If your initial claim for Social Security Disability Insurance (SSDI) is denied, you can challenge that decision. While appealing a social security decision can take months, even years, you have a chance of winning your appeal and obtaining benefits…especially if you get legal representation. Nearly a third of the claimants who received benefits between 2011 and 2020 received their benefits by filing an appeal.
THE FOUR STAGES OF the APPEAL process.
Reconsideration.
Medical eligibility for disability benefits is reviewed by state-level Social Security agencies called Disability Determination Services (DDS). If your claim is denied, your first option is to ask the Social Security Administration (SSA) to reconsider. At the reconsideration stage, a new examiner and new medical team from your state DDS take a fresh look at your claim. At this point you can provide additional evidence, including updated medical records or treatment plans. You can also point out evidence the DDS may have missed the first time. The examiners can and may request additional information from you.
According to the most recent SSA data available, the average time it takes to get a reconsideration decision is 147 days (about 5 months), and about 1 in 9 reconsideration appeals obtain a favorable decision for benefits.
Hearing before an administrative law judge (ALJ).
If the DDS won’t change its mind, you can request a hearing with an administrative law judge (ALJ). The ALJ will review the evidence in your case and listen to your testimony as well as the testimony of an expert witness. One important thing to note is that getting a hearing date may take a while. For June 2024, the state of Missouri’s average wait time was 7.5 months.
Disability hearings are generally less than an hour long but may be longer depending on whether there are multiple witnesses. After the hearing, it can take anywhere from several weeks to several months to get a decision. In 2022, the approval rate was around 50% at the hearing stage. Again, this number is shown to be higher when you obtain legal representation. (Insert 9.23 stats image).
Appeals Council.
If you are denied at the ALJ level, the next step is to request a review by SSA’s Appeals Council. At this step, a panel of Appeals Council members will review the evidence submitted, the judge’s findings, and any new information you want to add. If you or your attorney decides to present a verbal argument, the panel has three members. There are two members if the case is being reviewed without verbal argument. The council can rule in several ways: uphold, modify, or reverse the ALJ’s ruling. They can also order the judge to hold a new hearing and render another decision.
Federal courts.
The federal bench is the last resort. If the Appeals Council denies your appeal process, you can file suit in U.S. District Court. If an unfavorable ruling is issued at this level, it can be challenged at the U.S. Circuit Court of Appeals. Remember that at each stage of the process, you typically have 60 days from the date of an adverse decision to request an appeal to the next level.
NOW WHAT?
This is a lot of information that can very easily become confusing and overwhelming, not to mention the time involved in completing paperwork, writing a brief, scheduling appointments…the list goes on. Hopefully, this blog serves as educational, and if you choose to file a claim for disability benefits, you can get immediate approval. However, while that is ideal, it is not always the outcome.
If you apply for SSD benefits, allowing experts in this field to represent you is a great starting point. At Parmele Law Firm, our team of attorneys has over 135 years of combined SSD experience, including representing claims to the Appeals Council. Also, since opening our doors in 2001, we have helped 55,000+ individuals receive their SSD benefits. What a fantastic accomplishment—we feel this speaks volumes to our competency and experience. At PLF, your initial consultation is free of cost and can be scheduled by calling us at 866-889-2570.
Parmele Law Firm. Guiding you with integrity, competency, and experience.