Many applications for Social Security Disability Insurance are initially denied by SSA. The applicant should not be discouraged by an initial denial, however, as there is an appeals process. There are several levels of a Social Security Disability appeal, from the administrative level to a review of the decision by a federal court.
Request for Reconsideration
If an applicant’s initial claim is denied, he or she has a right to file a Request for Reconsideration. At this stage, another Social Security examiner will review the file and the initial decision. A short, informal conference may be conducted, but there will not be extensive witness testimony.
The applicant has 60 days from the date the initial decision been mailed to the applicant to file a Request for Reconsideration. SSA automatically adds five days to the 60 day period to account for mailing time. At the reconsideration phase in a Social Security Disability appeal, the applicant can supplement evidence and update medical records.
Administrative Hearing of the Social Security Disability Appeal
If the claim is denied after the Request for Reconsideration, the applicant has a right to request an Administrative Hearing. A Request for Hearing form must be filed within 60 days from the date the Request for Reconsideration was denied.
At the hearing level, the applicant will have a right to testify before an administrative law judge, or ALJ, as well as call witnesses. Prior to the hearing, the ALJ will normally request the applicant to update medical records, supplement the medications he or she is taking and update his or her employment history. The applicant will have the right to review the file before the hearing.
The ALJ will question the claimant about his or her medical condition, activities of daily living and work history. The judge may have a vocational expert prepared to testify as to which jobs, if any, the applicant is capable of performing. The ALJ may also have a medical expert testify. The applicant has the right to cross examine these witnesses.
The ALJ’s decision will be based upon the review of the file, witness testimony and other evidence. Though the ALJ is an employee of SSA, the decision is made independently. The judge is not bound by the previous decisions of the SSA in the claim, and any previous factual findings of the SSA may be overruled by the ALJ.
Appeals Council Review
The next stage of the Social Security Disability Appeal is a review by the Social Security Appeals Council. This appeal is conducted without a hearing at the SSA central administrative offices. The applicant will not testify, and usually, no further evidence is submitted. A request for Appeals Council review must normally be made within 60 days from the date of the ALJ’s decision.
The Appeals Council may agree with the ALJ’s decision, reverse the decision or return the claim to Social Security for further proceedings. This is called a “remand.” A decision from the Appeals Council may take a year or more as they handle appeals from all over the country.
Federal Court Review
If the applicant is still denied, the last level of a Security Disability appeal is review by a federal court. This level is a federal lawsuit, but there will be no trial or additional evidence. SSA will prepare a record of all proceedings in the case and provide it to the judge.
The judge will then require the applicant to file a brief, identifying all mistakes he or she believes SSA made in the case. The applicant may argue, for example, that Social Security ignored evidence or failed to consider the opinion of the applicant’s treating physician. There are dozens of issues that may be argued in a federal court review.
The federal court may agree with SSA, it may reverse their decision or it may send the claim back to SSA with specific instructions on what areas to review. If it finds SSA made errors in the claim, it will order that they correct the errors on remand.
The Security Disability appeal process is lengthy, and the time from initial application to federal court review may take a number of years. An applicant may not “skip over” one area of review, for instance, skipping the request for hearing level and move directly to federal court. On the other hand, if the applicant is ultimately successful, the SSA must pay benefits going back to the date of the initial application rather than the date of the favorable decision.