What Are the Different Stages in the Disability Appeals Process?

According to the Social Security Administration (SSA), 63 percent of initial applications for Social Security Disability Benefits are denied. If your disability application has been denied you should request an appeal in writing within 60 days.

The chances of winning a social security appeal will depend on the reason your disability application was denied in the first place.

Applicants are often denied simply because they failed to provide the SSA with sufficient information which would support a favorable decision. To increase your chance of winning the appeal, you should ensure that the SSA has a complete medical history from the day you became sick.

The Appeals Process

The SSA Social has 4 appeal levels as described below:

Stage One: Reconsideration

Social Security will review your denied disability application. A person is appointed who did not play any role in your denial. A complete review of your claim will be made where Social Security evaluated the evidence submitted in the initial claim plus any new evidence you have provided to support your claim.

You may be asked to attend more medical examinations before a decision is made. If the reconsideration is approved you will informed by Social Security and your disability payments will begin. The chance of approval at the Reconsideration stage is only 13 percent. If your claim is denied again you may request an Administrative Law Judge hearing.

Stage Two: Hearing by an Administrative Law Judge

This hearing is conducted by a judge who hasn’t played a role in making any decisions so far for that case. Before the hearing takes place, the Administrative Law Judge (ALJ) will review the evidence from the initial application and the reconsideration.

If any new evidence is provided this is considered as well. The ALJ may draw upon Medical Experts (ME), who are physicians who review all the medical records before the hearing takes place. The ALJ will ask the ME questions at the hearing about your medical condition.

Vocational Experts (VE) also review all the information in your disability benefits claim and provide their opinion on your ability to do any previous work you have done or other types of work.

The ALJ may also ask you questions about your medical conditions and work history. You can bring personal witnesses to the hearing who can vouch for your medical condition. They may be asked questions by the ALJ.

Stage Three: SSA Appeals Council

If the ALJ’s ruling is unfavorable you are entitled to request a review by the SSA Appeals Council. The Appeals Council will review the decisions made by the ALJ. If the Appeals Council agrees with ALJ's decision it will deny your request for your case to be reviewed.

You will be sent a letter by the Social Security Administration (SSA) explaining why your claim has been denied. If the Appeals Council decides it will review your claim it may make the decision or it may ask the ALJ for a review. The SSA will inform you of the decision.

There are some specific factors the Disability Appeals Council considers when deciding if it will review an appeal from the ALJ's decision. These are:

  • the ALJ's decision hasn’t used sufficient evidence to arrive at its decision;
  • the ALJ has abused his or her good judgment;
  • the ALJ's decision hasn’t considered any new evidence supporting your application provided by you.

The Appeals Council makes a decision in fewer than 5 percent of all appeals.

What Are the Different Stages in the Disability Appeals Process?

Stage Four: Federal District Court

If your claim has been denied at all the stages of the appeal process you can still take your case to the Federal Court. However, the Federal Court will ask you to pay a fee. If you can’t afford it you may be able to ask for a waiver in writing providing evidence that you don’t have enough money.

Your attorney will file a “complaint” on your behalf to the Federal Court explaining why you are appealing the SSA's decision to deny you disability benefits. The complaint is then served on the SSA. At this stage the SSA’s attorney will provide the reasons to the court for your disability benefits denial.

The negotiations between your attorney and the SSA’s attorney will be done in writing and it is rare that the case is heard in court. The Judge who is responsible for your case will make a final decision which may take 12 months or more.

Eventually the Federal District Court will either, deny your social security disability benefits, reverse the SSA’s decision and grant you Social Security Disability benefits, or return your case to the SSA for further review.

Chances of Winning a Social Security Appeal

At the initial application for disability benefits 30 percent of applicants are approved. If a claim is denied at the Reconsideration stage only 13 percent are approved. At the hearing stage in front of an ALJ about 47 percent of all cases are won by the claimants.

For any claimant who chooses to go to the Appeals Council to appeal the ALJ decision only about 1 percent is successful. The Appeals Council does have the power to return a case to the ALJ to correct any mistakes which have been made but this only happens in 9 percent of cases.

If the claim is sent to the Federal Court, the appointed judge only reverses ALJ decisions and grants benefits for about 2 percent of cases.

How to Find Help with the Appeals Process

How to win a social security disability appeal will depend on if you ask a disability attorney to work on your behalf through the appeals process. Research reveals that 34 percent of claimants who don’t hire an attorney are approved for disability benefits, while 60 percent of those who do hire an attorney are eventually approved.

To find help with the appeals process you should fill out a free case evaluation form today.

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