If Social Security turns down your initial application for Social Security Disability Insurance (SSDI) — as it does in a majority of cases — you have the right to appeal that decision at multiple levels. The same is true of claims for Supplemental Security Income (SSI), the other Social Security–run program that pays benefits to people with disabilities.
First, you can ask Social Security to have a different examiner and medical team reconsider your claim. If they also say no, your next step is to file for a hearing before an administrative law judge, in a special system that Social Security operates for this purpose. About a quarter of applicants who are ultimately awarded SSDI benefits get them only after such a hearing.
Disability hearings are judicial proceedings, but they are very different from a court trial. Rather than courtrooms, they are typically held in offices and special hearing centers the Social Security Administration (SSA) maintains across the country. (With these facilities closed during the COVID-19 pandemic, SSA is offering hearings via online video or telephone.) They generally last from 15 minutes to an hour, but they can run longer, especially if there are witnesses.
While disability hearings are less formal than trials, most claimants bring someone to represent them, according to SSA data — usually a lawyer, though a social worker, professional disability representative or even a relative can play that role. It's your choice, but a study by the federal Government Accountability Office (GAO) found that people who have a representative are nearly three times more likely to be successful.
Before the hearing, the judge will review your file, including any additional evidence you've submitted to support your claim, such as medical examinations conducted since the initial application. At the hearing, you can give sworn testimony, and the judge may ask you questions about your past work and current limitations.
You also can present expert witnesses, such as physicians, psychologists or other medical professionals, to make the case that you meet Social Security's definition of disability (that your condition will prevent you from working for at least a year or end in death). The GAO found that you're one-and-a-half times more likely to win if you present testimony from a medical expert. Social Security may present its own medical experts, or a vocational expert who can testify about the skill level and mental and physical demands of your occupation.
If the hearing judge rules against you, you can request a review by the Appeals Council, a panel of administrative appeals judges. The council can deny, modify or uphold the original judge's decision or ask him or her to hold another hearing. If you do not succeed here, or if the Appeals Council declines to review your case, the last option is to take the case to federal court.
Keep in mind
- You have 60 days from the rejection of a disability claim to request a reconsideration. The deadline is the same to request a hearing and an Appeals Council review.
- Disability attorneys generally work on a contingency basis, meaning they only get paid if you win. If so, they receive a portion of any back payments Social Security owes for benefits you would have received had your claim been approved in the first place. The fee agreement must be approved by the SSA and can be up to 25 percent of the back pay or $6,000, whichever is less.
- If you're unable to attend a scheduled in-person hearing due to illness or some other problem, you must notify the hearing office in writing as least five days beforehand and explain the reason.
Published April 1, 2021