Most people who are approved for Social Security Disability do not get their claims approved on their first attempt. In fact, only about one in three applicants receive a benefit check after the initial application. Why is Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) so difficult to get?
Let’s shed some light on where the other two-thirds of disability applicants end up—in other words, what are a person’s chances if the initial claim is denied? Answering this question requires knowing a bit about how the entire Social Security Administration (SSA) application process happens.
After being denied the first time, an applicant will jump through any (or all) of the following SSA hoops, officially known as the Social Security Appeals Process.
4 Steps of the Appeal Process
- Request for Reconsideration
- Hearing by Administrative Law Judge (ALJ)
- Appeals Council Review
- Federal Court Review
Most claims are approved either initially or at the ALJ level, and there are several reasons for this (see Step 2: Administrative Law Judge Review section).
Many claimants have success at the Reconsideration level, especially if their initial claim was reviewed by a Disability Examiner (DE) or SSA employed physician who did not find their alleged impairment(s) to be severe or long lasting enough. In other words, a new set of eyes can make a difference in approval.
Appeal Process: An Overview
A Request for Reconsideration (Recon) must be filed within 60 days of receiving a denial letter. The Recon phase sometimes involves gathering more medical evidence and may even include a Consultative Examination (CE) scheduled by the agency who is reviewing the medical portion of the claim. But the Recon case is always managed by a different DE and reviewed by a different physician, psychologist, or psychiatrist. Over 85% of Recon appeals are denied disability benefits.
The ALJ is an important person in the disability process, too, because he or she will review the claim with yet another set of eyes and, most importantly, will see the claimant in person and follow different disability adjudication rules.
The Administrative Law Judge has a somewhat different set of policies and rules to follow, and that can impact approval or denial. For these reasons, many ALJ hearings result in positive decisions: nearly one-third of disability claims seen by an ALJ are approved. (By the time a claim has gone through initial, reconsideration and ALJ review, half of all claimants are awarded benefits).
The next two stages—Appeals Council Review and Federal Court Review—require real perseverance and most people do not make it to this stage. The reasons are many, but specifically, most applicants get worn down by the sheer wait time. The ALJ process alone can take up to two years, so by the time claimants reach the Appeals Council many have given up.
The Appeals Council is only superficially similar to the Reconsideration Review. The appeal must occur within 60 days of the denial letter and the process can begin online. However, the Appeals Council may turn down an applicant if, after reviewing the claim, the Council determines that the decision to deny was based on failure to follow all SSA rules, policies, and procedures correctly.
It’s estimated that over 95% of claims never reach the Appeals Council. Even fewer pass beyond the Council to Federal Court Review.
If the Appeals Council denies an application because they refuse to even review the claim (if they decide all rules were properly followed), the next step is to file a civil suit in Federal Court. At this stage, 9 out of 10 disability claimants hire a disability attorney.
A Detailed Look at the 4 Steps of the Appeal Process
Step 1: Reconsideration Review
The Social Security appeal form at reconsideration is not difficult and can be done online using a link provided by SSA. The steps for initial claims and reconsideration are virtually the same. The key difference is that when filling out the online SSA Request for Medical Reconsideration (Recon) the claimant must add any recent medical exams or newly discovered medical evidence.
For example, maybe the claimant was scheduled to attend a Consultative Examination (CE) during the initial claim, but missed the appointment. The claimant then decided to see her own doctor instead, but those records never made it into the DDS file. At Recon, the claimant (or her attorney) will need to make sure to list the recent doctor’s appointment on the electronic application.
The same is true for any other information (even non-medical) associated with a claim. Perhaps the claimant forgot to submit a required Activities of Daily Living (ADL) form – it’s important to note that on the application and fill out an ADL to update the file.
Of all the appeals steps, Recon is the most straightforward and the quickest. Most applicants will hear back about a decision within four months.
As with the initial claim, anyone applying should be sure to contact (or have a disability attorney contact) the DE who is assigned to the Recon claim immediately. The DE working the Recon claim is likely to be more experienced than the one who handled the initial application, which is a plus. It’s also important to ask the right questions. The claimant or his attorney should ask:
- What are the impairments listed?
- Do you have all of my non-medical forms?
- Is there any missing medical evidence?
- Do you think I’ll need a CE for more information? What about labs or X-rays?
Do not ask the DE how long it will take or why the claim was denied the first time.
Anyone can check the status of a Recon claim at any time once he or she has created a My Social Security Account on the SSA website.
Step 2: Administrative Law Judge
Like the Recon stage, the request for an ALJ review begins with an online application found on the SSA site. However, there are a few big differences. First, this process means a claimant will be seen in person, either at an office within 75 miles of home or using video conferencing (such as Zoom).
