There are two ways a disability claimant can ask the Social Security Administration (SSA) to review a denied claim for Social Security or SSI benefits: by appealing the denial or by reopening the previously denied claim. Both of these methods can result in an approval of benefits and an award of backpay.
There are generally four steps in the appeal process.
In most states, the next step after an initial denial is called a “request for reconsideration.” This has to be filed within sixty (60) days of being denied. The reality is that most requests for reconsideration are denied—this means that, ultimately, requests for reconsiderations end up being decided by an administration law judge (ALJ) at the hearing level. If you live in a state that has eliminated the request for reconsideration step, you will simply request a hearing after your initial denial. This procedure may speed up the decision-making process, but isn’t an option in all states.
If your request for reconsideration is denied, or if you are in a state that has eliminated the request for reconsideration, the next step is to ask for a hearing in front of an ALJ. This request must be made within sixty (60) days of being denied your request for reconsideration. Cases that are ultimately approved are usually approved at the hearing level.
If your claim is denied by an ALJ at the hearing level, you can appeal the denial to the Appeals Council (AC). Like the previous requests, this one must also be made within sixty (60) days of your denial. The AC may or may not decide to review your claim. If the AC decides to review your claim, it can conclude that the ALJ’s denial was wrong and award you benefits accordingly or can send your claim back to the ALJ to be reviewed.
This is the final stage in the appeals process and most claims never get to this point. Federal appeals require that the claimant submit a brief, a detailed explanation of why you think the prior decisions in your case were wrong. Federal briefs are difficult to write and must comply with complex federal rules. For this reason, it is particularly helpful to have a disability attorney who is licensed to practice in federal court to represent you at this stage.
If you are denied benefits and decide not to appeal your claim, or if you miss the deadline for your appeal, then the SSA will close your case. However, you may be able to have the claim reopened at a later date if you file a new claim and it's related to the original one.
An example of a related claim would be if you initially applied for benefits based on spinal stenosis and you later apply because of a herniated disc. But even a related prior claim can only be reopened if the time period of the disability overlaps with the new claim. And you are limited as to how long ago the claim was closed as to whether or not it can be reopened. You can read in detail about this topic in our article Reopening a Social Security Disability Claim.
When you are approved for disability benefits, you are eligible for payments going back to the initial application date (these are called backpayments). If you are approved for Social Security Disability (SSDI), you can get even more money in the form of retroactive benefits (these benefits are paid back to the date the SSA concluded you became disabled). The SSA will use the date of your first application as the date from which you may be eligible for these back benefits.
It is generally better to continue appealing a denial through the various stages (request for reconsideration, hearing, and so on) than it is to reopen a previous application. Here are some reasons why.
One of the main reasons it's better to appeal a denial is the time factor. The decision-making process for a claim can take as much as two years (and in some cases even longer) and if you fail to appeal, you will likely add substantial time to how long it takes to get a final decision in your case.
The SSA has the discretion to open or not to open a prior application. Again, if the prior case isn’t related, the time period doesn’t overlap, or too much time has passed, the SSA won’t reopen the case. This means that you won't be able to get disability backpay for this time period even if you otherwise met the SSA’s definition of disabled.
Although ALJs are supposed to look at claims de novo (from the beginning) they don’t always do this. This means that if you reopen a prior claim, the ALJ may deny it simply because it was denied before. Again, the result of this is that you may lose valuable backpay.