Appealing a Social Security Disability Denial Through the Legal Process
Many claims for Social Security disability benefits fail at the initial stage, only to be approved on appeal. Thus, a claimant who receives an initial denial should not give up but instead should proceed to the next steps if they believe that they meet the eligibility criteria. The Social Security Administration provides three levels of appeals: reconsideration, a hearing before an administrative law judge, and review by the SSA Appeals Council. If a claimant does not get a favorable outcome at one of these stages, they can go to federal court.
Reconsideration
When a claimant requests a reconsideration, their claim will get a fresh look from members of Disability Determination Services who did not review their initial claim. (The DDS is a federally funded state agency that determines whether a claimant is medically eligible for benefits on behalf of the SSA.) At this stage, a claimant can submit further evidence in support of their claim, and the new reviewers may seek information as well. For example, if the claimant has received further evaluations or treatment since they filed the initial claim, they can provide these records to the new reviewers.
Hearing Before Administrative Law Judge
If they receive an adverse decision after the reconsideration, a claimant may ask for an ALJ hearing. These are conducted at Social Security hearing offices. The ALJ will consider documents related to the claimant’s eligibility, in addition to hearing their testimony and the testimony of any witnesses whom they bring to the hearing. The ALJ also may ask witnesses such as medical or vocational experts to testify at the hearing, discussing the claimant’s condition and the limitations that it imposes on their ability to work. A claimant and their attorney can question any witnesses. The ALJ then will issue a written decision based on their evaluation of the evidence.
A claimant may be encouraged to learn that claims are much more likely to be approved at this stage than during reconsideration. In the late 2010s, over half of the claims that reached an ALJ hearing were approved at this stage.
Appeals Council Review
If the ALJ finds that the claimant is not eligible for benefits, they can appeal this decision to the SSA Appeals Council. This consists of a panel of three members if the claimant wants to present an oral argument, or a panel of two members if they are simply asking the Appeals Council to review the case file. However, a third member will be used as a tiebreaker if a two-member panel is split on whether a claimant is eligible after reviewing the case file. Several things can happen at this stage. The Appeals Council may uphold or reverse the decision by the ALJ. Alternatively, it may modify the decision, or it may order the ALJ to start over with a new hearing.
Federal Court
Finally, if a claimant does not get a favorable decision from the Appeals Council, they can file a lawsuit in a federal court. This is the U.S. District Court for the area where they live. In theory, a claimant who receives an adverse ruling from the District Court could appeal that decision to the U.S. Circuit Court of Appeals above that District Court, but this rarely happens.
