Social Security Denials: Davenport SSDI & SSI Appeals Help

The four levels of administrative adjudication of Social Security claims include:

• The initial determination
• Reconsideration determination
• Hearing before an administrative law judge
• Review by the Appeals Council

After this, a case may be filed in federal court. The time limit for most Social Security disability appeals is 60 days from the date of receipt of a decision. Unless contrary evidence exists, you are presumed to receive these decisions within five days. Thus, the effective time limit is 65 days from the decision date.

The only exception to the 65-day effective time limit is when appealing an Administrative Law Judge (ALJ) denial to the Appeals Council after a federal court remand. The time limit for these appeals is 30 days.

Initial and Reconsideration Determinations

Social Security disability claims (but not SSI) can be completed online or by telephone at an SSA teleservice center. Teleservice center staff make appointments for you with SSA representatives from a local office. You can also go to a local Social Security office to complete an application in person. 

When applying, you will be asked for basic information, which will be entered into a computer application form that will be printed. If it is a telephone interview, the form will be mailed to you for signature, along with other forms to be completed and signed. 

An application for benefits is one of the few forms in a disability case that may not be signed by a lawyer on your behalf unless that lawyer is appointed to do so by a court. However, a lawyer may assist you in filling out the application. 

At the initial and reconsideration levels, the SSA does not make medical disability determinations. Instead, claims are referred to a state government agency contracted with SSA for disability determinations.

At the state agency, a medical doctor and a layman known as a disability examiner typically evaluate claims. The SSA then adopts these determinations.

If you are dissatisfied with the initial determination, you may appeal. In most states, this appeal is a request for reconsideration. If you request reconsideration, a team other than the one that issued the initial determination will make the determination, but the result will probably be the same. Relatively few reconsideration determinations result in an award of benefits. The next step is to request a hearing before an administrative law judge (ALJ).

The Hearing

After you request a hearing, an attorney advisor (whose job includes writing decisions for ALJs) may review the file, request additional evidence, and conduct an informal prehearing conference (usually by phone with your attorney). 

The attorney advisor may issue a fully favorable decision. If so, the hearing request will be dismissed unless a request to proceed with the hearing is made within 30 days after the attorney advisor's decision date. The Appeals Council, not an ALJ, has the authority to review a decision by an attorney advisor. 

You may appear in person before the ALJ or by video teleconferencing. Evidence may be received, and vocational or medical experts may testify. The hearing is not adversarial. After the hearing, the administrative law judge issues a written decision. 

Differences Between State Agency Determinations and Hearing Decisions

A significant difference exists between the way state agencies evaluate disability and the way ALJs approach the issue. The rule at all levels is that a disability decision cannot be inconsistent with the medical evidence. However, the state agency decision-makers, who have only the cold file to review, seldom look beyond medical findings to consider your actual ability to work. 

At the state agencies, the Listing of Impairments is used much more often as a basis for a favorable decision. Despite several successful lawsuits challenging this, state agency decision-makers tend to use the Listing of Impairments as the unstated basis for a denial, especially for claimants under age 50.

If a younger claimant’s impairment does not meet a Listing, they likely will not be found disabled by the state agency. State agency decision-makers tend to apply specific formulas (found in state agency manuals) to determine residual functional capacity (RFC) for certain medical impairments. This treats all claimants with similar medical findings the same. Few state agency formulas conclude that a claimant can do less than a wide range of sedentary work.

ALJs, on the other hand, tend to view medical findings as setting the parameters for a range of possible RFCs, some of which may lead to a finding of disability. They view their role as evaluating the entire case, including your credibility, to determine which RFC best describes your capacity. ALJs find claimants under the age of 50 disabled much more often than state agency decision-makers.