We know how crushing it can be when you get that letter. The sad truth is that most people who apply for Social Security Disability will get a “Notice of Disapproved claim,” like the one shown here. You are not alone! In fact, the Social Security Administration (SSA) only approves benefits for about 21% of initial applications.
There are instructions in the letter on how to appeal and there’s even more information available online at ssa.gov. Before you begin the appeal process, you need to understand exactly why you were denied.
Figuring Out Why Your Disability Claim Was Denied
The explanation why your claim was denied will be included with your “Notice of Disapproved claim” letter. If you need help figuring out why your claim was denied, this article might help you interpret the letter. If you still aren’t sure, we recommend seeking help from a legal professional. To win your appeal, you must prove their previous determination was wrong. To prove it was wrong you must know exactly what that determination was (and exactly what the law is).
The Appeals Process for Disability Denials
The following stages of appeal are also known as levels of “adjudication.” In our article explaining why claims take so long, we go into greater detail on what happens at each level of appeal.
Each appeal must be filed within 60 days of the latest denial letter.
Appeal #1: Ask SSA to Reconsider
The first appeal is called a Reconsideration. You can file the “Request for Reconsideration” online or using Form SSA-561-U2. If you do this online, you’ll see that SSA gives 2 different options for the Reconsideration based on why you were denied. One option for “non-medical reconsideration” (for technical denials) and another for “disability reconsideration” (for medical denials). Those denied for medical reasons must also submit a “Disability Report – Appeal,” Form SSA-3441.
Getting Denied Again at Reconsideration
The SSA will send their decision in a “Notice of Reconsideration” letter. If your appeal was denied, it will say that the “previous determination was proper under the law,” like this example here.
Don’t be surprised if you’re denied again at this stage. Social Security denies about 90% of all Reconsiderations. The following chart shows at which stages Social Security approves claims for disability benefits. This data from the SSA is only for SSDI claims, however the data for SSI claims are similar.
After receiving your “Notice of Reconsideration” denial letter, you then have 60 days to file the next appeal – a Request for Hearing.
Appeal #2: Request a Hearing
Requesting a Hearing with an Administrative Law Judge (ALJ) is your best chance at getting your claim approved. Around 50% of people who appeal up to this level are awarded benefits after their hearing. People are also much more likely to have hired an attorney by this stage, so that likely explains the higher success rate.
One study found that having a lawyer can more than double your chances of winning at the hearing level. Yes, we are disability attorneys, and this is how we earn a living, but the statistics show that you really should hire an attorney. Many people don’t realize that they don’t need any money to get a disability attorney. It’s a common misconception that you have to pay a lawyer to get help with your disability appeal. While that seems logical, most clients never pay anything out of pocket. We only get paid after we win, and our fee comes out of the back benefits SSA owes you. You never even get a bill because SSA pays us directly, 25% of your back pay. Without an attorney, you will most likely get 0% of your back pay so you literally have nothing to lose.
If you’d like to learn more about the hearing, we have an article on what to expect and how to prepare for your Disability Appeal Hearing. We have also reviewed how sometimes the ALJ can still deny a claim even when the Vocational Expert says you cannot work! All the more reason to hire an attorney. If you still decide to go it alone though, this second appeal can also be filed online or with Form HA-501, aptly named “Request for Hearing by Administrative Law Judge.”
Unfavorable Decision from the Administrative Law Judge
If the ALJ denies your appeal for Disability Benefits, you’ll receive a “Notice of Decision – Unfavorable.”
The only way the ALJ’s decision can be overturned is by the Appeals Council.
Appeal #3: Request Appeals Council Review
The hope is that the Appeals Council will overturn the unfavorable decision from the Administrative Law Judge. This would be called a “remand,” and it would send your case back to the ALJ for a new, and assumingly favorable decision.
There are a few possible outcomes though. The Appeals Council may…
- deny your request for review,
- remand (return) your case to the ALJ for a new decision,
- or, very rarely, award you disability benefits
If they deny your request for review, your only final option is to file a civil suit against them in federal court. Balin Law is one of the very few Disability Law Firms in Ohio who take cases to the federal court level, so if your lawyer has given up, give us a call.
Appeal #4: Federal Court Review
This final review is outside of the Social Security Administration. You are actually suing the government at this stage. This lawsuit is called a civil suit and it gets filed in a Federal District Court. It’s also referred to as “federal court litigation.” The SSA reviews the specifics of this process, which they refer to as a Federal Court Review.
Federal court litigation is the absolute last possible review of your case. In addition to being one of the few who take cases to federal court, Balin Law is also one of the very few who step in to litigate claims in federal court where other attorneys have lost. Attorney Matt Shupe, who has experience winning many cases at the federal level, talks more about the Federal Review process in this article.