"My claim for Social Security Disability was denied. What happens next?" There are many steps between filing a claim and getting to a final answer about your claim being approved or denied.
The First Step: Initial Review
When you first file your claim it goes through an initial review. At initial review, a staffer at the Social Security Administration will look at both your technical eligibility and your medical eligibility for Social Security benefits. Your technical eligibility is based on criteria such as your work credits, and your assets and resources. Your medical eligibility is based on whether you have one or more physical or mental conditions that could prevent you from working. If you meet these eligibility criteria, then the staffer will evaluate whether your conditions are disabling by SSA’s definition.
Reconsideration is Available for Claims That Are Initially Denied
If you are denied at Initial review, then in most states, you can request Reconsideration. If you request Reconsideration, you can submit additional and updated records to support your claim. You can also tell SSA about any changes in your condition or any new conditions that have developed. A staffer will review all the evidence that was already in the file and all newly submitted evidence to determine whether there is enough support to find that you meet SSA’s definition of disability.
You Have the Right to Request an Administrative Hearing
If you are denied at Reconsideration (and in states where there is no Reconsideration stage), you can then request a hearing with an Administrative Law Judge. An Administrative Law Judge is also called an ALJ. At the Hearing, you will have an opportunity to describe your education and work history. You will also be able to talk about your conditions and how your conditions impact your life on a regular basis.
Judges tend to ask questions about what symptoms you have, how long you’ve had symptoms, whether your symptoms are the same all the time, whether you have good days and bad days, and the kinds of activities you can do despite your symptoms. Judges also tend to ask for examples of things you need to do differently or things you can no longer do because of your conditions. If you have a representative, your representative will also ask you questions about your conditions. After your testimony is completed, a vocational expert will provide testimony that is supposed to help the judge understand how certain limitations impact your ability to perform work. Sometimes other experts attend these hearings to provide additional evidence. Usually, your friends and family will not be asked to testify.
How the Appeals Process Works
If you are denied after the Hearing, the next step would be to file a Request for Review with the Appeals Council. The Appeals Council is a group of judges within SSA who determine whether to review decisions made after hearings. If the Appeals Council declines review, the next possible step would be to file a Petition with the Federal District Court where you reside. If the Appeals Council accepts review, it will review the evidence and then make one of two decisions: 1) to let the decision stand or 2) to remand the claim for further proceedings.
If the Appeals Council accepts review, but then lets the decision stand, the next possible step would be to file a Petition with the Federal District Court where you reside. If the Appeals Council accepts review and then remands the claim for further proceedings, your case will be sent back to the ALJ who held your hearing before and another hearing, called a Remand Hearing, will be held.
If a Remand Hearing is scheduled in your case, you will have another opportunity to testify about your conditions. Often medical experts are asked to testify at remand hearings to address issues from medical records or to explain how or whether certain conditions are associated with certain symptoms. These medical experts are expected to have thoroughly reviewed your medical records. There is also usually updated testimony from a vocational expert.
Federal Court Appeals: The Final Option
If you file a Petition with the Federal District Court, the focus of your case will shift from whether you are disabled under the rules of the SSA to whether the ALJ followed the rules about making that decision. It is a bit like when there is a replay review in a sporting event: The referees watching the replay only change the ruling made by the original referee if it is clear that the original referee made the wrong call. Similarly, the Federal District Court is not making a determination of whether you are disabled; it is considering whether the ALJ used all the correct criteria and applied all the correct rules in determining the outcome of your case.
Our Social Security Attorneys Are Here To Help, Every Step of the Way
Each of these steps take time, sometimes lots of it, so it is always a good idea to put your best case forward at each step. Our experienced Social Security disability attorneys can typically help you to consolidate your records and can help you prepare for a hearing. We've been fighting for the rights of people just like you since 1936. Contact us today to schedule your free, no-obligation consultation.