the SSA’s Office of the General Counsel in the area you filed the suit.
There is no form to submit at this level. To use this level of appeal, an attorney needs to file a civil suit for you through Federal Court.
Do I Need a Disability Attorney?
It’s easy to see that you will need to consult an attorney if you make it to the Federal Court Review stage of the appeals process. But getting legal advice early in the process can help you avoid an appeal altogether.
First, a Social Security disability attorney can set up a free consultation where they’ll do a quick review to estimate your chances that your disability claim will get approved. Then they can help you put together a solid initial claim. Putting together a claim can be confusing and time-consuming. Having legal help along the way makes the process less stressful. An attorney may even be able to increase your amount of disability back pay.
Having the help of a disability attorney is even more important for a denied claim. With half a million hearing and appeals decisions made by the SSA per year, it’s safe to say denials are common. It helps to have an expert by your side to make persuasive arguments on your behalf. A disability attorney will prepare you for questions the judge may ask at your hearing and will cross-examine experts brought in by the ALJ.
How much will a Social Security disability attorney cost?
Most often, there is no upfront cost for their services. Disability attorneys charge a federally regulated amount of 25% of your back pay or $6,000 (whichever is less).
What’s the difference between a disability attorney and a disability advocate?
Keep in mind that a disability attorney is not necessarily the same as a disability advocate. A disability advocate has passed a certification exam showing proficiency in disability matters but is not required to have a law degree. However, many disability advocates are also attorneys. Disability advocates can help in the appeal process through the hearing level – however, only a licensed attorney can represent you if you file a civil suit in Federal court.
A disability attorney has more trial experience and is more well versed in legal precedence that can help get your case approved.
Your Right to Appeal a Denial
If your initial disability claim is denied, don’t lose hope. You have the right to appeal. To be successful in the appeal process, you should address any reasons your claim was denied and submit thorough documentation to back up your claim. It’s vital to meet the 60-day deadline to appeal at each stage. If you need an extension for any reason, you will want to contact your local Social Security office as soon as possible.
The first appeal stage your claim will go to is the reconsideration stage. Here your case is reviewed by officials that had no part in deciding your initial claim. If you disagree with their decision, you can appeal to the hearing stage.
During a hearing, you can present your case in person and have witnesses speak on your behalf in front of an Administrative Law Judge.
Should you be denied at the hearing level, your claim can undergo another review by the Appeals Council. If your claim is still denied, your last recourse is to file a civil claim in a Federal district court.
If you have new medical records or administrative documents to submit along the way that could help win your case, you can submit them for review. Maintain contact with your local Social Security office so they can reach you with any appointment dates or requests for information. Getting help from a Social Security disability attorney can be the most important thing you do to get your claim approved. Don’t wait for your claim to be denied. Disability attorneys can help at the initial stage of the claims process to ensure you submit a quality claim. If you need to submit an appeal, an attorney can represent you at hearings and prepare persuasive arguments to get your disability claim approved.