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If benefits are denied: Deadline is 60 days + mailing time Initial claim approvals are no more than 40%

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Presentation on theme: "If benefits are denied: Deadline is 60 days + mailing time Initial claim approvals are no more than 40%"— Presentation transcript:

1 If benefits are denied: Deadline is 60 days + mailing time Initial claim approvals are no more than 40%

2 LEVELS OF APPEAL WHEN DISABILITY BENEFITS ARE DENIED -Reconsideration: Approximate Approval Rate of 13% -Hearing (Before an Administrative Law Judge): Approximate Approval Rate over Two-Thirds

3 LEVELS OF APPEAL (CONTINUED) 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”

4 EXPEDITING APPEALS 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

5 APPEALS BEYOND THE INTERNAL SSA PROCESS If you are unsuccessful through the Appeals Council, your only appeal option is to file in U.S. District Court. You may choose instead to file a new claim. There have been recent changes in the regulations covering this situation. You are well advised to consult with your attorney to see which choice is better in for you.


7 APPEALS WHEN DISABILITY BENEFITS ARE STOPPED 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” to 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.

8 APPEALS WHEN DISABILITY BENEFITS ARE OVERPAID 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)

9 REPRESENTATION By SALA, Center for Disability Law, or Direct Center for Independence, in certain situations 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

10 ROLE OF A CONGRESSIONAL OFFICE 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

11 WHAT A CONGRESSIONAL OFFICE CANNOT DO 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 Rep. Barber)

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