If the Judge Denies Your Disability Case, You Have a Third Chance to Appeal
The hearing level of the Social Security disability appeals process is perhaps your best opportunity for getting approved for disability benefits. But what if the judge rules against you? There is a third step to the appeals process you can pursue. You can request that Social Security’s Appeals Council review the judge’s decision.
What is the Appeals Council?
The Appeals Council is a group of about 54 Administrative Law Judges and 54 Appeals Officers and is part of the Office of Disability Adjudication and Review (ODAR), SSA’s administrative adjudication system.
The Council does not review details of your case or meet with you, as your hearing judge did. The Council’s purpose is to review the judge’s actions to determine if he or she made errors that impacted the final decision.
How to Request a Review
If you disagree with the judge’s denial decision, you have the right to ask the Appeals Council to review that decision but you must make your request in writing within 60 days of the date of the hearing decision. You may also include new evidence with your appeal and reasons why you disagree with the judge’s decision.
If you miss the 60-day window to request an appeal, you may ask the Council, again in writing, if they will consider giving you an extension. You must include reasons why you were late in asking for a review.
There are no hearings with the Appeals Council. All communication is done through written briefs and letters back to you from the Council explaining their decision.
You can request a review of your case on your own. But, considering the highly technical issues surrounding a disability case, it is advisable to ask your non-attorney disability advocate or attorney to prepare this request for you.
Actions the Appeals Council May Take
This is what the Appeals Council may decide to do:
- Reject a review because they feel the judge’s decision was right
- Review your case and reverse the decision because they feel the judge was wrong
- Review your case and decide to send it back – or remand it – for a second hearing with a different ALJ because:
- Your judge made a technical error, or
- Your judge did not properly consider all medical evidence
How Much Longer to Wait
The Appeals Council could make a decision as quickly as three months, or it may take as long as 18 to 24 months. If your case is remanded for a second hearing with a different Administrative Law Judge, you may have to wait another one to three more years to get scheduled for a new hearing.
The Appeals Council processed about 119,500 requests for review in 2010 and expects to review 131,800 cases in 2011.
The Final Step
If you are still dissatisfied with the outcome of your disability case, you have the option to file a civil action in U.S. District Court. Again, you have 60 days after receiving the Council’s decision to do so. This is the last level of the Social Security disability appeals process.
During SSA’s fiscal year beginning October 2009 and ending in September 2010, SSA processed 12,420 new civil actions.
I am now getting ready my third appeal which is to go in front of a judge. My last appeal was denied. ( been going at this since 2009 on my own) I have until March 2011 to get the appeal in for a judge to see me.
My question is how do I make sure that all my medical gets to the Judge or do I have to bring all the paperwork?
LaNell,
Once you send in your request for a hearing the Office of Disability Adjudication and Review (ODAR) will send you more forms to fill out and advise you on what will be needed to supplement your case. Your papework must be as complete as possible and as current as possible. The Disability Learning Center section of this Web site will give you more insight on what to expect. At this level of an appeal it is strongly advised that you get the help of a disability expert to help you. Also, once you request a hearing, it can still take a very long time to get scheduled, depending on where you live.
I would like to know “Why is it so hard for people with Lupus and RA to get approved?” I’m 27 years old and I’ve been suffering for 13 years with Lupus and RA. I try to work so I can help my husband take care of the bills but most days i ca’t even get out the bed. A few challenges that I face everyday is picking up my children to hug them, washing the dishes, walking to the bathroom to use it, holdng a pen/pencil, opening jars and bottles. I’ve had my case reviewed and denied sice 2006. Something got to give
Im so sorry
Hope it worked out
Viola,
To guess why you are having problems with winning I would say it is your age!
My wife had the same problem at 27 (2005 claim filed) she just won her claim this year.
If you really want to win it this is what you need to start with.
- Hopefully to start you did – Get all your medical records (ER visits, medicine profile, therapy records, Xray, MRI’s, EVERYTHING)yourself do not rely on the Gov’t to get everything.
- Then you went to your local office. They will give you on a disk everything they have scanned in or have on file for your claim. They are BAD for not getting all the info in! The Judge cannot rate what he does not have, having said that they also skip things on purpose to not rate.
- Get the reason for denial and check all the records they claim to reviewed on the denial.
- Listen, point blank they denied my wife’s because 1. Age. 2. Race. Every reason the ALJ denied her claim there was medical evidence for and so much for she used his reasons for denial and countered with medical evidence. A. She is on oxygen 24/7 all medical records submitted and acknologed by SS. She simply appealed and this was one with her doctors statements and limitations. This was one of about 13 reasons for appeal.
