When you apply for Social Security Disability, there is a 65% chance your claim will be denied. Yet, more than 70% of claimants who were denied at first are awarded benefits at the administrative level of the Social Security disability appeals process.
Does this mean that the claims were not justified when they were first filed? No – it means do not give up.
To maximize your chances with a Social Security Disability appeal, it is beneficial to use appeal attorneys experienced and knowledgeable with the Social Security Disability benefits process.
Most claims for Social Security Disability or SSI disability benefits are initially denied. Unfortunately, this happens even when a claimant’s case is strong. For this reason, having legal representation on a disability claim is especially important and can even make the difference between winning and losing.
Where Does Your Claim Go, If You Appeal a Social Security Disability Denial?
Click here to check out an infographic that follows 1,000 example applicants as they go through each stage of the Social Security Disability appeals process — from the initial review stage, to an appeal in Federal Court.
Throughout the appeals process, if the SSA denies your claim at any level, you must appeal to the next level. Otherwise, your file will be closed and you must start the process over.
Many claimants will be awarded disability benefits during different stages of the process. Many others will give up, and drop their claim along the way.
Basics of the Social Security Disability Appeal Process
Appeals for social security claims begin at the administration level, and may progress, if continually denied, to the final appeal which is a lawsuit filed in the federal court system.
When a Social Security Disability (SSD) claim is denied at any level of the appeals process, you must appeal to the next level. Otherwise, your claim will be kicked out of the system and you must restart from the beginning.
There are four levels of administrative Social Security Disability appeals:
- Initial Determination
- Request for Reconsideration
- Hearing before an Administrative Law Judge (ALJ Hearing)
- Review by the Appeals Council
Step 1: Initial Determinations (120 days)
Most claims are denied at the first two stages of the process: the Initial Determination and the Reconsideration stages. The initial application for Social Security Disability benefits begins with the administrative review process.
If your claim is denied at the initial filing, you should promptly appeal the decision.
Step 2: Reconsideration (90 days)
The Reconsideration stage becomes the first level of appeal. This entails a complete review of your claim by a different examiner, and you may include new evidence. If your initial claim for disability is denied, you should follow with a Social Security Disability appeal for a Request for Reconsideration.
You have in effect 65 days to file this appeal from the date you received the decision (the timeline is actually 60 days, which is extended 5 days because of the time it takes to receive a decision by mail).
Step 3: Administrative Law Judge (ALJ) Hearing (530 days)
If the Request for Reconsideration is denied, your next step is to request a hearing before an Administrative Law Judge (ALJ). This is known as the ALJ Hearing. Again, the 65-day timeline applies.
Often, the biggest mistake claimants make after a denial at reconsideration is not appealing to the next level, the ALJ hearing. This hearing is your chance to argue your case to the judge and present additional details and evidence including how your circumstances have changed since the previous decision. You have the opportunity to present your own witnesses and question any SSA vocational or medical experts who may be present at the hearing.
If you do not have legal representation by this point, it is to your definite advantage to retain an attorney. Most claims are won at the ALJ hearing with the aid of an experienced Social Security disability lawyer who understands how to fortify your case and work successfully with administrative law judges.
Step 4: Appeals Council (270 days)
If you receive an ALJ denial, the final administrative appeal is to the Appeals Council in Falls Church, Virginia. The time limit for this appeal in most cases is 65 days.
At this level, we can introduce new evidence for consideration; otherwise, the Appeals Council will review the ALJ’s decision for procedural error.
Your claim may follow one of three paths at this point. The Appeals Council may:
- Overturn the denial and award benefits;
- Return the disability claim to the ALJ for a new decision;
- Deny the request for review, or refuse benefits. If the Appeals Council denies the request for review, you must file an appeal in federal district court within 60 days.
Step 5: Federal Court (540 days)
If you still have not received a favorable decision during the administrative appeals process, the final Social Security Disability appeal is to file a lawsuit in the Federal District Court where you live. A federal court appeal is litigation, where only a licensed attorney can represent a claimant’s case.
How Can I Win My Case?
The key to winning a disability case is to keep appealing. This gives you the opening to provide additional evidence that most likely was missing in any earlier appeals.
The complexity of the Social Security disability appeal process has made the task of pursuing claims through all the levels of appeal difficult. Aware of this problem, the Social Security Administration (SSA) allows you to be represented by attorneys on a contingent fee basis.
In other words, you can hire a lawyer to represent you with no money up front. Social Security regulations limit the payment that attorneys receive. The attorney is paid only if you win your case, and payment is a percentage of the past due benefits.
- As of 2020, the standard contingency fee to the attorney is 25% of all past due benefits up to a maximum of $6,000 if the case is won before appealing to the Appeals Council or to federal district court.
- If a case must be appealed to the Appeals Council (which is the appeal prior to Federal Court), the $6,000 maximum cap is removed and the fee is 25% of all past due benefits.
Legal Representation for Your Social Security Disability Appeal
As an attorney that has practiced Social Security Disability law since 1992, Marc Whitehead firmly believes that a claimant’s chances of winning their claim is greatly increased by having an experienced attorney represent them.
If your claim is denied, you need a strong strategy for getting your case approved. No matter what stage of the Social Security Disability appeal process you are in, the law firm of Marc Whitehead & Associates can help you.
We have expert knowledge regarding the laws and regulations that steer the Social Security and SSI disability approval process. We are experienced with all types of medical evidence needed to successfully support a claim — and we know the proper way to present this evidence from the initial application to appeals in the federal court system.
When a lawsuit is necessary to win a Social Security Disability appeal, we are thoroughly prepared to take the case to the final appeal in federal court. If you want justice, we are your strongest allies.