If you are unable to work due to a disability, you may qualify for disability benefits through one or two programs offered by the Social Security Administration (SSA). If you qualify as disabled and have paid into the Social Security system by working, you can apply for Social Security Disability Insurance (SSDI) benefits. If you are disabled and also have limited income and assets, you may also qualify for Supplemental Security Income or SSI.
The process of applying for Social Security Disability can be complicated and incredibly frustrating. The majority of initial applications for SSDI benefits are denied by the SSA, with just 49.3% of all initial claims approved. Fortunately, you can file an appeal of a denial of SSDI, with four distinct levels of appeal available:
- Request for Reconsideration
- Administrative Law Judge (ALJ) Hearing
- Appeals Council
- Federal Court Review
There are specific deadlines and requirements for each step of the appeals process, which can make it challenging for the average person to figure out what to do. If you live in New York, a seasoned Albany Social Security disability benefits lawyer can work with you to successfully appeal a denial of benefits by the SSA. To learn more about appealing a denial of SSDI or SSI benefits, read on – or reach out to our office to schedule a free consultation.
Request for Reconsideration
There are two situations where you may request a reconsideration of your claim. First, if your first-time application is denied, you would file a request for reconsideration of the original claim. Second, if you were already receiving Social Security disability benefits and they were stopped for some reason, you would file a request for reconsideration of continuing benefits.
In either case, you must file your request for reconsideration within 60 days of receiving a letter from the social security office denying your benefits. Typically, you would do this at your local Social Security office, or you can file your request online through the SSA website. Whether you file online or through your local SSA office, an experienced Social Security disability lawyer can help you gather evidence and put together the appropriate paperwork for your appeal.
Your request for reconsideration will be reviewed by an SSA employee who was not involved in your initial denial. If your request is to restore suspended disability benefits, you will have to meet with a representative. In other cases, you may provide additional evidence, such as medical records, which will be reviewed along with the original application and supporting documentation.
After reviewing this evidence and/or any information learned during a meeting with an SSA representative, a decision on your request for reconsideration will be made. If you get a second rejection, the next step is to request a hearing with an administrative law judge (ALJ). As with a request for reconsideration, you must request an ALJ hearing within 60 days of receipt of the rejection letter. There is an assumption made that you would receive the rejection within five days of mailing.
Requesting an ALJ Hearing
One of the most important things you should know before you start this process is that you have the right to legal representation when you are appearing at an ALJ hearing. If your initial disability claim was rejected, and your first appeal step (reconsideration) is also denied, an attorney can help you through the next part of the process.
According to the Social Security Administration’s website, along with the formal request for a hearing (Form HA-501) you also need to file the following documents:
You may also need to complete a form SSA-1696, Appointment of Representative if you are appointing a representative to assist you with the case.
Once this paperwork has been filed, a hearing will be scheduled. Generally, these hearings will be held within 75 miles of your home. Under limited circumstances (such as traveling more than 75 miles), you may be entitled to be reimbursed for the expenses associated with the hearing. Because there is a significant backlog in these cases, the SSA may also offer you the opportunity to participate in a video conference in lieu of an in-person ALJ hearing. Your Albany Social Security disability lawyer can advise you on whether it makes sense to attend this type of hearing instead of going in person, where the ALJ will be able to hear from you directly.
At the hearing, the administrative law judge will hear testimony from you and from other witnesses, as well as arguments from your lawyer. The ALJ will then review your entire case file before rendering a decision. If you receive an unfavorable determination, then you can request a review from the Social Security Appeals Council.
Social Security Appeals Council
If an ALJ denies your appeal and you disagree with this decision, the next step is to request a review by the Social Security Appeals Council. Once the council reviews your case, one of two things may occur: (1) they can return it to the ALJ to review again; or (2) they could agree with the ALJ and uphold the denial of your disability claim.
If the case is referred back to the ALJ, you will be notified that another hearing may be scheduled. However, they agree with the ALJ, you will get a letter advising you the SSA Appeals Council has decided against you. If your claim is denied once again, your last possible appeal is done by filing a lawsuit in federal district court.
Federal Court for SSDI Appeals
The last option if you have exhausted all of your possible appeals is to file a lawsuit in the U.S. district court. Because this option can be costly and time-consuming, you should discuss this option with your Social Security appeals attorney before making the decision to go forward.
An important consideration in deciding whether to pursue a lawsuit is the type of appeal that you are filing. If you are appealing a suspension of benefits, you may have the option to continue to collect benefits throughout the appeals process. However, if you lose on appeal, you may have to repay all of the benefits that you collected during the appeals process, which can be very lengthy – particularly if you file a claim in federal district court.
What Percentage of Social Security Appeals are Approved?
According to data from the SSA, in 2017, 11.3% of all requests for reconsideration for SSDI benefits are approved. That same year, 56% of appeals at the ALJ hearing level or above were approved. These numbers demonstrate that while requests for reconsideration are rarely approved, appeals at higher levels have a much higher success rate.
High percentage denials of initial applications are for technical, rather than medical, reasons. For this reason, it can be incredibly helpful to work with a skilled Social Security disability lawyer from the start of your case. If your first-time application is denied, an attorney can help you navigate and win at the appellate level.
How Long Does a Social Security Disability Appeal Take?
The amount of time that it takes to resolve an SSD appeal depends on a number of factors, including what levels of appeal you seek. A request for reconsideration is usually decided in as little as 4 weeks, or as long as 12 weeks. If you file a request for an ALJ hearing, it can take much longer due to the hearing backlog. Based on where you live, you may need to wait anywhere from 1 to 3 years to get a hearing scheduled.
If your application for disability benefits has been denied, reach out to a seasoned Social Security disability attorney. Your lawyer can examine your case file and give you an estimate of how long it may take to appeal a denial.
What Happens After You Win an SSD Appeal?
If you win an SSD appeal at any level, then you will start to receive a monthly cash benefit from the SSA. The exact amount that you receive will be based on your work history and how much you have contributed through payroll taxes. In addition, you will typically receive a lump-sum back payment, starting from the time that you filed your application plus up to 12 months retroactive to this date based on your disability onset date.
After you are deemed eligible for SSDI, you will also receive Medicare benefits 2 years after your eligibility date. Your spouse and minor or disabled children may also be entitled to SSDI benefits for dependents. If you have questions about what benefits you may receive, contact an Albany Social Security disability lawyer today to schedule a free consultation.
How We Can Help
The process of applying for SSDI or SSI benefits can be daunting, particularly when you are already facing health issues and are unable to work. Whether you are just starting your application or have already received a denial, our law firm can help.
Paul Giannetti, Attorney at Law represents people with disabilities or who have suffered injuries in all types of matters, from personal injury and workers’ compensation to Social Security disability claims and appeals. In each case, we work hard to help our clients get the money that they are entitled to under the law. To learn more or to schedule a free case evaluation with an Albany Social Security disability attorney, give us a call at 518-243-8011 or fill out our online contact form.