If you have recently received notification of denial from the U.S. Social Security Administration (SSA) for disability benefits, it is important to understand the process of appeal for Social Security Disability Insurance. Negotiating the steps can be complicated, but it is important to first understand the difference between Supplemental Security Income and Social Security Disability Insurance—two programs that are often confused.

What is the difference between Supplemental Security Income and Social Security Disability Insurance?

The SSA administers Supplemental Security Income benefits, but doesn’t fund them. The benefits are rather dispensed from the general U.S. Treasury and are federal welfare designed to monetarily assist an elderly population age 65 and above or recipients who are blind or otherwise disabled.

The program was part of Social Security Amendments of 1972 and went into effect in 1974 in an effort to create criterion uniformity for financial assistance across multiple states.

On the other hand, Social Security Disability Insurance is funded by the payroll taxes of U.S. citizens. It is administered by SSA and helps to give those unable to work through documented physical disability a monetary safety net. It can be provided on a short-term or long-term basis depending upon the determination of the nature of the disability in question.

What is the first step in filing an appeal for Social Security Disability Insurance?

If you receive a denial notification for your social security disability claim, not all hope is lost. According to the SSA website, the first step in an appeal for Social Security Disability Insurance is known as reconsideration. Reconsideration involves a complete review of your file by another individual that was not a part of the first determination cycle.

Requesting reconsideration can be done through the SSA site, by phone, or in person, but it is first necessary to study the denial letter provided and determine if the reasons stated were medical in nature or non-medical.

A number of additional documents may be helpful to submit with your appeal, including:

• A letter from your physician
• Any previously missing key documentation
• Documented visits to physicians and medical facilities, treatments, tests, and medications

Medical reasons for being denied Social Security Disability Benefits may include an assessment by SSA that your disability does not qualify for coverage. In this instance, it may be helpful to provide further evidence that your disability is serious enough to require the distribution of benefits. Having your physician write a letter detailing the extent of your disability may be useful for patients who have been denied benefits for medical reasons.

Applicants who have been denied for non-medical reasons may have been denied due to several factors. Many applicants who were initially denied Social Security disability benefits are missing key pieces of documentation to support their case. People who appeal for social security disability may want to ensure that all of the documentation necessary to support their claims is submitted with their appeal, including relevant medical records and test results.

SSA recommends that preparation in advance of filing a medical reason appeal can make the process less daunting. Since just providing the same documentation as the initial application is not likely to produce different results, the federal agency recommends creating lists and gathering documentation.

Any visits to physicians and medical facilities since the previous effort should be added to the list. Any treatments, tests, or new medications should also be added. Documents that support any changes in diagnoses or ability to occupationally function should be collected.

Some applicants may be denied due to covert surveillance indicating that they are not as disabled as they claim to be. Although SSA claims to rarely conduct this kind of surveillance on applicants, other disability insurance companies routinely use covert surveillance to check up on people’s claims.

In 2019, the Trump administration proposed that SSA use social media surveillance to assess the eligibility of people who receive disability funding. While it is unknown whether SSA is doing so, people who are appealing their disability benefits denial may want to be careful to follow their doctor’s instructions regarding their restrictions.

Even for people who have disability conditions that result in “good days” and “bad days,” following their doctor’s instructions every day may aid them in pursuing disability benefits.

Filing an appeal and ensuring you have all the right documentation to best support your claim can be complicated, so you may want to consult an attorney experienced with Social Security disability claims for help with the process.

What are subsequent steps involved in filing an appeal if my reconsideration is denied?

The next step in the appeals process is requesting a review by an administrative law judge. Again, this judge will not have had a hand in any part of the original application and denial or reconsideration and denial. They look at the case with “fresh eyes.” The appealing individual will have to again assess whether the denial was on the basis of medical or non-medical reasoning.

The last two steps are requesting a review by the Appeals Council and then, if that fails, requesting a federal court review. The Appeals Council will likely deny this level of appeal, if the administrative law judge has provided adequate reasoning and support for the hearing decision based upon the body of regulation governing the SSA.

How long does an appeal take?

An appeal for social security disability can take anywhere from months to years, depending on how far a person needs to take their claim through the process.

Claimants who are facing the first denial of their social security disability application have 60 days to file an appeal. Reconsideration can be done remotely; a new disability examiner reviews the applications, along with any new information. Reconsideration should take place within 30 days; however, only 11 to 15 percent of disability claims are approved during reconsideration.

If the claim is denied upon reconsideration, the next step is a hearing with an administrative law judge. The Social Security Administration says that these hearings are usually held within 75 miles of the claimant’s home. Generally, they require the presence of the claimant, along with witnesses. However, there is reportedly a backlog of these hearings, so it can take years before it is scheduled. Once the hearing is held, claimants should receive a decision within 90 days.

The final appeals processes, review by the Appeals Council and federal court review, can take a significant amount of time.

Will benefits continue during the appeals process?

According to the Social Security Administration, benefits will not continue during the appeals process, unless the claimant requests continuation and the claim meets certain criteria. The agency may continue to pay disability benefits when the claimant is appealing a decision that their condition is not disabling or they are appealing a decision that they are no longer eligible for SSI payments.

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This article is not legal advice. It is presented
for informational purposes only.