4 Steps of the Social Security Appeal Form Process

//4 Steps of the Social Security Appeal Form Process

4 Steps of the Social Security Appeal Form Process

Unfortunately, it is rather common for a Social Security disability application to be denied, especially when it is the initial application for disability benefits. However, the Social Security Administration (SSA) has an appeal process that allows you to appeal the decision made by the initial SSA examiner.

4 Steps of the Social Security Appeal Form Process

  1. Request for Reconsideration
  2. Hearing by an Administrative Judge
  3. Review by the Appeals Council
  4. Federal Court Review

When the SSA notified you that it denied your Social Security application, the letter you received contained information about how to appeal the decision, and which Social Security appeal form you should use. You must file your Social Security appeal form within 60 days after receiving the SSA’s notice of decision.

The SSA has four levels of appeal when a Social Security disability application is denied. Each level of appeal for disability benefits has specific requirements and steps.

1. Request for Reconsideration

The first level of appeal in the SSI appeals process and the SSDI appeals process is the Request for Reconsideration. The request may be based on a medical determination or non-medical determination. Non-medical reasons for a denial of Social Security benefits include issues related to overpayments, income, living arrangements, resources, and other non-medical issues.

A request for reconsideration is a complete review of your entire case by a different person with the SSA. The person conducting the review was not initially assigned to your case and has not seen your application, the medical records you requested from your doctor, or any of the evidence you submitted with your application for Supplemental Security Income or Social Security Disability Benefits. The reviewer looks at the original information with fresh eyes. The reviewer also considers any new evidence you submit with your request for reconsideration.

The easiest way to request a reconsideration is to file your Social Security appeal form online at www.ssa.gov. There are separate web pages to request a reconsideration based on medical reasons and non-medical reasons. If you are providing additional documentation or evidence, you may submit the information online, by mail, or by visiting your local Social Security office. Some documents may only be accepted in their original form or as certified copies. You can contact the SSA office for more information about which documents must be originals or certified copies if you are unsure about submitting documents.

It takes about 10 to 15 minutes to complete the Social Security appeal form online. You will need:

  • Your name, address, and telephone number
  • Your Social Security number
  • The date of the denial decision
  • Your representative’s name, address, and telephone number
  • Name and contact information for a friend or family member who is familiar with your medical condition
  • Description of any changes to your medical condition since your first Social Security application
  • Names, addresses, and telephone numbers for all medical providers you have seen since providing your initial medical information
  • The names of all medications you are currently taking, why you are taking medicine, any known side effects, and the name of the doctor who prescribed the medication
  • Description of any change in your ability to work, daily activities, or education
  • Supporting documentation and evidence

Which Form Do I Need to Submit?

If you do not want to file your Social Security Administration appeal form online for reconsideration, you need to complete the required forms and submit them with your additional evidence to your local SSA office.

To file for reconsideration based on a medical decision, you need:

  • Form SSA 561 (Request for Reconsideration)
  • Form SSA-3441 (Disability Report Appeal)
  • Form SSA-827 (Authorization to Disclose Information to the Social Security Administration)

When requesting a reconsideration for non-medical reasons, use Social Security Appeal Form SSA 561 Request for Reconsideration. If you have questions, you can reach an SSA agent by calling the Social Security Office at 1-800-772-1213.

When the examiner completes the review, you receive a notice with the decision from your request for reconsideration. The notice explains the decision and how to appeal the decision if you disagree.

Does the Social Security Reconsideration Take as Long as the Disability Application?

Typically, it does not take as long for you to receive a decision on a Request for Reconsideration as it does to receive a decision on your initial disability application. The sooner you submit your Social Security appeal form requesting a reconsideration, the sooner your case will be processed.

2. Hearing by an Administrative Judge

The next step you can take to file an appeal if you disagree with the decision from the reconsideration is to request a hearing before an administrative law judge (ALJ). The easiest way to request an ALJ hearing is to request the hearing online. You may also submit your request in writing by downloading the forms you need from the SSA website.

The Social Security appeal form for requesting a hearing with an ALJ is Social Security appeal form HA-501 (Request for a Hearing by Administrative Law Judge). You can also check the Notice of Reconsideration Determination form you received from the SSA to ensure this is the correct form to use to request an appeal of the decision from the reconsideration. Be sure to submit additional evidence when requesting a hearing.

You may also need to submit the following forms with your Social Security appeal form:

  • SSA-3441 (Disability Report – Appeal)
  • SSA-827 (Authorization to Disclose Information to SSA)
  • SSA-1696 (Appointment of Representative)

Your appeal and request for a hearing with an ALJ must be filed within 60 days from the date you receive the reconsideration decision. The SSA assumes you received the notice within five days from the date of the notice.

What Should I Expect After Requesting a Hearing Before an Administrative Law Judge?

