Steps to Appeal a Disability Denial

Step 1: Understand Why Your Claim Was Denied

Before proceeding with an appeal, it's essential to understand the reason your disability claim was denied. The SSA will send you a letter explaining the specific reasons for the denial, which may include:

• Lack of medical evidence showing that your condition meets SSA’s criteria for disability.
• Failure to meet the required work credits for SSDI or income/assets for SSI.
• Your condition does not prevent you from working or engage in substantial gainful activity (SGA).

Knowing the exact reason for the denial will help you address the issue when filing your appeal.

Step 2: Request a Reconsideration

If your disability claim is denied, the first step in the appeals process is to request Reconsideration. During this stage, the SSA will review your case again, taking into account any new evidence you provide. Reconsideration is handled by a different person or team than the one who initially reviewed your case.

How to Request Reconsideration:

• Submit the appeal online through your SSA online account.
• File a request by phone by calling the SSA at 1-800-772-1213.
• File in person at your local SSA office.

You have 60 days from the date you receive the denial letter to request Reconsideration.

Step 3: Request a Hearing Before an Administrative Law Judge (ALJ)

If your claim is denied again after Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). This is your opportunity to present your case in person, and it’s an important stage of the appeal process. The ALJ will review your medical records, work history, and other relevant evidence before making a decision.

At the hearing, you can:

• Testify about your disability and how it impacts your ability to work.
• Present additional medical evidence or witness testimony (such as from doctors, family members, or coworkers).
• Cross-examine any experts presented by the SSA.

Many disability claims are approved at the hearing stage, so it’s essential to be well-prepared and have strong evidence to support your case.

How to Request a Hearing:

• You can request a hearing through your SSA online account.
• Alternatively, you can complete and submit Form HA-501 (Request for Hearing) or call the SSA.

The waiting time for a hearing varies depending on your location, but it can take several months to schedule one.

Step 4: Appeal to the Appeals Council

If the ALJ denies your claim, you can request a review by the Appeals Council. The Appeals Council does not hold a new hearing but will review the ALJ’s decision to ensure it was correct. If they find an error, they can:

• Send your case back to an ALJ for further review.
• Overturn the decision and award you benefits.

The Appeals Council may also deny your request if they find that the ALJ’s decision was correct.

How to Appeal to the Appeals Council:

• You will need to file your appeal within 60 days of receiving the ALJ’s decision.
• Submit the request through your SSA online account or by filling out Form HA-520 (Request for Review of Hearing Decision).

Step 5: Federal Court Appeal

If the Appeals Council denies your appeal or doesn’t review your case, you have the option to file a lawsuit in federal court. This is the final stage in the appeals process, and you should consult with a disability lawyer if you’re considering this option.

At this stage, the federal court will evaluate whether the SSA made a legal error in denying your claim. If they find an error, they can send the case back for further review or approve benefits directly.

Tips to Strengthen Your Appeal

• Gather additional medical evidence: If the SSA denied your claim due to insufficient medical evidence, make sure you provide updated records, letters from doctors, or additional medical opinions.
• Work with a disability lawyer: An experienced lawyer can guide you through the appeals process, help gather evidence, and represent you at hearings.
• Be thorough and detailed: Ensure that all information, including your medical history and work limitations, is clearly explained and supported by evidence.
• Act quickly: Be mindful of the deadlines for each appeal stage. Missing a deadline could result in the loss of your right to appeal.