Social Security Disability appeal process: Steps to file an SSA appeal.
Many people who apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) do not receive disability benefits the first time they apply. The Social Security Administration (SSA) reviews every application, but denials are common and in most years the majority of applications are denied. Applicants can take specific steps appeal these decisions, no matter the reasoning for the denial. This article explains how the disability appeal process works and what options are available if disability benefits are reduced, stopped, or denied.
Always keep in mind that denial, whether the 1st time or subsequent applications, does not mean the end of possible benefits. As applicants have the right to appeal each as there are multiple levels of appeal. Each step of the process also has its own deadlines and requirements.
What exactly is denial of disability from the Social Security Administration
A denial notice must give the details the causes of the denial and explain why benefits were refused. The notice also may be used to explain appeal rights and deadlines as it is a regulated process with deadlines as well as steps to follow.
You have 60 days to appeal, which means it is advised to start appeal process as soon as possible. The SSA assumes you received the notice 5 days after the date on the letter, giving you a total of 65 days from the letter date to ensure your appeal is received. Note that missing the deadline can cause the claim to close permanently.
Common reasons why disability benefits are denied
Applications can be denied by the Social Security Administration for many reasons. A written notice sent to you at the time of denial should identify the reason. Some of the more common reasons often include technical “reasons” (which contains information on your medical condition), the agency may say there are still some types of jobs you can do, or there could be a non-medical reason. Some of the more common non-medical reasons for denial often include the following.
- One non-medical reason is that your income or work activity is too high under the substantial gainful activity rules. This issue is most common denial with SSDI claims that involve recent work as the benefit is focused on helping low-income households. It can also affect SSI when earnings or other income reduce eligibility.
- Another non-medical reason for a denial is missing information. Forms may be incomplete or other issues may be medical sources may not be listed or even administrative deadlines may be missed during the application stage.
- Another non-medical reason is failure to cooperate with requests. This can include not attending a scheduled consultative examination. It can also include not providing records that Social Security requested.
- A medical denial can occur on a disability application when the evidence does not show a condition that meets the duration requirement. Social Security generally requires that an impairment is expected to last at least twelve months or result in death and short-term conditions usually do not qualify.
- Be sure to listen to your medical providers. As denials can be the applicant did not follow prescribed medical treatments, without an acceptable excuse.
- A medical denial can also occur when treatment records do not show functional limits in a clear way. A diagnosis alone is often not enough to get approved for benefits. Records usually need to show symptoms, limitations, and how the condition affects basic work activity.
- Disability payments can be denied or stopped for certain criminal justice reasons under Social Security rules. These situations depend on the specific status and the benefit type.
- Benefits can also be terminated when Social Security finds fraud or dishonest actions connected to the claim or the application process. Those cases often involve additional procedures and overpayment issues.
Even when an initial claim was denied, an appeal is often the next step when deadlines can be met and medical evidence can be strengthened. The success of an appeal depends heavily on complete records and consistent treatment history.
How to appeal social security disability application
Here is a quick-reference table you can use to help understand the process and where you may be.
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Level
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What Happens
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Likelihood of Change
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1. Reconsideration
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A new reviewer looks at the same file + any new evidence.
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Low (Most are denied again
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2. ALJ Hearing
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You present your case to a judge (in-person or video).
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Highest chance of approval
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3. Appeals Council
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They review if the judge made a legal error.
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Rare (Mostly "Remands" for a new hearing)
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4. Federal Court
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A lawsuit is filed against the SSA
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Last resort; requires a lawyer.
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The appeal process can be slow, complicated in navigating the bureaucracy and it can be paperwork heavy. Some people choose to use a representative to help them. Representatives can include attorneys and qualified non-attorney advocates. If you take this approach then be sure to review any contracts closely before entering into an agreement with a representative. Be wary of unfair contracts or scams (look to our comprehensive guide on common scams to be aware of) and any fee agreement should be reviewed carefully before it is signed.
Social Security allows appeals to be filed online for many claim types, or, if you prefer paper forms can also be used. The online appeal entry point for appealing disability denials is at https://www.ssa.gov/apply/appeal-decision-we-made.
If an application was denied for medical reasons, Social Security usually requires updated details from your medical provider(s). This often includes recent treatment notes, test results, imaging reports, and the names of medical providers but the specific will vary based on case. A Disability Report for the appeal is commonly required and the SSA has a list of forms at this link https://www.ssa.gov/forms/ssa-3441.html.
