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Social Security Determinations & Decisions: Steps in Appealing

Social Security Administration (SSA) has created appeals procedures if an individual disagrees with a determination or decision made in their case. There are 4 different decisions or determinations an individual can appeal: 1) Initial Determination; 2) Reconsideration; 3) Hearing; and 4) Appeals Council Review. To begin, when you file an application for Social Security Disability Insurance and/or Supplemental Security Income benefits, you will receive what is called an initial determination. This initial determination basically explains whether Social Security has found you disabled or not. If you are denied at initial, you have the option to appeal this decision. A request for appeal must be in writing within 60 days as of the date you receive notice. Once a timely appeal of the initial determination is submitted, Social Security will then review the claim. They will look at any new medical evidence or change in circumstances before they issue a reconsideration determination. If you are denied at reconsideration, you have the option to request a hearing before a judge. Again, this request for hearing must be done within 60 days after you get the notice of reconsideration determination. A hearing will be scheduled before an administrative law judge. You and your representative will appear before the judge to discuss the factual and legal issues. After the hearing, you will receive a hearing decision in the mail. If you disagree with the judge’s decision, you may request for an Appeals Council review within 60 days after getting the hearing decision. The Appeals Council will either grant, deny, or dismiss your request for review. If the Appeals Council denies the request for review or if you disagree with their action, you may file a civil action with the U.S. District Court in your area. This civil action must be filed within 60 days after you receive the notice of Appeals Council action. The District Court will review the evidence and final Agency decision. Overall, the Social Security Disability process has many levels of determinations and decisions that may be appealed. Because of the time constraints and complex legal issues involved, it is crucial to work with an experienced law firm who can help guide you through this process and explain what appeals options are best for your case.

 

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