To appeal a denial of Social Security disability (SSDI) or Supplemental Security Income (SSI) benefits, you'll need to follow the instructions included in your notice of denial from the Social Security Administration (SSA). The first step is to file a request for reconsideration. If that fails, you may want to take your case to the next level of appeal. This article covers the various levels of appeal after denial of Social Security disability benefits.
To get your appeal started, you first request that the initial denial (or the termination of benefits after a continuing disability review) be reviewed again.
A reconsideration is a complete review of your claim. It takes place at the Disability Determination Services (DDS) level, but is performed by a medical consultant and examiner who were not a part of the initial decision. This means that any claims examiners and medical consultants who had anything to do with the denial of your initial claim are barred from deciding your reconsideration claim. DDS grants benefits in about 10-15% of all reconsideration claims.
Your denial notice will include information about your right to request a reconsideration, along with a paragraph about your medical condition. Contact your local field office to begin your reconsideration appeal. To find the nearest local field office, go to www.ssa.gov and select "Find a Social Security Office."
If your claim is denied again, you will receive a denial notice and an explanation very much like the one you received when your initial claim was denied. The next level of appeal—if you want to pursue it—is a request for a hearing before an administrative law judge (see Step 2, below).
Once you begin receiving disability benefits, your case will be re-examined periodically through a continuing disability review (CDR). The SSA may end your benefits for a variety of reasons, including:
If your benefits were terminated and you want to appeal the termination, you must request a reconsideration of a CDR at a hearing before a disability hearing officer (DHO). Before your claim goes to the hearing officer, it will receive a second review by a different DDS medical consultant and examiner who could reverse the prior decision to terminate your benefits.
Although the DHOs are not doctors or psychologists, they are allowed to form their own medical opinions about the severity of your physical or mental impairments. As you prepare for the DHO hearing, keep in mind that the SSA must show reliable evidence that you have had significant work-related medical improvement. This is a matter of medical judgment. Social Security must consider your treating doctor's opinions on your limitations and whether they have lessened. If your case is borderline, you should win your appeal and your disability benefits should continue. If your claim is denied, your next step in the appeal process is to request a hearing before an administrative law judge (see Step 2, just below).
If your request for reconsideration (of an initial claim or a continuing disability review termination) is denied and you want to appeal further, you must request a hearing before an administrative law judge (ALJ) within 60 days from receipt of your denial.
ALJs are attorneys who work for the SSA's Office of Hearings Operations (OHO), formerly known as the Office of Disability Adjudication and Review (ODAR). Most of their work involves upholding or overturning decisions to deny or terminate disability benefits; they also hold hearings on some nondisability Social Security issues. Overall, ALJs grant almost half of the claims that reach them—that means that 50% of disability applicants who take their appeal to an ALJ hearing win their appeal and will start receiving disability benefits.
If you lose at your disability hearing, you can request that the Appeals Council review your case. The Appeals Council randomly selects cases for review and has discretion to grant, deny, or dismiss your request for review. The Appeals Council can dismiss your case without review unless it finds one of the following:
If you file late, request a dismissal, or die, the Appeals Council may also dismiss your claim without reviewing it.
The Appeals Council usually looks for a flaw in the ALJ decision before granting a review. In those situations, your chance of winning is only 1%. The Appeals Council is not a place where you are likely to find success. But, in about 10% of cases, the Appeals Council sends the case back to the ALJ to take another look at it (called a "remand").
For most people, the only reason to file a request with the Appeals Council is to exhaust all of Social Security's administrative appeal avenues, which you must do before you sue Social Security in federal court.
The next step in the appeal process is filing a lawsuit in U.S. District Court. If you don't yet have an attorney representative, you will almost certainly need one now. (You can use Nolo's Lawyer Directory to find a Social Security attorney in your area.)
Federal judges hear disability cases without juries. The judge is supposed to review the case only for legal errors, but in reality, many judges rule on factual questions, too. District court judges reverse ALJs or the Appeal Council in only a small number of cases, but they remand (send back to Social Security) about half of the disability cases they see, often saying that Social Security did not consider a treating doctor's opinion sufficiently, did not consider pain and other symptoms, or should have asked for assessments of abilities from treating doctors.
Although you have a fair chance of winning an appeal after going to federal court, it is not an attractive option. Suing the SSA is expensive and time consuming. Even if you win, it might take years to reach that level of the appeals process. Consequently, not all disability attorneys are willing to file a disability case in federal court and fewer than 1% of disability claimants actually take their cases to court.
For more information about appealing a denial of your claim, see Nolo's articles Social Security Disability: Deciding Whether to Appeal a Denied Claim and Social Security Disability: Appealing Denied Claims.