How to Fight Your SSI or Social Security Disability Denial
Authored By: Northwest Justice Project
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7401EN - This publication explains what you can do if the Social Security Administration (SSA) denies your application because they say you are not disabled. If you have been receiving benefits and are notified that they will stop, see our publication How to Fight a Termination of SSI or SSD.
- Social Security denied my initial application. How can I appeal?
- What if I did not file my appeal in time?
- How can I prove that I am disabled?
- They denied my reconsideration. Now what?
- Should I reapply or appeal and wait for my hearing?
- Can I represent myself at the hearing?
Yes, if the Social Security Administration (SSA, Social Security) denies your application because they say you are not disabled. If you have been getting benefits and are notified that they will stop, see our publication How to Fight a Termination of Supplemental Security Income (SSI) or Social Security Disability When SSA Decides You are No Longer Disabled.
You have to the right to ask Social Security to reconsider its decision. (People call SSD benefits a variety of names, including Disability Insurance Benefits, Social Security Disability Insurance, SSDI, SSA, and Title II benefits.) They deny many SSI and Social Security Disability applications but later approve them on appeal. If you ask for reconsideration, Social Security will review its decision and approve or deny your claim.
You must fill out a Request for Reconsideration form which you can get at your local Social Security office, by calling their toll-free phone number or at their website (see below). They must receive your form within 60 days (plus five days for mailing) of the date on the denial notice of denial. You must have a good reason if you request reconsideration is late.
If you had a good reason for not filing the request for reconsideration in time, you may still be able to file if you had a good reason for why you missed the deadline. This is a Request for Good Cause. You must fill out a Statement of Claimant form (http://www.ssa.gov/online/ssa-795.pdf) asking for good cause (example: "I request good cause for late filing of my appeal") and explaining why you could not file the appeal on time. Either bring it or mail it to your local Social Security office. You may also pick up a copy of this form at your local social security office.
Social Security will decide if you had a good reason to file the appeal late. If you did, they will process the appeal as if you filed it on time.
Social Security denies many SSI or Social Security Disability claims because it believes the person is not disabled. In the denial notice, they should explain generally why they denied your claim and list all the places where they requested and received medical evidence.
If they denied your claim because they determined you are not disabled, make sure they had all the information they needed to make that decision. You may ask to see the medical evidence in your file. If you have a regular doctor who has not sent Social Security a letter or report, ask him/her to do so. If your doctor did submit a report, ask her/him to make another one explaining why your doctor thinks you are disabled and unable to work. Your own doctor's opinion is very important in proving your disability. Social Security may have sent you to see a doctor who has never seen you before. If this happened in your case, ask them to order and pay for another evaluation from your own doctor if s/he believes you are disabled and is willing to do an evaluation. If you can get a second evaluation showing you are disabled, Social Security may change its decision in your case.
You may also get letters from counselors, ARNPs, past employers, and friends and family if they describe your functional limitations and if those limitations have an effect on your ability to work. Social Security must take into consideration information from other people regarding your level of functioning (example: what you can and cannot do as a result of your disabling impairment) when making their decision.
You may ask for a hearing before an Administrative Law Judge (ALJ). You must file a hearing request within 60 days plus five days mailing of the date of the notice of the denial. You may file the hearing request at your local Social Security office. Or, you can call Social Security and have them mail the request for hearing form to you, then fill it out and mail it back to them. Their toll-free phone number is 1-800-772-1213 from 7:00 am to 7:00 pm; TTY 1-800-325-0778. You can also get a hearing request form from the SSA website, at http://www.ssa.gov/forms/ha-501.html
Your hearing will probably place many months after the date of your request. The ALJ will notify you at least 20 days before your hearing. If you have more evidence, such as new medical records which show that you are disabled, give them to the ALJ as soon as they are available. You may have a lawyer or an experienced paralegal, represent you at the hearing, or you may represent yourself. Generally, represented people do better at the hearings.
If you would like a lawyer who often represents people in Social Security or SSI claims, contact your local bar association or call the National Organization for Social Security Claimants Representatives referral line at 1-800-431-2804. The Social Security Administration regulates fees. Your representative is paid only if you win your case. Representatives may not charge more than 25% of your back benefits (up to a maximum of $6,000). You will also have to pay any costs the representative incurs in preparing your case (example: the cost of medical records). Be sure you get an explanation of the fee arrangement from the lawyer before hiring her/him.
It can take many months before a hearing is held. Some people choose not to appeal a reconsideration denial. They file a new application instead. Filing a new application, instead of appealing and requesting a hearing, may keep you from getting all the benefits you are entitled to.
Also, in certain cases involving SSD benefits, not appealing can result in your inability to get SSD benefits even if you reapply. If you believe you are still disabled and unable to work, it is advisable to request a hearing.
Yes. If you choose to do this, you should get a copy of your file on an encrypted CD. The evidence on the CD is called the "exhibit file." It has the only information the judge has about you. If you know of other medical information that is not in your file, such as hospital records, therapist's notes, doctor's records, or x-ray reports, get copies of them to the judge before the hearing if possible. (Note: If you have trouble getting your medical records, ask for the publication about Reviewing and Getting Copies of Your Medical Records. If you believe your medical records are wrong, see What Can I Do if My Medical Records Are Wrong?)
Your hearing is the only time during the application process that you will meet the decision maker in person. It is important to present your whole case: everything about your disability and its effects and why it keeps you from being able to work. Tell the judge all of this. You may want to take someone such as your spouse or a friend to testify about how your disability affects you in your day-to-day activities.
When you get ready for your hearing, make a list of
things you want to tell the judge
things you want your witnesses to tell the judge
If you think there is incorrect information in the file, you should tell the judge at the hearing why you think the information is incorrect.
There may be a vocational expert at your hearing. This is an expert who will give his/her opinion about what jobs you can perform, given your functional limitations. This is why it is important to explain at the hearing what you can and cannot do. The judge will make a decision and notify you by mail within a few months of his/her decision.
This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice.
This information is current as of June 2015.
© 2015 Northwest Justice Project — 1-888-201-1014
(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for non-commercial use only.)