Life is full of uncertainties.
People get hurt, develop illnesses and find themselves unable to
work. The bills don’t stop even when the income does. This
article will discuss the process of how to appeal the denial of a
Social Security disability insurance benefits claim.
To make this process clearer,
I’ll use the hypothetical case of Deanna Jones. Ms. Jones has
worked as a sales person in a large discount store for fifteen
years. She develops diabetes which at first is manageable by
medication. Unfortunately the diabetes becomes more severe and she
is placed on insulin.
She begins to suffer from fatigue
and diabetic neuropathy in her feet which creates even more
problems for her because she is required by her job to stand up 40
hours per week. Her employer makes an effort to give her lighter
duties but eventually her health problems are so bad that she can
no longer do her job and she is fired.
She begins her application for .
Social Security Administration ( SSA ) disability insurance
benefits by going to the local Social Security office. She
completes their application and signs medical releases authorizing
the SSA to obtain her medical records.
The local office forwards
Ms. Jones file to Raleigh where a state agency called the
Disability Determination section reviews the material to make a
determination as to whether Ms. Jones meets the qualifications to
receive disability benefits.
If the claim is approved, then
the system moves on efficiently and Deanna begins to receive
monthly disability checks after a five month waiting period from
the onset date that the SSA determines she is disabled.
However if the SSA determines
that Deanna is not disabled, then she will receive a letter from
the SSA called the initial denial. This letter is mostly a form
but will include a brief listing of all the medical information
which the SSA relied upon in making the decision to deny her
claim. Deanna then has 60 days from the date of the denial letter
to appeal her claim.
If she does not appeal within the 60 day
period then the SSA will close her file and take no further
action. Obviously it is important to file a timely request for
the next level of review.
A substantial number of people
who have filed disability claims become discouraged by this
initial denial letter and just let their claim drop. This can be a
mistake as many claims that are initially denied are ultimately
approved by an Administrative Law Judge.
The next level of appeal after
the initial denial is the Reconsideration. Deanna can request the
Reconsideration by either going to the local SSA office to pick up
the forms or by calling them and requesting the forms be sent by
mail. The Reconsideration request forms must be mailed within the
60 day period after the initial denial. These forms are fairly
easy to complete.
They essentially consist of a
request for reconsideration and a statement as to any changes that
may have occurred in Deanna’s medical condition and any medical
treatment she has had since her initial application. Deanna should
carefully review the list of medical sources of treatment on the
denial letter to see if the SSA may have missed any medical
providers who could provide helpful information about her
Deanna will not have the right to
personally appear before the Agency making the initial denial or
Reconsideration determination. Those two steps of the claim
process are done by staff obtaining and reviewing various medical
documents. However she may very well be contacted by telephone to
discuss her situation with the case worker assigned to her claim.
The Reconsideration is made again
by the State Agency Disability Determination. A different set of
employees reviews the reconsideration requests, but usually the
results are the same as the initial decision and they deny the
Deanna will then be notified by
mail that her claim has been denied at the Reconsideration level.
As in the Initial Denial stage, Deanna then has 60 days to request
the next level of review which is a hearing before an
Administrative Law Judge. Once again this request must be made
within the 60 days or the case is closed and the SSA will take no
further action on the claim.
The hearing before the
Administrative Law Judge is extremely important. It is the only
point in the whole process where the Claimant actually gets to
appear in front of the person who is deciding if she is
The Administrative Law Judge is
independent of the SSA and will make a new decision based upon the
evidence that is presented to him at the hearing. The Judge will
have reviewed Deanna’s case file and any additional medical
information submitted by her or her attorney prior to the
The Administrative Law Judge is
not bound by the fact that Deanna has been denied twice by the
The hearing before the
Administrative Law Judge is closed to the public. In some cases
the Judge may have the case assigned to a doctor paid by the SSA
to render a professional opinion regarding the Claimant. This
doctor will not personally exam the Claimant but will have
reviewed the Claimant’s medical records and will observe the
hearing and may ask questions of the Claimant.
The doctor will then offer expert
testimony regarding the Claimant’s medical condition. In some
cases the Judge may also assign a Vocational Expert to review the
file and attend the hearing.
The Vocational Expert will then
offer expert testimony as to whether the Claimant is able to
maintain full time employment based upon the claimant’s work
history, physical limitations, educational background and other
The Judge typically does not
announce his decision after the hearing but writes a written
decision outlining the reasons for his decision. The Judge will
frequently overrule earlier denials and grant the disability
However if the Judge denies
Deanna’s claim, then she has another level of appeal to the
Appeals Council. The Appeals Council is in Virginia and Deanna
will not have the opportunity to personally appear before this
The Appeals Council can approve
the Judge’s decision, overturn his decision or send it back to
the Judge for another hearing to take additional evidence. If the
Appeals Council upholds the denial of Deanna’s claim then she
has the right to file a complaint in the U.S. District Court to
review the Appeals Council’s decision.
As shown above the entire process
is fairly complex. However with adequate preparation and with
competent legal representation many disability claims that are
initially denied by the SSA can be approved at the Administrative
Law Judge hearing.