Reconsideration Appeal with the SSA

The federal Social Security Act (SSA) was passed in 1935. It created a program entitled the Old Age, Survivors, and Disability Insurance program, or OASDI.

This is the technical name for the Social Security program, although it is typically just referred to as social security. This program is run by the federal government and provides benefits to individuals who are eligible.

The Social Security program is funded by withholding social security taxes from the paychecks of current employees. This system is often referred to as a pay as you go system, meaning it pays benefits from funds that are collected from working individuals.

When working individuals retire, their benefits will be paid from funds that were collected from individuals who are working.

Social Security eligibility is available for four categories of individuals:

• Retirees;
• Disabled individuals;
• Those who are eligible for supplemental security income; and
• Those whose spouses passed away while they were receiving social security benefits.

What Is the Purpose of the Social Security System?

There are several purposes for the social security system, including:

• Providing for the material needs of both families and individuals;
• Protecting seniors and disabled individuals against the various expenses of illnesses that could otherwise deplete their finances and savings;
• Keeping families together whenever possible; and
• Providing children with an additional opportunity to grow up healthy and financially secure.

Examples of the programs that are included under the SSA and other applicable laws include, but are not limited to:

• Retirement, survivors, and disability insurance;
• Hospital and medical insurance for disabled individuals, the aged, and those experiencing end-stage renal disease;
• Prescription drug benefits, as well as additional assistance with Medicare prescription drug costs;
• Supplemental Security Income (SSI); and
• Public assistance and welfare services, for example, child support enforcement and food stamps.

What Should I Do if I Have Been Denied Social Security Benefits?

Individuals who apply for social security benefits may have their application denied by the Social Security Administration (SSA). The reasons an application may be denied vary depending on the type of social security benefits an individual may have be trying to obtain, for example:

• Retirement benefits: An individual will likely be denied retirement benefits if they do not meet the minimum age requirement; or if they indicated that they have never worked in a job in which they paid U.S. Social Security taxes;
• Surviving spouse: Denial of surviving spouse benefits may occur if an individual does not meet the minimum age requirement or if they were never married. Another example of a cause for denial would be if the individual remarried before reaching the age of 60;
• Child: Children may, in some cases, receive their parent’s social security benefits. A child would be denied if their parent is not deceased, nor are they receiving Social Security retirement or disability benefits;
  • Another reason for denial would be if the child is over the age of 18 and they are not in high school, nor are they disabled;
• Disability: Denial of disability benefits may be denied if an individual is over full retirement age or if they indicated that they are not disabled;
  • Another reason would be if they indicated that they have never worked in a job in which they paid U.S. Social Security taxes;
• Supplemental Security Income: An individual will be denied SSI benefits if:
  • they are not 65 years of age;
  • they are not disabled or blind; or
  • their income or assets are above the limits set by SSI;
  • Other reasons may include that:
    • they are not a U.S. citizen or a lawfully admitted non-citizen;
    • they do not live in the U.S. or the Northern Mariana Islands; or
    • that they live in a jail or other correctional facility; and
• Medicare: Medicare benefit denial will occur if an individual is not 65 years of age or if they are already receiving Social Security disability benefits.

Individuals whose claims are denied have the right to appeal the denial. In general, the appeals process is as follows:

• Reconsideration: An individual may request reconsideration if they have been denied benefits, which will initiate a complete review. The review will be conducted by an individual who played no part in the initial decision;
• Hearing by an administrative law judge: Should an individual disagree with the reconsideration decision, they may request a hearing before an Administrative Law Judge;
  • Before the hearing occurs, Social Security may request that the individual submit additional evidence, or clarify certain claim information;
  • At the hearing, the judge will question the individual and any witnesses, including medical witnesses. This hearing is generally conducted in person. This means that claimants who are unable or unwilling to attend an in-person hearing must notify Social Security;
  • Once the hearing is concluded, the judge will make a decision regarding the social security case; and
• Lawsuit against the social security administration: If an individual does not agree with the judge’s decision, they may file a lawsuit in federal court against the Social Security Administration.

Can I Appeal a Social Security Denial?

Yes, as noted above, if an individual’s application for benefits is denied by the Social Security Administration, they can file an appeal. The first step in the appeals process is requesting reconsideration.

What Is Reconsideration Appeal with the SSA?

Reconsideration is a complete review of an individual’s disability claim. In general, filing a reconsideration request is fairly simple and only requires the individual to complete a few forms.

Do I Have to Appeal Immediately?

Because an individual’s appeal has to be made within 60 days after receiving their SSA claim denial letter, an individual should begin work on their appeal as soon as possible. If an individual fails to appeal within 60 days, their reconsideration will automatically be denied and they will be required to file a new claim.

If, however, the individual has a good reason for missing this deadline, the SSA may waive this timeframe requirement.

How Does the Review Process Work?

An individual’s denied claim will be reviewed by an employee who did not participate at all in the first decision. All of the materials that were used to process the individual’s claim will be examined in addition to any new evidence that was provided.

Can I Meet with the Person Reviewing My Case?

No, if an individual is appealing their benefits claim, they cannot meet with the official who is reviewing their case. If, however, an individual is appealing an SSA decision that they are no longer disabled, they have two options, including:

• Meeting with an officer and explaining why they disagree as well as bringing along any other individuals who can provide medical information contradicting the SSA decision; and
• Submitting for a file review.

How Long Does SSA Have to Make a Decision on Reconsideration?

An individual has 60 days from the time they received their SSA decision letter to submit their reconsideration request as well as any supporting documentation. The SSA may take anywhere between 30 days and six months to make a decision on reconsideration.

When And How Will I Be Notified?

The SSA will send the individual a letter that notifies them of their decision. If an individual’s claim is denied after reconsideration, the next step in the appeals process is an Administrative Law Hearing.

What Happens if Reconsideration Is Denied?

If an individual is denied after reconsideration, they can request that the SSA provide them with a hearing with an administrative law judge (ALJ). This request must be submitted in writing within 60 days of the reconsideration notification by filling out an online form, printing and mailing it, or by writing a letter stating a hearing is desired.

Do I Need a Lawyer?

If you have been denied by the SSA, it is important to consult with a Social Security lawyer as soon as you can. Your lawyer will review your denial letter and help you throughout the appeals process. They can provide guidance and representation for your case.