Many deserving claims for Social Security benefits are initially denied, only for a claimant to receive benefits after an appeal. The appeals process involves several possible steps. First, the claimant can file a request for reconsideration. This is an informal review by the same Social Security office that reviewed the initial claim.
If the office affirms the denial, the claimant can arrange a hearing before an administrative law judge. The ALJ will not be affiliated with the local Social Security office and will bring a fresh perspective to the case. Afterward, a claimant can appeal to the Social Security National Appeals Council, which is based in Washington, D.C. If they still do not receive benefits and believe that they are eligible, they can take their case to federal court.
Deciding Whether to Appeal
You should review the grounds on which your claim has been denied to determine whether you should appeal. If the denial is legitimate, there is no reason to appeal. However, if you feel that Social Security misinterpreted the application or misapplied its rules, you should consider an appeal. Social Security typically reviews an initial claim very strictly, and a high percentage of denied claims are reversed on appeal. Denials of disability benefits are appealed more often than denials of retirement benefits, since the standard of eligibility is more complex and subjective. Almost half of these denials are eventually reversed.
You will have 60 days to appeal once you receive notice of a denial, or 65 days if you received notice of the denial by mail. Filing an appeal may involve submitting additional information that will clarify your eligibility for benefits. You should focus on the reason why your claim was denied and try to find new evidence to address that issue. Evidence from a third party, such as a doctor or an employer, may be especially useful. If there is no new evidence that would bolster your case, you can present the same evidence, accompanied by a stronger argument for why you are eligible. A Social Security attorney can help you decide whether to present new evidence and how to reshape your arguments.
Sometimes the Social Security Administration will grant benefits initially, only to stop or reduce them later. You can appeal this type of decision through the same process.
Forms Used in Appeals
The form for a request for reconsideration of an initial claim is Form SSA-561-U2. You also will need to complete Form SSA-3441-BK if you were making a claim for disability benefits. A situation in which the claimant is appealing the cessation of benefits requires completing Form SSA-789-U4, as well as Form SSA-3441-BK if your disability benefits were stopped.
The forms are fairly straightforward, giving a claimant a chance to explain why they believe that the denial or cessation of benefits was unjustified. They also will need to provide their Social Security number and other identifying information. A claimant will need to attach any additional evidence to the form if it was not included in their initial claim. You can access these forms online or at your local Social Security office.