Step 1: Understand the Reason for the Denial

Before starting the appeals process, carefully review the denial letter or notice you received from the SSA. The letter will explain why your SSI claim was denied or reduced. Common reasons for a denial include:

• Income or resources exceeding SSI eligibility limits.
• Failure to meet disability criteria: If the SSA determined that you are not disabled according to their rules.
• Insufficient medical evidence to support your disability claim.
• Failure to follow SSA instructions or missing deadlines.

Knowing the specific reason for the denial or disagreement will help you address the issue effectively during the appeals process.

Step 2: Request Reconsideration

The first step in appealing an SSI decision is to request reconsideration. This is a review of your case by someone who was not involved in the original decision. To request reconsideration:

• File a request: You have 60 days from the date you receive the denial notice to request reconsideration.
• How to request: You can request reconsideration online through your SSA account, by calling the SSA at 1-800-772-1213, or by visiting your local SSA office.

During reconsideration, the SSA will review the medical evidence, financial information, and any other documents you submit. If additional medical evidence is available, now is the time to provide it. Be sure to include any new or updated documentation that supports your claim.

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

If your reconsideration is denied, the next step is to request a hearing before an Administrative Law Judge (ALJ). A hearing allows you to present your case in person and provide additional evidence to support your claim. The ALJ will listen to your testimony, review your case, and make a new decision.

• How to request a hearing: You must request the hearing within 60 days of receiving the reconsideration denial.
• Prepare for the hearing: The hearing is an opportunity to explain how your disability prevents you from working and how it affects your daily life. Be ready to present:
• Your medical records.
• Testimony from medical professionals or specialists who can explain the severity of your condition.
• Any other relevant documentation that can support your claim.

You are allowed to bring witnesses, such as family members, friends, or professionals, who can testify on your behalf.

Step 4: Appeal to the Appeals Council

If the ALJ denies your claim, the next step is to appeal to the Appeals Council. The Appeals Council reviews the ALJ’s decision to ensure that it was made correctly based on the law and facts. The Council will not hold a new hearing but will review the case and can either:

• Approve your claim: If they find that the ALJ made a mistake, they may overturn the decision and approve your benefits.
• Send the case back to the ALJ: If the Appeals Council finds that there were issues with the ALJ’s decision, they may send the case back to the ALJ for further review.
• Deny the appeal: If the Council agrees with the ALJ’s decision, they may deny the appeal.
• How to request an Appeals Council review: You must request the review within 60 days of receiving the ALJ’s decision. You can submit your request online, by mail, or by visiting your local SSA office.

Step 5: Take Your Case to Federal Court

If the Appeals Council denies your claim or refuses to review it, your final option is to file a lawsuit in federal district court. A federal judge will review your case to determine if the SSA made a legal error in their decision. Keep in mind that this is the last step in the appeals process, and it’s generally best to consult with an attorney before proceeding to court.

• How to file a lawsuit: You must file your lawsuit within 60 days of receiving the Appeals Council’s decision. A disability lawyer can help you with this step and guide you through the process.
• What happens in court: The judge will not reconsider the facts of your case but will evaluate whether the SSA made an error in applying the law. If the judge finds in your favor, they may order the SSA to approve your claim or send it back to the SSA for further review.

Step 6: Gather Additional Evidence

Throughout the appeals process, it’s important to continue gathering medical evidence and any other documentation that supports your claim. If your condition has worsened or you’ve received additional treatments, make sure the SSA has up-to-date information.

• New medical records: Updated records, test results, or additional doctor’s statements can strengthen your case.
• Personal testimony: In addition to medical evidence, personal testimony about how your disability affects your daily life can help the ALJ or Appeals Council understand the full impact of your condition.

Step 7: Consider Getting Legal Assistance

The appeals process can be complex, and having legal representation can improve your chances of success. A Social Security Disability attorney can help you:

• Understand the process: Guide you through each step of the appeals process and explain the legal requirements.
• Prepare your case: Assist with gathering the necessary medical and financial evidence, as well as preparing witnesses and supporting documents.
• Represent you at the hearing: A lawyer can attend your hearing, present your case, and cross-examine witnesses, which can significantly improve your chances of success.
• Handle the Appeals Council and federal court: If your claim continues to be denied, an attorney can help with further appeals and take your case to federal court if necessary.