SSDI Appeals, Levels, Council reviews, and Form

Appeal SSDI denial

How long does the process take

SSDI Appeals process can take longer or shorter-all depending on the level of the appeal. Ideally, appeals have to be made within 60 days of receiving the first determination(or benefits termination following a continuing disability review) from the Social Security Administration (SSA) via the denial notice (maximum of 65 days allowing 5 days of mailing time).

Late applications (beyond 65 days) are allowed and can only be made if supported by a “Good Cause for Late Filing” request.

Remember, The 60-day period is applicable to appeals against adverse decisions to the next level.

There are four levels of SSDI appeals:

Reconsideration over first determination (As per 2021 data, the First level of appeal takes an average wait time of 5 months).
Hearing requests before an Administrative Judge (the Second level of appeal, by necessity, takes longer than the reconsideration as per 2021 data the wait time was between 5 to 15 months).
Review by the Appeals Council over the administrative law judge’s decision(As of 2016 data-where most data was available, the third level of appeal takes around 12 months).
Federal Court review over Appeals Councils’ decision (This is your last resort. Due to workloads experienced by Federal District Court judges, it can take up to one year or more to receive decisions regarding this appeal).

Reconsideration (First level of SSDI Appeals).

This is an opportunity to have your application (claim form) reviewed by a different medical consultant and claims examiner at the disability determination services (DDS).

The reconsideration examiner may request additional medical records (not older than 90 days). However, most of the records are still available from the initial examination. Do ensure you point out evidence that may have been missed out in the initial review.

A written application can be submitted in person or online via iAppeals (highly recommended).

The chances of overturning the initial decision are between 10% and 15%. This is due to the fact that most Reconsiderations are sent back to the same state DDS for a decision; which will use the same procedures and methods of evaluation.

If the reconsideration is denied, DDS will send another denial notice with an explanation of why your claim is denied. This allows for the next level of appeal.

Administrative Law Judge (ALJ) hearing (Second level of SSDI Appeals).

The second level of appeal is markedly different from the request for reconsideration. It’s handled by an Administrative Judge Court rather than the DDS.

This hearing is scheduled by the Office of Hearings Operation (OHO) and Its flexibility is marked by the following:

The SSA is no longer involved in gathering medical records for the case at this level. The claimant or their representative (social security lawyer) assumes this responsibility.
If deemed fit, the judge may allow testimony from an expert witness to support a claimant’s inability to re-enter the workforce, based on their condition, education, and skills.
The claimant or their representative has an opportunity to interact with the decision-maker, an administrative law judge at a hearing office.
The claimant can be allowed to make certain types of requests to either the judge or the hearing office director.

This includes a request to expedite a claim due to dire need (medical or dire financial reasons that might lead to eviction, homelessness, foreclosure, etc.). This can be allowed as long as it’s substantiated by some type of documentation.
The claimant can also Request for review of presented evidence before the trial (on-the-record review). If sufficient medical evidence (which is fully favorable) is presented, the administrative law judge may approve the claim following an on-the-record review of the case.

Statistically, there is a 50% chance of winning the disability appeal at an ALJ hearing. But, Should this appeal be declined, you can file an Appeals at the Council Review or a new claim for disability benefits.

However, the New Social Security rules prohibit filing a new disability claim while pending the decision on your Appeal at the Council Review.

Appeals Council Review (Third level of SSDI Appeals).

The third appeal is less common and very few cases end up in outright approval.

The appeal is carried out by the appeals council and may deny, modified, or remanded back to the ALJ for review.

This council randomly selects cases and will only review findings and evidence and determine if there was a flaw in the ALJs decision that touched on;

Abuse of the court’s discretion e.g. hearing being cut short.
The error of law.
Rulings not supported by any concrete evidence
Matters that affect Broad policy or procedures e.g. notifications for preparation were not sent or not sent on time.

Based on the aforementioned reasons, the chances of the Appeals Council reviewing a case are slim, and if they do you have less than a 2% chance of an outright win.

You have about 10% of your case being remanded back to the ALJ for reconsideration.

The next course of appeal is the federal court. However, this can only be done after exhausting all SSDs appeal avenues including the Appeals Council.

Federal Court review (Forth level of SSDI Appeals).

You definitely need an attorney for an appeal to the US District Court. The process is costly (one must pay a filing fee) and may take years to conclude.

Federal judges will hear the case (without a jury). They will review a case on the basis of legal errors (but may also rule on factual questions).

The chances of success are very slim. The District Court judges may deny an appeal, grant the benefit, or remand the ALJs or the Appeal Council decision.

70% of claims are denied at this level with 50% of their cases being remanded.

SSDI Appeal Form

These forms can be downloaded, printed, fill, and submitted in person to a local Social Security office (or you can simply do an online application via iAppeals -highly recommended).

When making a Request for Consideration, please use;

SSA-561-U2 (Request for Reconsideration) or Form SSA-789 (Request for Reconsideration Disability Cessation) if you do not agree with a medical decision.
SSA-3441-BK (Disability Report – Appeal)
SSA-827 (Authorization to Disclose Information to SSA)– Used by SSA to request your medical records.
SSA-1696 (Appointment of Representative Form)

To request a hearing before the ALJ, please use;

When filing an Appeals Council appeal, please use;

HA-520 (Request for Review of Hearing Decision/Order)

Bottom Line

Many applications are denied not because they do not qualify. Most applicants do not fully comply with the application process (timely applications) or do not present the necessary documentation. Consider hiring an experienced lawyer to do the appeal for you.

An appeal may open up for review of the whole application including those parts that were initially in your favor. Only make an appeal if you have significant new information that will work in your favor.

Try to utilize the appeal process fully rather than filing multiple claims. The appeal is more likely to be handled by the same DDS which will still issue a denial. (Decisions are strictly based on an individual’s medical and work history). It also affects the protective filing date that will be used to calculate possible back pay.

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