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29 September 2016

How To Appeal A Supplemental Security Income Denial

Supplemental Security Income can be a big help, especially for families of children with disabilities. Monthly payments can make meeting budgets a lot easier, helping parents pay for medical treatments, educational needs and assistive technologies.

The SSI Appeal Process Explained

But every year, tens of thousands of deserving children are denied SSI. In fact, most people get denied – at least initially.

Child Sleeping

Some observers even believe that the Social Security Administration denies everyone – as a rule – on the first application. That’s not true, but it’s obvious how this myth got started. Just look at the denial statistics. Only 19.5% of applicants under the age of 18 were approved for benefits in 2014, according to Social Security Administration statistics.

How To Appeal SSI In 4 Steps

There are actually four levels of appeal and some families will need to “escalate” – moving up the appeal levels – in pursuit of approval.

1. Request Reconsideration

The first step in appealing an SSI denial is to ask the government to review the initial application again. Between 5% to 10% of initially denied applicants are granted approval at this point – upon initial appeal.

Check your denial letter to make sure, but in most states, you’ll be required to contact your local Disability Determination Services office – often the same state-run office that reviewed the medical information in your child’s application the first time. The same people, however, aren’t allowed to re-review the application. A new medical consultant and examiner will look over the application again and make their own determination.

Denied again? You’ll have to do some more work, but stay strong. The next step is successful for the majority of applicants.

2. Hearing With An Administrative Law Judge

Applicants who are denied at the reconsideration level can appeal up the ladder by requesting a hearing before an administrative law judge. Time is of the essence, though. The request for a hearing must be made within 60 days of the subsequent denial.

Hearings are usually short, between 15 minutes and an hour long, according to Administrative law judges are attorneys, but going to a hearing isn’t really like being involved in a court case. Hearings are usually informal, although a medical expert contracted by the Social Security office will probably be present to provide testimony.

Going before an administrative law judge can be intimidating, but for most families, these hearings have a positive outcome. Around 67% of the claims that reach administrative law judges are approved.

3. Go To The Appeals Council

After going before an administrative law judge, most families will be required to request an application review from the Appeals Council.

The Appeals Council, headquartered in Falls Church, Virginia, is the last appeals step within the Social Security Administration. To request a review, you have to do so in writing, using Form HA-520, but don’t get your hopes up. The Council doesn’t consider every case. In fact, the 71 Adminstrative Appeals Judges that make up the Appeals Council select cases at random, but can also dismiss requests for review of their own volition.

Judges on the Appeals Council look for problems with the administrative law judge’s prior decision, like an error of law, rather than determining cases on the merits. The Council rarely finds such problems. Only around 3% of applicants are successful at this stage of appeal, and most only go through with the process to exhaust all of their administrative options.

4. File A Federal Lawsuit

While an unattractive option for many families, the next step in an appeal is to file suit in a federal court. Disability cases are heard by judges, not juries. File a lawsuit and you have a fair chance of being granted approval. In around one out of three disability lawsuits filed, a federal judge will reverse prior denials, often because previous authorities failed to give sufficient weight to the opinion of an applicant’s treating physicians. While often successful, most applicants don’t reach this step for financial reasons.

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