If your initial claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) is denied, you have multiple opportunities to challenge that decision. And while pursuing an appeal can take months, even years, you do have some chance of succeeding. Among workers who were awarded SSDI benefits from 2009 through 2018, nearly a third were applicants who appealed after first being turned down, according to Social Security's most recent annual report on the program.
There are four stages in the appeal process.
Medical eligibility for disability benefits is reviewed by state-level Social Security agencies called Disability Determination Services (DDS). If they reject your claim, your first recourse is to ask the Social Security Administration (SSA) to reconsider. You can file for reconsideration online, or by filling out forms SSA-561, SSA-3441 and SSA-827 and sending them to your local Social Security office.
In a reconsideration, an examiner and medical team from your state DDS who were not involved in the initial review take a fresh look at your claim. You can provide additional evidence, such as records of more recent medical examinations or treatment, and point out evidence DDS may have missed the first time around. The examiners may request additional information themselves.
The average time for a reconsideration decision in 2018 was 103 days, according to the most recent SSA data. About 1 in 10 reconsideration requests yield benefit approvals.
2. Hearing before an administrative law judge
If DDS won't change its mind, you can request a hearing with an administrative law judge (ALJ), who will review the evidence in your case and also listen to your testimony and that of expert witnesses. To request a hearing, use the online appeal system or complete and send in a form HA-501.
Be prepared for it to take a while to get a date: In March 2021, wait times in the country's 168 regional Social Security hearing offices ranged from 5 to 16.5 months.
Disability hearings generally last less than an hour but can run longer if there are multiple witnesses. Afterward, it can take anywhere from several weeks to several months to get a decision. ALJs rule in the applicant's favor about half the time, but the approval rate has steadily declined over the past two decades, according to Social Security data.
3. Appeals Council
If an administrative law judge rules against you, the next step is to ask for a review by SSA's Appeals Council. You can file online for an Appeals Council review or submit form HA-520 to Social Security.
A panel of Appeals Council members will look over the judge's findings and the evidence, as well as any new information you want to add. The panel has three members if the claimant chooses to present an oral argument and two if the council is only reviewing the case record. (If those two disagree, a third member is brought in to break the tie.) The council can uphold, modify or reverse the ALJ's ruling, or order the judge to hold a new hearing and issue another decision.
In 2016, the most recent year for which data is available, it took about a year on average from the time the council received an appeal for it to issue a decision.
4. Federal courts
The federal bench is your last resort. If the Appeals Council turns you down, you can file suit in U.S. District Court. An unfavorable ruling there can be challenged at the U.S. Circuit Court of Appeals. The letter Social Security sends you about an Appeals Council ruling will include information on how to take your case to court.
While there aren't separate statistics for disability cases, in 2020 federal appeals court cases of all sorts took slightly more than nine months to be decided.
You'll find more detailed information about the process at the SSA's Hearings and Appeals site.
Keep in mind
- At each stage of the process, you generally have 60 days from the date of an adverse decision to request an appeal to the next level.
- You can use your online My Social Security account to check on the status of a pending disability application or appeal and to obtain electronic copies of the case documents.
- Social Security hearing offices are closed during the COVID-19 pandemic. The SSA is offering hearings by phone or online video.
Published April 27, 2021