When a person in Pennsylvania suffers an injury and is in need of Social Security disability benefits, a frequent concern is what to do if they are subject to a denied claim. While this might seem to be a final word when the Social Security Administration decides that the claimant doesn’t meet the federal requirements, there are still options for a claimant to file an appeal. The rejection of an appeal is not a formality and it may be possible for a qualified claimant to have the decision reversed and receive benefits.
When a decision is made, the claimant will receive a letter explaining it. In order to file an appeal, the request has to be made within 60 days of receipt of the decision letter. There are four different levels to file an appeal. A person can ask for: reconsideration of the decision, a hearing in front of an administrative law judge (ALJ), a review to be made by the Appeals Council or a review by the Federal Court.
Reconsideration is a full examination of the case by an independent observer. New evidence can be presented. With a hearing, the ALJ will oversee it and study the aspects of the case. This is conducted within 75 miles of the claimant’s residence. More evidence may be requested as to why the decision was wrong. The judge will question the claimant and possible witnesses. Medical and vocational experts can also provide information to help the case. The Appeals Council will look at any request for a review of the case, but it is able to deny it if it is of the opinion that the right decision was made. In the event that a claimant is still unsatisfied by the Appeals Council’s decision, there can be a request that the case be reviewed by the Federal Court.
It is possible to continue receiving benefits while the case is being reviewed. This is applicable when a claimant was already receiving benefits and those benefits have been discontinued because the injuries have sufficiently improved or because there is no longer eligibility. When considering filing an appeal for a denied claim for qualifying SSD benefits for injury, long-term care and other issues, it is also wise to discuss the matter with a legal professional experienced in denied claims.
Source: SSA.gov, “The Appeals Process,” accessed Dec. 1, 2014