A first-level appeal is often a request for reconsideration. This is a new review of the claim by someone from the Social Security Administration who did not make the first decision. The request can be made online or by form and a common form is the Request for Reconsideration is at this site https://www.ssa.gov/forms/ssa-561.html.
Some claims are denied for non-medical reasons as noted above. In those situations, calling Social Security can clarify what correction or appeal is needed. The national phone number for SSA is 1-800-772-1213 with the TTY: 1-800-325-0778.
Appeal process at a disability hearing
A hearing request is the next step after a reconsideration denial in many disability cases. A hearing allows the applicant’s situation to be presented to an Administrative Law Judge. Hearings about the appeal may be held in person, by video, or by telephone, depending on scheduling, location and office practices among other factors. The request is usually due within sixty days of the reconsideration denial but the timing may change.
A common hearing request form is listed here, which is the Request For Hearing By Administrative Law Judge at https://www.ssa.gov/forms/ha-501.html.. Social Security also lists the additional forms that are often required with a hearing request.
During a hearing, the judge reviews the medical file, application and other evidence. The judge may hear testimony from the claimant and a representative or even a vocational expert at the discretion of the judge. In some hearings a medical expert is also used. The role of these experts is to address work capacity and medical limits using the evidence in the record.
As indicated, at this stage it is common for people to use a representative for the disability appeal. A major reason why is the process to appeal is often burdensome and challenging for many people to navigate. A representative (disability advocates, etc.) may help by gathering records and submitting evidence in the format Social Security expects. A representative, some of whom may be a disability lawyer, may also help prepare testimony and address vocational issues raised at a hearing.
Representation fees (or how much a representative can charge a client) in Social Security cases are limited by federal rules. Under the fee agreement process, the fee generally cannot exceed twenty-five percent of past-due benefits, and it also cannot exceed the maximum dollar amount set by Social Security for that period. Social Security lists the current maximum dollar limit and the fee agreement rules at https://www.ssa.gov/representation/fee_agreements.htm.
When appealing a claim, medical evidence is central and be sure you need to have a substantial amount of medical evidence from approved professionals. Records that are often needed include office visit notes, hospital records, mental health treatment notes, test results, and medication history. Functional information is also important. This includes limits on standing, walking, lifting, concentration, pace, and attendance, when those limits are supported by treatment records.
Work history and education history are also considered during the hearing and appeal process. Social Security reviews prior job duties and job demands. It also reviews whether a person can perform past work or other work based on the full record.
Even after going through this process, there is no guarantee to success. If a claim to get disability is still denied after a hearing, the next step can be Appeals Council review. The Appeals Council does not usually take new testimony from the applicant or their representative, rather it reviews whether the hearing decision followed Social Security rules and whether key evidence was handled correctly. The Appeals Council request can be filed online or by form. A common form is the request for review is at https://www.ssa.gov/forms/ha-520.html.
If the Appeals Council does not grant relief and approve the applications, a final option can be filing in federal court within the allowed time. That step is outside the Social Security administrative process and it is handled through the court system.
Note, in some cases, the Social Security Administration reduces or stops benefits after approval. This can occur during a continuing disability review. It can also occur when work or household earnings are reported. This further review that leads a benefits being stopped can also occur when Social Security believes medical improvement has occurred. Those decisions can be appealed and the deadlines are still strict.
Applicants must report changes in work, income, or health as they apply for disability.. If Social Security reviews a case and benefits are threatened, updated medical evidence is usually needed to show that the condition has not improved, or that limits remain severe. If the government were to reduce or cut your social social security payments or benefits are stopped, the appeal should be filed on time to preserve rights under the notice.
Additional contact information for SSA offices for help
Most local Social Security Administration offices and the official SSA website provide forms as well as other instructions for appeals. Some of the key resources include the following.
File a appeal online at https://www.ssa.gov/apply/appeal-decision-we-made.
In person and local offices can also provide customer support. Visit or call the main Social Security office at 1-800-772-1213 (TTY: 1-800-325-0778)
Field office staff, using the Social Security Administration find an office link at https://www.ssa.gov/locator/, can help with general questions but cannot represent applicants. Applicants may also contact local legal aid programs for free or low-cost assistance.
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