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Appeals Process

Right to Appeal:

If your client disagrees with their decision, it can be appealed. That means Social Security will look at the case again. When your client asks for an appeal, Social Security will look at the entire decision, not just the part he or she disagrees with. If Social Security made a wrong decision on the case, we will change it.

Four Levels of Appeal:
There are four levels of appeal. If your client is not satisfied with the decision at one level, it may appealed to the next stage. The levels of appeal are:

File an Appeal: www.socialsecurity.gov/pgm/appeal.html

Your clients and/or their representatives may appeal a disability decision online at https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp.  Your clients and/or their representatives can appeal a medical decision on their Social Security and/or Supplemental Security Income disability claims by easily completing and submitting online the request for reconsideration or a hearing.  To learn more, please go to www.socialsecurity.gov/disability.

Your client has 60 days from the date the client receives the letter telling about Social Security’s decision to request an appeal. Social Security assumes they received the letter five days after the date on the letter, unless they can show it was received later.

If the appeal is not filed within the 60-day time limit, clients may lose the right to appeal. If your clients have good reason for not appealing within the time limit, Social Security may give more time. To do so, they must make a request in writing, which states the reason for the delay.

Appeals can be filed on many issues. The steps of the appeal process are the same for all appeals; however, the routing of appeal decisions varies depending on the issue involved. This guide includes a description of each of the processes but focuses on the disability appeal process.

Reconsideration:

In most states, the first level of appeal is the reconsideration. A reconsideration is a complete review of the claim by someone other than the individual who made the original decision. All evidence, plus any additional evidence submitted, will be reevaluated and a new decision will be made. This review may be completed in the district office, a payment center, or the Disability Determination Services.

The Disability Determination Service makes the decision when the claim is denied because of medical reasons. When a decision is made on the reconsideration, Social Security sends a letter explaining the decision. It usually takes about 60 days to receive a decision.

Appeals Hearing:

If the client disagrees with the reconsideration, the next level of the appeals process is a hearing before an Administrative Law Judge. This is the second level of appeal for people in most states.

The judge working the case has had no part in any decision up to this point. The judge notifies the client of the time and place of the hearing. It can be many months before the hearing is scheduled.

Before the hearing, Social Security may ask the client to provide more evidence and to clarify information. The client may appoint a representative. If your client does not wish to come to the hearing, Social Security must be notified in writing. At the hearing, the judge will question your client and any witnesses, such as a vocational expert. Sometimes a video hearing is conducted rather than a face-to-face hearing. The length of time for a hearing decision varies greatly but on average, it is about 500 days.

Appeals Council:

If your client disagrees with the hearing decision made by the Administrative Law Judge, a review by Social Security’s Appeals Council (third level) can be requested. The Appeals Council looks at all requests for review, but may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review the case, the Council will either decide the case itself or issue an order returning your case to the Administrative Law Judge for further action. The Appeals Council will notify your client by mail of the actions it has taken on the case. In fiscal year 2010, the average processing time for a request for review was about 11 and a half months from the date the request was filed until the Appeals Council released its final action. The Council was able to process about two-thirds of its actions in 365 days.

Federal District Court:
If you disagree with the Appeals Council’s decision or if the Appeals Council decides not to review your case, you may file a lawsuit in a federal district court. The letter we send you about the Appeals Council’s action also will tell you how to ask a court to look at your case.

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Q and A

Q. What is the web address to file an online appeal application?

A. The address is www.socialsecurity.gov .  To find out how to file appeals electronically, view our webcast, “Filing a Disability Appeal Online,” at www.socialsecurity.gov/webinars/.

Q. What happens after my client files a hearing request?

A. After SSA receives the request for hearing, a letter is sent to your client from the hearing office assigned to process the appeal.  The letter contains the local hearing office’s telephone number and mailing address.  It also explains the right to representation. Your client and any appointed representative will receive a Notice of Hearing at least 20 days prior to the date of the hearing. Your client should read this notice carefully and contact the local hearing office if they have any questions.  The Notice contains a form asking if he or she will be present at the hearing.  Please make sure your client returns this form right away.  It is critical that your client notifies your local office if he or she cannot appear at the time the hearing is scheduled.

Q. What can my client do to speed up the hearing process?

A. Submitting any additional information and notifying Social Security if you move or your telephone number changes can help save time.  Also, if your client wishes to secure representation, they should do so as soon as possible.  Lastly, it is extremely important that your client attend the hearing.

Q. If my client has a hearing pending, whom do they contact with changes?

A. If changes occur, contact the hearing office processing your request of hearing.  The local hearing office telephone number is located on the letter you received acknowledging your request for hearing.

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