How to Win An SSI Appeal (Step by Step)

How to Win An SSI Appeal Step by Step

If you have applied for SSI or SSDI, you probably know that for many, getting approved on your first shot is a challenge. 

Getting approved is not an impossible challenge, but the odds can be against you if you did not sufficiently prove your disability, or if you did not demonstrate how you rate social security benefits. 

If you now have, or fear that you will have a denial letter in hand, here’s a step-by-step approach to help you in appealing an SSI or SSDI denial.

 

Step 1: Create a Plan to Appeal Your SSI or SSDI Denial

In a previous article, we covered, briefly, what you can do if you do receive the dreaded denial letter.  The first thing you should do is not panic, take a few breaths, and accept that this is not the end of the process.  Like most initial applicants, you have been denied.  However, the evidence shows that if you stick with the claim, you have a strong chance of eventually overturning the denial in appeal.

Of course, your chances of success at this point are directly related to the quality of your plan and your ability to execute it.  Or for many, to find someone who can build a plan for you and carry it out as well.  We are talking about a professional advocate or attorney.

 

Step 2: Retain an Attorney (Optional but Encouraged)

Technically, this step is optional.  Also, you can retain an attorney at almost any point during the claim or appeal process.  However, a strong case can be made that hiring an attorney early on is the more prudent approach.  Regardless, you are reading this article from a post on a law firm’s website, so…

There are some reasons, a lot of reasons actually, that you would want to consider this as an option.  First being that this is one form of law that is based entirely on contingency.  If a lawyer does not win your case for you, they will not be getting paid.  Everyone then, you and the law firm, has a financial incentive, and hopefully a personal one too, to get you the benefits you need.

The second reason, and from a coldly logical perspective, a very powerful reason is that you might go through this process only once in your life.  Many of the things that will gum-up the process are avoidable.  And the un-avoidable issues can be addressed quickly and efficiently if you know they are likely to arise.  Only going through this process once, you have to learn all of this the hard way, or be extremely lucky.  Alternatively, a disability attorney goes through these processes a couple of hundred times a year (thousands of times in a career).

You can get pretty good at handling these things throughout several thousand claims. Still, for the die-hard do-it-yourself type, we will go back to the step-by-step.  Remember though; you can retain an attorney at almost any point in the process.

 

Step 3: File for Reconsideration

You need to know that at the point of denial the clock starts ticking.  60 days.  That’s what you have to act.  Whether that action is retaining a disability attorney or beginning the process of appeal yourself, you need to make sure you do so before 60 days is up.  Otherwise, you’re going to have to start all over again.

You can file for reconsideration a couple of ways.  One way is to file a Form SSA-561 (Request for Reconsideration).  The other is to file online at www.socialsecurity.gov/disability/appeal.  The basic instructions for this process will also likely accompany your disability denial letter.

So what is a reconsideration, you ask?  It’s an independent review of the original claim by someone who has not been a part of the original decision.  Their job is to take a look at the initial evidence submitted (by you or others) and to take into account any new evidence you might have.  This last point is something that you want to start investigating at this point too.

 

Step 4: Get Your Records Together

To understand the basis for your disability denial, you usually have to investigate what records the Social Security Administration considered in making their determination.  It’s very common for critical pieces of medical evidence to be absent from the disability determination records.  It may be that you, or your doctor, didn’t share specifically what was needed.  Or that there was confusion about the conditions leading to your inability to work.

Whatever the case may be, getting a copy of your records is going to be essential to re-stating, re-phrasing, and correcting your appeal claim.   Write down a list of all the doctors, therapists, support groups, or even friends who’ve helped you during the last five years.  If you can’t remember the last five years, write down what you can remember.


Tip!

Sometimes remembering when a meeting or appointment occurred can be hard. Using holidays or key dates as markers to your memory can be very helpful.

For example, if you remember you had a Dr. appointment a couple of years ago but not when thinking about what else you had to adjust to make it happen.

“I remember I had to schedule that Dr. appointment around Thanksgiving because my sister was visiting..”  <-  The appointment happened sometime before or after Thanksgiving.

It can be hard to remember all this stuff, but if we use something we’re better at remembering to act as a memory anchor, it can help.


Step 5: Start Working on Understanding Why you Were Denied

Good to go, you’re getting your records together.  This simple act is going to give you the tools to understand where your claim went sideways.  At this point, you want to work on figuring out if there was a lack of understanding on the part of the Social Security Administration, or was there a lack of evidence.  Sometimes these go together.

If it was a lack of understanding, you can start approaching the problem from the perspective that Social Security has all the evidence, they didn’t have the understanding to put it together.  Naturally, you’re the one living your life, so in many respects, you’re the only one who knows how your challenges affect your ability to work.  Not even your doctor may understand why you can’t pursue gainful activity.

