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When You and Social Security Disagree

How to exercise your right to appeal an agency decision

social security appeals


The people who distribute the benefits and the people who get them don't always see eye to eye.

En españolQ. I've got a problem. Social Security is paying me less than what I deserve. The person I reached on the toll-free line says the amount is correct, but I'm not convinced. How can I challenge this decision?

A. Last year, about 60 million Americans got about $870 billion in retirement, disability or other benefits. It's no surprise that the people who distribute the benefits and the people who get them don't always see eye to eye.

For those situations, Social Security has an appeals process. It can take time and, perhaps, money, but the agency makes a public commitment to handle disputes fairly and pledges, "If our decision was wrong, we will change it."

Q. So how does it work?

A. Basically, there are four levels of appeal:

  •  Reconsideration

  • A hearing in front of an administrative law judge

  • A review by the Social Security's Appeals Council

  • Federal court appeal and review

Q. So I would start with reconsideration?

A. Yes. It consists of a complete review of your case by one or more representatives at Social Security who did not take part in the first decision. The reviewers will look at the evidence that the agency had when the original decision was made, as well as at any new evidence.

You may have the opportunity to provide some of that new evidence. For instance, if you're appealing a decision that you're no longer eligible for disability benefits because your condition has improved, you can meet with a Social Security representative and explain why you believe you still have a disability.

Ideally for you, this level of review will result in a decision that Social Security erred and it will change its original ruling. But if the reconsideration process goes against you, you'll get a letter explaining that and laying out your rights and procedures for going to the next level (a review by an administrative law judge), should you decide to do that.

Q. And what usually happens at these reviews?

A. At this level you're in something resembling a courtroom proceeding. Social Security tries to convene it within 75 miles of where you live, but sometimes the hearings are conducted by videoconference. As with reconsideration, the judge will not have been part of the original decision that you're appealing.

The judge will make an expanded examination of the facts involved in a case. You'll have a right to bring witnesses. The judge may question them and you. Likewise, the judge may call witnesses, such as medical or vocational experts, who can help clarify the issues.

If the judge rules against you, you can appeal to Social Security's three-member Appeals Council, the last level of review within the Social Security system. The council may decline to hear your case, it may make a decision on it, or it may send your case back to an administrative law judge.

Q. And if I lose again?

A. Now you move outside of the Social Security system, to file a lawsuit in federal court. If you lose again, you've exhausted your rights to appeal.

Each level of appeal has its own rules, which are too complex to explain here. But you can get more details by reading a pamphlet called "The Appeals Process."

Q. How much time do I have to file an appeal?

A. Sixty days, starting on the date you received the Social Security decision that you're disputing.

Q. What happens if I miss the deadline for an appeal?

A. Tell Social Security why you were late. If the agency finds that you have a good reason, such as the forms it sent you did not arrive on time, you may still be able to appeal.

Q. Do I have to represent myself?

A. You can, but you don't have to. You have the right to choose a lawyer, a friend or someone else to advise you on how to organize your case and testimony. Social Security pledges to cooperate with those guest advisers. But your representative cannot charge you or collect a fee from you without first getting written approval from Social Security.

To learn more, read "Your Right to Representation."

Q. How do I get the ball rolling on an appeal?

A. You can call Social Security and ask for an appeals form, or simply write a note with your Social Security number, asking for an appeal. If it's a disability decision that you're contesting, you can file the appeal online at this webpage.

Q. What kinds of cases are typically heard?

A. Many are disability cases. Other disputes involve the dollar amount being paid to individuals. All in all, there are quite a few cases. One of the delay factors in getting appeal decisions is the heavy workload that administrative law judges face.

As you can see, you'll want to give real consideration before embarking on an extended appeal — it's not a pleasant process. You'd do well to first see if you can arrive at some other solution.

For instance, many disputes over benefit levels turn on errors in your work record — Social Security's year-by-year tally of how much you earned over the course of your working life. These numbers help determine the size of your benefit. You can check your work record in a paper statement mailed to you or by signing up for a My Social Security account.

If you find errors (missing earnings, perhaps), you may be able to correct them. You'll need proof of the money, such as a W-2 form or a tax return. An earnings record can be corrected at any time up to three years, three months and 15 days after the year in which the wages were paid or the self-employment income was derived, though there are certain circumstances when a correction can be made later.

Stan Hinden, a former columnist for the Washington Post, wrote How to Retire Happy: The 12 Most Important Decisions You Must Make Before You Retire. Have a question? Check out the Social Security Mailbox archive.

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