February 22, 2020

My Initial Application was Denied – How do I Appeal?

8When you apply for disability benefits, you can expect to wait between 4 and 6 months to get a decision. During that time, the state agency adjudicator assigned to your case will request medical records and other information, organize your file then consult with an in-house physician at the state agency office to render a decision.

Generally, state agency adjudicators are looking for listing level impairments – in the case of a traumatic brain injury, they will be looking at  Listing 11.18, or perhaps one of the other neurological listings.

File Your Appeal Within 60 Days of Denial

There are many reasons why even the most legitimate claims can be denied – sometimes the problem is simply that the adjudicator had a bad address for your doctors or even that some of your doctors did not respond fast enough to the request for medical records.

Whatever the reason, if you are denied, you should not give up.  You need to file your appeal – called a Request for Reconsideration – within 60 days from the date you receive your denial notice.  Obviously there is no reason to wait until the last minute – you should file your appeal as soon as possible.

The reconsideration appeal process is used in most jurisdictions.  If you live in an area where Social Security is conducting test programs that do not use reconsideration your denial notice will so state.

Your denial notice, by the way, will be a form letter that lists all of the medical records considered and it will include a statement to the effect that while your medical issues can be expected to cause some impairment, we (Social Security) have concluded that your limitations do not rise to the level that you are disabled  under SSA’s rules.

The denial notice will not include copies of the forms you need to file your appeal.  The forms you will need are:

  • SSA-561 – Request for Reconsideration
  • SSA-3441 – Disability Report – Appeal
  • SSA-827 – Medical authorization

You can also file your reconsideration appeal online.  Here is a link to both the paper forms and the online portal: https://www.ssa.gov/forms/ssa-561.html.

While you can certainly prepare and file your reconsideration appeal on your own, many claimants choose this point to hire a lawyer to work on their behalf.  A lawyer can make sure that all impairments are disclosed to SSA (if you get to a hearing and assert disability based on a condition not previously disclosed, the hearing judge can refuse to consider that impairment).  Also, a lawyer can make sure that the adjudicator has correct contact information for all medical providers, or the lawyer can submit missing medical records directly.

Finally, when you designate a lawyer, both you and your lawyer will get copies of all paperwork issued by SSA.  SSA does have a problem with losing files or not mailing things timely so a second address will improve the odds that you will receive timely notice of decisions from SSA.

If you would like to speak with us about your case, please use the form on the side of this page.