When the Social Security Administration (SSA) makes a decision about an individual’s Social Security Disability (SSD) eligibility or the amount of an individual’s benefit award, the SSA sends a letter (called a Notice of Decision) to the individual which explains the SSA’s decision. If the letter is a denial of benefits, the letter is called a Notice of Disapproved Claim. If the letter is in response to a request for reconsideration, the letter is called a Notice of Reconsideration.
Regardless of the type of denial letter an individual receives, if the individual does not agree with the SSA’s decision, he or she has the right to ask the SSA to take another look at its decision. The process of asking for a review of the SSA’s decision is called an appeal. There are four levels of appeal. An individual who is disagrees with an SSA decision begins at the first level of appeal. If the individual is not satisfied with the decision at the first level of appeal, he or she can move to the next level, until the individual receives a satisfactory result or until all levels of appeal are exhausted.
The four levels of appeal are:
A reconsideration is a complete review of an individual’s claim by someone who did not take part in the first decision. At the Reconsideration level, an individual completes a Request for Reconsideration and an Appeal Disability Report. These can be submitted electronically to the SSA or the individual can submit a paper version.
After the request for reconsideration is received, if the individual is a Florida resident, the individual’s case is sent to the Florida Department of Health’s Division of Disability Determinations. During Reconsideration, the reviewer looks at the documentation submitted when the original decision was made, plus any new information or documentation that was submitted by the individual as part of the reconsideration. A reconsideration generally involves a review of an individual’s files, without a need to be present. However, if an individual is appealing a decision that he or she is no longer eligible for SSD benefits because his or her medical condition has improved, the individual can meet with the Social Security representative to explain why a disability still exists. After the reconsideration is complete, the SSA sends the individual a Notice of Reconsideration, which informs the individual of the outcome of the review.
Many individuals find it helpful to retain a knowledgeable SSD lawyer at this stage to help gather additional information to support the benefits application and improve his/her chances of a favorable decision.
Administrative Law Judge (ALJ) Hearing
If an individual is dissatisfied with the results of a Reconsideration, the individual can make a written request for a hearing with an administrative law judge (ALJ). At the hearing level, it is important to provide any additional evidence or clarification about the individual’s disability claim. At the hearing, the individual seeking benefits will be questioned along with any other witnesses the individual brings to testify on his or her behalf. The SSA also may bring witnesses, such as medical or vocational experts. After the hearing, the ALJ makes a decision based on all of the evidence that has been submitted. The SSA sends the individual a letter and a copy of the ALJ’s decision after it is made.
More individuals choose to have an experienced SSD attorney help them at the ALJ hearing level because of the increased formal nature of the appeal, including the calling of witnesses and the use of all information that can support the individual’s chances for a favorable decision.
Social Security Appeals Council Review
If an individual disagrees with the ALJ’s decision, the individual may ask for a review by the Social Security Appeals Council. The Social Security Appeals Council looks at all requests for review, but it may deny the request if it believes the ALJ’s hearing decision was correct. If the Appeals Council agrees to review the ALJ’s decision, it can decide the case itself or return it to the ALJ for further review. When the Appeals Council makes any determination, the SSA sends a letter to the individual seeking benefits to inform the individual of the Appeals Council’s decision.
The help of a tough and skilled SSD lawyer is very helpful at this stage to ensure that the Appeals Council agrees that the case requires review.
Federal Court Review
If an individual disagrees with the Appeals Council’s decision or if the Appeals Council decided to not review the case, the individual may file a lawsuit in federal district court.
An attorney is required at this level of appeal to successfully navigate the legal hurdles to filing a lawsuit.
Time Limits For Appeal
It is important not to wait long to appeal a decision by the SSA because there are strict time limits in place. Under SSA rules, an individual who is denied SSD benefits has 60 days from the date the individual receives the SSA’s denial letter to appeal the SSA’s decision. The SSA assumes that the individual received the denial letter five days after the date of the letter unless the individual can show that he or she received the letter at a later time. If an appeal is not made in writing within the 60 day time limit, the individual can lose his or her right to appeal, and the last decision will become final.
Help With Your Florida SSD Appeal
Appealing a denial of eligibility for SSD benefits can be complicated and stressful, especially for individuals who are already coping with the day to day demands of having serious medical problems. The law offices of Hoffman, Agnetti & Larin, P.A. have years of experience helping clients seek SSD benefits. If you have questions about appealing a decision by the SSA, please call our helpful Florida Social Security disability attorneys today at (305) 653-5555 or use our convenient online contact form to arrange for a free consultation.