If you are unable to work due to a medical or mental health condition, you may be entitled to disability benefits from the Social Security Administration (SSA). There are two main types of disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Depending on your situation, you may qualify for one or both types of disability benefits.
Unfortunately, many initial applications for disability benefits are denied by the SSA. There are a number of reasons why a claim for disability compensation may be denied, from failure to submit sufficient medical evidence to not completing the necessary forms. Whatever the underlying reason may be, if your application for SSDI and/or SSI is denied, you have the right to file an appeal.
A Social Security disability appeal lawyer can help you with the process, even if you did not retain an attorney for your initial application. With the assistance of legal counsel, you can put together a strong case to convince the SSA that you are eligible for disability benefits. To learn more or to schedule a free claim review, call the experienced disability attorneys of Bross & Frankel.
What to Know About Social Security Disability Appeals:
- How to Appeal
- What if my condition has gotten worse?
- Administrative Law Judge
- How Long Do I Have to File an Appeal?
- How to pay to hire someone to help with social security benefits appeal?
- Should you hire a local lawyer for SSD appeals?
The Basics: How to Appeal a Social Security Denial
Most appeals in Social Security cases must be filed within 65 days of the date on the denial letter. The SSA technically allows 60 days to appeal from the date that you receive the letter; 5 days are added based on the assumption that it takes this much time for a letter to reach you. You never want to wait until the last day to file your appeal, but 65 days is usually the absolute deadline.
There are four levels of appeal:
- Hearing by an administrative law judge (ALJ)
- Review by the SSA Appeals Council
- Federal Court review (lawsuit)
If your initial application for disability benefits has been denied, then your next step is to request “Reconsideration” of your claim. When you request Reconsideration, you are asking for Social Security to take another look at its decision. As part of this process, you will need to provide any new information that you have that might change the government’s decision.
A request for reconsideration can be filed online. Alternatively, you can print out Request for Reconsideration and Disability Report-Appeal forms to fill out by hand. You can then take or mail the completed forms to your local Social Security field office or the office that issued the denial letter. However you decide to complete your forms, this may be a good time to consider talking to a Social Security disability appeal attorney to review your options before going further.
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What If My Condition Has Gotten Worse?
If your condition has worsened, you should tell Social Security about any changes when you file the appeal. However, you should be careful about doing this, as Social Security may use any information about worsening to consider a later onset date. If your claim is eventually approved, this may reduce the amount of your award.
Ordinarily, you are appealing because you don’t agree with Social Security’s decision from the date that you filed, not because some new condition has intervened to make you “truly” disabled. Use caution when informing the SSA about any new or worsening condition.
Make sure you make copies of everything you submit to Social Security. Be sure to follow up to make sure your documents and appeal were received before the deadline to appeal has passed. These are all steps an attorney can take for you, including confirming that your appeal was received on time, and is well supported by medical evidence.
Statistically, most claims are denied at the reconsideration level. As of 2017 (the most recent published data) the percentage of claims awarded at the Reconsideration level ranges from 7.1 to 11.3%. The likelihood of having your claim approved at this level may be improved if you work with an experienced Social Security disability appeal attorney.
The ALJ Hearing
Because the approval rate at the Reconsideration level is so low, most people whose initial applications are denied will need to request a hearing with an Administrative Law Judge (ALJ). Like the deadline to request Reconsideration, a Request for a Hearing must be filed within 65 days of the date of denial.
If your case has been denied initially and on Reconsideration, you should seriously consider discussing your case with a skilled disability law firm. No matter how disabled you believe you are, or how confident you are that if you just get your day in court, you’ll win your case, working with a lawyer on an appeal makes sense. In fact, fees are so low in Social Security cases that you should stop what you’re doing and research how little it will cost you to get help on your claim before you take another step.