The ALJ was slammed it was remanded (to the same Judge) something she found out about this ALJ he never had one case remanded. So when he approved her claim, ironically he awarded her SSDI but with no reasons that concured with the “Remand”……isn’t that some crap!
- File your appeal within the time frame, I think it is 60 days.
- Review medical records and if you cannot read some things hopefully you have a friend in the medical field.
- Appeal and COUNTER every reason they denied you. Don’t give up. My wife has Autoimmune diseases your doctors need to say WHAT CANNOT DO AND HOPEFULLY IT IS WITH OUR DAILY LIVING, RECREATIONAL AND JOB RELATED. Not just you have lupus, RA or mixed connective tissue disease.
Like the front page says for the appeal say what you don’t agree with…….
don’t say you have limited range of movement without citing the medical documentation and statement to back that up.
don’t say you cannot sit for 2 hours a day without having FMLA stating this and your doctor records stating this with your medicine list.
Everything you cannot do must be medically dx’d and treated.
I have been trying to get my diability every since I was shot back in 1994 , and I have been turned down every time , and each year I have been trying and still get turned down , even now since my left foot turned inward with me and I can’t walk without wearing a heavy brace. I haven’t worked since March 16,2011 because i can’t perform the duties of my job that I was hired on to do at Bi-Lo so they have me on medical leave until I am released from my doctor, but even after the surgery I might not walk straight again .. Then what I ask you !!! I also have Graves Disease which isn’t a cure for…. I have 2 torn ligaments in my left foot at my ankle and nerve damage as well in my left leg …………. I only have one eye cause from me being shot in the head back on August 18, 1994 and I almost died that night but I didn’t and I praise d the good Lord up above for that
Thank you – this is sheerest sympathetic !
Took me 3 years to get a court case with a fed judge. I went to court and the judge after 2hours granted me full approval of my case. For the next 3months I spent talking with the SS office asking when would I see my payment. She would say very soon,very soon. It’s in the system now.
3months like I said go by and on monday morning she calls. saying” I don’t know whats wrong I must have miss read something. But you have been rejected by Appeals Council, call your lawyer.”
Wow, shocked,sad and dam right pissed off! So fight fight fight, get court case the hardest judge aprroves.. SS office plays me for another 3 months saying soon and then bam.. Oh we are sorry some Appeals Council said no.
I have cronies disease, pretty much stay on the toilet 24/7 up for my 33 colon example..
Going on 7 Years, 6 Denials, 1 Rejection No Money and No Healthcare. I wish everyone God Speed and Blessing. Second Attempt at Appeals Council. was told SS Insurance has run out so this is it. Maybe you have to loose it all even your life. Don’t Vote Republican they don’t believe in any entitlements people and there is “no money in the coffers”
We were denied disability from a “judge from he__” last year. We won an appeal, and now the judge was remanded and the case was sent back for consideration. We assumed it would go befote the same ALJ for re-consideration, but according to your article it would go before a different judge. Can anyone let us know?
i’m not sure how much this will help but we were told by an ALJ that if your case was at the appeals council level and they send it back to be remaned for further review, that you just able positive that you will get your disability. the judge at the app council see’s something that he should of taken into consideration the first time. hope all goes well with you. my husband had faught 5 years to get his. and i ‘ve been fighting since 2004 it’s been along road but hoping sometime s o on i’ll get to the end of t his nasty road you must t ravel in the mean time. gool luck and God Bless everyone that is in this process.
My son was rejected for SSD because he ( was told ) doesn’t have enough work credits. He has ( none ), but he applied since he is under the age of 22 and he can qualify with my work credits since I am disabled and getting SSD. His attorney never acknowledges the emails forwarded to him, so we may lose the chance to file an Appeal. He has until May to do it. I can do the Appeal myself, but he has an attorney and I figure it’s his job to do it or let us know, so we can do it ourselves.
SSI is what he needs to be filing for.
yes if you have not enough work credits you only qualify for SSI….
I had a hearing in December 2011. I just got a decision notice for unfavorable. I have depression anxiety, seizures, thyroid problems and asthma. I am 45 yrs old. My lawyer stated that he sees several errors on ALJ part and is appealing. This is a nightmare.
