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Disability Reconsideration: Appealing a Denied Claim

What do you do if the Social Security Administration (SSA) denies your initial application for disability benefits? You can file an appeal, a common next step for many claimants denied disability benefits.

You will “request reconsideration" with the agency to begin the appeals process. During the reconsideration stage, a disability examiner will take a second look at your application for Social Security Disability Insurance (SSDI) benefits or Supplemental Security Income (SSI) payments. This is an examiner at the Disability Determination Services (DDS), a State agency, who wasn't involved in the denial the first time. The DDS examiner issues a reconsideration determination on your claim for Social Security disability benefits. Don't expect a favorable decision; the reconsideration approval rate is meager at only 11%.

This article discusses the reconsideration process. You will learn how to file, submit new evidence, and what to do if your claim gets denied again.

Why Was My Initial Claim Denied?

Before you request reconsideration, it's important to understand why the SSA denied your case in the first place. The SSA may deny disability claims for the following medical reasons:

  • The claimant's medical condition isn't severe or expected to last 12 or more months.
  • The claimant can perform their usual or other types of work.
  • The claimant provided insufficient medical evidence.
  • The claimant failed to cooperate or didn't adhere to the prescribed medical treatment.
  • The claimant resumed substantial gainful activity before the disability could be proven.

If you know why the SSA denied your case, you can take steps to fix any issues. This may include submitting supportive medical evidence to improve your chance of success.

New Evidence Rebutting the Denied Disability Claim

One effective way to challenge a denied disability claim is to include new evidence in your appeal. A statement from your treating medical provider might help. But don't submit a brief statement from your provider concluding you are disabled and can't work. This type of statement is generally unpersuasive to the SSA and won't help your case. Instead, a well-written letter from your doctor can help overturn a denied Social Security disability claim. Your doctor's letter about your limitations should be consistent with your medical records. The medical records should generally contain the following information:

  • Medical history
  • Laboratory findings
  • Clinical findings, including symptom reports
  • Medical diagnosis and prognosis
  • Medical treatment prescribed with response and adherence

Your doctor may include information about your ability to perform work-related activities in the statement. For physical impairments, these activities may involve hearing, talking, walking, standing, and sitting. These activities may also include carrying, lifting, and handling objects. If you have a mental impairment, your doctor's statement may discuss your ability to remember, understand, and carry out instructions. The statement may also include your ability to respond to your supervisor, co-workers, and pressures in the workplace.

How To File a Request for Reconsideration

You have 60 days from receiving the SSA's notice of the initial determination to file your request for reconsideration. The SSA presumes you received the notice five days after the date on the notice. It's important to file the disability appeal on time. If not, you might have to start over by filing a new application. You can submit a late request for reconsideration. But the SSA only grants a late request if the "good cause" exception applies.

If the SSA denies your disability claim, you can request reconsideration online. Or you can file your request for reconsideration by completing Form SSA-561-U2. You will then go to your local Social Security office and mail or fax your completed, signed forms to the SSA. Don't expect an immediate decision. The agency will generally issue a reconsideration determination in around six months.

My Reconsideration Was Denied. What Now?

Don't be surprised if the reconsideration level results in another denial letter. But the good news is that you can continue to appeal your claim. There are three more levels of Social Security appeals.

The next stage of appeal is a hearing before an Administrative Law Judge (ALJ). The ALJ hearing stage has a much higher approval rate than reconsideration. About 57% of the hearing decisions are favorable. The ALJ may ask you about your medical impairments during the hearing. The ALJ may also question medical experts and vocational experts. Your hearing may be in a hearing office, by telephone, via video teleconference, or by online video.

If the ALJ issues another denial, the next step is to request Appeals Council review. The Appeals Council is also likely to deny your Social Security disability application. After that, you have one more chance to receive Social Security benefits. You will file a civil action in the U.S. district court near you to appeal. Federal court review is the last chance for Social Security benefits.

The federal district court judge will decide whether the ALJ made errors in the decision. Many federal court judges return cases to the SSA for review. But the process is costly and time-consuming, and many claimants don't pursue federal court review.

Get Professional Legal Help With Your SSDI Appeal

Filing a request for reconsideration involves many legal considerations. Let an experienced Social Security disability attorney help you with your claim for benefits. Your disability lawyer can help you with the application process and appeals processes. Your representative can also help you meet critical deadlines and win your case.

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Contact a qualified social security lawyer to assist in your social security disability matter.

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