Prior to COVID-19, the SSA allowed claimants to opt-out of the video option. Now, it may be necessary to be seen by a judge only on video, but this is dependent on where the claimant lives. To find out if in-person is still an option, contact the local SSA office.
Using a secure SSA linked form, claimants update their file to reflect any changes in medical condition, records, contact information, or daily living. Is there any new medical information? If so, claimants will add details, documents, or links to the newly created ALJ file.
Although an applicant cannot track the progress of the ALJ review, the SSA office will announce their decision via My Social Security. In the old days, a letter of approval or denial showed up in the mailbox, but today the results of the hearings are usually online. Bear in mind that according to the SSA website, the longest average wait times for a claim to reach an ALJ are between 272 and 622 days. In short, it can take a year before an ALJ claim is reviewed, although this is dependent on where the claimant lives.
Because the ALJ process can be slow, many people seeking disability benefits choose a disability lawyer. The attorney can file an appeal very quickly because it is their sole job to ensure that SSI and SSDI benefits get approved. An experienced attorney will closely monitor all decisions on the disability adjudication process, from initial to Recon through—in rare cases—federal court review.
Step 3: The Appeals Council
At this stage, most people hire an SSD attorney. The reason an attorney can be critical is that the Appeals Council (AC) often states that all rules and regulations were followed correctly and then deny a chance for review. A disability attorney who is experienced can request that the claim be returned to the ALJ for further review, for example.
The Appeals Council will either deny a request for appeal or, if it agrees to review the claim in a hearing, it may conduct the review itself or return the claim to the ALJ.
The ALJ has to follow a set of complex SSA rules and procedures. There have been times when they did not follow the rules correctly. In those cases, a denial was reversed, resulting in a favorable decision for the claimant.
Step 4: Federal Court Review
The Federal Court Review is unique. It requires following specific steps laid out by SSA on their Federal Court Review Process page. There are some similarities with other disability appeals—for example, the time limit to file a civil action is still 60 days.
A claimant would only file a civil action if:
- All other options are exhausted
- The claimant disagrees with the Appeals Council decision
- The Appeals Council decided not to review the claim
The claimant, or his attorney, must file the action in the appropriate judicial district where the claimant lives or has a business. He or she will also need to pay a filing fee, even if using the services of an attorney.
The Appeals Council will send a notice explaining everything that needs to be done at the federal review level, but the bottom line is that any complaint filed, or any summons issued by the court, needs to be copied and forwarded when the claimant or attorney files in federal court. The copies have to be sent by registered or certified mail to the SSA Office of the General Counsel for the geographic area. To find the office for the area where you live, SSA provides a link with detailed instructions.
Should I Hire a Disability Attorney?
Many have chosen to hire a Social Security Disability attorney long before arriving in front of a Law Judge. If you’ve read this far, it might be obvious why. The appeals process isn’t simple, quick, or necessarily fair.
We encourage all claimants, at all stages in the appeals process, to consider getting the help of an experienced disability law firm when they apply for SSDI. Disability benefits are far easier to obtain with persistence and assistance. Remember, Social Security disability benefits are every American’s right, whether taking advantage of entitlement programs (Title 2) based on work history or accessing welfare assistance programs (Title 16) due to a change in life circumstances.
Attorneys are also skilled at setting the date of onset for a disabling condition realistically, which can result in more SSDI back pay. In turn, back pay means the applicant receives a larger lump sum to help get caught up on bills and payments.
We encourage you to reach out to a qualified and experienced team of disability attorneys when applying for social security benefits. For the appeals process, an attorney is a must.
Social Security Appeals Process
About half of all disability claims are approved by the end of the appeals process. It’s important to understand that an initial denial does not necessarily mean a person won’t receive disability benefits. A denial letter, for most people, is just the beginning of a longer appeals journey. And many claimants who are turned down find an attorney who can make the whole process less stressful and more successful.
SSA statistics show that a small percentage of claims at the Reconsideration level are allowed, and this makes sense because usually very little has changed from the initial level of review. If the DE and medical reviewers were doing their jobs correctly, there should be no reason why an initial denial won’t also become a Reconsideration denial.
At the Administrative Law Judge level, however, claimants often see real progress. Many people don’t know, for example, that an ALJ has to do less work to allow a claim, and much more work to deny one. If the Appeals Council or Federal Review steps are necessary, many claimants are rewarded for their persistence.
The key piece of knowledge when it comes to the Social Security Disability Appeals Process is to be patient, seek professional assistance, and never, ever give up.
