Most people who apply for Social Security Disability or SSI receive an unfavorable decision after filing their initial application. Often this is the result of financial assets, lack of medical records, lack of treatment, errors in paperwork, or the adjudicator not knowing the law. Many, if not most, make the mistake of refiling a new application rather than filing an appeal. Failing to file an appeal can be an enormous mistake costing the claimant large amounts of money in retroactive benefits.
If Social Security finds you disabled as of the day you allege you became disabled, they then owe money in retroactive benefits as if they had been paying you since the date you became disabled (provided that date isn’t more than a year behind the application date). Here is an example. Steve files an application for Social Security Disability benefits on January 1, 2019, alleging he became disabled on January 1, 2018. On January 2, 2019, Social Security agrees he became disabled on January 1, 2018, and Monthly benefits are $1000 a month. Social Security owes Steve 12,000 dollars because they found him disabled on January 1, 2018, and they owe him money from the date of disability.
Another example. Steve files an application for SSI benefits on January 1, 2016, alleging he became disabled on the same day. He is denied. He appeals. On January 1, 2019, Social Security finds him disabled as of January 1, 2016. His benefits are $1000 a month. He is owed $36,000 in retroactive benefits.
The next example is where things get tricky, and the advantage to appealing becomes apparent. SSI only grants benefits as of the application date. Steve applies for SSI benefits on January 1, 2016, alleging disability the same day. He is denied. He doesn’t appeal but files another application. He is denied. He keeps refiling. Finally, he files a claim for benefits on January 1, 2019, alleging his disability began January 1, 2016. On January 2, 2019, Social Security grants him disability and finds he became disabled on January 1, 2016. He won’t receive any money in retroactive benefits. Why? Because Social Security pays back benefits on SSI cases only as of the date of the application. By not appealing, he lost 36,000 in back benefits. There are exceptions to these rules, but this is the general rule.
There are different types of appeal. If denied at initial application, the first stage of appeal may be “reconsideration.” A “request for reconsideration” must be filed within 60 days of the initial denial. Many in Social Security feel the “reconsideration” stage is a waste of time. You go through the same procedures as you did when you filed the initial application and minimal changes. In the name of efficiency, many districts have eliminated this phase of appeal, and those denied at the initial application will appeal by filing a “request for hearing.”
You have 60 days from the date of denial on reconsideration, or if you’re in prototype district denial of your initial application, to file a request for a hearing. Submitting a “request for hearing” means a Judge will hear your case and you disagree with Social Security’s determination saying you are not disabled. Up until this point, the people deciding your case haven’t been lawyers or judges. They have been bureaucrats within Social Security. Now, your case will be evaluated by lawyers within Social Security and decided by a judge.
The hearing will take place in a small room due to privacy concerns. Depending on the judge and the issues within your case, it can last anywhere from 30 minutes to 2 hours. There are often a medical expert and vocational expert. You will need an attorney to cross-examine and question them should they give unfavorable testimony. There will be an opening and closing statement. It is probably most important to have a lawyer at this stage. Once a judge makes a decision, a presumption is created, the decision is correct.
If not appealed, it becomes final.
The last of the administrative stages is an appeal to the “Appeals Council.” It is challenging to win at this stage and requires precise analysis of each law. The uphill battle at the appeals council highlights the importance of hiring an attorney and winning before this level of appeal. This level of appeal can take 2 or more years.