SOCIAL SECURITY APPEAL PROCESS - EXPLAINED

Since most Social Security disability claims are initially denied the Appeals process becomes vitally important. And it is a "process," usually not just one simple appeal. There are really 4 appeals available when the application has been denied.

"Reconsideration" - is the first appeal. The denied claim goes back to the state Disability Determination Service (DDS) for review. A new examiner within the same office that issued the denial will "review" the claim to see if errors were made. The success rate at this stage is barely 15 percent. Thus, 85 percent of claims will again be denied at Reconsideration. The Recon process, incidentally, usually takes 12 to 15 months.

The Hearing. The second appeal is a hearing before an Administrative Law Judge (ALJ). The claimant appears with his/her lawyer to argue the case before the ALJ. The average success rate here is around 52 percent (depending on the judge assigned). This is actually where more cases are approved than at any other step in the process.

Appeals Council: After a hearing denial, your case can be taken to the Appeals Council (AC) -- a group of appellate judges in Falls Church, Virginia. No, you don't go to Falls Church and there is no hearing. The AC will conduct a paper review to determine if the hearing judge made a fair decision. Your only chance with the AC is to show that the hearing judge made an error at your hearing. The usual results at the AC are:

• Reversal and Approval - about 3 percent of cases.

• Remand - Your case goes back to the Administrative Law Judge for a new hearing or other action - about 15 percent.

• Dismissal - The AC dismisses your appeal and takes no action - about 80 percent. This leaves the denial the final decision by the Social Security Administration.

• Federal Court Appeal - You file a lawsuit in Federal District Court (FDC) against the Commissioner of Social Security. This is typically the last appeal. Only about 1 percent of SSDI claims go before the FDC. The usual outcome in FDC?

• Reversal and approval of your claim - about 1 percent

• Remand - the case is sent back to Social Security for more action - about 30 percent.

• Unfavorable Decision / A final Denial - nearly 70 percent.

As you can see, your best chance for approval and payment of your case is at the Hearing Level. For the best chance of approval at the hearing, your case must be prepared adequately to ensure that proper evidence and testimony is presented to the judge. Your case should be prepared and presented by someone who understands Social Security Regulations as set out in the 20 Code of Federal Regulations. The judge will hold you to a high burden of proof. And the burden of proof always rests upon the claimant, not upon Social Security. (The claimant must prove that (s)he is disabled; Social Security does NOT have to prove that the claimant is not disabled).

It is my belief that most hearings are won BEFORE the hearing date--by adequate preparation of the case in the weeks prior to the hearing. One of the most critical parts of this preparation is the gathering of objective medical evidence to PROVE your case. Another important aspect of the hearing is preparing the claimant for effective testimony before the Administrative Law Judge. Knowing what to say and what not to say at the hearing is extremely important. A third vital aspect of the hearing is handling the testimony of the vocational expert, who is present at all adult hearings. Only someone trained in Social Security disability law and cross examination of witnesses can adequately handle the vocational testimony.

If you need help with an appeal or hearing, contact THE FORSYTHE FIRM in Huntsville, AL. Get a FREE consultation about your case and get contingency fee arrangement. This means you never pay a legal fee unless you WIN your case and collect past due benefits. Call (256) 799-0297 or email forsythefirm@gmail.com

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