If you have applied for SSI, the federal program that helps support people who are disabled, your application may be denied even if you think you or your child should be eligible.
If SSI reviews your application and tells you that your child is not eligible, you have the right to appeal an SSI denial. This means you try again right away, maybe with some new information or proof of the disability. If you win the appeal, Social Security will pay you for the months you missed since your original application.
So how do you appeal an SSI denial?
This article talks about what to do if your family member was denied because of disability status. Here’s what to do if you were denied because your family has too many resources.
Whether or not you are successful in your appeal, don’t forget to look into other financial help for your family.
Before you appeal, review your file to learn as much as you can about why your application was denied. If you wish, you may also want to talk with a lawyer.
Step 1: Request for Reconsideration
Your first step to appeal an SSI decision is to complete the Request for Reconsideration form. You have 60 days from when you get the written notice about the decision (65 days from the date on the letter). DO NOT MISS THIS DEADLINE!
You can complete and submit the reconsideration form online or print the form and mail or fax it in.
If your appeal is based on SSI’s decision that your family member’s disability does not qualify, this is how you should complete the Request for Reconsideration form.
You should submit any new evidence before the review, like a more recent evaluation, doctor’s letter, or other information that can help your case. New evidence is extremely helpful at this stage, so do your best to obtain additional doctor’s letters, and letters from teachers and therapists. Unless the denial was a mistake, you will need this new evidence to succeed with your appeal.
The Reconsideration form, Part 1: under ISSUE BEING APPEALED, write ‘disability,’ and then write in your reasons on the next line. Attach additional pages if you need more space to explain your reasons.
Part 2: Since the denial is disability-related, you’ll choose Case Review. An outside team hired by Social Security reviews the disability determination. In this case, there’s no meeting or hearing with the reviewers.
Part 3: Fill in your contact info and sign it.
Social Security will fill out the rest of the form, so you should leave it blank.
Complete the form and make a copy for yourself to keep on your computer or in a binder.
Keep a record of your form!
- If you submit your form electronically, keep the record from SSI to show when you submitted it.
- If you mail it, send it by certified mail so you have a record from the post office.
- If you bring it to your local office, bring your extra copy and ask SSI to date stamp it so you have proof it was filed on time.
Social Security will notify you of their decision on the appeal through the mail. You can also set up an online account to monitor the status of your application.
Step 2: Request a hearing
If you disagree with the decision you get after submitting your Request for Reconsideration, your next step is to request a hearing with a judge. You have 60 days from when you get the written notice about the decision (65 days from the date on the letter) to request a hearing. Again, this deadline is firm. Do not miss it!
You must also fill out and sign two more forms:
- Disability Report – Appeal. This form asks questions about your medical history, education, work or vocational program, and other information that may have changed since you submitted your first application.
- Authorization to Disclose Information to SSA (Social Security Administration). This form gives permission for SSA to get information from your providers, including doctors, schools, and social workers.
You can choose not to have a hearing. In this case, a judge will make a decision based on the evidence in your file.
If you do have a hearing, you can choose to have the hearing in person, on a videoconference, or by phone. SSI will give you at least 75 days notice about the date, time, and place of your hearing.
You can submit new evidence or pre-written statements for the hearing up until 5 business days before the hearing.
Step 3: Appeal again and consider seeking legal help
If you’re denied again, you can appeal again by asking for an Appeals Council Review.
If you disagree with the decision of the Appeals Council, you can file an action in US District Court.
At this level, if you do not already have legal help, you may want to find a lawyer with experience in this area.
Don’t panic about legal fees!
There are limits on the fees private attorneys can charge. The maximum fee is 25% of any past due benefits, or $6,000, whichever is less. Past due benefits means the unpaid SSI benefits that you should have been paid while the appeal was being processed. If SSI does not award you back pay, your attorney does not get a fee.
In an appeal, a lawyer can review documents to find flaws in the case, help get expert evaluations and reports, and write legal briefs. They can even argue your case to the judge.
If your child has been denied SSI benefits, don’t lose hope! Many people who are denied with their first application appeal the SSI denial and then win.
- I have too many resources to qualify for SSI. What’s next?
- Understanding the SSI appeals process
- How to apply for SSI
- Is my child with a disability eligible for SSI benefits?
This content was reviewed for accuracy by Karen B. Mariscal, Esq. www.Kmariscallaw.com