Write An Appeals Letter After A Benefits Denial
The Social Security Administration Appeal form allows you to summarize why you believe your denial was the incorrect decision.
Utilize the disability determination rationale letter you received from the SSA to construct a full explanation of the issues in the SSA evaluation of your claim.
Be sure to include information if anything was incorrect or missing from your initial evaluation. Always remember that the more statements, records, and additional information you can provide as evidence of your disability will help strengthen your claim.
Start Working On Understanding Why You Were Denied
Good to go, youre getting your records together. This simple act is going to give you the tools to understand where your claim went sideways. At this point, you want to work on figuring out if there was a lack of understanding on the part of the Social Security Administration, or was there a lack of evidence. Sometimes these go together.
If it was a lack of understanding, you can start approaching the problem from the perspective that Social Security has all the evidence, they didnt have the understanding to put it together. Naturally, youre the one living your life, so in many respects, youre the only one who knows how your challenges affect your ability to work. Not even your doctor may understand why you cant pursue gainful activity.
This brings up a very common situation. Although we are all the expert on what we experience, we cant always describe it or convey it very well. Sometimes, we lack the speaking or writing ability to describe adequately the level of impairment we are facing. Consider trying to convey the level of your disability in various ways .
Should You Appeal Your Case In Federal Court
Moving a disability appeal to a federal court can be highly beneficial for claimants. Considering it may have taken a long time, even years, for a claimant to get to this stage, starting the application process over again after the Appeals Council denies a claimant a case review or disability benefits may not be in the claimants best interest. Starting the application process erases the possible back pay the person could get for the whole period he or she was waiting on his or her claim.
A federal court appeal keeps a claimants case alive and preserves the original disability application date. Consequently, when the benefits are ultimately approved, the person may get a larger payment for the back benefits based on the time that has passed since he or she applied.
Nevertheless, the specifics of a case may make it better for a person to reapply for benefits. For example, a persons medical condition may have worsened significantly, or he or she may have developed new conditions. Since one cannot introduce updated information to a federal judge, starting a new disability application could be a good option in such a case.
It is also worth mentioning that the federal court level may cost people money, as the federal court requires people to pay a fee to file their disability cases. People who cannot afford the fee can have it waived if they ask for the waiver in writing and provide evidence of why they cannot afford it.
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Hire A Disability Attorney
The first tip in getting approved during the appeal process is hiring a disability attorney. You may think that this sounds like it will cost a lot of money, but disability lawyers typically work on a contingency basis, meaning that they dont get paid until you see any of the benefits. So its a win-win for you and your attorney in getting you disability benefits. Most often, these attorneys take 25 percent of payback or $6,000whatever is less. While disability attorney fees may vary, including some costs that they may incur during the process, its typically more affordable than ssdi applicants think.
The disability attorney will know exactly what to do for the appeals process, which already gives you a leg up in the journey toward approval. Instead of waiting months during the appeal process, alone and not knowing whats going to happen, having someone behind your back who works in this field will also give you a great peace of mind in the process.
Hearing By An Administrative Law Judge
If your reconsideration gets denied and you disagree with the reasons for denial, you can request a hearing online. This hearing usually happens within 75 miles of where you live. Its carried out by an administrative law judge who was not involved in any part of your application or reconsideration review.
Once this hearing has happened, you can also check the status online at the SSA website. The waiting period for a disability hearing can take hundreds of days to happen, and after that, youll typically wait 45 to 90 days for a decision from the hearing.
Attend The Cumulative Exam
The SSA may require you to attend a cumulative exam, which can be a physical or mental examination depending on your disability. Its purpose is to determine how serious your disability is and how it affects your ability to work. You should attend the cumulative exam if the SSA schedules one for you.
What Are Your Chances Of Approval At The Hearing Level
Your next step in the appeals process will be to request a hearing with an Administrative Law Judge . An ALJ will both review your case and listen to your testimony. You may also present testimony from other experts.
Around 47 percent of cases taken to an ALJ receive approval. However, there are things you can do to improve your chances of receiving an approval. One study indicated that people who used a Social Security representative, such as a disability attorney, were three times more likely to receive an approval. An additional study showed that people were twice as likely to win at the hearing level if they had attorney representation.
