What Should You Not Tell A Disability Doctor
The last thing you want to do during a Disability medical exam is exaggerate your condition. Dont say you have pain everywhere or try and make your condition look worse than it really is. The doctor and staff will observe you arriving at the office, entering the exam room, and getting on and off the table.
The Different Levels Of Appeals
There are four levels of appeals available to you. They are:
- A hearing in front of an Administrative Law Judge
- Appeals Council Review
- Federal Court
The SSA may be able to help you with the appeals process up to the point where you file a civil lawsuit in federal court. At that point, the SSA will only give you information about the process.
What Is The First Step In Filing An Appeal For Social Security Disability Insurance
If you receive a denial notification for your social security disability claim, not all hope is lost. According to the SSA website, the first step in an appeal for Social Security Disability Insurance is known as reconsideration. Reconsideration involves a complete review of your file by another individual that was not a part of the first determination cycle.
Requesting reconsideration can be done through the SSA site, by phone, or in person, but it is first necessary to study the denial letter provided and determine if the reasons stated were medical in nature or non-medical.
A number of additional documents may be helpful to submit with your appeal, including:
- A letter from your physician
- Any previously missing key documentation
- Documented visits to physicians and medical facilities, treatments, tests, and medications
Medical reasons for being denied Social Security Disability Benefits may include an assessment by SSA that your disability does not qualify for coverage. In this instance, it may be helpful to provide further evidence that your disability is serious enough to require the distribution of benefits. Having your physician write a letter detailing the extent of your disability may be useful for patients who have been denied benefits for medical reasons.
Even for people who have disability conditions that result in good days and bad days, following their doctors instructions every day may aid them in pursuing disabilitybenefits.
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Social Security: Ssd/ssi Appeals Reconsiderations Hearings
As of March 17th: All local Connecticut Social Security offices will be closed to the public for in-person service until further notice due to the COVID-18 pandemic. However, Social Security services are still able to provide critical services over the phone and online. Information is about programs and services are available at
Note: Although all offices are not providing service for walk-in visitors, individuals may be able to schedule an appointment for limited, critical issues if they cannot get help by phone and if they cannot get the information they need or conduct their business online.
Social Security Disability Insurance and Supplemental Security Income are administered by the Social Security Administration . If you are blind or disabled or over 65 years old, you may be eligible for one or both of these programs. Applications are submitted through your local Social Security office. Many applications are denied at first.
If SSA denies your application for benefits, or decides that you are no longer eligible for benefits, or that the amount of your payments should be changed, you will receive a letter explaining their decision. If you dont agree with the decision, you can ask them to consider your case again.
When and How Can I Appeal?
Can Someone Help Me File an Appeal?
Will My Benefits Continue While My Case is Being Appealed?
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What Are Valid Reasons To Submit An Appeal
You may file a Medical Reconsideration if it appears your initial attempt to secure Social Security Disability Benefits was denied because your health issue did not meet the agencys definition of disabled.
You may file a Non-Medical Reconsideration if your claim was denied because your income was deemed excessive or because you have earned an insufficient number of work credits.
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Level : Federal Court Review
The last level of your SSDI appeal is to file a civil lawsuit through your legal representative with a federal district court. In most cases, a district court judge will remand the case back to an ALJ or the Appeals Court to review the previous finding. On rare occasions, a judge will reverse a lower courts decision and approve your disability benefit. This is the only level that takes your disability case outside of the SSA and moves it into the U.S. Federal Court system. Since the previous three steps can take months or years to complete, most claimants do not make it to the final stage.
Required Social Security Appeal Form
There is no SSA form for this level of appeal. Instead, youll have to work with a Social Security disability attorney to file a civil lawsuit.
Submit The Right Paperwork
When you are filing a reconsideration appeal, you are required to submit a specific form. This is known as the Form SSA-561. In addition, you must also provide a Reconsideration Disability Report. This report essentially augments your original claim by furnishing new and relevant information pertaining to your application.
A third form that is also required when filing for disability reconsideration is . As the name suggests, this is a medical release form that allows SSA to access the medical records related to your disability.
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Should You Hire An Attorney To Handle Your Ssdi Appeal
If youve been reading our description of the SSDI appeals process, then our answer to this question should come as no surprise. Should you hire a lawyer to handle your SSDI appeal? Definitely. And this isnt just a sales pitch: hiring a lawyer is undoubtedly in your best interest, and it gives you the best chance at winning your SSDI appeal.
