Due to the many factors that SSA officials will look at when determining your social security income, it can become a bit complicated determining one’s eligibility. If you believe you’ve been wrongfully withheld social security, you have the right to appeal, and the right to an attorney. Let’s take a look at what this appeals process might look like.
What is an SSI Appeal?
To appeal an SSI decision, there are established procedures to follow. First, you’ll need to know what decisions you can appeal, sometimes called “ initial determinations”. These are written findings that you or an attorney can refer to when making your appeal. The SSA will send you a notice following these determinations, and you and your attorney must request an appeal within 60 days.
So when will you be sent a notice? Well, initial determinations cover a scope of decisions, including when the SSA first determines that you are:
You’ll receive a notice for each of these things, and if you believe any of these decisions were wrong, you will have a 60 day window to appeal it.
The appeals process will have a few main steps.
One of these steps is called “reconsideration”, which is to quite simply ask the SSA to reassess their decision and determine for themselves if an error was made. You may immediately file a request for reconsideration if your notice is for:
A disability claim is proving you are eligible for the SSA’s criteria of “being disabled”. The burden of proof will fall with you, and so you will need to provide any statements or documentation that you have legitimate disabilities that impair your ability to live your day-to-day life and any activities or work for at least 12 months.
A non-medical claim is a dispute regarding income and resources. Much like proving income to a landlord, you may need to provide pay stubs, tax returns, or bank statements that prove what income you may be receiving and from where. Same goes for resource documentation or living situations, you may need to provide either proof that you own or rent the property you are living in as well as bank information or bills you are responsible for.
Medical disability cessations are for situations where one may have previously received SSI, but the SSA deemed your condition has improved to the point that you no longer need to be reliant upon it. To disprove this, you may be asked to provide a statement from a medical professional about your current health status to legitimize the claim.
Technical error claims determine whether or not an error may have been while your application was still processing. There may not always be much to disprove here other than clarifying any information that may have been misappropriated at any point. These errors could have been human or machine-related, but these claims are simply a matter of sorting out the facts.
You and your attorney may request a hearing before an ALJ, a.k.a. an administrative law judge, to assess your claims. Following the reconsideration requests you made, you’ll have 60 days once again to request a hearing. In the case that you do not want to appear before a judge, you can ask the judge to make a decision based on the evidence already on file. If you do wish to appear, the agency on your behalf will choose a time, date, and location.
During a hearing, one should expect relevant experts to testify and answer any of the judge’s questions, such as a medical expert in the case of either disability claims or cessations. The hearing will likely be recorded.
If you then disagree with the administrative law judge’s decisions and wish to pursue your claim further, you may do so in writing to the appeals council for review. The appeals council is a board made up of SSA officials who serve as the last level of administrative review. Your representation will stay by your side at every phase of the review process. You can also do so online by completing a Form HA–520, which is a request to review a hearing for a decision/order regarding SSI claims.
If even the appeals council denies it, the case will either be denied or sent back to the ALJ for a recess and to check if any procedural errors were made. Should they agree with the appeal, you’ll be reimbursed for any inconvenience and granted the SSI benefits you were withheld, depending upon your updated situation.
Finally, if you disagree with the SSA initial determinations, administrative law judge, and the appeals council, then your last resort is the federal court. At this point, assistance from the SSA will no longer be available and you will only be able to rely on your lawyer and the strength of your case for a judge at a US federal district court to appeal the decision. Like the others, there will be a timeframe of 60 days upon receiving notice from the appeals council to file a civil action (lawsuit or claim).
The federal court will further examine the evidence and, like the appeals council, will either dismiss the case, send it back to the previous judges, or grant your request. This course of action is only taken when all other methods have been exhausted, and it should be noted that the vast majority of these appeals are resolved at the administrative level.
Now that you’re equipped with knowledge of all the phases of an SSI appeal, you could be ready to lawyer up and present your case firstly to the SSA and receive the necessary assistance you deserve. It’s never too late to hear the opinion of a seasoned legal professional, so make today your chance to consult with an SSI lawyer.