First, you have the right to have a representative, including an attorney, appear with you at the ALJ hearing. The SSA provides information about your right to representation in Publication No. 05-10075. Hearings are scheduled as promptly as possible, but there could be a significant delay depending on the number of hearings to be scheduled. Consenting to hold your hearing by video teleconference can result in an earlier hearing date.

The SSA sends notices of hearings at least 20 days before the hearing date. You will be informed of the date, time, and location of the hearing. Hearings are typically held within 75 miles from the applicant’s residence, but the distance could be further. You should notify the SSA immediately if travel arrangements are a problem. If you must travel more than 75 miles from your residence for an ALJ hearing, you may be entitled to reimbursement for certain transportation costs.

It is important that you and your representative attend the hearing. The ALJ can dismiss your appeal for failing to attend the hearing. If you cannot attend the hearing for any reason, contact the ALJ’s office immediately.

At the hearing, the ALJ may question you, the witnesses you bring to the hearing, vocational experts, doctors, and any other witnesses the ALJ has requested to appear at the hearing. An ALJ hearing is informal, but the hearing is recorded, and all questions are answered under oath. You or your representative may also question the witnesses during the hearing.

Will a Social Security Judge Give Me an Immediate Decision at The Disability Hearing?

After the hearing, the ALJ reviews all evidence and considers the issues on appeal. The judge then issues a written decision and notifies the SSA, you, and your representative of the decision.

3. Review by the Appeals Council

The Appeals Council is located in Falls Church, VA, but has additional offices in Crystal City, VA, and Baltimore, MD. If you disagree with the decision by the Administrative Law Judge, you can submit a request for review by the Appeals Council. You have just 60 days from the date you receive the notice of the ALJ’s decision to file a request for review by the Appeals Council. As with the deadlines for other appeals, the SSA assumes that you receive the notice within five days after the date on the notice.

Which Form Do I Need to Submit?

As with the other levels of appeal, the quickest and easiest way to submit a Social Security appeal form for the Appeals Council is to submit the request online. However, you can also download the Social Security appeal form for an Appeals Council Request for Review from the SSA. Once you complete the Social Security appeal form HA-520, mail the form and any requested information to:

Appeals Council, OARO
5107 Leesburg Pike
Falls Church, VA 22041-3255

You can call the Social Security Office at 1-800-772-1213 if you have questions or need assistance filing a request for review. Filing a request for review does not guarantee that the Appeals Council will review the decision by the ALJ. If the Appeals Council consents to review your case, it may return the case to the ALJ for further review of the denial or review the case itself. When the Appeals Council reviews a case, it may consider all issues in your case, even issues that were decided in your favor.

You have the right to have someone represent you during the appeal. If you cannot afford a representative, you can contact the Social Security Office for assistance. If you have a representative, you need to complete Form SSA-1696-U4 (Appointment of Representative).

The Appeals Council is the last level of appeal for a denial of Social Security disability by the SSA. If you disagree with the decision of the Appeals Council or the Appeals Council declines to review your case, your only other option is to file a civil lawsuit in a federal district court.

4. Federal Court Review

Filing a civil lawsuit in a federal district court is the last step in the appeals process. You have just 60 days after receiving the decision by the Appeals Council to file a civil lawsuit.

Which Form Do I Need to Submit?

There is not a Social Security appeal form for the lawsuit. An attorney must draft a summons and complaint and file it with the federal district court. A copy of the summons and complaint must be served on the SSA by registered or certified mail to the Social Security Administration’s Office of the General Counsel.

The process of filing a civil lawsuit for a denial of Social Security disability benefits is a complex process. You should contact a Social Security disability lawyer immediately if you want to proceed with this step.

Appeals vs. New Applications for Social Security Disability 

If you do not file your Social Security appeal form before the deadline expires for appealing a denial of benefits, you are required to file a new SSDI application or SSI application if you believe you are entitled to disability benefits. Filing a new application is not your best option for several reasons.

If you file another application for disability benefits, it is likely to be denied for the same reasons your original application for Social Security benefits was denied. An initial examiner is likely to review the information you provided with your original application and arrive at the same conclusion as the initial examiner.

However, appealing a denial of Social Security benefits places your file in the hands of a person that may have more experience dealing with special cases, and many denials may involve a unique situation. Examiners who handle requests for reconsideration and administrative law judges often have more experience with issues that are not specifically addressed in the Social Security Blue Book or other standard materials used by initial examiners when they review Social Security disability applications.

In addition, by filing a new application for disability benefits, you further delay receiving disability benefits. A new application means you are starting the process all over again. If your claim is denied, which is likely, you then face the same appeals process that you are facing right now.

If you receive a denial of benefits or you disagree with a decision, it is crucial that you take steps to file the correct Social Security appeal form before the deadline expires for appealing a denial of Social Security benefits.

