Applicants who find a decision of the Social Security Administration (SSA) to be unfavorable may appeal the SSA’s decision. An appeal involves a review of the decision’s complete file, including any evidence favorable to an applicant’s claim. Any letter from the SSA related to a decision on an application will inform the recipient of the appellate process.
There are four levels of review or appeal in disability cases, including:
- Hearing by an administrative law judge (ALJ);
- Review by the Appeals Council; and
- Federal Court review.
The reconsideration of a decision includes the complete review of a claim by a different decision-maker. Thus, the decision is not made by the same party that made the original decision perceived as unfavorable. This new decision-maker will examine the entire body of evidence submitted at the time of the original decision, in addition to any new evidence.
Typically, reconsideration involves the review of a file without the need for a claimant to be present. However, claimants appealing a decision that they are no longer eligible for disability benefits because of the improvement of a medical condition may meet with a Social Security representative to explain any personal reasons for believing that a disability continues to exist. Reconsideration has a very high affirmation rate, meaning that most cases are denied at the Recon level.
Once a reconsideration decision is rendered, claimants who disagree with this decision may request a hearing before an administrative law judge (ALJ) who did not participate in both the original or reconsideration decisions. The ALJ notifies a claimant of the time and place of the hearing, which is usually held within 75 miles of the claimant’s home.
Prior to the hearing before an ALJ, the SSA may request a claimant to provide more evidence and/or to clarify information about a claim. Claimants may review their file and even add evidence to it by providing new information. At the hearing, the ALJ will question a claimant and his or her witnesses, including medical or vocational experts. A claimant’s representative may also question any witnesses.
There are circumstances when the SSA will hold a hearing by video conference rather than in person. These types of hearing may be scheduled faster than an in-person hearing and a video hearing location may be closer to a claimant’s home, increasing the likelihood that claimants and their witnesses will attend the hearing.
Unless the ALJ believes a claimant’s presence is necessary to decide a case and requires attendance, a claimant will not be required to attend this hearing. However, attendance at such a hearing, with qualified and knowledgeable representation, is essential in presenting the best evidence to win the case and secure a finding of disability. It is highly recommended that all claimants attend this hearing! If a valid reason exists for changing the time of the meeting, the SSA must be informed as soon as possible.
Once all of the information is gathered and reviewed, a decision will be made by the ALJ. As usual, a claimant will be informed by mail with instructions on how to further appeal any unfavorable decision.
After the hearing before the ALJ, his or her decision may be reviewed by Social Security’s Appeals Council, of course, at the request of an applicant. The claimant can request review, and it is possible for the Appeals Council to take up a case on their own. Typically, I have seen the Appeals Council take own motion review of only favorable ALJ decisions.
The Appeals Council examines all requests for review and will deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review a case, it will issue a decision that: pays the case in whole or part, denies the request for review, or sends it back to the ALJ for a new decision (further review). Again, as usual, the SSA will send a letter notifying a claimant of any of the aforementioned decisions.
Finally, if a claimant disagrees with the Appeals Council’s decision or if the Appeals Council chooses not to review the case, a lawsuit may be filed in a federal district court. If this occurs, licensed legal representation is crucial and necessary to an applicant’s success at this level. Non-attorney advocates cannot file a lawsuit on behalf of someone else.
Every application for long-term disability benefits requires the consideration of an extensive list of factors. Disability cases are complicated and time-consuming. The interim period between application and award requires the strict observance of formalities, details, time limits, and other deadlines. The Sullivan Law Office provides over twenty years of experience in all types of disability cases, including Social Security Disability, long-term disability, short-term disability, state retirement and workers’ compensation. But how do you know whether or not you should hire a long-term disability attorney, or any attorney for that matter? Contact Sullivan Law Office today. We offer free consultations, so you have absolutely nothing to lose! We look forward to hearing from you. Call 888-587-0228 or visit us online.