Most people who apply for social security disability (SSD) or SSI benefits (about 70 percent) are denied on their application and must choose to either resubmit their claim or to appeal the decision of the disability examiner in their case.
In just about every instance, it makes more sense for a disability claimant to appeal their case rather than filing a new disability claim (the exception to this rule is when their case has been refused on a technicality, such as too much monthly income or assets, and then only if this issue has changed since the initial filing). This is because each time a claim is appealed its chances of approval increase.
All disability appeals, both SSD and SSI, are evaluated in the same state agency that makes disability determinations on the first claim for the federal social security administration. This agency is called disability determination services (DDS) in most states, although its name may vary slightly from state to state.
The appeals process for Social Security disability and SSI includes several levels. After the first round when the claim is denied, the majority of states offer a chance at what is termed reconsideration. This must be requested formally within sixty days of the denial date. As the procedure is complex, it is highly advisable to enlist the services of an experienced disability refusal lawyer.
The most important thing to recognize with disability claims is that the decisions will be made based upon the information that has been provided. Therefore, claimants need to know what’s in the file and have their own copies available. This is where having a lawyer on the case is very beneficial since they understand how the law works and what is necessary to establish and win the claim.
In order to respond to requests, claimants must understand their medical condition, what it entails and what doctors have reported. There is also a detailed work history and other data that Social Security and any disability claim will require. For example, claimants must have this information at hand so that when it is requested it can be supplied correctly. Otherwise, claims could drag out much longer than they need to or even continue to be refused.
Request Appeal on Time
After every decision, you have only 60 days to submit your appeal in writing. If you wait more than 60 days to request an appeal, your appeal will probably be dismissed. At the very first three levels of appeal (reconsideration, ALJ hearing, and Appeals Council review), you have to file your appeal by submitting specific forms. You can find these forms on the SSA website or by stopping by your local Social Security office.
Write an Appeals Letter
The Social Security forms for appealing a decision give you just a few lines to write your explanation on why you think the decision was wrong, but you should feel free to write the phrase “see attached page” on the form and submit a letter along with the form that carefully outlines the problems you see with the conclusion.
The denial letter you received from the SSA that denied your eligibility for benefits will include an “explanation of determination,” which is sometimes called the “impairment determination rationale.”
This explanation of decision will include issues such as what sources the SSA used to evaluate your claim, why the SSA denied your claim, what impairments the SSA evaluated, and a description of your medical condition. If anything is incorrect or missing in your explanation of conclusion, include this in your letter to the SSA. Also submit any statements, records, or other information which makes your claim stronger.
Strongly consider hiring an attorney
The better organized your claim is, the better your chances of a swift and favorable decision. Being represented by an attorney from the beginning will reduce your stress level and will increase your chances of winning the highest possible award at the earliest possible date.
By law, all attorneys’ fees are subject to acceptance by the Social Security Administration. Many lawyers charge the same fee for all work up to the first hearing, no matter when they get involved: 25% of any back due to benefits.
Involve your doctor
For a successful claim, your physician should provide you with a letter detailing how your medical conditions limit your ability to return to work and to do everyday activities. Many physicians are reluctant to involve themselves with the paperwork you require for a successful claim, but if you have an attorney, he or she should make sure that your medical records are clear and complete. The advice your doctor provides will have a huge impact on your claim.
Submit All New Medical Evidence
Should you have new medical evidence, such as physician’s records of recent medical exams, submit it to the Office of Adjudication and Review well before the hearing. The ALJ will want to see current medical records no more than 60-90 days old.
New medical evidence that is submitted in advance of the hearing will be reviewed by the Administrative Law Judge (ALJ) before the hearing. Many ALJs like to have the opportunity to review the new information before the hearing so they can come up with and ask questions about the brand new evidence in the hearing. If it’s really not possible to submit the new medical evidence before the hearing, you can bring it with you to the hearing (this is better than not submitting it all).