The problem I see with social security is simple! Social security does not follow it’s own rules. Social security defines a disability as a condition that prevents substantial work. My understanding is that social security considers substantial work as part time work or better. So in other words if you can work four hours per day five days per week your not disabled. Howeer in practice thats not the definition they follow. In practice you have to be pretty close to an invalid to win a social security case. Many folks with back problems can’t work a four hour day yet social security is constantly rejecting back injuries. It’s really a no brainer whats happening. You have a mentality in this country that if you can walk you can work. Even if you walk hobbled or in pain you can work. So hear is what I think should happen. Every working American should have the choice to opt out of social security and it’s rules. Although I don’t believe in just giving each citizens their social security holdings I do believe a citizen should be able to choose to put what would have gone to social security into privately held pensions. It’s easy to do this, we do it all the time for 401k plans. You would fill out the paperwork and what you normally hold out for social security goes to a private interest bearing fund and if you become disabled after 25 or 30 years you don’t have to prove anything to anyone. Oh one more thing. Those funds should not be taxed. Good Day, Joe.
I’m 27, I’m on 7 daily medications. I have fibromyalgia, endometriosis, chronic fatigue syndrome, chronic migraines, depression, and severe anxiety disorder. Fibromyalgia and endometriosis are both two very very painful conditions, so are migraines. Between the depression and chronic fatigue, it’s very hard to concentrate on things and stay motivated. In public places I get severe anxiety attacks and it’s very hard to be in public places even just for food shopping. I applied for ssd/ssi in April 2010, got my first denial Oct. 2010. I appealed in oct.2010 for a request of the ALJ, I waited a year for the hearing which was in Oct.2011, then I got the denial from the ALJ in late Jan.2012. I appealed that decision and now I’m waiting on the Appeals council to review my case. I know so many people have waited so much longer than me but now my state eliminated general cash assistance program, which is normally for people that are disabled waiting for ssi/ssd and they just cut the whole program. I’m divorced with no income except medical assistance and food stamps. How can I even pay my copays for my needed prescriptions with no income whatsoever? I have no one that can support me…..I don’t know what I’m going to do. The federal government needs to do better than this…..I worked for 13 years since I’m 12 paying into social security, medicare, state and federal taxes. They OWE me!! they owe us, people that have paid into the system and they make us wait years for our benefits when we become disabled. They get their money every week we work…..but we have to wait for ours!!
I’m 31 and my life is simply ruined. My doctor whether intentional or not has sabotaged my maedical records. I’m listed as having given birth to five children when in fact I have only ever given birth to two out of of my only two pregnancies. Things I have been in for repeatedly are not in my files. My doctor even looked at me, and stated flatly that I was too young to be disabled! Before this new doctor was given to me through medicaid I had a good doctor who patted my arm sympathetically saying, “oh your poor dear, you’re too young to have all these problems.” I was told by this doctor to file for disability. I have arthritis in my knees, severe fibromyalgia, mineares disease, polycystic ovary syndrome, irritable bowel syndrome, scoliosis in my neck, migraines lasting from one day up to one month, carpal tunnel in both wrists,bilateral hip bersitis, positional imbalance, swelling in my feet and legs for no reason that makes it way too painful to either stand for too long, walk, or even sit a certain way too long. I feel that my doctor purposefully ruined my chances at getting disability, and then to top it off my pain clinic stated that they thought I was faking when they first saw me. Why then do they give me narcotic pain meds if this is the case, and if they no longer feel this way it should have never been stated in my fight for disability. It was also noted in my denial letter after going before the judge that I quit physical therapy! I have never quit physical therapy, my city was flooded which wiped out my hospital where I was recieving physical therapy, and so we had to wait until they were set up at another location. The cherry on top is my terrible lawyers who never told me that they never got some of the medical records I signed for them to be able to get! I didn’t find this out until after going before the judge, my lawyers told me everything was in order. If not for my mom I would have to place my kids in foster homes, and sleep in the streets. I’m tired of living this way! I’m now waiting to hear something from the appeals council, and I pray to God that I get approved, or at least another chance to prove that I’m disabled. I haven’t been able to work since 2006, so if I were faking I would have given up long ago!
I found out that every American is entitled to disability benefits by law these social security judges want people to believe you are only entitled based off their opinion which is totally false. I found out if anybody interferes or attempts to interfere with a person from participating in or enjoying any benefit, privilege, program, etc administered by the united states is a federal crime a violation of title 18 USC section 245 sub paragraph 1b… file a civil suit in federal court and get your entitled to by law…. this is a legal issue not a medical issue
so what does this mean, how would this help in a disabilty case.. thanks
Ray,
If the judge denies you, you will have the opportinity to have the Appeals Council review your case. The Council’s purpose is to review the judge’s actions to determine if he or she made errors that impacted the final decision.
@ Freedom,
Our ALJ kept going off the record saying things like …….”why didn’t you call me”, “We could have worked something out”, “I will approve you if you use this lawyer”
Is this “normal” and justified behavior?