Applying for Social Security Disability (SSD) requires a lot of information from a number of people including doctors, hospitals and therapists. SSD is a safety net for those who truly cannot work, so the review process is very strict. Approximately two-thirds of SSD initial applicants are denied benefits. When an applicant is denied benefits, they have the right to appeal that decision.
When an individual is denied SSD, benefits, they have 60 days to appeal the decision from when they receive the denial letter. There are four levels of appeal: reconsideration; Hearing before an administrative law judge (ALJ); review of an ALJ decision by the Appeals Council; and review by a Federal Court.
A first level appeal is called reconsideration. At this level, an applicant’s entire file is reviewed by someone who was not involved in the original determination. The applicant has the option to submit additional documentation that was not in the original file. When a file is originally reviewed, the applicant is commonly present for the review. With an initial reconsideration appeal, the applicant is not present.
Administrative Law Judge Hearing
If an applicant is denied SSD benefits at the reconsideration level, the applicant can appeal to an administrative law judge. The ALJ hearing is usually held within 75 miles of an applicant’s home. The applicant will be informed of the time and place of the hearing by mail. The applicant can bring witnesses to the ALJ hearing. These can be doctors, hospital personnel, and/or therapists. The hearing letter may request the applicant to bring more evidence or to clarify information contained in the original file.
There are occasions where ALJ hearings are held by video. These video hearings can be arranged sooner than an in-person hearing and can be closer to the applicant’s home. It is beneficial for an applicant to attend the ALJ hearing.
Appeals Council Review
An applicant can appeal an ALJ hearing decision to the Social Security’s Appeals Council. The Appeals Council can take one of a number of actions. The Council can deny the appeals request if it agrees with the ALJ’s decision. The Council can review the applicant’s file anew and issue its own decision or review the file and send the file back to an ALJ for another review. No matter which action the Appeals Council takes, the applicant will receive a letter detailing the action taken.
Federal Court Review
If an applicant is denied benefits at the Appeals Council level, they can file a lawsuit in their local federal district court.
Discontinuation of Benefits
An individual who receives SSD benefits will have their case reviewed to determine if they are no longer disabled. The Social Security Administration (SSA) will request updated medical records from doctors, hospitals, or therapists. SSD benefits “continue as long as the recipient’s medical condition has not improved and the recipient cannot work. Because of advances in medical science and rehabilitation techniques, many people with disabilities recover from serious accidents and illnesses.” The SSA looks at the individual’s current medical condition and how it affects the kind of work that individual can do. The SSA looks at work done in the past and what work an individual can possibly do now.
While the SSA tells applicants they can have an attorney to represent them, it does not require it. There is a great amount of information an individual must submit and keep track of during the initial consideration and any appeal. To help you in all phases of an SSD initial claim or appeal, contact our knowledgeable Social Security Disability attorneys at 1-800-803-5555.