What Happens When You Are Denied Disability at Reconsideration
Filing a claim for Social Security disability benefits can be a frustrating process for several reasons. The most frustrating reason regards the high denial rate of claims as processed by the Social Security Administration (SSA). From lack of evidence to inaccurate applications, the SSA denies a large majority of claims for financial assistance.
Because of the high rate of denied disability applications, the SSA has established an appeals process that involves going through four steps, with the first step called reconsideration of the initial application for Social Security disability benefits.
Unfortunately, the SSA also denies a majority of appeals for reconsideration. This means you should know what happens after you receive a notice of a denied disability benefits appeal.
The first thing to happen involves hiring a Social Security disability attorney. Your legal counsel has 60 days to request in writing a hearing held in front of an administrative law judge (ALJ). Your lawyer can submit the request for an ALJ hearing by mail or by submitting the online form provided by the SSA.
Federal law requires the SSA to notify you of the date, time, and location of the ALJ hearing at least 20 days before the hearing is to take place at a legal venue that is no more than 75 miles away from your home.
You should be prepared to submit more evidence during the ALJ hearing, especially physical evidence that demonstrates you can no longer work because of an SSA-approved disability. The ALJ hearing your case examines all the evidence, as well as questions witnesses. Your disability attorney strengthens your disability claim by deferring to medical experts that verify your disability symptoms.
There are five steps in the Social Security disability application process:
the initial application and up to four different appeals. The first appeal is a reconsideration , where another disability examiner completely reviews your application and any new evidence provided. If you are denied by the second examiner, there are a number of steps you can take.
It is strongly advised that you get a lawyer if you do not have one already. The next three appeals involve going in front of a judge, and having a lawyer who is knowledgeable of the Social Security Administration (SSA) will put you at an advantage.
Hearing
If you are denied at the reconsideration, you can ask the SSA for a hearing with an administrative law judge (ALJ). This request needs to be in writing within 60 days of your reconsideration notification by filling out the form online, printing and mailing them, or by writing a letter stating your desire for a hearing. The ALJ will not have had any part in the original decision or the reconsideration. Missing the hearing should only be done if there are extreme circumstances, because it’s in your best interests to attend the hearing and speak for your case.
You will be notified you of the date, time, and location of the hearing at least 20 days before the date. The SSA tries not to schedule a hearing that is more than 75 miles away from your home, but there are only 169 offices nationwide. The ALJ might offer to do a video conference, which is generally more convenient and scheduled faster. The SSA also might ask for more evidence and clarification of previously submitted evidence. Make sure to submit any new evidence you want considered in the decision as early as possible. At the hearing, the ALJ will question you and any witnesses you bring and give you or your representative the chance to question your witnesses. You will receive the ALJ’s decision in writing.
Learn More: Appealing After A Denial
Appeals Council
If you are denied by an ALJ, the next step is to ask for a review with the Appeals Council. They will review the claim and either make a decision themselves or return it to a different ALJ for further review. You must request in appeal in writing (form HA-520-U5) within 60 days and mail it to the Appeals Council headquarters in Falls Church, Virginia. If have any new evidence, send it with your written request. You will be sent a copy of the Appeals Council’s decision on your case.
Federal Court
If you are denied at the Appeals Council, the last level of appeals is to file a civil lawsuit with the federal district court within 60 days. The SSA will send you information with your denial. Keep in mind, there is a fee the file a civil suit, in addition to the fees you have to pay your representative, if any. You must send the SSA copies of your complaint and court summons. The Office of Disability Adjudication and Review will prepare the documents for court. This is your final decision on whether or not you will receive disability benefits.
Tips for Appealing a Social Security Denial
If you have been denied disability benefits, you can still obtain these benefits that you may need by appealing a social security denial. Here are some tips:
Tip #1 File in a timely manner
The Social Security Administration’s (SSA) appeals process is quite rigid and it is critically important for you to ensure you are aware of time limits at each step of the appeals process. While you could have your denied application overturned at any stage of the appeals process, you might not. And, if this is the case—meaning that you have failed to win approval at a certain stage—you need to make sure that you file your request to go to the next stage way before the time limit is reached; otherwise, your appeal may be denied.
Tip #2 Complete all required forms
It is quite common for disability benefits applications to be denied initially because the application form was not fully completed by the applicant. Some examples of incomplete applications include the application (1) having sections that were left out (i.e., not filled in), and/or (2) missing some essential information.
Similarly to the application process, all requests at each stage of the appeals process must also be completed fully; otherwise the appeal may be rejected.
Tip #3 Add more medical evidence if possible
Another common reason why disability benefits applications are denied is because the original application supplied insufficient medical evidence.
The first two stages of an appeal involve (1) a request for reconsideration of your application, and then (2) a hearing with an Administrative Law Judge (ALJ). At either of these two stages, you might be able to supply further medical evidence which could highlight more clearly that your symptoms match the Blue Book’s criteria and/or that you are clearly unable to work for at least the next 12 months because of your disability.
Tip #4 Respond to requests quickly
At any stage of the appeal, the SSA’s disability examiners may ask you for clarification or more evidence. It is critically important that you make sure you address these requests as quickly as possible.
Tip #5 Work with a lawyer
While working with a lawyer may not speed up an appeal, the advice you may get as well as the legal help could increase your chances of having a denied application overturned.
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