Social Security appeals

If you are dissatisfied with a decision the Social Security Administration (SSA) makes, you can request a new decision by different parties at the agency. As I have written before, because SSA regulations are so complex, it is not unusual for an agency representative to make a mistake.

Following are some examples of situations in which you can initiate an appeal: Entitlement or continuing benefits Disagreement with the amount of benefits you receive.

Revision of your earnings record Disagreement regarding reduction or termination of benefits

Disagreement regarding disability eligibility

If you wish to dispute a decision, your first step is to contact SSA at 1-800-SSA1213 and request an explanation. If you are dissatisfied with the response, request an appeal, which is called “reconsideration.”

Reconsideration is the first level of appeal, which involves only the initial determinations with which you are dissatisfied. If the issue is the waiver of an overpayment or the cessation of a disability claim, then the first level of appeal is a hearing, which will be subsequently discussed. If the issue is a medical denial of a disability claim, you may file an “iAppeal,” an online alternative to reconsideration. See https://secure.ssa.gov/ iApplsRe/start.

A reconsideration is a new decision made by a new SSA representative. You have the opportunity to review your file and present new evidence or indicate important factors of evidence already submitted.

Issues reviewed in the reconsideration process are not limited to the disagreement. For example, reconsideration might reveal another error to be corrected.

You must request the reconsideration in writing. Based on your request to SSA, you will be provided a one-page form in which to document the disagreement.

The request must be signed and submitted to SSA within 60 days of the initial determination. A postmark before the deadline is acceptable. The time frame for SSA to review the decision can vary between one week to several months.

You will receive a written notice of the determination, which becomes final 60 days after the date of the notice, plus 5 days for mail time. If you are not satisfied with the determination, you or your appointed representative can request a hearing within 60 days of the date of the reconsideration decision.

A hearing is the second level of appeal. Securing a hearing also requires a one-page form in which to state your disagreement. The hearing is similar to a legal proceeding but less formal. The typical venue is a federal courthouse or by a video connection. The presiding judge is an administrative law judge (ALJ) assigned to the hearing. The ALJ works for SSA and makes decisions only on Social Security cases. You have the option to bring experts to support your case.

After the hearing, the ALJ will write a determination, which may or may not be partly or wholly favorable to you. In some cases, the judge may send the case back to a lower level if the judge thinks the earlier procedure was flawed. The hearing decision becomes final 60 days after you receive the written notice, unless you appeal to the Appeals Council. The time frame from request to decision can take several hundred days.

If you disagree with the hearing determination, you can request a review by the Appeal Council. There is a panel of three ALJs near Washington, D.C., who review hearing decisions. It is not necessary for you to attend this review. The only issue this review considers is whether the hearing followed proper procedures. If the Appeal Council finds that there was a procedural flaw, the case is sent back to the original hearing judge for review. However, even if there was a procedural flaw, the eventual decision could still be adverse to you.

If the Appeal Council upholds the hearing decision, it becomes the final decision of the SSA. At this point, the administrative appeals process is exhausted. The only option available to you then is suing in federal court. The time frame for the Appeal Council review can take months to years.

Although you could hire an attorney to represent you in the appeal process, it is not necessary. You can represent yourself or appoint a friend, family member or professional represent you.

Review the appeals process at www.ssa.gov/pubs/EN-05-10058.pdf.

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