APPEAL PROCESS FOR DENIED SOCIAL SECURITY DISABILITY CLAIMS

A little under 30 percent of applications for Social Security disability benefits are approved at the first level.  The others must file an appeal.

If you have a terminal illness, are in a nursing home or on life support, there's a good chance of being approved by filing an application.  If not, you could be approved anyway--but there is an excellent chance that you will be denied.  You may get a letter stating that you are "not disabled according to our rules."  You now enter the appeal phase of your claim.

The following refers to the appeal process in the state of Alabama.  Other states may use a different process. Note that these steps must be followed in order.  You can't skip a step along the way.

REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE

This is a request to appear before a special judge who hears disputes between claimants and the US Government, in this case, the Social Security Administration. It currently averages about 16 months of waiting to get a hearing scheduled. The hearing itself will last less than 1 hour and the judge will review all available evidence, including any new evidence submitted by the claimant or his representative.  The judge will ask a lot of questions and give the claimant's representative an opportunity to "present the case."  A vocational (jobs) expert will probably testify.  Your representative can question the vocational expert if needed.  A new decision will be issued on your claim within 90 days.  The new decision can be....
  • Fully Favorable
  • Partially Favorable, or
  • Unfavorable
REQUEST FOR REVIEW BY THE APPEALS COUNCIL

If the decision by the administrative law judge is not fully favorable, this decision may be appealed to the Appeals Council (AC), a group of administrative law judges headquartered in Falls Church, Virginia.  A different judge will be assigned to determine if the hearing was properly conducted and if the hearing judge properly considered all the evidence.  The AC will take one of three possible actions, listed according to their most frequent action:


1.  Take no action and let the denial stand (most common).

2.  Remand (send back) the case to the hearing judge for some action - probably a new hearing (in about 15 percent of cases).

 3.  Reversal - award the benefits directly (in only about 2 percent of cases).

LAWSUIT AGAINST SOCIAL SECURITY

If the Appeals Council takes no favorable action, the claimant may file a lawsuit against the Commissioner of Social Security.  This suit would be filed in the United States District Court for North Alabama.  The attorney filing this lawsuit will usually submit a detailed legal brief.  The federal judge hearing the appeal will sometimes schedule oral arguments (for the attorney only, not the claimant).  Oral arguments are sometimes done over the phone.  It takes over one year to get a case heard in this venue. If the judge agrees with the claimant, benefits will be awarded, including payment for all the time that has passed since the original disability onset date (back payments).

REVIEW BY FEDERAL APPEALS COURT

If the federal court takes no favorable action, then the claimant may request a review by the appropriate US Circuit Court(s) of Appeal.  It is generally agreed that by this time the odds of being approved are very low.  

At any time during the appeals process, the claimant may choose to stop the appeal and file a new claim (start over).  Filing a new claim, however, does not protect back pay and does not extend the "date last insured," the deadline for filing a new claim under the claimant's work record.  A new claim cannot be filed while the appeal process is underway. 

SUMMARY:  Unless you are very fortunate and get approved on the initial application (within 90 to 120 days), the appeal process is very slow:

HEARING - Wait an average of 16 months.
AC REVIEW - Wait an additional 12 to 16 months.
LAWSUIT - Wait an additional 12 months, plus, depending on how many appeals are filed. 




 



 

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