What are the Four Appeal Stages and How Do I Approach Them?

by | Jul 15, 2016 | Lawyers

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1. Reconsideration: If you don’t agree with the initial determination, you should complete Form SSA–561 or Form SSA–789. You or your representative must ask in writing for reconsideration within 60 days of the date you receive the written notice of the initial determination.  We consider that you receive a notice 5 days after the date of the notice. If you ask for reconsideration in writing within 10 days after you receive the notice, any payment we are currently making will continue until we make our reconsideration determination, if you continue to meet all other SSI eligibility requirements. You will be sent a notice of the reconsideration determination. If you appeal a disability cessation, and you want to keep receiving benefits until we make a determination, you must make a written request for benefit continuation within 10 days after the date you receive the written notice. You are entitled to a face-to-face hearing with a disability hearing officer.

2. Hearing: If you disagree with the determination, you or your representative can request a hearing before an administrative law judge (ALJ) by completing a Form HA–501. You must request a hearing within 60 days after receiving the notice of reconsideration determination. You or your representative should review your file before the hearing and also submit new evidence if needed. You may continue to receive your SSI once you are appealing a determination that your disability is ending. In writing, you should ask for your benefits to continue, but it should be requested within 10 days of the cessation notice. If you do not want or cannot make it to appear in person, you may ask the ALJ to make a decision based on the evidence in your file. If you do request to have a hearing before an ALJ, it is critical that you or your representative appear in person at the scheduled hearing. If you do not attend the scheduled hearing, you are at a high risk of losing your appeal rights and benefits. In disability cases, the ALJ may also want to see more medical exams or tests.

3. Appeals Council: If you disagree with the ALJ’s decision,  by completing a Form HA–520 (Request for Review of Hearing Decision/Order). You must ask for an Appeals Council review within 60 days after you get the hearing decision. If you or your representative have new evidence, you may submit that before the hearing. The Appeals Council will review your case and will decide whether to grant, deny, or dismiss your request for consideration. If the Appeals Council grants your request for review, it will either decide your case or return it to the ALJ for further action, which could include another hearing and a new decision. The Appeals Council will send you a copy of the action it takes on your request for review and explains the reasons for this action.

4. Federal Court: If the Appeals Council issues a decision or denies your application for review of an ALJ’s decision and you disagree, you may file a civil action with the U.S. District Court in your area. It is recommended that you contact a lawyer or a legal aid group to help you with your case. You must file an action in U.S. District Court within 60 days after you receive the Notice of Appeals Council action. The U.S. District Court will review the evidence along with the final decision. Click here for more info.

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