Social Security Disability Denied? How the Appeal Process Works
This guide is general information, not legal advice. Laws differ from state to state and change over time. For advice about your situation, talk to a licensed lawyer in your state.
Many applications for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are denied the first time. A denial is not the end. The Social Security Administration (SSA) has a multi-step appeal process, and many people are approved at a later stage.
SSDI and SSI: the difference
- SSDI is for people who worked long enough and paid Social Security taxes. Benefits are based on your earnings record.
- SSI is a needs-based program for people with limited income and resources, whether or not they have a work history.
Both use the same basic definition of disability for adults: a medical condition that prevents you from doing substantial work and has lasted, or is expected to last, at least 12 months or result in death.
Why claims are denied
- Not enough medical evidence, or records that do not describe your limitations
- Earning above the “substantial gainful activity” limit
- SSA believes you can do your past work or other work
- Not following prescribed treatment without a good reason
- Missing forms or consultative exams
The appeal levels
- Reconsideration: a different examiner reviews your claim, including any new evidence.
- Hearing before an administrative law judge (ALJ): you can testify, bring witnesses and submit more evidence. Many claims that were denied earlier are approved at this stage.
- Appeals Council review: the Council can review the judge’s decision and approve, deny or send the case back.
- Federal court: you can file a lawsuit in U.S. District Court.
The deadline: 60 days
At each level, you generally have 60 days from the date you receive the decision to appeal. SSA assumes you received the letter five days after the date on it unless you show otherwise. If you miss the deadline, you may have to start over with a new application, which can cost you months of back pay. You can usually appeal online at ssa.gov.
If you appeal within 10 days of a decision stopping your existing benefits, you may be able to ask for benefits to continue during the appeal.
How to strengthen your appeal
- Keep getting treatment. Regular medical care creates the records your case depends on.
- Ask your doctors for detailed opinions about your specific limitations, such as how long you can sit, stand, lift or concentrate.
- Submit all relevant records, including mental health treatment, therapy and test results.
- Keep a symptom diary describing how your condition affects daily life.
- Be consistent and honest in forms and testimony.
Getting help: representative fees
You can have a lawyer or qualified non-attorney representative help with your claim at any stage. Fees in Social Security cases are regulated by law. In most cases, the representative is paid only if you win, through a fee approved by SSA that is generally limited to 25% of your past-due benefits, up to a maximum dollar amount set by SSA. You do not usually pay anything upfront for the representative’s time.
A disability lawyer can gather medical evidence, prepare you for the hearing, question vocational experts and make legal arguments to the judge. Representation is especially valuable at the hearing stage.
Find a Disability lawyer near you
Browse Disability lawyers on NearLawyers, or choose your state to see lawyers grouped by city. You can also search by legal issue and location from the home page. Searching and contacting lawyers through NearLawyers is free.
