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Appeal Questionable Social Security Administration Decisions

Are you interested in appealing a decision made by the Social Security Administration (SSA)? You have the right, but certain steps must be followed.

Is it worth filing an appeal? Definitely, because approximately half of appeals of Social Security disability benefit denials are successful.

You must make an appeal request in writing within 60 days from the date you receive a letter from the agency. (The SSA assumes you receive the letter five days after the date listed on it, unless you can prove you received it later.)

There are four levels of appeal:

Level 1: Reconsideration

A reconsideration is a complete review of your claim by someone who didn’t take part in the first decision. The SSA looks at all the evidence submitted when the original decision was made, plus any new evidence you may have.

Most reconsiderations involve a review of your files without the need for you to be present. But when you appeal a decision that you are no longer eligible for disability benefits because your condition has improved, you have a choice of a file review or meeting with a Social Security representative to discuss your case. You can meet with a disability hearing officer and explain why you believe you still have a disability.

Level 2: Hearing

If you disagree with the reconsideration decision, you can ask for a hearing.These hearings are conducted by an administrative law judge who had no part in the first decision or the reconsideration of your case. The hearing is usually held within 75 miles of your home. The administrative law judge will notify you of the time and place of the hearing.

You and your representative, if you have one, may come to the hearing and explain your case in person. You may look at the information in your file and give new information.The administrative law judge will question you and any witnesses brought to the hearing. You or your representative also may question the witnesses.

It is usually to your advantage to attend the hearing. If you don’t wish to do so, you must tell the SSA in writing that you don’t want to attend. Unless the administrative law judge believes your presence is needed to decide the case, he or she will make a decision based on all the information in your case, including any new information given.

After the hearing, the SSA sends a letter and a copy of the administrative law judge’s decision.

Level 3: Social Security’s Appeals Council Review

If you disagree with the hearing decision, you can ask for a review by Social Security’s Appeals Council.This Council looks at all requests for review, but it can deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it can either decide your case itself or return it to an administrative law judge for further review. You will receive a copy of the Appeals Council’s decision or order sending it back to an administrative law judge.

Level 4: Lawsuit

Finally, you may file a lawsuit in a federal district court if you disagree with the Appeals Council’s decision or if the Appeals Council decides not to review your case.

You can appoint your attorney, elder care adviser, or other professional to represent you in Social Security appeals.

Request Continued Benefits

In some cases, you can ask the SSA to continue paying benefits while the agency decides on the appeal, including when:

      • You are appealing a decision that you are no longer eligible for Social Security disability benefits because your condition has improved.
      • You are appealing our decision that you are no longer eligible for SSI payments or that your SSI payment should be reduced.

If you want benefits to continue, you must inform the Social Security Administration within 10 days of the date you receive the decision letter. If your appeal is turned down, you may have to pay back any money you weren’t eligible to receive.

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The information contained on this website is for informational and educational purposes only and is not legal, tax or financial advice. Always consult a qualified licensed attorney and/or appropriate professional to provide advice for your individual needs and circumstances. Use of this website does not create or constitute an attorney-client relationship. This website may include advertising material for Perkins & Zayed, P.C., The Estate and Trust Law Group.