SSA Appeals: What Are They and When to Request One

SSA stands for the Social Security Administration, a federal agencies in the United States that manages social security benefits programs.

SSA appeals are a process through which a person who has been denied social security benefits or is unhappy with the amount of benefits received can request a review of their case. The appeals process can result in the original decision being overturned or modified.

What Is A Social Security Determination?

A determination is a decision that SSA makes for a claim. If you disagree with the SSA’s determination for your claim, you can make an appeal. If you submit a claim for your SSI payment, SSA will give you the amount they determined you are eligible for. If you think that the payment is too low, you can make an appeal.

The Social Security Administration (SSA) Appeals Process: Step-by-Step

The stages of SSA appeals are:
1.) Reconsideration
2.) Hearing by an administrative law judge (ALJ),
3.) Appeals Council Review, and
4.) Federal Court. The SSA appeals process comes in stages and timelines so that if you disagree with the second determination, you move higher up to take your case to a person of a higher position. Each stage may need you to meet requirements within 60 days to proceed. You can also have a hearing with an ALJ to discuss your case. 

Tips For Preparing For A Hearing For An SSA Appeal

When you are in a hearing, the judge will have to explain why your case has been determined as such and ask you and your representative questions about your case. You may bring a witness to answer the judge’s questions under oath. The judge may also call an expert if needed to testify.

Therefore, you can do the following for your hearing preparation:

1. Review all evidence in your case file. Submit new evidence, if available, to strengthen your case. The new evidence must be submitted within five days before the hearing. If you have less than five days before the hearing, you can appeal for a time extension to review the new evidence.

2. If you have any evidence you want the ALJ to consider, submit them as soon as possible. You can send electronic evidence through a special fax number and bar code provided by the hearing office through the Electronic Records Express (ERE).

The Reconsideration Stage: How to Request Another Review

At the reconsideration stage, a different SSA claims examiner reviews the original decision to ensure all evidence is considered and the correct decision is made. You must fill out the following forms based on your SSA appeal. Once the request is received and reviewed, the SSA will send a notice of reconsideration determination. 

During this stage, we recommend adding any additional evidence that you have available. 

Appeals Council Review: The Final Administrative Step

If the ALJ decision is not satisfactory, the next stage of appeal is to request a review to the SSA Appeals Council. The Appeals Council may review the case and make a new decision or send the case back to the ALJ for further review.

The Appeals Council can either grant, deny or dismiss your case upon examination. Therefore, you must have new evidence on or before the hearing decision. If there is reasonable cause to believe that said evidence would change the outcome, the Appeals Council will review your case. 

Upon reviewing your case, they can return it to the ALJ for another hearing. If they choose to decide your case, it can go two ways. 

1. If they make a less favorable decision to you, you will be sent a notice before issuing the decision. This way, you or your representative can respond appropriately. 
2. However, if the decision puts you in a more favorable end, they will enact it and send you a notice afterward. 

Either way, you get a copy of the review process and the reasons behind the decision-making.

Appealing to Federal Court: What You Need to Know

If the Appeals Council decision is unfavorable, the final stage of appeal is a federal court appeal. 

In this stage, you must file an action in the US District Court. The deadline will be up to 60 days after receiving your notice of the Appeals Council’s action. You are expected to receive the notice five days after the date of the notice.

The US District Court will process the presenting case and determine the final Agencies decision. You can expect the court to:

1. Send the case back to SSA for a new hearing and issue a new decision
2. Order the SSA to award the benefits
3. Dismiss the case.

Why You Need a Representative to Help with Your Appeal

Appealing claims can take a lot of time and energy that you can use for your other priorities. A representative experienced with the SSA appeals process can help increase the likelihood of a successful appeal. They can help you get your benefits by navigating the complex appeals process and qualifications. 

Many qualified non-attorneys representatives work on a contingency fee basis, which means they only get paid if you win your appeal. This can be a helpful option for individuals who cannot afford legal fees upfront.

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