The Appeals Process for Social Security Programs

If the Social Security Administration (SSA) sent you a letter denying your claim for benefits, telling you it is decreasing your benefits, or telling you that you have been overpaid benefits, you may be able to appeal it. You can appeal most decisions the SSA makes about your benefits. When the SSA sends you that letter, it will also send you a letter with information about how you can appeal the decision.

Filing an Appeal

If you decide to appeal the decision, you will need to appeal in writing and file the appeal with the SSA. The SSA offers different forms you can use to request an appeal. The SSA allows you to file an appeal and upload more documents through its website on the Disability Appeal page. You can now file an appeal from outside the U.S. using the SSA website.

Filing Time Limits

The SSA must receive your request within 60 days of when you received the letter with the negative decision. The SSA will assume you received the letter five days after the date written on the letter. If you did not and that is an issue, you will need to prove to the SSA when you received it.

If the last day to appeal (the 60^th day) falls on a weekend day or holiday, the deadline extends until the next business day. If you do not get your request in on time, you may lose your right to appeal the decision. That means the decision becomes final. If you have a good reason for not getting your appeal to the SSA on time, the SSA may give you more time. When deciding if you had a good reason, the SSA will consider:

• Conditions that may have prevented you from filing on time
• Whether the SSA did something confusing or misleading
• Whether you did not understand what you were supposed to do
• Whether you have a physical or mental condition, or a language barrier, that prevented you from filing on time

You will need to file your request for more time in writing and include the good reason why you were not able to meet the deadline.

The Different Levels of Appeals

There are four levels of appeals available to you. They are:

• Reconsideration (for disability claims)
• A hearing in front of an Administrative Law Judge (ALJ)
• Appeals Council Review
• Federal Court

The SSA may be able to help you with the appeals process up to the point where you file a civil lawsuit in federal court. At that point, the SSA will only give you information about the process.

Reconsideration

A reconsideration is a complete review of your claim by someone who did not take part in the decision you are appealing. The SSA will look at all the evidence it had at the time the decision was made, along with any new evidence it receives.

With most reconsiderations, you will not need to be present. However, it is best to ask for an in-person review so that you can participate in the process. If you are appealing a decision that you are no longer eligible for disability benefits because your medical condition has improved, you can ask to meet with an SSA representative. During the meeting, you can explain why you believe you are still disabled.

To ask for a reconsideration, file your request with the SSA. Depending on your situation, you can use Form SSA-561 or Form SSA-789 for your request. You can file your appeal and upload additional documents through the SSA’s website on the Disability Appeal page. The 60-day time limit applies to your request. To learn more about the time limits, read the “Filing Time Limits” section above.

If you have questions about requesting a reconsideration, you can contact the SSA. A lawyer may also be able to help you. If you have a low income, you may qualify for free legal services. Whether you have a low income or not, you can use the Guide to Legal Help to find lawyers in your area. If you are not able to get free legal services but can’t afford high legal fees, consider hiring a lawyer for part of your case instead of the whole thing. This is called limited scope representation. To learn more, read Limited Scope Representation (LSR): A More Affordable Way to Hire a Lawyer. To find a limited scope lawyer, follow this link to the State Bar of Michigan lawyer directory. This link lists lawyers who offer limited scope representation. You can narrow the results to lawyers in your area by typing in your county, city, or zip code at the top of the page. You can also narrow the results by topic by entering the kind of lawyer you need (divorce, estate, etc.) at the top of the page.

Administrative Law Judge Hearing

If you disagree with the reconsideration decision, you can ask for a hearing by writing a letter to the SSA or filing Form HA-501 with the SSA. You can file your appeal and upload additional documents through the SSA’s website on the Disability Appeal page. The 60-day time limit applies to your request. To learn more about the time limits, read the “Filing Time Limits” section above.

Schedule the Hearing

The hearing will be in front of an ALJ. The ALJ assigned to your case will not have been involved in the original decision or the reconsideration. There can be delays in scheduling the hearing based on the ALJ’s travel schedule and the number of pending appeals.

Hearings usually happen within 75 miles of your home. However, your hearing could be farther than that. If your hearing is more than 75 miles from your home, the SSA may cover certain costs. To learn more about this, read the section When We Can Pay Travel Expenses on the SSA website.

If you cannot travel or if traveling is hard for you, include that information in your hearing request. If you cannot travel for a medical reason, submit a note from your doctor with your request.

