Only about 25% of applicants for Social Security disability benefits, SSI and SSDI, are approved the first time they apply. For the 75% of applicants who are denied, there are four levels of appeal: Reconsideration, Administrative Law Judge hearing, Appeals Council review, and filing a civil suit in Federal Court. This post will focus on the first appeal: the reconsideration.
When you submit your Social Security disability application for SSI and/or SSDI benefits, you are at the “initial determination” stage, and can expect to receive a decision in 3-6 months. If your SSI/SSDI application is denied, you can appeal that decision 65 days from the date of the denial letter. You can also file a reconsideration if you were approved for benefits but not granted all of the back benefits you asked for.
If you appeal the denial of your initial claim, you are filing what is called a “reconsideration.” There is no cost to file a reconsideration.
Your reconsideration claim will go back to the same Disability Determination Services (DDS) office that denied your initial claim. However, a different claims examiner and doctor will review your case. Unless you inform DDS that you have new evidence relevant to the determination, your condition has worsened, or you have a new condition, this new claims examiner will simply review the evidence already in file and make a decision. With no new information, it is highly unlikely that DDS will approve your claim.
If, however, you allege a worsening in your condition, or a new condition, DDS must develop your claim further. DDS will request any updated medical records from your doctors, and, depending on how long it was since you completed the questionnaires about your daily activities, they may send you new questionnaires to fill out.
Additionally, if DDS did not request or receive all of your medical records during your initial claim, you should point that out to them and tell them why those records are important. To determine whether DDS considered all of your medical records the first time, check out last week’s post.
It typically takes 90 days or less to receive a decision on your reconsideration claim. Nationally, only about 15% of reconsideration claims are approved. At this point in the process the odds are simply stacked against you.
However, you should always file a reconsideration claim if you have a good case. There are three more levels of appeal after a reconsideration claim, and if you are approved at any level of appeal, you may be eligible for back benefits dating back to your original application. However, if you do not file a reconsideration claim and instead opt to file a brand new application, you may be limited to receiving back pay only from the date of your second application. Though your claim may be approved faster than if you went through the appeals process, choosing to start over again with a new application could cost you thousands of dollars in back benefits.
Additionally, if you are filing for SSDI benefits, you may not be permitted to apply again due to something called the “date last insured,” or DLI. The DLI is the date at which you are no longer eligible to receive SSDI benefits. If your DLI passes while you are waiting for a decision, going through the appeals process may be the only way you can receive SSDI benefits.
If DDS denies your reconsideration claim, you can request a hearing before an Administrative Law Judge (ALJ). At this stage your chance of approval dramatically improves. In the next episode of The Social Security Secrets, we will discuss what happens at an ALJ hearing and how you can prepare.