Only about one-third of Social Security disability claims are approved at the initial level. Read the denial notice you receive from Social Security carefully — it will tell you what you need to do. Generally, here are the next steps to take:
1) File an appeal right away!
If you are denied benefits at the initial level, you should appeal as soon as possible (within 60 days of the date on the denial notice). In most states, you do this by filing a special form called a Request for Reconsideration (all states will have the Reconsideration phase by June 26, 2020).
2) Request a hearing before an Administrative Law Judge (ALJ)
In the Reconsideration phase, your claim will be reviewed a second time. If you are denied at this phase, you must file a request for an ALJ hearing to appeal.
Learn more about Social Security hearings.
3) Request review by the Appeals Council
If your claim is denied at the ALJ hearing stage, you have the right to appeal to Social Security’s Appeals Council. The Appeals Council reviews hearing decisions, and has the power to “remand” or send cases back to judges when they make mistakes. It also reverses decisions in a small share of cases. It can take about a year to get a decision from the Appeals Council.
If your claim is still denied at this level, you can file an appeal in Federal Court.
4) Get help!
You have the right to representation. Consider getting help from a Social Security disability attorney or representative — the sooner the better.
NOSSCR offers a referral service with experienced Social Security disability attorneys around the country. Click here to learn more.
When a claim for Social Security disability benefits is denied at the initial level, the next step for a claimant in most states is to request “Reconsideration,” or a re-evaluation of their case. The case is then reviewed a second time and a new decision is made. Unfortunately, in nearly 90% of the cases, the reconsideration decision is the same as the initial decision—a denial.
In most case Social Security makes the reconsideration determination within four months.
Processing time varies by hearing office. Nationally, the average processing time for an ALJ hearing in 2017 is 595 days.
About a year, maybe longer.
While tens of millions of Americans live with disabilities, Social Security disability benefits are restricted to individuals with the most severe disabilities and illnesses. Individuals who are unable to do “substantial gainful activity” (defined as gross earning of $1,220 per month in 2019 for non-blind individuals) due to one or more severe mental and/or physical impairments may be eligible for Social Security disability benefits. Social Security wants to make sure that everyone who receives disability benefits meets Social Security’s definition of disability — a process that typically requires a review of extensive medical and other evidence.
Social Security has different, often stricter requirements for determining disability. While it will consider your doctor’s opinion or the decisions made by other agencies, Social Security must make its own decision of whether you meet the disability standard for Social Security disability benefits.
Many Social Security disability claimants become frustrated with claim delays and eventually ask their U.S. Representative or Senator to help. The local Congressional office typically will have staffers who are experienced with Social Security procedures and personnel. A “Congressional Inquiry,” as it is called, may help to get a stalled process moving again. However, a Congressional Inquiry will have no impact on how Social Security decides the outcome of the case.
Adapted from a publication from Charles T. Hall, Esq., NOSSCR Past President.