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Levels Of The Appeal Process
When going through the appeal process, you must perform each step in order before moving on to the next. Each level must be initiated within a specific time frame , and for most steps, youll need to provide additional documentation or medical evidence to support your disability claim. Additionally, many people choose to retain legal help since the appeals process can be time-consuming, and having legal counsel on your side can lessen your burden and will usually shorten the time you have to wait between stages.
Contact A Florida Social Security Disability Attorney Now For Help
In Florida, the Social Security disability attorneys of Rue & Ziffra know how to get results. Our Social Security disability team is led by Attorney Luis Gracia, a specialist in this field and a board-certified Social Security disability lawyer. We fight tirelessly to get you the results you deserve. Call 1-800-JUSTICE or contact us today to schedule a free, no-obligation consultation or to speak with a Social Security disability lawyer now.
Win Your Appeal Contact Us Today
If you are ready to receive assistance on your claim and move one step closer to getting your case approved, fill out this form or call us at the number above to speak with a qualified agent.
We are prepared to help you through every step of the application process and we are skilled in winning an SSI appeal on behalf of our clients. Crest SSD is here to help you through this difficult time.
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The Process To Appeal An Adverse Determination
You need to go through the administrative stages of the appeal process before asking a federal judge to review your case. The following are the administrative stages, so-called because they occur within the Social Security Administration, of the process to appeal an adverse decision on your claim for disability benefits:
- Appeals Council Review
An adverse determination that you have the right to appeal includes denial of eligibility, the amount of the disability benefits, and a decision made that you were overpaid and must pay it back.
Reconsideration, which is the first stage of the appeal process, is initiated by having your SSDI or SSI lawyer send a written request to the SSA within 60 days of the determination being appealed. The claim will be reviewed by someone at SSA who did not participate in the initial determination that was made on it.
An adverse determination after reconsideration may be appealed by requesting a hearing. The case will be assigned to an administrative law judge for a hearing.
Your SSDI lawyer may offer additional evidence, including medical records or witnesses, to support your request that the determination made should be overturned. The judge will decide in writing and send it to your lawyer after the hearing.
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Keep At It Never Give Up On Your Ssi Or Ssdi Appeal Even If It Means Asking For Help
The best thing you can do to eventually get the decision youre looking for is to stick with your claim! Keep at it. Dont miss deadlines, and reach out for help when you need it. Or even before you need it. Do your best to be proactive. And try as best you can to stay patient and stay centered.
If you need help, reach out. Fill out the form below to get connected with someone that will help you in your disability claim.
The Federal Appeals Court Process
Appealing disability denials at the federal court level can be complicated and confusing. Winning federal court appeals requires one to have some basic understanding of this stage of appeals, which is different from the other stages.
Appealing the denial of disability benefits in federal court is the last level in the appeals process available to claimants. The four SSDI appeal levels are:
- Administrative Law Judge hearing
- Appeals Council review
- Filing a claim in federal court
Before reaching the federal court appeal level, one will have applied for disability benefits and been denied, requested for reconsideration and been denied, taken the claim to an ALJ and received an unfavorable decision, and asked the Appeals Council for a review and been denied or gotten a negative result.
If a claimant receives a negative decision from the Appeals Council or the Appeals Council refuses to review the claimants case, he or she has 60 days to appeal to Federal District Court. If the Appeals Council sent the persons case back to the ALJ for rehearing, but the ALJ still denied the person benefits, the person will have 65 days from the date on the denial form to appeal.
The written opening brief can make a claimant win or lose a federal appeal, making it crucial for the person to have an attorney experienced in writing such briefs. Such an attorney will know how to appeal a denied claim correctly at the Federal District Court stage.
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Prepare For Your Hearing
Your testimony at your hearing will be crucial to winning your appeal. One of the benefits of hiring an attorney is that they can help you prepare for your hearing. They will know the types of questions you will be asked and guide you on the best way to answer them.
Whether you are filing an application for Social Security Disability Insurance benefits or have to appeal a denial of your claim, our knowledgeable legal team is here to assist you. Call our Roswell office or start a live chat to schedule your free consultation today.
The Social Security Tribunal Appeal Division
Once you are given leave to appeal, there is no need to fill out a separate Notice of Appeal to confirm that you want to appeal. The Appeals Division will automatically move on and start the process of assessing your appeal.
