When it comes to the process of determining the eligibility of Social Security benefits, all involved, whether an applicant, attorney, administrator, medical examiner, or judge, want the Social Security Administration (SSA) to make a decision that is accurate and correct based on the underlying facts and circumstances of a case. The SSA calls this making the right decision at the earliest point in the process.

Social Security, in theory, considers all of the information in a case file before it renders any decision that affects an applicant’s eligibility or amount of benefits. The SSA will always inform an applicant by mail of any decision on a claim, including an explanation of the decision. Applicants who disagree with Social Security’s decision may appeal, which involves a review of the entire decision, including any evidence favorable to an applicant’s claim. Any letter from the SSA about a decision on an application will instruct the recipient about how to appeal the decision.

Applicants who are denied disability benefits for medical or non-medical reasons must request an appeal in writing. This letter must be received by the SSA within 60 days of the date of the SSA’s letter providing notice and containing an explanation of the unfavorable decision.  The SSA allows a 5 day grace period for mailing.   Here is a tip: if you appeal, the burden is on you to prove the SSA received the appeal in a timely fashion.  If they claim non-receipt, you need to be able to prove they are mistaken.

In some instances, a beneficiary may request the SSA to continue paying benefits while an appeal is pending. A request for the continuation of benefits may be approved by Social Security when a beneficiary is actually appealing a negative decision regarding ongoing eligibility for benefits. Typically, in this situation, the SSA is claiming that the recipient has experienced medical improvement, and is no longer disabled under the law. There is the general 60-day appellate window as to any termination, but to keep benefits continued during such an appeal, the SSA must receive your appeal with a request to continue benefits within 10 days of the termination.  Not much time- so always open SSA mail immediately.

Again, to stress this point: for benefits to continue, a beneficiary must inform Social Security within 10 days of the date of receipt of the letter containing the notice and explanation of the unfavorable decision. Keep the envelope that contained the termination letter- you may need the postmark to prove that you are within 10 days…. If an appeal is ultimately denied and you exhaust all appeals (or worse, if you fail to use all appeals and are truly out of time for any further appeal), an individual may be required to repay any money received for which he or she was not eligible. This is the inherent risk of benefit continuation- an overpayment may occur and you may owe the SSA money. A qualified disability attorney may offer essential and invaluable assistance to those applicants and beneficiaries who need to appeal an unfavorable decision of the SSA.  Call an attorney with questions specific to your situation.

For most cases, there are four levels of appeal, including:

  • Reconsideration;
  • Hearing by an administrative law judge (ALJ);
  • Review by the Appeals Council; and
  • Federal Court review.

Part two will discuss these different levels of appeal. The Sullivan Law Office provides assistance in ensuring that all applicants and recipients receive all of the benefits to which they are entitled to even if it requires a lengthy appeal process.

Every application for social security benefits requires the consideration of a substantial list of issues over the life of a case. It is one thing to apply for benefits and win at the first level, but for the majority of cases, it’s an entirely different animal to understand what happens as your case traverses the levels of appeal and adjudication.  It can be long road ahead. The Sullivan Law Office provides over twenty years of experience and can represent and assist you throughout the entire process in all disability cases.Understanding The Appeals Process In Disability Cases