It’s All About Appeals – 4 Levels

serious mature woman with notebook and documents at table in office

The Social Security Administration has an appeals process in place for applicants who disagree with its ruling. In fact, most people approved for disability benefits had to go through at least one level the process.

Even if your request for benefits is denied at the initial appeal level – don’t fret! Your chances of approval go up after filing multiple appeals.

There are four levels of appeals in the Social Security Administration’s disability program. These four levels are:

Level 1: Request for Reconsideration

Depending on which state you live in, a request for reconsideration will be the first level of appeals you go through (some states have eliminated this part of the process). A request for reconsideration simply tells the Social Security Administration that you’d like Disability Determination Services to take a look at your case again. It will be assigned to a different medical consultant and examiner who were not involved in the initial evaluation of your case, and they will go through the same process they use to evaluate initial claims. You chances of a successful approval at this stage are around five to 10 percent.

Level 2: Administrative Law Judge Hearing

If your request for reconsideration is unsuccessful, you will move on to an administrative law judge hearing, the second level of the appeals process. At this stage, your disability claim will go before a judge who is contracted with Social Security’s Office of Disability Adjudication and Review. The judge will evaluate your medical files, work history and day-to-day activities while giving you the opportunity to clarify anything about your case that may seem ambiguous. This level is your best chance for receiving an approval, about 70 percent of claimants are awarded benefits.

Level 3: Appeals Council

If you are not approved for benefits during the administrative law judge hearing, you can appeal your case with an Appeals Council. The Appeals Council doesn’t necessarily review whether you should get benefits, but whether the administrative law judge made a mistake when reviewing your case. This is important to note because the Appeals Council can grant, deny or dismiss your request for a review. If they don’t think the judge made an error, they are likely to just outright dismiss your case. Your chances of a successful approval are very slim at this level; roughly about two to three percent.

Level 4: Federal Court Review

The final step of the appeals process is to sue the Social Security Administration in U.S. district court. A federal judge will hear your disability case and decide whether any legal errors were made in the process of reviewing your disability claim. They may also take factual questions into account. In fact, it’s not uncommon for them to award you benefits because they decide that the Social Security Administration did not give enough weight to your doctor’s opinion, didn’t consider other conditions/symptoms or should have asked for more assessments. While the federal courts, on average, award benefits in a third of all the cases they see, only about one percent of disability claims actually take their case to court.

If your disability claim is not approved during a federal court review, then you will have to file a whole new claim and re-start the process.

One common frustration among disability applicants is how long it takes to get approved for benefits. Understandable. The appeals process is one of the primary reasons it takes so long (in addition to high caseloads and limited resources). For this reason, it’s important to stay patient, never give up and consult with an attorney to ensure your case is as strong as possible.