Getting your initial claim denied isn’t the end of your SSI journey. You can still appeal the SSA’s decision. The tricky part, however, is winning your SSI appeal.
According to the SSA, more than 60% of disability and SSI applications are denied each year. That means the chances of getting approved at the initial application stage are pretty slim.
The good news, however, is that most appealed claims eventually got approved. SSA data suggests that more than half of disability and SSI appeals are eventually approved.
But how do you appeal an SSI denial? More importantly, how do you make sure that you get your benefits this time around?
If you’re planning to appeal the SSA’S decision, here’s a quick guide on how to win your SSI appeal.
Understanding the SSI Appeal Process
The SSA’s appeals process has four levels:
- Hearing before an Administrative Law Judge (ALJ)
- Appeals Council review
- Federal court review
Upon receiving the SSA’s notice of denial, you only have 60 days to file a request for reconsideration. If you fail to file a request within this time period, it means you agree with the SSA’s decision and you’re not pursuing your claim anymore.
Upon receiving your request for reconsideration, the SSA will review your entire case. They will take a look at their records and the new evidence (if any) you present in your appeal.
If they deny your request for reconsideration, you can request a hearing before the administrative law judge. Most denied claims are usually approved after an ALJ hearing.
However, if the ALJ also denies your claim, you can request the Appeals Council to review the ALJ’s decision. If this still fails, your last recourse is to take your case before a federal court judge. The federal court’s decision is final and irrevocable.
You may also file a new claim but you may have to lose some benefits or become totally ineligible for any benefit.
How to Appeal Your SSI Denial
Now that you know how the SSA appeals process works, here’s a step-by-step guide on how to appeal an SSI denial.
1. Understand Why You Got Denied
There are lots of reasons why the SSA will deny a claim. It could be due to a lack of supporting documents, incomplete paperwork, or a clerical error among others.
Understanding why your claim got denied will help you plan your appeal and increase your chances of getting approved.
In most cases, the SSA will explain the reason/s for the denial in their decision notice. So read through the notice and list down those reasons. Then figure out ways to address them in your appeal.
If it’s due to incomplete paperwork, make sure to submit all the required forms and documents this time around. Or if it’s due to a clerical error, make sure to inform the SSA about it to correct it as soon as possible.
2. Gather Additional Evidence
Most of the time, claims are denied due to a lack of supporting evidence. This is especially true if you’re claiming SSI based on your disability.
To increase your chances of winning your SSI appeal, you should gather as much supporting evidence as you can. This can include:
- formal diagnosis
- doctor’s statements
- sworn statements from witnesses
- medical and treatment records
- employment history
3. File an Appeal
Once you have all the paperwork and supporting evidence on hand, it’s time to file an appeal.
There are two ways to go about this: appeal the SSA’s decision online or file a Request for Reconsideration.
If you want a faster turnaround time, the SSA recommends filing your appeal through its website. For claims that were denied due to medical reasons, you can file an appeal here. If the denial is due to non-medical reasons, you can appeal it here.
If online applications aren’t your cup of tea, you can instead fill up the Request for Reconsideration Form and send it to your local Social Security Office. You will also need to submit the following forms:
Remember that you need to submit your appeal within 60 days of receiving the SSA’s decision notice.
4. Request for ALJ Hearing
If your request for reconsideration is denied, no worries. You can still request a hearing with an administrative law judge.
During this hearing, you will get the chance to plead your case before a judge. You can present witnesses and any other evidence that will strengthen your claim.
ALJ hearings can be held through video conferencing, by phone, or in person.
You can file your request online or fill out the SSA’s Request for Hearing by Administrative Law Judge form and submit it to your local SSA office.
5. Request for Appeals Council Review
As mentioned, most denied claims are approved after an ALJ hearing. But if you don’t agree with the judge’s decision, you can request the Appeals Council to review your case.
6. File an appeal at the federal court
When all else fails and you still receive an unfavorable decision, you can file a civil suit in a federal court.
The suit has to be filed in a judicial court that has jurisdiction over your place of business or residence. You’ll need to file the suit within 60 days of receiving the Appeals Council’s decision.
Top Tips on How to Win an SSI Appeal
As mentioned, winning an SSI appeal can be tricky. So aside from familiarizing yourself with the appeals process, here are some tips to keep in mind too:
1. Make sure to submit your appeal within the deadline.
Remember that you only have 60 days from receipt of the SSA’s decision notice to submit an appeal. Failure to do so can mean losing your benefits forever. So make sure to keep this deadline in mind when planning your appeal strategy.
2. Submit an appeal letter.
You’re not really required to submit an appeal letter. But attaching one to your request for reconsideration form can increase your chances of success.
An appeal letter helps the SSA understand your situation better. You can also use it to provide additional information that may not have been considered during the initial determination.
No idea what to write in an appeal letter? Check out our quick guide on how to write a disability appeal letter.
3. Get better and more convincing evidence.
We could not emphasize this more. If you want to convince the SSA to approve your claim, you’ll need to present more convincing evidence.
If you’re going to present more medical evidence, make sure that they are:
- are complete and comprehensive
- from a licensed medical practitioner
For non-medical evidence, make sure that they are from trustworthy sources.
4. Complete all the required paperwork.
Submitting all the required paperwork can make it easier for the SSA to make a determination. It will also help them better determine your eligibility for benefits.
5. Don’t exaggerate your symptoms.
Exaggerating your symptoms tends to lead to inconsistent statements. Obviously, this doesn’t bode well for your claim. So just be honest and transparent about your symptoms so the SSA can better assess the severity of your condition.
6. Hire an experienced social security lawyer.
This is one of the first things you should consider when filing an SSI appeal. An experienced social security lawyer like Victor Malca knows SSA rules and processes like the back of his hand. He can help you identify the right supporting documents and how to file a winning SSI appeal.
Atty. Malca has already helped thousands of disabled individuals get the benefits they rightfully deserve. He can help you get yours too. Call us now for a free consultation.
VICTOR MALCA – Florida Workers Compensation & Social Security Disability Attorney
Victor Malca P.A. has over 27 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success when fighting for his clients puts him among the most trusted workers’ compensation attorney’s in Florida. He specializes in representing injured workers on compensation benefit cases and disabled individuals claiming lost social security disability benefits.
Book a free consultation today. Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida.
About The Author
Judy Ponio is a writer and editor for the Victor Malca Law P.A. website and blog. She enjoys helping people in need with questions about social security disability and workers compensation law. She has a passion for helping those in need and the elderly with accurate legal information that can make a positive difference in their lives.