SSI

What If the Request for SSI Benefits is Denied or I Disagree with a Decision?

In most states there are three levels of appeal available to you if you disagree with a decision to deny SSI benefits. After you use these methods of appeal at the agency level, you can appeal the decision in civil court.

Reconsideration
The first level is to ask for a reconsideration of your application. You must ask for this in writing, through a letter or through a form, which can be provided to you by your local Social Security office. Keep in mind that you have to request reconsideration within 60 days of receiving the notification of denial.

Ask your local Social Security office where you should mail this letter or form. You will want to include why you disagree with the initial decision. Your application file is always available to you, and you can ask for a copy of its contents. You may also ask for an interpreter at any point in the appeals process. You will be notified in writing of the reconsideration decision.

Hearing
If after reconsideration your application is still denied, the next step of appeal available to you is a hearing before an administrative law judge. You must request this hearing through a letter or through a form that can be provided by your local Social Security office. You must request a hearing in writing within 60 days of receiving the reconsideration decision. Ask your local Social Security office where you should mail this letter or form.

There is no cost to you for the hearing. If you choose to be represented by an attorney, you may be able to hire one for a contingency fee of 25% of past due benefits to a maximum of $5,400. All fees for representation must be approved, and depending on the difficulty of the case, the hearing officer could award additional sums to your lawyer. Be careful about retaining a lawyer, and make sure the fee agreement is in writing and that it clearly sets forth what the attorney will do for you. The benefit of a contingency fee agreement is that you will owe the attorney nothing if he or she does not win. In some areas, legal aid attorneys may provide representation at no cost regardless of the outcome. You can also have representatives who are not lawyers accompany you to this hearing, but you should make sure that non-lawyers have the proper skill and expertise.

In addition to reviewing the record, the administrative law judge will hear what you and others believe about the denial decision. The judge may also ask doctors, teachers, or others testify who know your child well.

If you do not want to go to the hearing, you may ask the administrative law judge to make a decision based on the evidence in the file. However, this does not allow you to explain in person your reasons for disagreeing with the reconsideration decision.

Request an Appeal Council’s review
If you do not agree with the administrative law judge’s decision, you may request an Appeal Council’s review. You must do this through a letter or through a form that you can get from your local Social Security office. You must ask for an Appeal Council’s review within 60 days of receiving the administrative judge’s decision.

The Appeal Council will examine your request and decide whether to grant a review. If it decides to proceed, it will either review your case or return it to the administrative law judge for further action, which could mean another hearing.

File a civil action in U.S. District Court
The Social Security Administration’s appeal process ends with an Appeal Council’s review. If you disagree with the decision of this review, your next option is to file a lawsuit in court. If you have not already retained an attorney, you will likely need to do so to take this step. You may be able to get assistance from local legal aid services. Remember, you must file this action in court within 60 days of receiving the decision from the Appeal Council’s review.