APPEALING DISABILITY DECISIONS. If benefits are denied: Deadline is 60 days + mailing time Initial claim approvals are no more than 40%.
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If benefits are denied:
Deadline is 60 days + mailing time
Initial claim approvals are no more than 40%
LEVELS OF APPEAL WHEN DISABILITY BENEFITS ARE DENIED-Reconsideration: Approximate Approval Rate of 12%-Hearing (Before an Administrative Law Judge): Approximate Approval Rate over 2/3
Request for Review of Unfavorable ALJ Decision (Goes to SSA Appeals Council in Falls Church, VA)
Appeals Council Can:
Overturn ALJ Decision (Once in 4.5 years)
Affirm ALJ Decision
Remand Case to Tucson Hearing Office “for further proceedings and a new decision”
This is at the discretion of the SSA office with jurisdiction and is generally only granted if the individual is:
Terminally ill or in “dire need,” most often characterized as facing “imminent loss of housing, food or medical care”
SSA will want documentation and to discuss the situation with you
If you are unsuccessful through the Appeals Council, your only appeal option is to file in U.S. District Court.
You can also file a new claim. The two processes are not mutually exclusive. While you were appealing, you may have reached a new age milestone, such as age 55, which increases your chances.
There is the possible issue of “insured status” with the new claim.
I have no experience in cases when they are stopped because of “medical recovery.”
My experience is in cases where the beneficiary has worked and had earnings that called into question continued receipt of benefits after a 9 month Trial Work Period.
You can request “expedited reinstatement” continue to receive benefits while your disability status is re-evaluated.
You must request this VERY quickly—within 10 days of the date of the notice.
Reasons for overpayment:
Workers Compensation “offset”
Period of ineligibility due to earnings
Types of appeals:
Request for Reconsideration-You dispute the Fact or Amount of overpayment (subject to appeal deadline of 60 days).
Request for Waiver-You don’t dispute the fact or amount of the overpayment but believe you shouldn’t have to repay it because:
It wasn’t your fault AND having to repay it would be a financial
hardship (no appeal deadline)
If either appeal is denied, it can be taken further (e.g. to ALJ hearing)
By Southern Arizona Legal Aid (SALA) or
Arizona Center for Disability Law (ACDL)
By a private attorney who specializes in SSDI cases
They are paid only if they win the case
They are paid out of past due benefits (25% up to a maximum of $6000) based on a “fee agreement”
In the event the appeal goes beyond the ALJ and is successful, the attorney may request additional compensation through a “fee petition”
Attorney fee awards can be successfully appealed
Cannot be a “representative” in the sense of attending a hearing before an ALJ, but can advocate on behalf of a constituent by:
Letting SSA know there is congressional interest in a case
Tracking the progress of an appeal
Notifying SSA a case might need to be expedited
Helping expedite payment when a claim/appeal is approved
Contacting a Payment Center that has begun regular monthly benefits but has not released past due benefits
Helping with a protest of an award of attorney fees
We cannot pressure SSA to rule or decide in a certain way. SSA makes decisions based on the law and regulations, not based on political pressure.
There is no point in contacting more than one Congressional office, for the reason above and because a second office will only get the same answer from SSA as the first office.
You have two Senators and one House Member. You can contact either senator or the House Member in whose District you reside (Rep. Grijalva or Rep. Giffords)