Once you’ve decided to file a Request for Hearing, be prepared to wait. Throughout the country, the backlog to get in front of a judge ranges anywhere from one year to almost three years in some parts of the country. You can file a request online, or by downloading the form and mailing or taking it to the SSA office.
In an effort to deal with this impossible wait time, Social Security has started using so-called “national hearing centers” and offering people the option of participating in a hearing by video. While the promise of a faster hearing is attractive, it may not always be the best choice.
The benefits of sitting down in person for the first time with the judge making the decision on your claim are very significant and should be considered before choosing an alternative hearing. A video hearing does not allow a judge to be in the room with you, to look in your eyes, or judge your demeanor and credibility. In many cases, these virtual hearings are presided over by a judge that isn’t part of your community, who doesn’t live where you live or understand your situation – which may lead them to be detached and unsympathetic.
This is your day in court. You’ve probably waited a long time for it, why give it up just to make life easier for the government?
How Long Do I Have to File an Appeal?
There are strict time limits for filing an appeal if your Social Security disability benefits application is denied. There are four levels of appeal with the Social Security Administration (SSA): (1) reconsideration; (2) administrative law judge hearing; (3) appeals council review; and (4) federal court. At each level of the process, you have 65 days from the date on the denial letter to file an appeal or request for reconsideration.
After you receive an initial determination on eligibility, you have 65 days from the date on the letter to file a request for reconsideration. If you receive an unfavorable decision at this stage, then you will have an additional 65 days from the date of that notice to request a hearing before an administrative law judge (ALJ). The ALJ will make a decision in your case, and the SSA will send you a letter notifying you of the decision.
You will then have 65 days to ask for a review by the SSA Appeals Council. The Appeals Council may deny your request for review, send your case back to the ALJ, or make a decision. Whatever action they take, the SSA will send you a letter and a copy of the order.
If the decision was unfavorable, you can file a lawsuit against the SSA in federal court. As with the other levels of review, you have 65 days from the date of the notice to file a complaint in court.
I Can’t Afford to Pay a Lawyer Out of Pocket. Can I Still Hire Someone to Help with My Social Security Benefits Appeal?
Lawyers who represent people in the Social Security appeals process are subject to strict regulations on how much they can charge. Generally, you will sign a contingency fee agreement with your attorney. With a contingency fee, you don’t pay any money up front; instead, you’ll pay a percentage of the back benefits that you may be awarded.
The SSA must review and approve all fee agreements, which include a provision that gives the SSA permission to pay your attorney’s fees out of a back benefits award. There is a cap on legal fees for Social Security disability benefits. In most cases, the limit on fees is 25% of a back benefits award, but not more than $6,000.
You will not receive a bill from your lawyer. Instead, the law firm will file for legal fees with the SSA. After the SSA reviews and approves the fee agreement, it will pay the attorney out of any back benefits that you are awarded.
If you are not awarded past-due benefits, your lawyer will not be entitled to a fee. In this way, these types of fee agreements align with the interests of clients and attorneys. At the same time, a contingency fee arrangement means that there is little risk to you if you choose to hire a Social Security disability appeal lawyer.
Do I Need a Local Lawyer for a Social Security Disability Appeal?
Each claim for Social Security disability benefits is unique. Many people are able to file for — and be approved for — benefits without the help of a lawyer. However, if your case is more complicated or if your disability is not listed in the SSA’s listing of impairments, an attorney can increase the likelihood of having your application approved.
If your initial application is denied, it is critical to work with a lawyer through the appeals process. There are a number of different steps in Social Security appeals, each of which requires you to comply with complicated rules. An attorney can make sure that you put together the best possible arguments — and the required evidence — at each level of the appeals process.
This includes advocating for you before an Administrative Law Judge (ALJ) during a Social Security disability hearing. The hearing represents the greatest chance of overturning the SSA’s decision to deny your claim. A lawyer can consult with experts, prepare you to testify, put together supporting documentation, and present a strong case to the ALJ.
