A number of different studies have shown that an initial application for Social Security Disability Insurance (SSDI) benefits will be denied. The reasons for these denials vary from case to case. Some applications lack adequate evidence of the existence of a permanent disability; other applications do not demonstrate the effect of a medical condition on the applicant’s ability to perform the basic task of his or her prior employment. Fortunately, the SSDI law and regulations enacted by the Social Security Administration (SSA) provide an extensive appeal process that can often result in the reversal of the initial denial.
Reconsideration
The first appellate step is the filing a request for reconsideration after an applicant receives the notice of denial from the SSA. A request for reconsideration must be filed in writing, but it does not require a hearing. The SSA will render a written decision on the request for reconsideration and mail the notice to the applicant or the applicant’s representative.
Hearing
If the SSA does not reverse the initial denial in responding to the request for reconsideration, the applicant can invoke the next appellate step by making a request for a hearing before an administrative law judge. The SSA will schedule the hearing at a place convenient for the applicant and the applicant’s representative. Many hearings are now conducted by video teleconferencing, thus obviating the need to travel to attend the hearing. The SSA may pay for any travel expenses necessitated by the hearing and for any medical tests or examinations that it may request. The applicant may wish to present live testimony from medical or employment experts to bolster the appeal.
Appeals Council
If the hearing does not produce a decision granting the application for benefits, the applicant can submit a written request for an appeal to the Appeals Council. The Appeals Council can take one of three actions: return the case to the administrative law judge for further proceedings, issue a fully favorable decision reversing the decision of the administrative law judge, or issue a decision that is partially favorable and partially unfavorable.
Judicial review
If the decision of the Appeals Council is not satisfactory, the applicant can commence an action for judicial review in the appropriate federal district court. A court appeal requires that all appearances be made by a lawyer representing the applicant.
The SSDI appeals process can be very complex. Retaining an experienced disability attorney at the outset can maximize the chances of receiving deserved disability benefits.