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The Administrative Appeal Procedures in a Disability Claim

Disability claimants who have been denied their benefits at first attempt can always appeal for reconsideration. As soon as they receive the denial letter, they are advised to contact the social security agency immediately to request an appeal.

After an appeal has been requested, the social security district office will mail the required appeal forms to the claimant. With the help of a lawyer or a representative, a claimant can accomplish the paperwork and submit it to the agency. A claimant has to make sure that the appeals document reaches the agency before the deadline of its submission.

Even after the forms have been mailed, a claimant must call the social security office to inform them that the deadline has been met in order to give one’s case a so-called ‘protected date’. This will also provide some security in the event that appeal forms get lost in the mail.

Generally, denied claims pursued through the appeals process have a much greater chance of being subsequently awarded of benefits than filing a new application.

The administrative appeals process in a disability claim involves four steps:

  1. Initial Determination - When a claimant is denied disability benefits on their initial application, they will receive written notification advising him of the initial determination and their right to a reconsideration of the decision. The claimant must then make an appeal and request for a reconsideration of the decision.

    An initial determination becomes final unless reconsideration is requested with sixty (60) days from the date of receipt of the notice of the determination.
  2. Reconsideration Determination - At the reconsideration level, the administration will review the initial determination and any other medical evidence that is submitted by the parties or otherwise obtained.

    A reconsidered determination becomes final unless a hearing is requested within sixty (60) days from the date of claimant’s receipt of notice of the reconsidered determination, or unless such determination is revised in accordance with 20 CFR Sec. 404.905, or unless the expedite appeals process is used in accordance with 20 CFR sec. 404.900 (a)(6)
  3. Administrative Law Judge Decision - Before an Administrative Law Judge (ALJ), a claimant is provided the opportunity for a full hearing during which he can present evidence and legal argument and cross examine witnesses. The ALJ renders a decision stating his finding of fact and conclusions of law.

    The decisions are based on the evidence presented and evaluated at the hearing or included in the hearing record. If the claimant is dissatisfied with the decision of an administrative law judge, he must file a written appeal within sixty (60) days after his receipt of the ALJ decision to the Appeals Council for their review.
  4. Appeals Council Review - The council reviews the ALJ’s decision, which it may affirm, modify or reverse or vacate. The council may also remand the case to an ALJ for rehearing, or take further testimony in the case.

After notification of its decision, a claimant has sixty days from receipt of the decision to seek review of the district court by filing a civil action.

To improve your chances of obtaining your claim, you will need the services of a lawyer who can represent you in your appeals. A skilled and experienced disability lawyer can increase your chances of getting your claim.


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