What to do when you are denied social security disability

Only about one-third of Social Security disability claims are approved at the initial level. Read the denial notice you receive from Social Security carefully — it will tell you what you need to do. Generally, here are the next steps to take:

1) File an appeal right away!

If you are denied benefits at the initial level, you should appeal as soon as possible (within 60 days of the date on the denial notice). In most states, you do this by filing a special form called a Request for Reconsideration (all states will have the Reconsideration phase by June 26, 2020).

2) Request a hearing before an Administrative Law Judge (ALJ)

In the Reconsideration phase, your claim will be reviewed a second time. If you are denied at this phase, you must file a request for an ALJ hearing to appeal.

Learn more about Social Security hearings.

3) Request review by the Appeals Council

If your claim is denied at the ALJ hearing stage, you have the right to appeal to Social Security’s Appeals Council. The Appeals Council reviews hearing decisions, and has the power to “remand” or send cases back to judges when they make mistakes. It also reverses decisions in a small share of cases. It can take about a year to get a decision from the Appeals Council.

If your claim is still denied at this level, you can file an appeal in Federal Court.

4) Get help!

You have the right to representation. Consider getting help from a Social Security disability attorney or representative — the sooner the better.

What is "Reconsideration"?

When a claim for Social Security disability benefits is denied at the initial level, the next step for a claimant in most states is to request “Reconsideration,” or a re-evaluation of their case. The case is then reviewed a second time and a new decision is made. Unfortunately, in nearly 90% of the cases, the reconsideration decision is the same as the initial decision—a denial.

What is the Social Security definition of "disability"?

While tens of millions of Americans live with disabilities, Social Security disability benefits are restricted to individuals with the most severe disabilities and illnesses. Individuals who are unable to do “substantial gainful activity” (defined as gross earning of $1,220 per month in 2019 for non-blind individuals) due to one or more severe mental and/or physical impairments may be eligible for Social Security disability benefits. Social Security wants to make sure that everyone who receives disability benefits meets Social Security’s definition of disability — a process that typically requires a review of extensive medical and other evidence.

Will it help if I ask my Congressional Representative to help me get Social Security disability benefits?

Many Social Security disability claimants become frustrated with claim delays and eventually ask their U.S. Representative or Senator to help. The local Congressional office typically will have staffers who are experienced with Social Security procedures and personnel. A “Congressional Inquiry,” as it is called, may help to get a stalled process moving again. However, a Congressional Inquiry will have no impact on how Social Security decides the outcome of the case. 

Adapted from a publication from Charles T. Hall, Esq., NOSSCR Past President. 

Reopening a Social Security disability claim can sometimes get you more backpay, but you should always use the appeals process if you can.

There are two ways a disability claimant can ask the Social Security Administration (SSA) to review a denied claim for Social Security or SSI benefits: by appealing the denial or by reopening the previously denied claim. Both of these methods can result in an approval of benefits and an award of backpay.

Appealing a Denial

There are generally four steps in the appeal process.

Request for Reconsideration

The next step after an initial denial is called a "request for reconsideration." This has to be filed within sixty (60) days of being denied. The reality is that most requests for reconsideration are denied—this means that, ultimately, requests for reconsiderations end up being decided by an administrative law judge (ALJ) at the hearing level.

Request for a Hearing

If your request for reconsideration is denied, the next step is to ask for a hearing in front of an ALJ. This request must be made within sixty (60) days of being denied your request for reconsideration. Cases that are ultimately approved are usually approved at the hearing level.

The Appeals Council

If your claim is denied by an ALJ at the hearing level, you can appeal the denial to the Appeals Council (AC). Like the previous requests, this one must also be made within sixty (60) days of your denial. The AC may or may not decide to review your claim. If the AC decides to review your claim, it can conclude that the ALJ's denial was wrong and award you benefits accordingly or can send your claim back to the ALJ to be reviewed.

The Federal Appeal

This is the final stage in the appeals process and most claims never get to this point. Federal appeals require that the claimant submit a brief, a detailed explanation of why you think the prior decisions in your case were wrong. Federal briefs are difficult to write and must comply with complex federal rules. For this reason, it is particularly helpful to have a disability attorney who is licensed to practice in federal court to represent you at this stage.

Reopening a Previous Claim

If you are denied benefits and decide not to appeal your claim, or if you miss the deadline for your appeal, then the SSA will close your case. However, you may be able to have the claim reopened at a later date if you file a new claim and it's related to the original one.

Related Claim

An example of a related claim would be if you initially applied for benefits based on spinal stenosis and you later apply because of a herniated disc. But even a related prior claim can only be reopened if the time period of the disability overlaps with the new claim. And you are limited as to how long ago the claim was closed as to whether or not it can be reopened. You can read in detail about this topic in our article Reopening a Social Security Disability Claim.

Why Reopening a Previous Claim Can Be Beneficial

When you are approved for disability benefits, you are eligible for payments going back to the initial application date (these are called backpayments). If you are approved for Social Security Disability (SSDI), you can get even more money in the form of retroactive benefits (these benefits are paid back to the date the SSA concluded you became disabled). The SSA will use the date of your first application as the date from which you may be eligible for these back benefits.

The Pros and Cons of Appealing a Denial Versus Reopening a Prior Claim

It is generally better to continue appealing a denial through the various stages (request for reconsideration, hearing, and so on) than it is to reopen a previous application. Here are some reasons why.

Reopening a Prior Claim Adds Time

One of the main reasons it's better to appeal a denial is the time factor. The decision-making process for a claim can take as much as two years (and in some cases even longer) and if you fail to appeal, you will likely add substantial time to how long it takes to get a final decision in your case.

The SSA May Not Reopen the Prior Application

The SSA has the discretion to open or not to open a prior application. Again, if the prior case isn't related, the time period doesn't overlap, or too much time has passed, the SSA won't reopen the case. This means that you won't be able to get disability backpay for this time period even if you otherwise met the SSA's definition of disabled.

An ALJ May Follow the Earlier Denial

Although ALJs are supposed to look at claims de novo (from the beginning) they don't always do this. This means that if you reopen a prior claim, the ALJ may deny it simply because it was denied before. Again, the result of this is that you may lose valuable backpay.

What happens when Social Security disability is denied?

How many times can you be denied Social Security disability?

Does everyone get turned down the first time for disability?

How do I fight Social Security denial?