In some cases, the SSA may schedule your hearing by video conference, meaning you and your witnesses will not be in the same room as the ALJ. You will still have to travel to a specific location, but you will use a monitor to see and communicate with the ALJ. The SSA can schedule video conference hearings more quickly than in-person hearings. The SSA can also be more flexible with scheduling times and locations for video conference hearings. If you want to object to having your hearing by video conference, you must do so within 30 days of receiving notice from the SSA of your video conference.

Review Evidence and Submit New Evidence

Before your hearing, look at any evidence in your case file. Use this opportunity to see if there is wrong or potentially confusing information you can fix.

If you have new evidence, it is very important you submit it as soon as you can. New evidence could eliminate the need for a hearing. You can submit new evidence along with your hearing request. You must submit new evidence at least five business days before the hearing. If you don’t, the ALJ could decide not to consider the evidence unless you have a good reason for missing the deadline. When deciding if you had a good reason for not submitting the evidence on time, the ALJ will consider:

• Conditions that may have prevented you from filing on time
• Whether the SSA did something confusing or misleading
• Whether you did not understand what you were supposed to do
• Whether you have a physical or mental condition, or a language barrier, that prevented you from filing on time

Attend the Hearing

During your hearing, you can have a representative with you, such as a lawyer. You can also bring witnesses who can testify about your condition and how it affects your work. There will not be a lawyer representing the SSA during your hearing. The ALJ may ask a medical or vocational expert to be at your hearing. This expert will answer questions about your impairment and how it affects your ability to work. You or your representative will also be able to ask them questions during your hearing.

It is always a good idea to attend your hearing. If you cannot attend it, you need to let the SSA know as soon as possible. You will need to write a letter to the SSA explaining why you cannot attend. If you have a good reason, the SSA may be able to make arrangements for you, such as changing the time or place of your hearing. If the ALJ decides you need to be present during your hearing, they will reschedule your hearing. Otherwise, your hearing will happen without you.

After the hearing, the ALJ will make a decision based on all the information in your case. This includes any new information you provided. The SSA will send you a letter and a copy of the ALJ’s decision.

Appeals Council Review

If you disagree with the ALJ’s decision, you can ask for a review by the SSA’s Appeals Council. You can request an Appeals Council review by using the Online Appeals Application or filing a request for review. You can use form HA-520 to request a review. The SSA provides instructions on completing the form. Once the form is completed, send it to:

The 60-day time limit applies to your request. To learn more about the time limits, read the “Filing Time Limits” section above.

The Appeals Council reviews all requests it receives. If it believes the hearing decision is correct, it will deny a request. If the Appeals Council decides to review your case, it may decide your case itself, or it may send the case to an ALJ for a review.

If the Appeals Council denies your request for review, the SSA will send you a letter explaining the denial. If the Appeals Council reviews your case itself, the SSA will send you a copy of its decision. If the Appeals Council sends your case to an ALJ for review, the SSA will send you a copy of the order.

Federal Court

If the Appeals Council decides not to review your case, or if your case is reviewed and you disagree with the decision, you can file a civil suit in the U.S. district court in your area. Unlike the other appeal levels, the SSA cannot help you file your lawsuit in district court. However, the letter the SSA sends you about the Appeals Council’s decision will also give you information about filing your case in a federal district court. Filing a case in federal district court is complex. You may want to speak with a lawyer who can help you.If you have a low income, you may qualify for free legal services. Whether you have a low income or not, you can use the Guide to Legal Help to find lawyers in your area. If you are not able to get free legal services but can’t afford high legal fees, consider hiring a lawyer for part of your case instead of the whole thing. This is called limited scope representation. To learn more, read Limited Scope Representation (LSR): A More Affordable Way to Hire a Lawyer. To find a limited scope lawyer, follow this link to the State Bar of Michigan lawyer directory. This link lists lawyers who offer limited scope representation. You can narrow the results to lawyers in your area by typing in your county, city, or zip code at the top of the page. You can also narrow the results by topic by entering the kind of lawyer you need (divorce, estate, etc.) at the top of the page.

The 60-day time limit applies to your civil suit. To learn more about the time limits, read the “Filing Time Limits” section above.

Getting Benefits During Your Appeal

If you are currently getting benefits, you may be able to keep getting your benefits while you appeal the SSA’s decision. The SSA will let you know if you are eligible to keep getting benefits during the appeals process. You will need to file your request within 10 days of getting the negative notice to continue getting your benefits. If your appeal is denied and you were receiving benefits during the process, you may need to pay back any money you got for the claim you were appealing.

If you have questions about getting benefits during your appeal, you can contact the SSA. A lawyer may also be able to help you. You can use the Guide to Legal Help to find lawyers in your area. You may also get information about your local legal services office that could offer you free help.