The Appeals Process

The stated policy of the Social Security Administration is to ensure that everyone who is entitled to receive Social Security Disability (SSD) or Supplemental Security Income (SSI) does in fact receive it. They are required to carefully examine all the facts before they decide whether or not someone should receive SSD or SSI.

If they decide you shouldn't receive benefits, or if you disagree with their decision because it is only partly favorable to you, you can appeal their decision. That means you can ask them to look at your case again.

When you ask for an appeal, they will reexamine the entire decision, including those parts that were favorable to you. If their decision was wrong, they are required to change it.

This short summary is designed to inform you about appeals and how you can use them to ensure the decision on your claim is correct. There are four levels of appeal. If you are not satisfied with the decision at one level, you may appeal to the next. The levels are (1) reconsideration, (2) hearing, (3) review by the Appeals Council, and (4) federal court review.

When we sent you a letter about a decision on your claim, we'll tell you how to appeal the decision.

The most important thing to remember about appeals is the limited time you have to notify Social Security that you wish to appeal a decision. Generally, you have 60 days from the date you get the letter about the decision in your case to request an appeal. They will assume you get the letter with their decision five days after the date on it, unless you can show them you got it later.

Your appeal of an adverse decision must be in writing. You can get the appeal form from your local Social Security Administration Office or you can send them a signed note with your Social Security number and claim number stating you wish to appeal the decision in your case.

Often, people file their appeals by themselves without assistance from anyone else other than the staff at the local Social Security office, other people get someone to help them or to "represent" them when they appeal a claim. We recommend that this representative be a lawyer who is familiar with the complex field of Social Security Disability Law.

Your attorney or other representative cannot charge or collect a fee from you without first getting written approval from Social Security. It is the policy of the attorneys at Wilkey Law Office that once we decide to take your case to put that agreement to take your case in writing . If we decide to take your case we will not charge an attorney fee unless we are successful in obtaining an award of benefits. If you want more information about having one of our attorneys evaluate your case at no charge, please call us. There is no obligation on your part.

In a reconsideration, a person who didn't take part in the first decision looks at your case to see if the decision is correct. If it's not correct, they are required to change it. It has been our experience that the Social Security Administration rarely changes their decision at this step of the process.

If you are appealing a decision about your medical condition, your reconsideration will be handled by a process they call case review. If you're appealing any other decision, you can choose either a case review or an informal conference. They are explained below.

Case review - In this kind of reconsideration, they look at your case without meeting with you. But you have the right to see what's in your file before they look at your case. You also can give them more information about your case.
Informal conference - Just like a case review, you can look at your file and give them more information. You may also attend the conference and tell the person who will be looking at your case why you disagree with their first decision. You can bring witnesses to talk about your case. You may also bring your representative, if you have one, to the conference. When the reconsideration is done, we'll send you a letter explaining the decision.

If you disagree with the reconsideration decision, you may ask for a hearing before a person who has not seen your case before. That person is an administrative law judge.

Some cases are first referred to the Adjudication Officer for evaluation and further development. If your benefits can be awarded at this stage they will be. If not then your case will be referred to the Administrative Law Judge (ALJ)for a hearing. The hearing is usually held within 75 miles of your home. The ALJ will notify you of the time and place of the hearing.

Before the hearing they may ask you to give them more evidence, clarification, or information about your claim. You should provide this information as soon as you can. You and your representative, if you have one, may come to the hearing and explain your case in person. You may look at the information in your file and give new information.

The ALJ will question you and any witnesses you bring to the hearing. You or your representative may also question the witnesses.

It is usually to your advantage to attend the hearing. If you don't wish to do so, you present your reason for not attending in writing. If you are unable to attend the hearing because of your health, you should advise them and they may be able to make other arrangements for the hearing. Unless the ALJ believes your presence is needed to decide the case and requires you to attend, you will not have to go. However the ALJ will be forced to make a decision on your case based only on the other information in your case and will not have the benefit of hearing your explanation as to how your condition prevents you from working.

When the ALJ makes his/her decision, they will send you a letter with a copy of the decision.

If the decision is unfavorable , and you wish to pursue the appeal , you may ask for a review of the ALJ decision by Social Security's Appeal Council.

The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or issue an order returning it to an ALJ for further review.

If the Appeals Council denies your request for review, they will send you a letter explaining the denial. If the Appeals Council decides your case itself, they will send you a copy of the decision. If the Appeals Council returns your case to an ALJ , they will send you a letter and a copy of the order.

If you disagree with the Appeals Council's decision or if the Appeals Council decides not to review your case, you may file a lawsuit in a federal district court.

If you don't appeal within the 60-day time limit, you may lose your right to appeal and the last decision will become final. For example, if you don't ask for a reconsideration within 60 days, you may lose your right to have your case reconsidered and you can't have a hearing.

If you have a good reason for not appealing your case within the time limits, they may give you more time. A request for more time must be made in writing, stating the reason for the delay.

When the last day of a time limit is on a Saturday, Sunday, or national holiday, the time limit ends on the next workday.

If you have any questions about the decision made on your claim or any other Social Security matter, please call us. We'll be glad to help you. Our address and phone number appear on our home page. We accept clients in Social Security cases from a wide geographic area that includes Western Kentucky and Southern Indiana. Please call us at 502-685-6000 or toll free at 1-800-367-5535.