While you are not required to have a lawyer at any stage of the appeals process, it is often beneficial to work with an attorney. SSA rules and regulations are complex and can be hard to understand at the best of times. If you are struggling with a disability, being represented by counsel can allow you to focus on what is truly important: your health and well-being.
Appeals beyond the ALJ Hearing
If the Administrative Law Judge denies your claim and you receive an Unfavorable Decision, you still have one appeal left with the government. At this stage, you can file a Request for Review with the Appeals Council. The form to request a review can be filed online or mailed to your local SSA office.
This is often the appeal of last resort, and the numbers are not great. The Appeals Council almost always “declines review. This means they find nothing in the decision of the ALJ to warrant sending the case back or awarding benefits. Cases at the Appeals Council are usually decided strictly by briefs, usually written by appeals lawyers who understand the specific legal errors ALJs may make. If the Appeals Council grants review, the result is usually to send the case back to the judge for another hearing, rather than an award of benefits.
Finally, if you have struck out at the initial application, reconsideration, ALJ hearing, and Appeals Council levels, you have the option to file a lawsuit in Federal Court. When you do this, you are essentially suing the government to try to get your benefits granted.
This is an incredibly hard process. In fact, there are very few Social Security attorneys who even practice in the federal courts. There are even fewer who will take on a case that they did not handle at the hearing level because the attorney is unable to submit new evidence to the court, and cannot reargue the case.
Instead, they are limited to finding legal errors that support the conclusion that the ALJ’s decision was not “supported by substantial evidence.” This legal standard means that even if a court would decide the case differently, as long as there is some reasonable support for the decision, the ALJ’s Unfavorable Decision will stand. Because of these limitations on federal lawsuits, it is always to get a lawyer sooner rather than a lawyer in the appeals process.
Can I Afford a Social Security Disability Appeal Attorney?
Hiring a Social Security attorney is more affordable than almost any other area of law. Social Security disability lawyers only earn a fee if they are successful in winning your case. The fee must be approved by Social Security. In most cases, the fee is capped so that it may range from 10 to 25% of your award of back benefits, depending on the size of your award.
Some people aren’t interested in hiring a lawyer or prefer to handle their case on their own. Our law office has prepared this guide to give you some information on what to expect when you appeal your denial of SSDI and/or SSI benefits.
Related: If you don’t know how long a Social Security Continuing Disability Review takes, you can check here.
Will My Disability Claim Be Denied?
Fewer than one out of three people applying for Social Security disability benefits will be approved based on their initial application. Sometimes this can be tied to how disabled you are or how much medical evidence you have to support your claim. Unfortunately, just as often, it depends on who actually looks at your claim, and what the other claims they looked at that day looked like.
The bottom line is that most people who are going to win their disability claims are going to have to appeal. Your odds of winning increase each time you take the time to file an appeal and follow Social Security’s specific procedures for doing so. The second level of appeal – a hearing before an Administrative Law Judge – is your best chance at winning your claim.
If you have been denied SSDI or SSI benefits, you should learn how to appeal. If you give up or file a new claim, there is a strong possibility that your applications will continue to be denied. It is always a good idea to consult with a skilled Social Security disability appeal lawyer before proceeding, especially because these claim reviews are typically offered free of charge. Below, we outline the basics of what you need to know about the process.
Disability Claim Denied? We Can Help.
Being approved for SSDI and/or SSI benefits isn’t easy – even when you have a well-established disability that prevents you from working. Paperwork errors or even a lack of medical documentation can lead to a denial of your application. While there are several levels of appeal, it can be difficult to appeal your case on your own.
Bross & Frankel represents individuals in all aspects of Social Security disability claims, from initial applications to final appeals. Our legal team has handled thousands of Social Security disability cases and has the knowledge and skill to help you achieve the best possible outcome. To learn more or to schedule a no-obligation claim review, fill out our online contact form or call our law office at (866) 708-3503.