Appealing the Denial of a Social Security Disability Insurance Claim

Social Security Appeal 3D GraphicIf your application for Social Security Disability Insurance (SSDI) has been denied, you can file an appeal with the Social Security Administration (SSA).

The Four Levels of Appeal of SSDI Claims

There are four levels of appeal that may be pursued in response to the denial of an SSDI claim:

Request for Reconsideration

When you receive a denial notice from the SSA it will include a statement about your medical condition, along with information regarding your right to appeal. First, you must contact your local field office and request a complete review of the claim. This review is conducted by a medical consultant and claims examiner who had nothing to do with the original claim denial. If your claim is denied for a second time, you will receive another denial letter and an explanation of the SSA’s decision.

Administrative Law Judge Hearing

To continue your pursuit of benefits, you may request a hearing by an administrative law judge (ALJ) within 60 days of your claim denial. ALJs are attorneys employed by the SSA’s Office of Hearings Operations, and they have the authority to uphold or overturn the denial or termination of disability benefits.

Appeals Council

If the ALJ upholds the denial of your SSDI claim, you can request a review by the Appeals Council. The Appeals Council chooses cases for review at random, and has the discretion to approve, deny, or dismiss your review request. The review is unlikely to be granted unless there is evidence that the ALJ:

●     Made an error of law.

●     Is guilty of an abuse of discretion.

●     Reached a decision that is not supported by substantial evidence.

●     Made serious procedural mistakes.

Federal Court Review

The final step in the appeal process involves filing a lawsuit in U.S. district court. Federal judges rarely reverse ALJ or Appeals Council decisions, but they frequently remand (send back) cases to the SSA. This typically happens when a judge cites the SSA’s failure to give adequate consideration to a treating physician’s opinion, account for pain or other symptoms, or ask for assessments of abilities from treating doctors.

You Need an Attorney

If your SSDI claim has been rejected, you need representation by an experienced New Mexico disability benefits attorney when filing an appeal. Your attorney can help you complete applications, keep paperwork organized, and guide you through the steps of the appeals process. To learn more, contact the Injury & Disability Law Center by clicking the Live Chat button on this page.

 

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