Social Security Disability Insurance (SSDI) provides important financial assistance to persons who have been disabled by an injury or illness. Unfortunately, the vast majority of SSDI benefit applications are denied at the first level of administrative review. Persons with severe conditions are forced to resort to the SSDI appeals process, a four-step administrative process that becomes more complex with each step. Nevertheless, a basic knowledge of the process can help turn many denials into approvals.
Request for reconsideration
An appeal can be commenced by filing a written request for reconsideration. The request must be addressed to the nearest office of the SSA and must be sent within 60 days after the initial decision denying the application is filed. The request must explain why the original decision was wrong. The petitioner may submit additional evidence to support the application.
Hearing with Administrative Law Judge
If the applicant disagrees with the decision on the request for reconsideration, the next step is a hearing before an administrative law judge (ALJ). The hearing will be scheduled at a place and time that is convenient for the applicant.
An ALJ, who is as attorney with special training in SSDI medical and legal issues, will take testimony from the applicant, the applicant’s physician, and other witnesses with knowledge of the case.
The ALJ will take testimony and review documentary evidence before rendering a decision. This hearing affords the applicant the most favorable opportunity to reverse the initial denial of the application for benefits. The applicant may offer evidence that was not available at the initial proceeding.
Appeals Council review
The ALJ may render an opinion that is contrary to the applicant’s position, in which case the applicant can seek review from the agency’s Appeals Council. The Appeals Council is the highest level of review within the Social Security system hierarchy. The Appeals Council’s main job is to ensure uniformity among the decisions made by the SSDI team of ALJs. If the ALJ affirms the unfavorable ruling of the ALJ, the applicant has 60 days to seek review before the federal judge which has jurisdiction over the case.
Federal Court Review
If all lower levels of administrative review affirm the original denial, the applicant can seek review by a federal district judge by filing an appeal within 60 days of the decision by the Appeals Council. The judge will consider all of the evidence submitted to the SSDI staff and the ALJ. A lawyer at this stage of the proceeding is both necessary and very helpful. A knowledgeable attorney can be a powerful ally in seeking to overturn the adverse administrative decisions produced by the administrative decisions of the SSA bureaucracy.
