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Obtaining review of the denial of a claim for SSDI benefits

One of the harsh facts of life faced by many residents of Scranton who seek Social Security Disability Insurance benefits is that most such claims are denied. The initial denial of an SSDI claim does not mean that the claim is forever rejected. Instead, the initial denial usually forces the claimant to resort to the multi-layered SSDI appeals process, and this process could significantly delay any award of benefits. Nevertheless, the availability of an appeal mechanism may give a claim a second or third life. This post will review each step in the process.

Requesting an Appeal

A claimant has 60 days to request an appeal after receiving notice that the claim was denied. The Social Security Administration regulations provide four levels of appeal, which must be taken in sequence. The four levels are reconsideration, hearing before an administrative law judge, review by the SSA Appeals Council, and lastly, review by a federal judge.

If an application for benefits was denied for medical reasons, the claimant can use the internet to request review. If the claimant requests a medical reconsideration, all of the evidence in the case will be reviewed by an employee of the SSA who did not participate in any way in the initial determination. If reconsideration results in another denial, the claimant can request a hearing in front of an administrative law judge.

Review by an Administrative Law Ludge

Most administrative law judges are attorneys, and they have spent many hours hearing appeals of SSDI claims that were initially denied. The hearing will usually be scheduled within 75 miles of the claimant’s home. Many cases are presented to the administrative law judge through a video circuit. Anyone who finds the video presentation awkward or uncomfortable can ask to have an in-person hearing, and the SSA will determine the most convenient time and location for the in-person hearing within the 75-mile radius.

The claimant can testify about the claim in person. Often, this testimony puts a more personal light on the case and may help persuade the judge to rule favorably.

The administrative law judge will review all of the evidence, including any new information submitted by the claimant. The judge will render a decision on the evidence within a few weeks. If the administrative law judge denies the claim, the claimant can request review by the SSA Appeals Council.

Review by the Appeals Council

The last review within the SSA is a request to the Appeals Council to review the decision of the administrative law judge. The Appeals Council is not obligated to review the appeal. Instead, the Council has discretionary power to affirm the existing decision without hearing evidence, or it can return the case to the administrative law judge for further review. The Council can also decide to reverse the decision of the administrative law judge based on the existing record.

Judicial Review

If the Appeals Council affirms the denial of the claim, the claimant has one route left: a petition for judicial review by a federal judge. If the claimant decides to follow this route, an attorney must be retained to draft and submit the necessary papers.

Hiring an attorney

As noted, an attorney must be hired if the claimant chooses to pursue the claim in federal court. Many SSDI claimants hire attorneys to help them much earlier in the process. For any significant claim, an attorney can provide critical assistance at the beginning of the claim process. A knowledgeable lawyer can assemble the medical and employment evidence,  help the claimant complete the initial claim submission and any appeal papers that may be need later in the process. If and when a claim reaches federal court, the services of a capable lawyer may be the difference between success and denial.