Appealing a Denial of SSDI Benefits

Many applicants for Social Security Disability Insurance (SSDI) benefits are denied at the initial stage for various reasons. Fortunately, denied applicants are entitled to appeal an unfavorable decision, with the assistance of legal counsel if they choose. Social Security lawyer Russell J. Goldsmith has over 35 years of experience representing SSDI applicants through each level of appeal. At the Law Offices of Russell J. Goldsmith, our legal team provides each client with individualized attention and guidance as we provide you with your best chance of winning your case on appeal.

The Social Security Administration (SSA) receives all SSDI benefits applications and makes an initial determination as to whether an applicant has met certain non-medical requirements, including whether the applicant has recently worked for a long enough period while covered by Social Security (that is to say, contributing to the Social Security disability insurance system through their payroll taxes), among other requirements. Disability Determination Services (DDS) will then review the claim and all the medical evidence to decide whether the applicant meets the federal definition of disability under the Social Security Act. This process can take several months before the agency finally reaches a decision. All applicants will receive a letter of determination that either approves or denies their application for SSDI benefits. If they are denied, the letter will state the reason for the denial and provide instructions for the applicant to dispute the decision by way of a request for reconsideration or hearing.

If an initial SSDI benefits application is denied, the next step is to timely appeal the decision. In most states, the first level of appeal is a request for reconsideration. However, in New Hampshire and some other states, applicants will appeal an initial denial directly to a hearing before an Administrative Law Judge (ALJ), as explained below. It is important to read the notice of determination, which provides instructions for the appeal process specific to each applicant. Typically, the deadline to file an appeal is within 60 days of the date of the denial (plus five days for mailing), although it may be extended in rare cases for good cause. The appeal may be submitted online or by mail, and it may be filed by your attorney in order to prevent any confusion for those unfamiliar with the process. During the reconsideration, an SSA claims examiner who was not involved in the initial decision will review your entire file, as well as any new evidence or updated information submitted by you or your attorney. Unfortunately, reconsiderations are denied at an even higher rate than initial SSDI applications, although the success rate is higher at the next level of appeal, an ALJ hearing.

If you disagree with the reconsideration determination, it is important that you or your attorney file a timely appeal requesting a hearing before an ALJ. At the Law Offices of Russell J. Goldsmith, our legal team can review your file in preparation for the hearing and submit any additional documents or recent medical records to the ALJ well in advance. The hearing allows you to testify and to present testimony from others in support of your SSDI claim. If the SSA calls its own witnesses to testify (usually vocational or medical experts), your legal team will have the chance to question those witnesses as well. We will also have the opportunity to argue on your behalf both during and after the hearing and to present our own witnesses and additional medical evidence on your behalf..

In many cases handled by the Law Offices of Russell J. Goldsmith, our legal team will make an On the Record request by way of a legal brief, requesting the ALJ to make a favorable decision prior to the hearing based on the evidence in the file. The brief will persuasively explain why the medical evidence supports a decision in your favor without the need for a hearing. If the ALJ agrees and issues a favorable decision, there will be no need to proceed to hearing.

If it is necessary to have the hearing, the ALJ will issue a written decision in the following weeks or months. You are entitled to appeal an unfavorable decision by the ALJ within 60 days of receiving notice by filing a written request with the Appeals Council or by filing what is called a Request for Review of Hearing Decision/Order form.

If you disagree with the ALJ’s decision, you may submit a request for the Appeals Council to review your case, along with any new evidence you may have. The Appeals Council will look at your claim, the ALJ hearing decision, and your appeal. In some instances, the Appeals Council may decline to formally review your case if the ALJ’s decision appears reasonable and procedurally sound. If the Appeals Council does review your case, it will re-examine all of the evidence and the legal issues, including those decided in your favor. The Appeals Council can affirm the ALJ’s decision, approve your claim, or remand the case back to the ALJ for further findings and potentially another hearing.

If the Appeals Council chooses not to review your claim, or reviews it and determines you are not disabled, you may file a civil action against the Social Security Administration in the United States District Court for the area in which you reside.

At the Law Offices of Russell J. Goldsmith, we offer personalized, honest, and ethical legal representation throughout the application process from your initial claim to a request for reconsideration and, potentially, all other levels of appeal. To schedule a free consultation with SSDI attorney Russell J. Goldsmith, call our office at (800) 773-8622 or contact us online.