People who have been employed and then become disabled may be in a position to file for Social Security Disability Insurance (SSDI) benefits. If you’re unable to work for at least a year or are facing a terminal illness, you may decide to apply for SSDI benefits that can provide you with a monthly income.
In most cases, an initial application for SSDI is denied. Therefore, many people need to appeal an unfavorable decision before they will be granted benefits. There are four appeal options that you may have to work through after a denial.
Reconsideration
The first step in the appeals process is the reconsideration phase. This is a complete review of your claim by someone who didn’t take part in the first decision. During reconsideration, all of the original evidence plus any new evidence submitted will be reviewed. In North Carolina, as in other states, you need to request a reconsideration within 60 days from the date you received your denial notice. The reconsideration is primarily a file review, meaning you generally don’t need to be present.
Administrative law judge hearing
If your claim is denied at the reconsideration stage, you can request a hearing by an administrative law judge (ALJ). This request must also be made within 60 days after you receive the notice of the reconsideration decision. The hearing is more formal and is typically held within 75 miles of your home. During this hearing, you can present evidence, bring witnesses and make your case as to why you believe you are entitled to SSD benefits. The judge will also question you and any witnesses you bring, including medical or vocational experts.
Appeals Council
If you disagree with the ALJ’s decision, you can ask for a review by the Social Security Administration’s Appeals Council. The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an ALJ for further review.
Federal Court review
The final stage of the appeal process, should the Appeals Council deny your claim or decide not to review your case, is filing a lawsuit in a federal district court. This step elevates your appeal to the judicial system, which is separate from the Social Security Administration.
The laws and procedures surrounding these cases can be complicated. Having legal representation throughout the appeals process may benefit individuals because of the complexity of these consequential matters.