This brings up a very common situation.  Although we are all the expert on what we experience, we can’t always describe it or convey it very well.  Sometimes, we lack the speaking or writing ability to describe adequately the level of impairment we are facing.  Consider trying to convey the level of your disability in various ways (recorded conversation, writing it down, pictures, etc.).

The whole point of understanding, in this step, is to put yourself in the place where you can see why your claim was denied.  If it was as we just described a lack of understanding on the part of Social Security, you can focus on making it more clear to everyone the challenges you face.  If however, your problem was lack of evidence, you can attack that problem in a relatively straightforward approach.  Get the evidence, everywhere you can.

 

Step 6: Request an SSI Appeal Hearing (If Your Reconsideration is Denied)

No one is going to be surprised that reconsiderations often result in the same outcome as the initial claim.  You have very little time to file for reconsideration and you’re probably still trying to get a grasp on why the initial application was denied – all while the reconsideration is processing.

Let’s assume for the sake of this step-by-step approach that your reconsideration failed to overturn the initial disability denial.  At this point, you can (should) request a hearing.

A hearing is your chance to present to an administrative law judge (ALJ) your claim.  You can provide witnesses and there may also be professional witnesses present (medical or vocational experts) as well.

After the hearing, you’ll receive a determination from the judge, usually received via US Mail.

 

Step 7: Study!  Find Info to Help You Through this Process

During this whole process, you should be looking to find resources to help you out. You don’t want to be figuring this out on your own.  If you do, you’re hurting your chances, and potentially costing yourself further financial burden and stress.

Here are some resources to help you with the process:

The Appeals Process: This is a PDF from Social Security that helps you understand the process of appealing.

MDJunction Forum: This is a forum for general advice and support relating to Social Security Disability and claims advice

Disability Answers WA State: This is a Facebook page built for the community and to facilitate sharing information for those experiencing disabilities.

Lilac City Law Blog: Shameless plug here, but we’re genuinely trying to provide as much information as possible for those working through the disability claims process.  And for those that need the help, we ensure that too.

Social Security Disability Resource Center: An incredible, free resource, compiled by a former disability claims examiner.  The goal is to inform applicants about the Social Security Disability and SSI claims & appeals process.

Our Lilac City Law Ultimate Disability Guide: A free resource that breaks down the basics in an easy to read & portable format.  

4 Biggest Myths About Social Security E-Book: Get to know how & why this process is confusing.  And best of all, what you can do to find success in your claim!


Step 8: Work on Centering Yourself

This step is about self-care.  In truth, this process is slow, it is stressful, and it doesn’t always result in the correct decision.  Sometimes you need to go through it more than once, and sometimes you need to appeal to a higher authority.  Regardless of where you fall in this whole mess, having a sense of urgency is going to result in you potentially harming your mental health.  The system won’t go faster, unfortunately.

Consider, joining a support group on Facebook (you can even join our Facebook page and share your questions & frustrations there).    Other things to consider is making sure your close family or friends know what that you’re pursuing this.  While this might be something you want to keep to yourself, you very easily could end up needing some moral support during the appeal process.  It’s not usually easy.

And, the last point on this, don’t discount the value of a good therapist — someone who can help you to stay confident and centered during the appeal.

 

Step 9: After the SSI Appeal Hearing

Well, one way or another, you’re going to get a decision.  It may be great – “your claim has been approved, and here’s the expected back-pay amount.”  Or it may feel like Groundhog’s day, yet another denial.  If you’re denied at the hearing level, is it the end?  No.

You can keep going; you have the option of asking for a review by the Social Security Appeals Council.  At this point, though, some requests are denied.  Meaning, you may not be given a review by the Appeals Council.  If the Appeals Council denies the review, you’ll receive a letter as to why you remain denied. You can either re-file for disability at this point (yes back to the beginning, sorry) or you can file

If the Appeals Council grants a review, they may review themselves or send it to back to an ALJ (judge) for review.

At this point, if you disagree with an Appeals Council decision, or if they decided not to review the claim, you can file a lawsuit in a federal district court.

This will all be laid out in the decision letters you receive at each stage of the process.

 

Step 10: Keep At It! Never Give Up on Your SSI or SSDI Appeal

We’ve said it several times at this point, but the best thing you can do to eventually get the decision you’re looking for is to stick with your claim.  Keep at it.  Don’t miss deadlines, and reach out for help when you need it.  Or even before you need it.  Do your best to be pro-active.  And try as best you can to stay patient and stay centered.

If you have questions about any part of this process or any support during the appeal – let us know.  And if you have great tips for others going through an appeal, we want to hear them too!

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