APPEALS PROCESS

You can appeal most determinations and decisions we make about whether you can get Supplemental Security Income (SSI) or if we make changes to your benefit amount. That means you can ask us to look at your case again.

When you ask for an appeal, we will look at the entire determination or decision, even those parts that were in your favor.

HOW TO APPEAL SOCIAL SECURITY DETERMINATIONS AND DECISIONS

We have established appeals procedures for individuals who disagree with the determinations or decisions we make. The levels of appeal are:

Reconsideration;

Hearing by an administrative law judge;

Appeals Council review; and

Federal Court review.

INITIAL DETERMINATION

We call the determinations we make that you can appeal “initial determinations.” These determinations are SSA’s written findings regarding any legal or factual issue, including but not limited to:

Whether you are eligible for SSI.

The amount of your SSI payment.

The fact that you were overpaid, the amount of the overpayment, and whether you must repay it.

After you file an application for SSI, we will mail you a written notice or our initial determination.  This is your first “initial determination”, but each time we make a determination about your eligibility or payment amount after that is also an initial determination.

Every time we make an initial determination, we will send you a written notice. If you want to appeal the initial determination in that notice, you must request an appeal in writing within 60 days of the date you receive your notice. That notice will tell you how to appeal. The notice will also tell you if you are entitled to continued benefits. If you file an appeal for a non-medical initial determination within 60 days after the date you receive your notice, your SSI payments may continue or be reinstated at the same amount until we make a determination on your appeal. If you file an appeal for a medical disability cessation within 10 days of the date you receive your notice and elect payment continuation, your SSI payments may continue at the same amount until we make a determination on your appeal.

Contact us if you need help filing your appeal.

You may appoint a representative to act for you in the SSI appeals process. For information on how to appoint a representative, see "How Someone Can Help You With Your SSI".

STEPS IN THE APPEALS PROCESS

1.  RECONSIDERATION

If you disagree with the initial determination, you may file a request for reconsideration.

• For a disability or non-medical determination, take one of the following actions to file a request for reconsideration.
• Online
  The quickest and easiest way to file a request for reconsideration on a disability or non-medical determination is online at our Appeal a Decision page. Select “Start disability request” or “Start non-medical request” button as applicable. Follow the instructions on the screens to complete and submit the appeal electronically.
• Send Us a Form by Mail or Fax
  You may also download, complete, and print the form Request for Reconsideration (SSA-561-U2) and then send the completed form to your local Social Security office. You can find the local office fax number and address from the Social Security Office Locator page by entering your ZIP code.
• Medical Disability Cessation
  
  You may write to us or complete a Form SSA-789 (Request for Reconsideration Disability Cessation).

You or your representative must ask in writing for a request for reconsideration within 60 days after the date you receive the written notice of the initial determination.  We assume that you receive the notice five days after the date on the notice unless you show us evidence it was received after the five days.

Payment Continuation for non-medical initial determination and medical disability cessation determination:

• Non-Medical Initial Determination:
  
  
  • If you ask for a reconsideration in writing within 10 days of the date you receive the notice, any payment we are currently making will continue until we make our reconsideration determination if you continue to meet all other SSI eligibility requirements.
  • If you ask for a reconsideration more than 10 days after the of the date you receive the notice, but within 60 days of the date you receive the notice, your payment may decrease temporarily. However, we will restart any payment we are currently making once we receive and enter your reconsideration. You will continue to receive that payment until we make our reconsideration determination if you continue to meet all other SSI eligibility requirements.
  • If you do not want to continue to receive payments, you can ask us not to continue payments by completing Form SSA-263 (Waiver of Supplemental Security Income Payment Continuation).


• Medical Disability Cessation Determination:
  
  
  • If you appeal a medical disability cessation determination and you want to keep receiving benefits until we make a new determination, you must complete a written request for benefit continuation within 10 days after the date you receive the written notice. You are entitled to a hearing with a disability hearing officer.

We have a service that provides detailed information about disability and SSI appeals filed either online at www.ssa.gov or with a Social Security employee. To check the status of your appeal, create or log in to your personal my Social Security account.

2.  HEARING

If you disagree with the reconsideration determination, you or your representative may request a hearing before a judge by writing to us or by completing a Form HA–501-U5 (Request for Hearing by Administrative Law Judge). Take one of the following actions to file a request for hearing.

• Online - The quickest and easiest way to file a request for hearing on a disability or non-medical determination is online at request a hearing online. Select “Start disability request”or “Start non-medical request” button as applicable. Follow the instructions on the screens to complete and submit the appeal electronically.
  

• Send us a Form by Mail or Fax - You may also download, complete, and print the form Request for Hearing by Administrative Law Judge (HA-501-U5) available at https://www.ssa.gov/forms/ and then send the completed form to your local Social Security office. You can find the local office fax number and address from the Social Social Security Office Locator page by entering your ZIP code.

You or your representative must request a hearing within 60 days after you get the notice of reconsideration determination (or, in rare cases, the initial determination).  We assume that you receive the notice five days after the date on the notice.  You or your representative may review your file before the hearing and may submit or inform us about new evidence no later than five business days before the date of the hearing.  You may continue to receive your SSI if you are appealing a determination that your disability has ended.  You must ask in writing for your benefits to continue within 10 days of the cessation notice.

If you do not want to appear at a hearing before a judge, you or your representative may ask the judge to make a decision based on the evidence in your file.

