What Happens if You're Denied?
Appealing Denied Claims
If you receive a denial of disability benefits, it does not necessarily mean that you do not still have a strong claim. Unfortunately, the process can be both long and confusing.
Generally, there are four levels of appeal. They are:
• Hearing by an administrative law judge
• Review by the Appeals Council
• Federal Court review
After the first denial, a reconsideration can be undertaken by the Administration that is a complete review of your claim by someone who did not take part in the first decision. This generally involves a review of your files without the need for you to be present. At this level your attorney can help identify and submit any medical documentation that may not have been included in the first application as well as third party reports and medical opinions that can be crucial to a successful claim.
Hearing by an administrative law judge
If you disagree with the reconsideration decision, the next step is to request a hearing that will be conducted by an administrative law judge (ALJ) who had no part in the original decision or the reconsideration of your case. The hearing is usually held within 75 miles of your home.
At the hearing, the ALJ will question you and any witnesses you bring. Other witnesses, such as medical or vocational experts, may also testify at the hearing. Your attorney will also be there to help develop your testimony as well as cross-examine any experts that the ALJ calls for testimony.
The hearing is your opportunity to explain why you believe you are disabled in your own words. Your attorney will speak to you before the hearing, let you know what to expect, and help you understand what issues are critical in your case in order to be found disabled.
Although the hearing process is designed as a non-adversarial process (there is no one arguing that you should be denied disability), it is still common for even the most obviously qualifying individuals to be denied due to the lack of an advocate who understands the ins-and-outs of what it takes to prove a disability claim.
Review by the Appeals Council
If you disagree with the hearing decision, you may ask for a review by Social Security’s Appeals Council. The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an ALJ for further review.
This step of the appeals process does not require you to appear or testify. Instead, your attorney may identify and submit additional evidence and outline any errors in the ALJ decision that should result in a favorable decision or a remand back to the ALJ for further review.
Federal Court review
If you disagree with the Appeals Council’s decision or if the Appeals Council decides not to review your case, you may file a lawsuit in a federal district court.
Unlike many firms, Daley Disability Law has extensive experience at this level of appeal and has won hundreds of cases for clients who ultimately get the benefits they deserve.
Generally, if a claim is successfully appealed, the federal court will send this back down to the hearing level with specific instructions regarding errors that need to be resolved. This can be a complicated and long process, but often a federal court appeal can provide one more chance when all seems lost.
Available Alternatives to Filing an Appeal
If you have been denied benefits, or if your benefits have been reduced or stopped, you do have other options available to you if you do not want to file an appeal.
• Reopening Your Claim. You can request that the Social Security Office reopen your claim and review the information. This is not an appeal. However, this may take some time to accomplish and it may end in the very same denial of benefits you received in the past. A denial to reopen a claim must be made within 2 years for SSI and 4 years for Disability Insurance Benefits (DIB), which is not reviewable on appeal.
• Start a New Claim. If denied and you do not file a timely appeal of the initial application, one may refile a new claim. This will start the process over again. This is usually only beneficial to you if you have new symptoms or your condition has worsened. Upon filing a new claim, the period denied cannot be considered, this is called res judicata, however in refiling the applicant may ask that the prior denial be reopened allowing one to receive benefits back to the onset date alleged in the prior unappealed application.
Starting the Appeals Process
If you are planning to file the appeal on your own, all the information you need for the procedure and which forms to use will be included in your letter of denial. However, you must remember that the Social Security Administration will require that you comply with all of their rules for filing an appeal. This includes filing the right paperwork and supporting documents within deadline times and to the right people and responding to all of their requests. Failure to comply with their deadlines and requests can cause your appeal to be denied.
If Your Benefits Have Been Cancelled, You May Still Qualify to Collect During the Appeals Process
If you were previously receiving disability benefits and it has been determined that something has changed in your situation and you no longer qualify for these benefits, you may still be able to collect during the appeals process. In your denial letter, you will receive form SSA-795. This form must be completed and returned to the Social Security Administration within 10 days of receiving your denial of benefits. This will help you continue to receive benefits during the appeals process.