The appellate process for a denial of Social Security disability benefits occurs through a process of administrative and legal appeals:
Reconsideration: Within sixty days of the denial of your claim following a Disability Determination Services (DDS) evaluation, you may request reconsideration through the DDS.
Administrative Hearing: After your initial application for Social Security disability benefits is denied, and your application for reconsideration has also been rejected, the next step is a formal appeal of the denial. The appeal involves a hearing before an Administrative Law Judge, who provides an independent review of the decision to deny benefits.
National Appeals Council: If the initial appeal is also denied, you can next appeal to the Social Security National Appeals Council in Washington, DC.
Federal Litigation: If that appeal also fails, you may file a lawsuit to try to obtain benefits. The lawsuit would be filed in federal court.
Your appeal from a Social Security disability denial will go through stages of appeal. You first seek reconsideration. If unsuccessful, you may request an administrative hearing. If the administrative hearing also results in an unfavorable ruling, you may appeal to the Social Security National Appeals Council. If you do not prevail before the appeals counsel, you may file a lawsuit in federal court.
What Happens During Reconsideration
A Disability Determination Services examiner who did not previously work on your claim will review your file and the denial of benefits to evaluate whether benefits should have been awarded. The examiner will make a determination of whether or not you are entitled to benefits based upon that review.
What Happens At an Administrative Hearing
Your formal appeal of a benefits denial will result in your case being scheduled for hearing before an Administrative Law Judge (ALJ). The ALJ is an employee of the Social Security Administration.
The ALJ makes an independent review of your application after a relatively informal hearing, and makes a decision on your claim. The only people who are likely to be at the hearing are the ALJ, an administrative assistant who records the proceeding, the claimant, the claimant's attorney, and any witnesses the claimant has brought to the hearing. The ALJ may also call a medical or vocational expert to testify at the hearing.
There is no "opposing counsel" at the hearing, meaning that no attorney is present to argue that you don't qualify for benefits.
What Is the Social Security National Appeals Council
The Appeals Council is based in Falls Church, Virginia, and reviews the decisions of the Administrative Law Judge.
There is no hearing before the Appeals Council that can be attended by either the claimant or the claimant's attorney. The Appeals Council reviews the evidence considered by the ALJ, and then makes a determination as to whether the ALJ's decision was proper.
Following the review, the Appeals Council may:
- Affirm the ALJ's denial,
- Request additional information,
- Order a new hearing before the ALJ, or
- Reverse the ALJ's decision such that benefits are awarded.
What Happens In Federal Court
If you lose your initial appeals, including a review by the National Appeals Council, you have the right to file a lawsuit in federal court asking that the SSA be ordered to award benefits.
A federal lawsuit is traditional, formal litigation, and the Social Security Administration will use a lawyer to defend against your lawsuit.
If your initial lawsuit fails, you may appeal to the federal appeals court, and even to the U.S. Supreme Court. Litigation in federal courts can be complex, expensive, and lengthy.
It is possible to pursue your administrative appeals without a lawyer, and the SSA offers online resources to help with the administrative appeals process.
To maximize your chance of prevailing on appeal, it is very helpful to use a lawyer who is familiar with the Social Security appeals process. In the event that your initial appeals within the Social Security Administration are denied, it can be very difficult to prosecute a lawsuit in federal court without the assistance of a lawyer.
The Social Security Administration limits the fees that an attorney can charge a client for Social Security proceedings, but not for subsequent appeals that take place in federal court.
Assuming you have properly documented that you are qualified for benefits, the chances of obtaining the reversal of a disability benefits denial are quite good. Approximately half of the appeals that follow disability benefits denials are successful.