How the Social Security Disability Denial & Appeal Process Works

It is easy to feel lost when attempting to navigate the world of Social Security Disability (SSD) benefits, especially if your initial application was turned down.

It is helpful to first understand the process of Social Security Disability denial and Social Security Disability appeal. Most importantly, remember that receiving a denial does not mean that you cannot obtain SSD benefits in the near future. That’s where the appeals process factors in.

We are here to help you understand the steps involved in the SSD benefits appeals process and help you along the way with however many times you need to appeal for disability benefits.

Two Types of Disability Benefits

Before walking through the denial and appeal process, it’s important to understand the two types of Social Security Disability benefits.

The Social Security Administration (SSA) identifies SSD benefits through two main categories: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). There are minimum qualifications you need to meet to be eligible for each.

Social Security Disability Insurance (SSDI)

• Required to meet SSA disability criteria.
• Must meet the minimum number of credits which are based on the number of years either you, a spouse, or a parents have contributed to FICA.

Supplemental Security Income (SSI)

• Required to meet SSA disability criteria.
• Must have limited income and resources.

Reasons for Denial of Social Security Disability Benefits

While it is disappointing to receive a denial determination notice, it is helpful to understand the possible reasons for denial, as this can guide you in the appeal process.

Reasons for denial vary depending on which SSA program you applied for and what criteria is required:

• If you were deemed unqualified medically … changes in diagnosis, severity, and length of your medical condition could improve your chances for appeal.

• If you qualified medically but were still denied SSI … this means you did not meet the financial eligibility requirements. Changes in income, resources, living arrangements, marriage status, and dependents could impact this decision.

• SSDI requires that you have a specific amount of work “credits” in order to qualify. A denial based on this reason would require you to have accumulated more work credits since you first applied. This is usually a more difficult denial reason to overcome.

What’s Next After Being Denied Social Security Disability Benefits?

When your initial application is denied, there are two steps you can take.

You can re-apply, which isn’t recommended, or appeal. We recommend that if you were denied disability, you should appeal the decision.

Remember, being denied doesn’t necessarily mean you aren’t disabled. In fact, nearly 70 percent of all disability claims are denied during the initial application stage.

The alternative of re-applying for benefits runs the risk of being denied a second time, leading you to the appeals route anyways and in turn losing valuable time.

If you choose to file an appeal, your appeal must be filed within 60 days of the denial decision as dated in the letter, not when you receive the letter. If you wait longer than 60 days, you will have to start over and re-apply at the initial level again.

Steps in the Social Security Appeals Process

It can be upsetting and concerning to receive an unexpected decision on your initial Social Security Disability benefits application, but the appeals process allows individuals multiple opportunities to redeem their benefits claim.

The following are different steps in the appeals process that the SSA follows:

• Request for reconsideration
• Hearing from an Administrative Law Judge
• Review from Appeals council
• Federal Court proceedings

While there are four possible steps in the appeals process, this does not mean that you can or should appeal using each route. Most individuals who have their initial application denied will utilize the first two levels of the appeal process.

Keep in mind that upon receiving the initial determination of your claim, you will also receive a letter explaining your determination. That letter should be used as a key point of guidance to decide which path to follow in the appeals process.

Request for Reconsideration

A reconsideration is a complete review of your claim by someone who did not take part in your initial determination.

You can request an appeal for reconsideration if your claim was denied based on medical reasons, income, resources, living-arrangements, and overpayments. You can file a request online at the SSA website, at your local SSA office, or by calling 1-800-772-1213.

Hearing from an Administrative Law Judge

The second level of the Appeals process is reached if you disagree with the outcome and determination of the appeal reconsideration.

In this step, a hearing is held by an Administrative Law Judge (ALJ) who had no part in the original determination or the reconsideration of your case. This hearing is usually within 75 miles of your home address. You can also request a hearing online after receiving your reconsideration determination.

At this stage, the Administrative Law Judge may approve you for benefits, even if you previously applied and were denied more than once.

ProTip: It’s important to know that while you wait for an appeal hearing with the ALJ, you can re-apply for benefits if something changes with your disability. If your condition worsens and you meet the SSA Blue Book listing for your disability, you can submit a new application.

Review from Appeals Council

If the ALJ also denies your application for benefits, you may advance to the third level of the appeals process having your case reviewed by an Appeals Council.

The Appeals Council takes time to investigate all requests for review, but the council may deny your request if they find that the determination from the Administrative Law Judge was in accordance with SSA law and regulations.

If your case is accepted for review under the Appeals Council, they will either (a) review and make a determination or (b) return your case to a different Administrative Law Judge who previously did not view your claim.

Federal Court Review

If you disagree with the Appeals Council’s decision — or they decide not to review your case — you have the option to file a civil lawsuit in a federal district court. You have 60 days to file the civil action from the time you receive notice of the Council’s decision.

This is the highest and final level of the appeals proceedings, and it is not currently possible to complete this level of the Appeals process online. Also, the fee to file a complaint is $400.

However, it is possible to petition to have this fee “waived,” which would allow your case to continue without paying the fee.

Find Assistance With Social Security Disability Appeals

Filing for benefits once can be stressful, and when you’re attempting to re-apply or appeal, it can be a very daunting process.

Our team of qualified representatives have years of experience helping people like you obtain Social Security Disability benefits. We know how to maneuver through the appeals process and set you on the right path to receiving benefits. Contact our knowledgeable team at the number above to discuss the specifics of your case. You do not have to do this alone going through the Social Security Disability appeal process!