How to appeal a denied disability claim

Note: Social Security allows 60 days from the date of denial (plus 5 days grace for mailing time) for an appeal to be at the Social Security office. Don’t delay.

In many states the first appeal available to a Social Security Disability Insurance (SSDI) or SSI disability applicant, whose claim has been denied, is the “reconsideration.”

In a reconsideration review (sometimes called a case review), a different disability claims examiner at the DDS (Disability Determination Services) reviews your application and medical records with the help of a medical consultant.

Many people familiar with SSA’s disability appeals process consider the “reconsideration” a time-wasting delay in resolving a disability claim. More than 85 percent of reconsideration requests are denied.

Fortunately, here in New York State the reconsideration step has been eliminated: an applicant who has been denied benefits can immediately request a disability hearing.

The easiest way to file an appeal is to send a letter requesting an appeal to your local Social Security Office.

Or you can request a hearing before an Administrative Law Judge (ALJ). To request a hearing, you may use Form HA-501.

With your request for a hearing form, or after you submit it, you will need to submit the following forms to Social Security:

Disability Report- Appeal, Form SSA-3441
Authorization to Disclose Information to SSA, Form SSA-827

After you have completed the above forms, send them to your local office to be forwarded to SSA’s Office of Disability  Determination and Review, also known as ODAR,  who will send you a notice informing you that they have received your request for a hearing and a copy (CD) of your disability file.  Be patient.  It can take as long as 4 to 6-weeks for ODAR to log in your appeal request and contact you.

If you don’t feel comfortable handling the appeal yourself you can hire a representative to help you with your claim.

Do you have to to hire an attorney or non-attorney representative to help you with your appeal. No, you don’t, but the odds of winning a disability claim before an Administrative Law Judge (ALJ) are markedly decreased when a claimant does not have a representative.

An experienced disability representative can greatly improve your chances of winning your claim. In fact, statistics show that a disability claimant (applicant) who has the assistance of a skilled representative at the hearing level is twice as likely to be approved than an unrepresented claimant.

Your claim will be won  or lost on the strength of your medical evidence.

There is no legal trickery to get around that.  If your medical records are incomplete, or there are inconsistent reports or gaps in your treatment history, your appeal may be denied. Therefore, one of the most important services a disability representive can perform is insuring that the proper medical records are submitted to the court. Although you can request records yourself, your representative will know what specific medical evidence is needed — what should not be submitted to the court — and when your medical records need updating.

A disability representative will review your records in detail and decide if they should be submitted to the SSA. This is important because it allows the representative to determine whether your case needs additional medical evidence, whether any key evidence is missing or spot other issues that may cause you problems at the hearing.

In addition, your representative can help you avoid the long wait for a hearing to be scheduled and go straight to an approval if you are eligible for an on-the-record decision (OTR. An OTR decision is based on the written information that is provided to the judge before a hearing — OTR is actually short for a decision based “on the medical records.”

A Reminder:  Social Security allows 60 days from the date of denial (plus 5 days grace for mailing time) for an appeal to be at the Social Security office. Contact SSA as soon as possible and tell them you want to appeal your case — you don’t need a representative to do that, and you don’t have to complete all the appeal forms until you decide whether or not you want to hire a representative.

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