What Are the Reasons for Social Security Disability Cases Being Denied?

There are eight basic reasons why you were denied Social Security disability:

  1. Insufficient medical records or evidence of disability
  2. Mistakes or omissions on the application or other paperwork
  3. Your physical or mental condition does not meet the definition of disability
  4. Lack of work credits to qualify for SSDI
  5. Failing to follow a physician’s treatment plan
  6. Failing to communicate or cooperate with the SSA during the application process
  7. Resources or income exceeds the maximum limit for eligibility
  8. Your disability is primarily caused by alcohol or drug abuse

Can an Attorney Help My Appeal?

The appeal process is designed to be straightforward. However, for anyone unfamiliar with the process of appealing the decision of an SSA examiner or ALJ hearing, the disability appeals process can be overwhelming. Just one mistake or error during the Social Security appeals process can result in a denial of your claim.

You are not required to hire an attorney to appeal a decision by the SSA; however, a Social Security disability attorney can be extremely helpful during the appeals process. There are several reasons why you may want to consult with a Social Security disability attorney:

  • A Social Security disability lawyer reviews your initial application for disability benefits to determine why the SSA denied your application. In some cases, a denial of disability benefits may have occurred because of a simple mistake on the application. The attorney can file a Social Security appeal form for a Request for Reconsideration to correct the mistake.
  • An attorney understands the disability appeals process. Instead of researching the steps involved in filing a Social Security appeal yourself, you receive guidance and support during the disability process when you retain an attorney.
  • Your attorney helps you understand the various SSA disability programs and explains your options for receiving SSDI or SSI benefits. Your claim may have been denied because you did not apply for the correct program.
  • Your application for disability benefits must contain sufficient medical evidence and documentation to prove that you have a disabling condition that prevents you from engaging in a substantial gainful activity. The SSA can request information from your physicians and medical providers; however, other evidence may be necessary to prove your disability claim. For instance, you may need to meet with a vocational expert, obtain statements from family and friends who understand your disability, or submit a daily record detailing how your disability limits your activities.
  • Appeals of Social Security disability decisions can be delayed for a variety of reasons. An attorney knows how to keep your case moving through the appeals process.
  • Even though the ALJ hearing is informal, it is still a hearing before a judge. The testimony provided during the hearing is under oath. A Social Security disability attorney prepares you for the ALJ hearing. The attorney also coordinates witnesses and medical providers who need to testify at the hearing.
  • The paperwork and forms necessary for a Social Security disability appeal can be substantial. An attorney can be a great asset by preparing and filing all necessary forms and documentation to appeal a denial of benefits.

Appealing a denial of Social Security benefits can be a complex and time-consuming process. A Social Security disability lawyer has the skills and resources necessary to tackle every step in the appeals process.

Can I Afford to Hire A Social Security Disability Attorney?

Many individuals believe that they cannot afford to hire an attorney to assist them with a Social Security disability appeal. The SSA regulates the fees that attorneys may charge for representing individuals who are seeking disability benefits.

In most cases, attorney fees in disability cases are limited to 25% of the past-due disability benefits up to a maximum of $6,000. When you receive your back disability pay, your attorney deducts the fee from the amount paid by the SSA. Therefore, you are not required to pay any attorney fees until you receive your disability back pay. In some cases, an attorney may request that an individual pay a small fee to cover costs and attorneys may be allowed to charge more for an appeal to the federal district court.

In almost all cases, the attorney does not receive any money unless he wins the case. However, you should discuss all fees and costs with your attorney before signing a retainer agreement.

The Social Security Appeal Form Process

SSI and SSDI benefits provide income for individuals who are unable to work because of a disabling condition. These programs are vital for many individuals throughout the United States. Without disability benefits, they would be unable to pay for necessary living expenses and basic needs. Even though millions of Americans receive Social Security disability benefits, obtaining approval may not be simple for some applicants. Unfortunately, the SSA denies valid claims each day.

If your disability claim has been denied, do not be discouraged. You have the right to appeal a decision by the SSA regarding your disability application. There are four levels to the appeals process, so don’t give up if you receive a rejection letter. Many people receive the notice of denial and give up because they are not aware of the appeals process, or the process seems confusing. Or, they may mistakenly believe they cannot afford an attorney to help with appealing a denial of benefits.

You can win a Social Security appeal. Filing a Request for Reconsideration, a request for an ALJ hearing, or request for review by the Appeals Council can be done online. You can get help from the SSA online at www.ssa.gov or by calling your local Social Security office. However, if you are unsure how to file an appeal or if you want help with your appeal, you have the option of hiring a Social Security disability attorney to assist you throughout the disability appeals process. Contact Acadia Law Group today for a free consultation.