Once you have sent in your application for SSI or SSDI, the Social Security Administration (SSA) will mail you a written decision, called the initial determination. If you have not already been receiving SSI or SSDI, your initial determination will state the SSA’s decision on whether or not you are eligible for disability and if you are, how much your monthly payments will be. If you disagree with either of those decisions, you have the right to appeal.
If you already have been receiving SSI or SSDI, you may receive a decision letter if the SSA believes you have been paid too much or if you are no longer eligible for disability. The decision letter will also state how much you have been overpaid and whether or not you have to repay that amount. If you disagree with any of those decisions, you can appeal.
After any 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 be dismissed in most cases. If you have a good reason for waiting more than 60 days to request an appeal, you should explain the reason why you are late and ask for an extension.
If you do not agree with the SSA’s decision in your initial determination, you can request that the SSA "reconsider" their decision. This is the first step in the appeals process. Your claim will be reviewed by a claims examiner (not a judge) who was not involved in your initial determination.
If you have any new evidence that was not submitted with your original application for disability, you should submit that evidence along with your request for reconsideration. All the evidence you submitted with your original application will be looked at again, along with any new evidence you submitted with your request for reconsideration.
In most situations, you are not seen in person when your claim is reconsidered. In some situations, however, you can meet with a Social Security representative. For example, if you are already receiving disability and your decision letter stated that you were no longer eligible for disability because your medical condition improved, you could meet with someone from the SSA and explain why you think you are still eligible.
If you do not agree with the SSA’s reconsideration decision, you can appeal it by requesting a hearing in front of an administrative law judge (ALJ). If you do not want to make a personal appearance at the ALJ hearing, when you request your hearing, you can ask the ALJ to make a decision based on the evidence in your file. This is called an "on-the-record" decision.
ALJ hearings are informal. The hearing will not be held in a courtroom, but will probably be in a room like a conference room. ALJ hearings are recorded.
The administrative law judge may ask witnesses to come to the hearing, and both you and the ALJ can ask the witnesses questions. The ALJ may also ask you questions and you may present new evidence. If you do have new evidence, you should try to submit it with your request for a hearing. If you receive new evidence after you request a hearing, you should submit it to the Office of Adjudication and Review (ODAR) as soon as possible.
The next level of appeal is the appeals council. The Appeals Council looked at every appeal that comes in, but the Appeals Council does not always grant requests for review. If the Appeals Council decides the ALJ’s decision was correct, it will deny your request for review, and the ALJ’s decision will stand as it is. In that case, you will receive a letter from the SSA explaining the denial.
If the Appeals Council does decide to review your case, it may decide the outcome of your claim itself or it may send your case back to an ALJ for additional review. The SSA will send you a copy of the decision if the Appeals Council decided your case itself, and if the Appeals Council sends your case back to an ALJ, the SSA will let you know that as well.
If you disagree with the decision of the Appeals Council, you can file a lawsuit with the appropriate federal district court. The court will review your claim, including all of the evidence and the prior decisions, but the court will not hold a hearing.
At the first three levels of appeal (reconsideration, ALJ hearing, and Appeals Council review), you must file your appeal by submitting specific forms. You can find these forms on the SSA website at www.ssa.gov or by stopping in to your local Social Security office. You can also call the SSA and a representative will assist you with appealing at the first three levels. The SSA cannot assist you in filing a suit in federal district court.
You have the right to hire someone to help you with your appeal, and it is common for people to do that. Many communities have attorneys or other representatives through legal aid services who will work with you to make sure you get the benefits you are eligible for. If you have requested an ALJ hearing, it makes sense to have a lawyer at the hearing with you. And you should also not hesitate to call the Social Security office and ask them questions at any stage in the process.