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  4.  » Understanding the SSDI appeals process

Understanding the SSDI appeals process

On Behalf of | Nov 14, 2022 | delayed and denied insurance claims, long-term disability insurance claims | 0 comments

The Social Security Administration (SSA) readily admits that most first-time applications for Social Security Disability Insurance benefits (SSDI) are denied. However, the regulations promulgated by the SSA specify several different levels of appeals that are available to applicants

The first step: request reconsideration

The first step in the SSA appellate procedure is a request for reconsideration. The request can be made by mail or online at the SSA website.

A reconsideration is a complete review of the file, including all medical evidence, by a person who was not involved in reviewing the initial application.

A request for reconsideration can be based on one of several grounds: error in interpreting medical information or a denial due to income resources or living arrangements. New evidence may be submitted with a request for reconsideration.

Hearing by an administrative law judge

The next step in the appellate procedure is a request for a hearing before an administrative law judge (ALJ). An ALJ is a lawyer who has been trained in the rules that govern SSDI cases.

The ALJ will review all evidence submitted, including oral testimony by the applicant, the applicant’s health care provider, and any other witnesses with relevant testimony. While an in-person hearing is probably the most persuasive method of presenting new evidence, the hearing may be held on-line and at a place that is convenient for the applicant.

Review by the Appeals Council

The Appeals Council is the highest level of internal review provided for SSDI claims. If the claim is denied by the ALJ, the applicant can file a request for review by the Appeals Council.

The Appeals Council has the power to accept the file for review or deny review at the outset. If the Appeals Council accepts the case for review, it may decide the decisions below were in accord with SSA law and regulations. The Appeals Council may also issue a new decision or return the file to an ALJ for further action.

Federal court review

If the Appeals Council affirms the denial of benefits, the applicant can seek review of that action by filing a lawsuit in federal court in the district where the applicant lives.

A lawyer can be helpful at any stage in the process, and is a necessity at the federal court stage. Given the relative complexity of the SSA appeals process, the claimant may wish to retain a lawyer with experience in the SSDI process before filing a request for reconsideration.