updated November 2016
How Do I Appeal If Social Security Denies My Application(s) Initially?
If you are found not disabled after filing your application(s), and you still feel that you are disabled, you should file a Request for Hearing by Administrative Law Judge (ALJ) (the form can be found at http://www.ssa.gov/online/ha-501.pdf) or you can call the local Social Security office and tell them you want to file the Request for a Hearing. You have to file this hearing request within 65 days of the date on the denial letter otherwise your case is over.
What If I Miss The 65-Day Deadline To File A Request For A Hearing?
If you have a really good reason why you missed the 65 day deadline, you have to tell Social Security in writing. Examples of circumstances where good cause may exist include, but are not limited to, the following situations:
- You were seriously ill and were prevented from contacting SSA by phone, in person, in writing, or through a friend, relative, or other person;
- There was a death or serious illness in your immediate family; pertinent records were destroyed or damaged by fire or other accidental cause;
- You were actively seeking evidence to support your claim, and your search, though diligent, was not completed before the time period expired;
- You requested additional information concerning SSA’s determination within the time limit. (After receiving the information, the individual has 60 days to request a reconsideration or hearing. The individual has 30 days after receipt of such information to request AC review or file a civil action);
- You were furnished confusing, incorrect, or incomplete information or were otherwise misled by a representative of SSA or CMS about your right to request reconsideration, a hearing before an Administrative Law Judge, AC review, or to begin a civil action;
- You did not understand the requirement to file timely or were not able (mentally or physically) to file timely;
- A notice of the determination or decision was never received (e.g., SSA used incorrect address or claimant moved);
- You transmitted the appeal request to another government agency in good faith within the time limit and the request did not reach SSA until after the time period had expired;
- You thought your representative had filed the appeal (good cause applies to you despite whether you are still represented or represented by a different person); or
- Unusual or unavoidable circumstances exist, which demonstrate that you could not reasonably be expected to have been aware of the need to file timely, or such circumstances prevented you from filing timely.
What Happens If You Cannot Show Good Cause?
If good cause is not shown, you will have to begin the application process over again, and because your new application was filed later you may not be eligible for as many benefits. Therefore, it is very important that you make every effort to file the request for hearing within 65 days of your denial.
How Do I Appeal The Judge’s Decision Finding That I Am Not Disabled?
There are options to appeal the decision of the ALJ. Your first appeal would be to the Appeals Council which is within the Social Security Administration. You have to file this appeal within 65 days of the date on the unfavorable decision or it becomes the final decision on the case. You may use the form found at www.ssa.gov/forms/ha-520.html or write a letter, but you must present your argument in writing. If the Appeals Council denies your request for a review, you can then appeal to the United States District Court. Again, you have to file an action in Federal Court within 65 days of the date on the denial of your request for review from the Appeals Council otherwise the decision on your case is final. For information on what you need to file an action with the Federal Court, you can visit http://www.nynd.uscourts.gov/social-security-appeal to print out the necessary paperwork for appealing a Social Security decision. There is also a handbook to help you at www.nynd.uscourts.gov/sites/nynd/files/ProSe_Handbook.pdf . You can also call the Clerk’s Office at (518) 257-1800 for more information. The Clerk’s Office can let you know if you are filing in the right location depending on where you live. If you cannot file the action within 65 days because of a good reason, you need to ask the Appeals Council (not Federal Court or the hearings office) for an extension of time. You can also file a new application for SSD and/or SSI any time after you are found not to be disabled but you will have to go through the whole process again and you may be eligible for fewer benefits.
More information about the process or to get forms can be found on Social Security’s website: www.ssa.gov or you can contact your attorney/representative.