Decoding the SSDI and SSI Appeals Process: A Comprehensive Guide
Securing Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) can be a complex but crucial journey.
We highly encourage people to appeal rather than reapply as they would get more back pay if their benefits are approved. Back pay is the money the government owes you that you have yet to receive based on your application date. Furthermore, reapplying only sets people back into the application process, which can take months.
Therefore, let us lead you on the SSDI and SSI appeals process together, empowering you with insights and clarity every step of the way.
The Four Levels of Social Security Appeal
When an application goes through the initial determination, it can get rejected. However, should an individual disagree with the decision made by the SSA, there exists a structured avenue for appeal, progressing through these sequential stages:
Reconsideration
This initial level allows applicants to request a case review by a different SSA representative.
Hearing by an Administrative Law Judge
If dissatisfaction persists post-reconsideration, applicants can pursue a hearing before an Administrative Law Judge (ALJ), presenting their case formally.
Appeals Council Review
Should disagreement persist even after the ALJ hearing, individuals can seek review by the Social Security Administration’s Appeals Council.
Federal Court
As the final stage of appeal, seeking resolution through a federal court is possible if dissatisfaction remains after the Appeals Council review.
What Happens First: Initial Determination
During the initial determination, SSA agents review applications for benefits, the amount of SSI/SSDI payment, and other issues.
After reviewing the application, SSA will send the applicant a written notice. If the application is denied, a reconsideration can be appealed within 60 days of the notice’s date.
Will My SSI or SSDI Benefits Continue with the Same Amount After I Make an Appeal?
Yes, if the conditions are met:
For Non-Medical Issues | For Medical Disability Cessation Issues | ||
|---|---|---|---|
If you file for reconsideration within 10 days of receiving the notice: | If you file for reconsideration within 11-60 days of receiving the notice: | If you decide to receive payments no longer: | For individuals appealing the SSA decision to cut off their benefits: |
Any payment will continue until reconsideration is made if the person continues to meet eligibility requirements. | Payment is temporarily decreased but will restart upon finishing reconsideration. | Fill out the form SSA-263 (Waiver of Supplemental Security Income Payment Continuation). | Individuals must complete a written request to continue their benefits within 10 days of receiving their notice. |
Level 1: If You Disagree with the Initial Determination, File for Reconsideration
To reiterate, a person must file for reconsideration within 60 days of receiving their written notice from the initial determination. SSA will assume that individuals receive their notice within 5 days of the notice date (unless there is proof otherwise).
People can file through the following options depending on the nature of their appeal:
For Disability and Non-Medical Issues | For Medical Disability Cessation Issues | |
|---|---|---|
Online | Fax or Mail | Fax or Mail |
Go to SSA’s Request Reconsideration Page. | Download, fill out, and print the form Request for Reconsideration (SSA-561-U2) and send it to your local Social Security office. | Download, fill out, and print the form SSA-789 (Request for Reconsideration Disability Cessation) and send it to your local Social Security office. |
How will I Receive the Notice of my Reconsideration Appeal?
The reconsideration notice will be sent to the appellant and legal representative (if they have one). But they can also check the status of their appeal through their Social Security account.
Level 2: If You Disagree with the Reconsideration, File for a Hearing
If the SSA agent who took on the reconsideration decides to continue the initial decision, the appellant can disagree and file for a hearing before a judge. They must file for a hearing within 60 days of receiving their reconsideration notice. Social Security assumes that individuals receive their notice within 5 days of the date of the notice (unless there is proof otherwise).
Here are the options to apply for a hearing:
Will My SSI or SSDI Benefits Continue If I Will Appeal a Hearing for My Benefits Being Cut Off?
Yes, but only if the individual can write a request within 10 days of the cessation notice.
Your Attendance of the Hearing
The appellant can choose whether to appear before a judge in the hearing.
You Choose NOT to Appear Before a Judge | You Choose to Appear Before a Judge |
|---|---|
The appellant or their representative can write a written request that the court decision be based on file evidence. | The appellant can appear in person, via video, or telephone. A notice on the hearing’s date, location, and issues to be addressed will be sent within 75 days before the hearing. |
What to Expect During an SSA Hearing
The following will be addressed:
- The appellant’s medical condition(s) is based on case file evidence, subpoena documents, and witnesses.
- Medical or vocational experts’ testimonials.
- For non-medical cases: reasons behind the request.
How will I Receive the Hearing Decision?
The hearing office mails a copy of the decision to the appellant and their representative if they have one. The appellant can also request a copy of the audio recording of the hearing.
Level 3: If You Disagree with the Hearing, File for an Appeals Council Review
If the appellant disagrees with the judge’s decision at the hearing, they can request the SSA for an Appeals Council (AC) review. They must do so within 60 days after reaching the hearing decision. As always, SSA expects the appellant to receive the decision within 5 days of the hearing decision date. However, the Appeals Council may decide to review your case on its own within 60 days of the hearing decision.
Appellants can apply through the following options:
What to Expect in an Appeals Council Review
Here are the scenarios of what would happen during the review:
If AC Decides a Less Than Favorable Outcome | If AC Decides a Favorable Outcome |
|---|---|
AC will send a notice of its proposed action and allow the appellant and their representative a chance to respond before officiating the decision. | AC will send a notice of any of the proposed actions: 1) Issue a favorable outcome, 2) Return the case to the judge with instructions on further proceedings to be done or 3) Issue a favorable outcome and return the case to the judge for the remaining issues. |
How will I Receive the Appeals Council Review Decision?
After the Appeals Council takes action, they will mail the appellant and their representative a copy of the action and its reasons.
Level 4: If You Disagree with the Appeals Council Review, File for a Civil Action
If the appellant disagrees with the decision of the Appeals Council, they can file a civil action with their US District Court within 60 days of receiving the action notice. SSA expects that the appellant receives the notice at least 5 days after the notice date.
Here are the actions the District Court may take for the final Agency decision:
Outcome 1 | Outcome 2 | Outcome 3 |
|---|---|---|
The District Court directs SSA to award benefits. | The District Court directs SSA to dismiss the case. | The District Court sends the case back to the SSA, and a judge will hold a hearing to issue a new decision. |
Improve Your Chances of Winning Your Appeal
The United States Government Accounting Office (GAO) reports that disability applicants who hire an attorney have a three times higher chance of getting their disability benefits approved.
A disability lawyer has in-depth knowledge of Social Security disability law to help you decide which action is best. They can also do all the proper paperwork and evidence for you and submit them before deadlines. They also have access to medical examiners to help strengthen your case for financial assistance.
A disability lawyer only gets paid if the SSA approves your claim upon winning your case. Their payment would be a 25% contingency fee of your first back pay. To help you further decide if you will need a disability lawyer for your case, why not request a free consultation? Contact us today to know the best action for your unique case.