If you do want to have a hearing before a judge, it is very important that you or your representative appear at the scheduled hearing.  While the agency determines the manner of appearance, there are several options: in person; video; and telephone.  We will provide notice of the hearing date, location, and issues to be decided at least 75 days before the hearing. If for any reason you cannot make it to your hearing, contact the hearing office in writing, as soon as possible before the hearing, but not later than five days before the date set for the hearing or 30 days after receiving the notice of hearing, whichever is earlier, and explain why you cannot attend. If you do not attend the scheduled hearing, you may lose your appeal rights and benefits.

We may pay you for travel costs if the distance to the hearing from your home is more than 75 miles one way. If you need money for reasonable and necessary travel costs, tell the judge as soon as possible before the hearing.

The hearing process is very similar for all types of appeals. If your request for hearing is about whether you have a qualifying disability, the judge will focus on your medical condition(s) and make a decision based on the evidence in your case file. The judge may also call witnesses to testify. For example, the judge may call a medical or vocational expert to testify. During the non-medical hearing process, the judge will focus on the reason you requested a hearing and request evidence specifically related to that issue. Examples of non-medical hearing request reasons include eligibility for SSA benefits, or issues that may have caused an overpayment.

In certain circumstances, you (or your representative, if you have one) may request to subpoena documents or witnesses.  You must file a written request for the issuance of a subpoena with the judge or at one of our offices at least 10 business days before the hearing date, unless you show that your circumstances meet the conditions described in 20 CFR 416.1435(b), including that you actively and diligently sought evidence and the evidence was not received.  The written request must give the names of the witnesses or documents to be produced; describe the address or location of the witnesses or documents with sufficient detail to find them; state the important facts that the witness or document is expected to prove; and indicate why these facts could not be proven without issuing a subpoena (20 CFR 416.1450).  The judge will decide if the documents or witnesses’ testimony is reasonably necessary.  During the hearing, the judge will explain your case and may ask you and any of your witnesses questions.  You may also ask any witnesses questions and present new evidence under certain circumstances.

For claims that are based on an application for disability benefits, you (or your representative, if you have one) must inform the judge about or submit all written evidence, objections to the issues, and pre-hearing written statements no later than five business days prior to the scheduled hearing and must submit subpoena requests no later than 10 business days prior to the hearing. The judge may decline to obtain or consider late submissions of evidence, objections, written statements, or subpoena requests unless you meet certain requirements listed in Social Security’s rules at 20 CFR 416.1435(b).  These rules do not apply to claims not based on an application for non-disability benefits (20 CFR 416.1435(c)).

The hearing is informal, but we make an audio recording. You may ask for a copy of the hearing recording.

The judge will send you (and your representative, if you have one) a copy of the hearing decision.

3.  APPEALS COUNCIL

If you disagree with the judge’s decision or dismissal of a hearing request, you (or your representative, if you have one) may request that the Appeals Council review that action. The notice you received will tell you how to appeal the judge’s decision or order. Take one of the following actions to file a request for review:

• Online
  The preferred method for appealing the judge’s decision or order is by using the SSA secure online process AC iAppeal. Select “Start an Appeal” button. Follow the instructions on the screens to complete and submit the appeal electronically.
• Send us a Form by Mail or Fax
  You may also download, complete, and print the form Request for Review of Hearing Decision/Order (HA-520) online and then send the completed form to:
  
  Social Security Administration
  Office of Appellate Operations
  6401 Security Blvd
  Baltimore, MD 21235-6401
  
  Or, fax it to 1-833-509-0817.

You (or your representative, if you have one) must request within 60 days after you get the hearing decision or order.  We assume that you receive the hearing decision or order five days after the date on the hearing decision or order. You (or your representative) may also request additional time to submit evidence or argument.

The Appeals Council may also decide to review your case on its own within 60 days of the date of the decision.

You or your representative may submit or inform us about new evidence. The Appeals Council will only review a case based on additional evidence if it is new, material, related to the period on or before the hearing decision, and there is a reasonable probability the evidence would change the outcome of the decision.

The Appeals Council will examine your case and will grant, deny, or dismiss your request for review.

If the Appeals Council grants your request for review, it will either decide your case or remand (return) it to a judge for further action, which could include another hearing and a new decision. If the Appeals Council plans to issue a decision that is less than fully favorable to you and does not intend to remand the case for further proceedings, it will send you (and your representative, if you have one) a notice of its proposed action and will allow you and your representative an opportunity to respond before issuing the decision. However if the Appeals Council plans to issue a fully favorable decision, remand your case for further proceedings, or issue a decision that is favorable in part while also remanding the remaining issues for further proceedings before a judge at the hearing level, the Appeals Council may send you a notice of its review with the decision or remand order.

The Appeals Council will send you (and your representative, if you have one) a copy of the action it takes on your request for review and explain the reasons for this action.

4.  FEDERAL COURT

If you disagree with the Appeals Council's decision or denial of your request for review of a judge’s decision, you may file a civil action with the U.S. District Court in your area.  We cannot help you file a court action.  You may contact a lawyer or a legal aid group to help you.

You must file an action in U.S. District Court within 60 days after you receive the notice of Appeals Council action.  We consider that you receive notice of the Appeals Council action 5 days after the date on the notice.  The U.S. District Court will review the evidence and the final agency decision. The District Court may send the case back to the agency, and a judge may be ordered to hold a new hearing and issue a new decision. The District Court may also direct the agency to award benefits or it may dismiss the case.

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