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Social Security & SSI Appeals

Overview

T + T

Background

HISTORY

The right to appeal an adverse decision issued by the Social Security Administration (SSA) with respect to an applicant’s or recipient’s claim has always been an element of the Social Security benefits program since Social Security retirements benefits first became available in 1936. While there have been fairly minor changes in the appeal process over the last five decades, the length of time it takes to process an appeal from initial determination through Appeals Council review, is a cause of major concern. In recent years SSA has made efforts to speed up the appeal process by adding, in disability claims, elements like "quick disability determination’ at the initial level of evaluation for some types of impairments, and “compassionate allowances,” applicable to 50 specific conditions, at any phase of the disability appeals process. In general, however, the appeals process continues to be slow.

WHO ADMINISTERS SOCIAL SECURITY APPEALS

The Office of Disability Adjudication and Review (ODAR) administers the appeals process for the Social Security Administration (SSA) and is responsible for holding Administrative Law Judge (ALJ) hearings and issuing decisions in appeals that claimants bring against the Social Security Administration. Administrative Law Judges are paid by the Social Security Administration, but their decision making authority is independent of SSA.

ODAR directs a nationwide field organization staffed with ALJs who conduct impartial hearings and make decisions on appealed determinations involving retirement, survivors, dependent, disability, and supplemental security income benefits. ODAR will also review ALJ decisions through the Appeals Council, either on appeal by claimants or on its own motion, and issues the final agency decision on such cases. If, on the other hand, the Appeals Council denies review, the ALJ becomes the final agency decision subject to judicial review.

A Summary of the Social Security Appeals Process

An applicant or beneficiary of any of the Social Security programs (Social Security Retirement and Survivors Insurance, Social Security Disability Insurance, or Supplemental Security Income) has the right to appeal any determination or decision the Social Security Administration (SSA) makes on initial eligibility or ongoing entitlement for benefits or on a finding of an overpayment or the overpayment amount.

In New York State, if an applicant/beneficiary disagrees with the Social Security Administration’s (SSA) disability decision, s/he has two levels of administrative review. His/her first step is to file a request for an ALJ hearing; the second step is to request Appeals Council Review. On all non-disability appeals, in NYS, there are three levels of administrative review, the first level is called a reconsideration. If the individual disagrees with the reconsideration determination, s/he can file a hearing before an Administrative Law Judge (ALJ). Finally, if s/he disagrees with an ALJ decision, s/he may file a request for review with the Appeals Council. Once these steps have been exhausted, s/he can file a judicial review in federal court.

The reason the appeals process is different for disability claims is that NYS, along with 9 other states, was chosen years ago to be part of an experiment to speed up the appeals process for disability claims.

Other Types of Appeal Procedures

INFORMAL ADVOCACY

Informal advocacy is the process of calling, writing and/or dealing with the local Social Security district office on behalf of an applicant/beneficiary on a case by case basis. By dealing directly with the local SSA district office and working up the chain of command, an advocate may improve an individual’s position or solve the problem without formal intervention. For an overview of informal advocacy procedures refer to Advocacy, Informal Advocacy.

Note

With respect to non-disability appeals, which are subject to reconsideration, there is more time for informal advocacy pending the reconsideration decision. However, once a claimant has filed a request for an ALJ hearing, the district office will state that the claimant no longer has the jurisdiction to work with the claim or discuss the case with an advocate.