If the Social Security Administration (SSA) decides that you are not eligible for disability benefits, or decides that the amount of your disability benefits needs to change, the agency will send you a notice outlining its decision. You have the right to appeal this decision, and if you disagree with the result of the appeal, you can appeal further to an administrative law judge (ALJ). If you disagree with the ALJ’s decision, you can appeal to the Appeals Council, and finally, if you disagree with the Appeals Council decision, you can appeal to a federal court.
Although the SSA requires you to fill out certain specific forms when you appeal a decision, those forms include a space for you to explain why you think the decision was wrong. The forms only give you a few lines to write your explanation, 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 determination.
Format of Disability Appeal Letter
If you do attach a disability appeal letter, you should include at the top:
- Name of Claimant: [type your name here], and
- Claimant Claim Number: [type your claim number here, which may be the same as your Social Security number].
You should include this information because if your attached letter gets separated from your form, you want the SSA to be able to tell which file the letter belongs to.
Read Your Decision Notice
The first thing you should do when you are getting ready to write an appeal letter is carefully read the notice you received from the SSA that denies your eligibility or reduces the payment amount. This letter will include an explanation of determination, which is sometimes called the disability determination rationale. It is very important to read this rationale, because it may contain a basis for your appeal.
The explanation of determination is supposed to be written in a way that is easily understood. It should not contain complicated medical or technical terms. The explanation should include the following information:
- A description of your medical condition.
- Which impairments the SSA evaluated.
- What sources the SSA used to evaluate your claim. This should include both medical sources (like treating physicians and emergency room visits) and non-medical sources (like family members and social workers).
- Why the SSA denied your claim. For example, the SSA might state that your impairment is not severe enough to prevent you from having a job.
Point Out Missing Medical Information
When you are writing your appeal letter that you will attach to the appropriate SSA forms, look at the information listed above and see if anything is incorrect or missing in your explanation of determination. For example, when the SSA includes what sources were used to evaluate your claim, important medical sources should be listed very specifically, by doctor or hospital name. If you have an important medical source that is not specifically mentioned in your explanation of determination, the SSA probably did not use it as a basis for their determination. You should point out in your appeal letter that you have evidence and records from your doctor that the SSA did not take into account.
Describe Any Mistakes in the Rationale
While you are reviewing the explanation (rationale), note any missing parts, whether those parts include specific medical records, inaccurate descriptions of your medical condition, or a mistake in your education or work history. Point out all of the missing or incorrect information, and submit any statements, records, or other information that makes your claim stronger. Depending on your situation and what information was contained in your explanation of determination, you may want to submit:
- Medical records that the SSA did not take into account that show your symptoms are more severe than the SSA found.
- New medical records that show your symptoms are more severe than what your previous medical records showed.
- A statement from your treating medical doctor where he or she expresses not only that you are disabled, but goes into detail on how he or she came to that opinion and what exactly your limitations are.
- Any new tests that show objective proof of the severity or your condition.
- Any other documentation that supports your claim, such as symptom or pain journals.
If you need more time to obtain some of these new tests or documents, you can let the SSA know that you intend to submit whatever specific type of evidence supports your claim.
Following the Instructions to Appeal
When you receive the decision notice that the SSA has denied your claim or is lowering your payment amount, along with the explanation of determination, there will also be directions on how to appeal. You must follow all of the instructions when you appeal. There are several different forms you may need to fill out, depending on what level of appeal you are at. Follow the directions in the decision notice. (You cannot just send in a letter appealing your claim; you must submit the proper forms with it.)
You must appeal in writing within 60 days of the date you receive the notice. Contact the SSA if you have any questions about appealing the decision.