SSDI and SSI claims at the initial application level will almost always be denied. If your initial claim is denied, you should expect to file at least two appeals.
The “First” Appeal
If your application for disability benefits has been denied, you must file a “Request For Reconsideration” within 60 days of the date of the denial. This level is typically referred to as “Recon” and takes you to the second level of administrative review. Your reconsideration request will then be reevaluated by someone new with Disability Determination Services (“DDS”). DDS is responsible for deciding which cases win and which cases lose.
Will I Need to File More Than One Social Security Disability Appeal?
Unfortunately, the odds of winning your claim at the reconsideration stage are very low. Most claimants have to file more than one appeal. Statistically, only about 10% of claims are approved for benefits on Reconsideration. That means nine out of ten claims continue to be denied. Generally, if your initial application is denied, your first appeal will also be denied.
If you think about it, it isn’t very likely for the same state agency to deny an application for benefits and then approve it just a few weeks later. Logically, for DDS to deny an initial claim and then, just weeks later, to review the paperwork and approve the claim upon a request for reconsideration would be admitting to decisional errors on the initial claim.
In other words, it is practically an admission that a denied claim should have won and been awarded benefits in the first place. For this reason, DDS very seldom approves a Social Security Disability or SSI case at the reconsideration level and the denial rate on reconsiderations is even higher than the denial rate for initial claims.
However, some reconsideration requests are approved. There are two primary reasons that some claims are approved at this level. First, the claim is reassigned to a new claims examiner at the reconsideration stage. So someone new is looking at the claim with a fresh set of eyes. The claim may be approved because of this new perspective. Second, some claims are approved because new and material evidence is submitted during the appeal that bolsters the strength of the claim.
For these reasons, you can expect a virtual automatic denial of the reconsideration because it happens roughly 90% of the time. Thus, the general “rule of thumb” regarding approvals and denials is that, unless you are approved on your initial application, you will likely need to have your case heard by a judge at a hearing before your case can be won and benefits can be approved.
The “Second” Appeal
If your Request for Reconsideration is also denied, you must file a “Request for Hearing Before an Administrative Law Judge”. As is the case for the previous appeal, you must appeal to this level within 60 days of Reconsideration denial.
Numerous studies have shown that ALJs are significantly more likely to approve disability benefits to those who are represented than to those who represent themselves. Statistically, less than 40% of unrepresented individuals who apply for SSI or SSDI and have their case heard before an administrative law judge (ALJ) will end up winning disability benefits. About 70% of individuals who are represented by an attorney will end up winning disability benefits. Before your hearing, you should have legal counsel.
The “Third” Appeal
If the Judge denies your claim, you have the right to take your case before the Appeals Council. Any appeal should be filed immediately following the denial by the Administrative Law Judge as you only have 60 days from the date on the decision to file your appeal.
- The Appeals Council assumes that you received the unfavorable decision five days after it was mailed to you unless you can prove that you received it later.
- The Appeals Council will most likely dismiss your appeal if it is late. This means that you lose your right to any further review.
- You need a good excuse to avoid a dismissal. You will have to explain the reason you are late and request that Social Security extend the time limit. It is then up to the Appeals Council to decide whether to extend the time limit.
In the alternative, you have the right to reapply and start a new Social Security claim. Unfortunately, you can no longer file an appeal and file a new application at the same time.