However, getting the leave to appeal does not necessarily mean that you win it just means that your case has reasonable chance of winning, and you now have an opportunity to fully present your case to convince the Appeals Division.
You will have 45 days to file written submissions arguing why your appeal should win. Note that this deadline starts running from the date the Appeal Division makes its leave decision. If you are appealing a summary dismissal, your written submissions are due 45 days after you file your Application to Appeal a summary dismissal.
Your submissions to the Appeal Division will likely look different than your submissions to the General Division.
This time, you need to focus on the mistakes in the General Divisions decision and/or why the process the General Division used was unfair. The Appeal Division is not required to hold a hearing, so your written submissions may be your last chance to state your case.
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Submitting Appeal Requests At The Right Time
People should file their federal appeal within the allotted 60 days after receiving the Appeals Council denial. The entire appeal could be dismissed if one requests an appeal after more than 60 days. The SSA is likely to close the persons case, making the person have to start the disability application process. A closed case may reflect poorly on the new application.
Other Impacts On An Appeal
The state in which you live is not the only thing that affects your chances of winning, of course. The thoroughness of your application, the details in your medical records, and the severity level of your disability all play a part in the outcome of your claim. Certain kinds of disabilities are also more or less likely to be approved for benefits.
Applicants with mental illnesses, chronic pain conditions, and disabilities that fluctuate in intensity or severity level over time all have a more difficult time winning their disability claims. To prove your disability case, you must have strong medical records, including a formal diagnosis.
An application without a definitive diagnosis is less likely to win, even in states that average a high approval rate at ODAR, so work closely with your doctor. If a definitive diagnosis is not achievable, be sure to build other parts of your medical evidence and work with your doctor and other healthcare providers to thoroughly document the full extent of your symptoms and limitations.
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How Medically Severe Are Your Impairments
If you have an impairment that qualifies under the Listing of Impairments — such as chronic heart failure that meets the requirements of the cardiovascular listing — then your claim should not have been denied and you have a very good chance of prevailing on appeal. The closer your disability fits into a medical listing, the greater chance you have of winning an appeal.
What Is the Listing of Impairments?
When the SSA first reviews your claim, it will compare your disability to those on a list — called the Listing of Impairments — to see if your impairments are severe enough to meet or equal the SSA’s requirements for disability benefits. Each impairment in the listing specifies a degree of medical severity that, if the applicant’s condition meets or exceeds it, presumes that any type of substantial work can’t be performed. The listings differ for adults and for children. If any of your impairments exactly match the criteria of a listed impairment, you will be found disabled and granted benefits regardless of your age, education, or work experience. For more information on how the SSA decides claims, see Nolo’s article Social Security Disability: How Claims Are Decided.
Chances Of Social Security Disability Approval At The Hearing Level
If your case is denied at the Reconsideration level, the next step is to request a hearing before an Administrative Law Judge . At this level , the odds of success go up significantly.
Nationally, about 47 percent of all cases at the Hearing Level are won by claimants.
Bear in mind, this percentage is for ALL claimants whether or not they were represented by a lawyer at the Hearing Level. Studies have shown that claimants who are represented by a lawyer at this level have a better statistical chance of receiving benefits.
> > DID YOU KNOW? In fact, research shows that only 34 percent of those who do not hire an attorney are ultimately approved for disability benefits, but 60 percent of those who do hire an attorney are ultimately approved.
This leaves over half of the claimants who asked for a hearing before an ALJ without benefits.
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Obtain Supportive Documents From Your Physician
The more evidence you can provide about your disability, the better your chances for approval during the appeal process.
When a claim is denied, it is usually due to the SSA representative determining that you do not meet the requirements to receive SSD benefits. To ensure your appeal results in a successful approval, you need to double-check that you provided the SSA with proper documentation and supporting evidence that validates the severity of your condition.
You can also ask your doctor for a supportive statement detailing how your condition limits your ability to work. These types of statements typically do not affect your standing at the initial stage of the appeal process, but there is evidence that this kind of supporting document from your physician can greatly impact your case at the disability hearing level in front of the Administrative Law Judge .
If your doctor believes that you would benefit from receiving SSD benefits, ask them to fill out this important SSA assessment form, the Physical Residual Functional Capacity Assessment .