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The Appeals Process

The Appeals Process

Social Security wants to be sure that everydecision made about your Social Securityor Supplemental Security Income (SSI) claim

is correct. We carefully consider all theinformation in your case before we makeany decisions that affect your eligibility oryour benefit amount.

When we make a decision on your claim,we will send you a letter explaining ourdecision. If you do not agree with ourdecision, you can appealthat is, ask usto look at your case again.

When you ask for an appeal, we willlook at the entire decision, even those partsthat were in your favor. If our decision waswrong, we will change it.

When and how can I appeal?

If you wish to appeal, you must makeyour request in writing within 60 daysfrom the date you receive our letter. Weassume you receive the letter five days afterthe date on the letter, unless you can showus you received it later. Call your localSocial Security office if you need help withyour appeal.

If you filed for Social Security disabilitybenefits or SSI and your claim wasdenied for medical reasons, you mayrequest an appeal on our website,www.socialsecurity.gov/disability/appeal.

How many appeal levels are there?

Generally, there are four levels of appeal.They are:

Reconsideration;

Hearing by an administrative law judge; Review by the Appeals Council; and

Federal Court review.When we send you a letter about a

decision on your claim, we will tell youhow to appeal the decision.

ReconsiderationA reconsideration is a complete review of

your claim by someone who did not take

part in the first decision. We will look at allthe evidence submitted when the originaldecision was made, plus any new evidence.

Most reconsiderations involve a reviewof your files without the need for you tobe present. But when you appeal a decisionthat you are no longer eligible for disabilitybenefits because your medical conditionhas improved, you can meet with a SocialSecurity representative and explain whyyou believe you still have a disability.

HearingIf you disagree with the reconsideration

decision, you may ask for a hearing. Thehearing will be conducted by an adminis-trative law judge who had no part in theoriginal decision or the reconsideration ofyour case. The hearing is usually held within75 miles of your home. The administrativelaw judge will notify you of the time andplace of the hearing.

Before the hearing, we may ask you togive us more evidence and to clarify infor-mation about your claim. You may lookat the information in your file and give

new information.At the hearing, the administrative lawjudge will question you and any witnessesyou bring. Other witnesses, such as medicalor vocational experts, also may give usinformation at the hearing. You or yourrepresentative may question the witnesses.

In certain situations, we may hold yourhearing by a video conference rather than inperson. We will let you know ahead of timeif this is the case. With video hearings, wecan make the hearing more convenient foryou. Often an appearance by video hearingcan be scheduled faster than an in-personappearance. Also, a video hearing locationmay be closer to your home. That mightmake it easier for you to have witnesses orother people accompany you.

It is usually to your advantage to attendthe hearing (in person or video conference).You and your representative, if you have

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one, should come to the hearing andexplain your case.

If you are unable to attend a hearingor do not wish to do so, you must tell uswhy in writing as soon as you can. Unlessthe administrative law judge believesyour presence is necessary to decide your

case and requires you to attend, you willnot have to go. Or we may be able tomake other arrangements for you, such aschanging the time or place of your hearing.You have to have a good reason for us tomake other arrangements.

After the hearing, the judge will makea decision based on all the information inyour case, including any new informationyou give. We will send you a letter and acopy of the judges decision.

Appeals CouncilIf you disagree with the hearing decision,

you may ask for a review by Social SecuritysAppeals Council. We will be glad to help youask for this review.

The Appeals Council looks at all requestsfor review, but it may deny a request if itbelieves the hearing decision was correct. Ifthe Appeals Council decides to review yourcase, it will either decide your case itself orreturn it to an administrative law judge for

further review.If the Appeals Council denies your

request for review, we will send you aletter explaining the denial. If the AppealsCouncil reviews your case and makes adecision itself, we will send you a copyof the decision. If the Appeals Councilreturns your case to an administrative lawjudge, we will send you a letter and a copyof the order.

Federal courtIf you disagree with the Appeals Councils

decision or if the Appeals Council decidesnot to review your case, you may file alawsuit in a federal district court. The letterwe send you about the Appeals Councilsaction also will tell you how to ask a courtto look at your case.

Will my benefits continue?

In some cases, you may ask us to continuepaying your benefits while we make adecision on your appeal. You can ask foryour benefits to continue when:

You are appealing our decision that

you can no longer get Social Securitydisability benefits because your medicalcondition is not disabling; or

You are appealing our decision that youare no longer eligible for SSI payments orthat your SSI payment should be reducedor suspended.

If you want your benefits to continue, youmust tell us within 10 days of the date youreceive our letter. If your appeal is turneddown, you may have to pay back any moneyyou were not eligible to receive.

Can someone help me?Yes. Many people handle their own

Social Security appeals with free help fromSocial Security. But you can choose a lawyer,a friend or someone else to help you. Some-one you appoint to help you is called yourrepresentative. We will work with yourrepresentative just as we would workwith you. Your representative can act for youin most Social Security matters and will

receive a copy of any decisions we makeabout your claim.

Your representative cannot charge orcollect a fee from you without first gettingwritten approval from Social Security. Ifyou want more information about having arepresentative, ask forYour Right ToRepresentation(Publication No. 05-10075)or you can find it on our website.

Contacting Social SecurityFor more information and to find copies

of our publications, visit our website atwww.socialsecurity.govor call toll-free,1-800-772-1213 (for the deaf or hard of hear-ing, call our TTY number, 1-800-325-0778).We can answer specific questions from7 a.m. to 7 p.m., Monday through Friday.We can provide information by automatedphone service 24 hours a day.

Social Security AdministrationSSA Publication No. 05-10041ICN 459260Unit of Issue - HD (one hundred)

January 2008 (Destroy prior edition

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