Understanding Levels of Appeals in a Disability Case

social security appeal status

For one reason or another, it’s not uncommon to have your claim for disability benefits denied by the Social Security Administration (SSA). Understanding your Social Security appeal status doesn’t have to be challenging, as long as you know the appropriate steps to take and educate yourself about the various levels of disability appeals.

Learn more about the four levels of appeal after having your claim for Social Security disability benefits denied.

1. Request for Reconsideration

In nearly all states, the first step is to file a request for reconsideration. This can be done by writing to the SSA directly, or by completing one of two forms:

  • Form SSA 561 (Request for Reconsideration)
  • Form SSA-789 (Request for Reconsideration, Disability Cessation)

Your reconsideration request must be submitted by you or your attorney within 60 days of your notice of denial or initial determination. The SSA will send you a notice of your reconsideration determination.

Reconsideration of an Initial Claim

This involves a complete review of your disability claim and is performed by a decision-maker who wasn’t part of the original decision. The examiner is part of the Disability Determination Services (DDS) level of the appeal. DDS typically grants benefits in 5-10% of reconsideration claims.

Reconsideration of a Continuing Claim

If you are receiving disability benefits, you can expect that your case will be periodically re-examined by the SSA. Benefits could be terminated for a variety of reasons, but are often related to the determination of a change or improvement in your health condition. If your benefits were terminated and you would like to appeal, you must request reconsideration before a Disability Hearing Officer (DHO) who will review. To maintain your benefits, the SSA must see reliable evidence that you have not shown any medical improvement that would allow you to return to work in some capacity.

2. Hearing by an Administrative Law Judge (ALJ)

If your request for reconsideration is denied and you want to continue with the appeal process, you will need to then request a hearing before an Administrative Law Judge (ALJ) within the 60 days after your denial.

For these hearings, it’s very important to appear in person if possible – the court will provide you with the date and location at least 75 days in advance. If for any reason you’re unable to appear in person, they may allow you to appear by video call or, in some rare cases, by phone. If you’re not able to attend the hearing, contact the ALJ as soon as possible – anything less than 5 days in advance can have a negative impact on whether you keep your appeal rights and existing benefits. Your attorney can help you work out communication with the ALJ.

You may be asked to provide any of the following prior to your hearing:

  • Pre-hearing written statements
  • Objections to the issues
  • First-person explanation of your case
  • Additional medical exams or tests
  • New evidence, if relevant
  • Witness testimony, such as medical experts

Generally speaking, about 40-50% of disability applicants who take their appeal to an Administrative Law Judge hearing will win their appeal.

3. Appeals Council Request

If you don’t win your appeal at the ALJ hearing, the next step is to request a review of your case by the Appeals Council. The council will also randomly select cases for review. They have the jurisdiction to uphold, reverse or remand the ALJ’s decision.

The Appeals Council will only review a submitted case if there is a legal or factual error that would change the outcome of the case.

The Appeals Council isn’t generally successful, and most people only file this request to exhaust all options for SSA appeal.

4. Federal Court Review

The last step of the appeals denial process is to file a civil lawsuit with the U.S. District Court in your state. Though you may have a fair chance of winning your appeal this way, it’s time-consuming and costly – it could take years to get your case seen by the federal court.

The federal judge that hears your appeal will review the case for legal errors – judges will tend to send cases back to the SSA for issues such as missing abilities assessments from treating doctors, not considering pain or other symptoms, and so forth.

Contact the Attorneys at Woodruff & Mathis

With more than 20 years of experience as a disability attorney, Samuel Mathis has represented over 1,500 clients through every stage of a Social Security claim. If you have questions about your Social Security appeal status or Maine disability requirements, please request an appointment with us today.