While an attorney can help you apply for SSDI the first time around, the truth is that most people who hire a lawyer do so at the appeals stage. Thats because the work involved in the appeals process hearings, expert witnesses, arguments before a judge are activities that are much more familiar to an attorney than to the average layperson. Plus, if nothing else, an attorney is someone who can put a fresh, experienced set of eyes on your case, letting you know what youre missing and what you can expect throughout the process.
Social Security Disability Appeal Basics
Believe it or not, most applications for Social Security disability benefits are denied upon the initial application. Typically, only the most obvious and slam dunk claims are approved after the first step of the application process. If your application for benefits is denied, that does not always mean that you do not qualify for benefits. It often requires an appeal of this initial decision to get your benefits approved. Many people wonder how to appeal a disability decision. The appeals process is the same for SSI vs SSDI.
First, you can simply submit a request for reconsideration. You might have some additional evidence or medical records to provide and you are requesting that the SSA reconsider their decision. Most initial determinations are made by local Disability Determination Services . These are often state agencies that make the initial decision for the SSA. Your reconsideration request is asking the SSA to review and reconsider the decision made by this agency. This is sometimes successful, but not often.
If you are unsuccessful at the hearing, you can continue to appeal your case. Your next step would be to the Appeals Council and finally to Federal court if the Appeals Council review is unsuccessful. Very few cases actually make it to Federal District Court in reality. If your benefits are not approved at the hearing level, then many cases simply get dropped at that point.
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How To File A Social Security Appeal Form
The Social Security appeal process is in place for applicants who were denied benefits by the Social Security Administration . If you are unhappy with this decision, you can request to have your case reevaluated. In order to do this, you must file an official Social Security appeal form with the SSA.
Generally, you have 60 days to appeal a Social Security denial. It is important that you do not let this deadline pass. Otherwise, you may risk forfeiting your right to file an appeal. While you may not want to have your application for Social Security denied, it is important that you know what to do if it happens.
How Social Security Collects Overpayments
If you receive SSI, Social Security cannot take more than 10% of your monthly benefit to pay down an overpayment. If you receive SSDI, Social Security can take your whole check each month to pay down an overpayment. Both SSI and SSDI recipients, however, can ask for Social Security to set up an affordable repayment agreement. When Social Security is considering whether to approve a payment agreement for an SSDI recipient, it will want an agreement that results in the overpayment being paid off within three years. For more information, see our article on how Social Security treats overpayments.
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Getting Your Denied Disability Claim Appealed Through Social Security’s System
By David A. Morton III, M.D.
To appeal a denial of Social Security disability or Supplemental Security Income benefits, you’ll need to follow the instructions included in your notice of denial from the Social Security Administration . The first step is to file a request for reconsideration. If that fails, you may want to take your case to the next level of appeal. This article covers the various levels of appeal after denial of Social Security disability benefits.
Reconsideration Of Continuing Disability Claim
Once you begin receiving disability benefits, your case will be re-examined periodically through a continuing disability review . The SSA may end your benefits for a variety of reasons, including:
- a determination that your condition has improved and you can now work, or
- your failure to cooperate in the CDR process.
If your benefits were terminated and you want to appeal the termination, you must request a reconsideration of a CDR at a hearing before a disability hearing officer . Before your claim goes to the hearing officer, it will receive a second review by a different DDS medical consultant and examiner who could reverse the prior decision to terminate your benefits.
Although the DHOs are not doctors or psychologists, they are allowed to form their own medical opinions about the severity of your physical or mental impairments. As you prepare for the DHO hearing, keep in mind that the SSA must show reliable evidence that you have had significant work-related medical improvement. This is a matter of medical judgment. Social Security must consider your treating doctor’s opinions on your limitations and whether they have lessened. If your case is borderline, you should win your appeal and your disability benefits should continue. If your claim is denied, your next step in the appeal process is to request a hearing before an administrative law judge .
