The Social Security Administration (“SSA”) administers two programs: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). Although a detailed discussion of the criteria you must meet to be eligible for benefits under either program is beyond the scope of this article, SSDI is generally for persons who are permanently and totally disabled according to SSA’s definition of disability and unable to work, but have accumulated sufficient work credits from working to be eligible for benefits. SSI is generally for persons who are older than age 65, blind, or disabled.
If you have applied for Social Security Benefits but your application has been denied, you can appeal that the denial, but you must act quickly because you only have 60 days from the date printed on the denial letter to appeal. There are four levels of appeal: (1.) Request for Reconsideration; (2.) Hearing; (3.) Appeals Council; and (4.) District Court. Each of these levels of appeal will now be discussed in more detail.
1. REQUEST FOR RECONSIDERATION
If your initial application for benefits is denied, you can submit a Request for Reconsideration (“RFR”). By submitting an RFR, you are asking SSA to have an agent other than the agent that denied you benefits in the first place review your application. The new agent will completely review your file, as well as any additional information that you submit, such as more recent medical records. Generally, the reconsideration occurs without a hearing, although if you are appealing a denial of benefits because SSA says that you are no longer disabled, you may have to appear before a SSA agent to explain why you are still disabled.
If your RFR is denied, you can request a hearing before an Administrative Law Judge (“ALJ”). Again, you must act quickly, because you only have a limited amount of time to request a hearing. After you request a hearing, SSA may ask you to produce additional information in support of your application for benefits. You may submit additional information, and you may be required to an independent medical, psychological, or vocational examination.
At the hearing, the ALJ will question you, your witnesses, and SSA’s witnesses about your disability and other qualifications for benefits. There may adverse witnesses from or on behalf of SSA who will testify against your claim, but you or your representative will have the opportunity to question those adverse witnesses. After the hearing is concluded, the ALJ will issue a determination of your eligibility for benefits. The ALJ will take into account all of the evidence submitted in support of your application, including your testimony, the testimony of any witnesses on your behalf, the testimony of any adverse witnesses, all of the evidence already in the file, and any additional evidence that you have submitted in support of your application for benefits.
3. APPEALS COUNCIL
If the ALJ denies your application, you may appeal the denial to the Appeals Council. Your case will be reviewed by an Appeals Analyst, who will review all of the information in your file and then make a recommendation to an Appeals Judge or Appeals Officer. The Appeals Judge or Appeals Officer will consider all of the information in your file, the ALJ’s decision, the reasons for the ALJ’s decision, the reasons for the original denial of your application for benefits, and the recommendation of the Appeals Analyst. After considering all of these factors, the Appeals Judge or Appeals Officer will issue a decision either granting or denying your application and explaining the reasons why your application was granted or denied.
4. FEDERAL COURT
The last stage in the appeals process is filing a lawsuit in federal district court. Again, you must file your lawsuit within the period of time listed on your denial letter from the Appeals Council. Very few applicants get to this point, so I won’t discuss it in detail. However, suffice it to say that filing a lawsuit in federal district is an extremely complex and difficult process, and you are well advised to seek out the services of an attorney to represent you.
Applicants for social security benefits frequently ask if they should have an attorney represent them in the application and appeals process. From my perspective, the short answer is yes, for two reasons. First, you typically hire the attorney on a contingent-fee basis of 25% of past-due benefits, or $6,000.00, whichever is less. That means that you don’t pay any money out-of-pocket, except for expenses, and that the attorney does not get paid unless you prevail. Second, the law related to social security benefits is mind-numbingly complex, and you need an attorney to navigate the maze of laws, regulations, and cases that govern social security, apply the law to the facts of your case, put the facts most favorable to you forward, and zealously represent you in your application and at all stages of appeal.
So, you really have nothing to lose by hiring an attorney to represent you. Some people apparently believe that you should apply for social security benefits by yourself the first time, when you do the initial application, but then hire an attorney if your application is denied. I have to disagree with this notion, because you’re better off with an attorney representing you from the beginning. The ultimate attorney fee might be less, but I’d rather see you qualify for benefits sooner After all, the focus is on you, not the attorney.
Baland Law Office, P.L.L.C. represents applicants for social security benefits at all stages of the application and appeals process. Please call (763) 450-9494 to set up an initial consultation to discuss your case and options.