People who are unable to work because they have a serious injury or illness may opt to file for Social Security Disability Insurance (SSDI). This program is only available to individuals who have worked and earned enough credits to qualify.
While it may seem as though SSDI would be easily accessible to those who qualify, most people are denied and have to go through an appeal process. Appealing an SSDI denial isn’t an easy process. There are four possible kinds of appeals with each one building off the previous one.
Reconsideration phase
The first step in the appeals process is the Reconsideration phase. This is a complete review of the claim by a new set of eyes at the Social Security Administration (SSA). During this stage, the reviewer will look at all the evidence submitted with the original application and any new evidence. To initiate a reconsideration, claimants must file a request within 60 days of receiving their denial notice.
Hearing by an Administrative Law Judge
If the reconsideration doesn’t result in a favorable outcome, the next step is to request a hearing before an Administrative Law Judge (ALJ). This hearing is more formal than the Reconsideration phase and allows the claimant to present their case in person, or via video conferencing. During the hearing, the claimant and their representative can present evidence, call witnesses and respond to questions from the ALJ.
Review by the Appeals Council
If the ALJ’s decision is still unfavorable, the next recourse is to request a review by the Social Security Appeals Council. The Appeals Council doesn’t have to accept every request for review. It may deny a request if it believes the ALJ’s decision was correct and supported by sufficient evidence. If the Appeals Council decides to review the case, it may either decide the case itself or return it to an ALJ for further review.
Federal Court Review
The final step in the SSDI appeals process is filing a lawsuit in a federal district court. This step is taken if the claimant disagrees with the Appeals Council’s decision, or if the Appeals Council decides not to review their case. This is the last resort and requires the claimant to file a civil lawsuit.
The appeals process is complex and requires swift action because of set deadlines. Working with a legal representative throughout the appeals process may help a claimant to more effectively prove their eligibility so they can get the benefits they need as quickly as possible.