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Why Was My Disability Claim Denied
There are two main disability benefits programs that are run through the Social Security Administration : Social Security Disability Insurance and Supplemental Security Income . These two programs currently provide monthly cash benefits to over eight million Americans, though only a little over 35% of applications are approved after an initial claim is submitted. However, after accounting for those that go through the appeals process, the final rate of acceptance jumps to over 50%. There are several reasons why your initial claim could be denied due to the SSAs comprehensive eligibility guidelines.
To better understand the reasons for your Social Security disability benefits denial, it helps to know the basic criteria for qualifying. Disability insurance is reserved for those with severe impairments that are expected to last over 12 months or end in death, and prevent them from engaging in substantial gainful activity . Applicants must also have paid into the Social Security system by acquiring a certain number of work credits in their working life. A typical worker earns four credits per year of employment, and an applicant needs 20 credits, or to have worked five out of the last 10 years. It is strongly recommended that you double-check your eligibility before submitting your application to ensure you meet the basic criteria. Once your application is received, it will be reviewed by your states disability determination agency to see if it meets federal criteria.
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Level : Request For Reconsideration
This is the most straightforward stage of the appeals process. Within 60 days of receiving your denial letter, you can request reconsideration. Reconsideration simply means that someone at Disability Determination Services will perform a complete review of your application to see if an error was made. The representative that completes this review must be different from the original reviewer. You are also allowed to submit more information during this review process if your application was incomplete or if you were denied due to lack of evidence, though this is not required. This stage of appeals typically takes four to 12 weeks to receive a decision.
Required Social Security Appeal Form
The form you use to request reconsideration depends on the reason for your denial. If you were denied for medical reasons, you must submit Form SSA-561 , Form SSA-3441 , and Form SSA-827 . If you were denied for a non-medical reason, you only need to submit Form SSA-561. These forms can be printed, filled out, and mailed to the SSA, or it can also be done entirely online.
What Is Good Cause For Missing My Appeal Deadline
Good cause can include several reasons. Social Security considers:
- What circumstances kept you from making the request on time
- Whether Social Securitys action misled you or you didnt understand what you needed to do to appeal
- Whether you had any physical, mental, education or language limitations that prevented you from appealing on time
How Long Does A Social Security Appeal Take
Once you file your request to appeal a Social Security denial, you may need to wait until your case is reevaluated. The Social Security Administration Office of Hearings and Appeals may be unable to hear your case quickly. This is especially true if there is a high volume of pending cases. However, you can always check your Social Security appeal status online.
How To Appeal A Denial
The Social Security Administration provides several ways to appeal. Whichever way you choose to appeal, it is a good idea to obtain proof that you appealed on time .
Go to your local Social Security office to file your appeal. You can find the address in your denial letter. Take along the denial letter, a list of current medications and a list of names and addresses of all medical care providers you have seen since you last updated SSA – since you filed your claim or last appealed – so that you can complete all appeal papers at the Social Security office with the help of a claims representative. Be sure the SSA claims representative gives you a copy of everything you submit and a receipt for your appeal.
Appeal by phone and mail. Telephone SSA at 1-800-772-1213 and explain that you want to appeal. You will be sent the appropriate appeal form, a Disability Report – Appeal, and an Authorization to Disclose Information to the Social Security Administration . Your appeal is not complete until you have mailed the appropriate appeal form back to SSA. Mail the appeal papers back by certified mail that requests a return receipt for merchandise.
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Is There An Alternative To The Full Application Process
Yes. The Social Security Disability Insurance has an initiative called Compassionate Allowances . This is a process whereby the Social Security office can provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards. There are 88 qualifying rare diseases and cancers on the list. Compassionate allowances allow the office to quickly identify diseases and other medical conditions that qualify under the Listing of Impairments, based on minimal objective medical information. Compassionate allowances allow Social Security to quickly target the most obviously disabled individuals and get their benefits to them.
It is possible that certain members of your family qualify for benefits based on your condition and your previous work.
Those family members include:
Deadline For Reconsideration Request
A failure to appeal within the 60-day time frame will result in an “untimely appeal,” meaning that you would have to file a brand new SSDI or SSI claim to be considered for disability benefits.
There are exceptions for “good cause” to this deadline. Such exceptions generally include illness, hospitalization, or other extenuating circumstances that might account for the late filing of a SSDI or SSI disability appeal. Often, Social Security claims representatives are somewhat lenient when it comes to the late filing of a reconsideration request, if the individual has a good reasonable reason for filing their request late.
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