ROADMAP: Appealing a Social Security Denial for the First Time

Social Security Appeal Roadmap — Know Your Rights

Video: Overview of how to appeal a SSDI or SSI denial for the first time — Steps 1 to 3

The Social Security Administration provides two benefit programs for people with disabilities. Some people qualify for both programs.

  • Social Security Disability Insurance (SSDI) is a federal benefit that helps people who were working but cannot work anymore. It pays an amount related to your wages when you were working.
  • Supplemental Security Income (SSI) is a federal benefit that helps people who have a very low income and cannot work — even if you didn’t work enough to qualify for SSDI.

To qualify for SSI or SSDI, you must have an “impairment”, or combination of impairments, that will keep you from working for at least 12 months. An impairment is any medical condition that makes it harder for you to work.

Applying for SSI or SSDI benefits can be a long and time-consuming process. Many people who apply are denied at first, but you may be able to get benefits through the appeal process.

This Roadmap helps you with the following situations

  • You applied for SSI or SSDI benefits and you were denied — and this is the first time you are appealing the decision.
  • You were getting SSI or SSDI benefits and Social Security stopped paying because they say you aren’t disabled anymore — and this is the first time you are appealing the decision. This is called a “medical cessation.”

Please note: Do not use this Roadmap if you were getting SSDI and the Social Security Administration stopped paying because they say you earned too much money at work. Instead, contact us at Legal Services Vermont right away for advice. If you aren’t sure about your situation, contact us.

Almost every decision Social Security makes about you is sent in a letter called a “notice.” You have the right to appeal if you disagree with their decision.

Deadlines

Did you get a notice saying you do not qualify for SSI or SSDI? You have 60 days from the date printed on the top of your notice to submit forms to tell them you don’t agree, plus 5 days. Those extra days are for the time it took for your notice to reach you.  

Were you already getting an SSI or SSDI benefit? You still have 60 plus 5 days to appeal, but if you want to keep getting benefits while Social Security reviews your appeal, you must appeal within 10 days (plus 5) of the date printed on the top of the notice.

The appeal process has several levels. The first one is called “Reconsideration,” where the agency looks at your case again. This Roadmap describes what to do for a Reconsideration appeal.

If you lose at Reconsideration, you still can move on to the next level of appeal. You can ask for a hearing with an Administrative Law Judge (ALJ). You must make a new request for an ALJ hearing.  If you get a denial from the ALJ, you may also be able to appeal that decision to the “Appeals Council” or to the federal courts. To learn about the other levels of the appeal process, visit:

You can get help

People often appeal their SSI or SSDI denials without a lawyer, but you can get help with your appeal. Here are some of the kinds of help you can get:

  • You have the right to “reasonable accommodations” if your medical conditions mean you need help participating in your appeal. For example, maybe you are blind or have a vision impairment—you can ask for large print notices or notices in Braille. Or maybe you have a hearing impairment and need a sign language interpreter when you go to meet with Social Security workers.
  • If you have trouble understanding or speaking English, you have the right to communicate with Social Security in your own language, and
  • You have the right to choose someone to advocate for you. This can be a lawyer, a paralegal, or a friend or family member.

When you should consider a lawyer

Many private lawyers will take on Social Security denials. You should speak with a lawyer if:

  • You have already been denied before on a previous application for SSI or SSDI benefits.
  • This is not your first appeal of this denial (we will help you understand the levels of appeal in the next step).
  • You have trouble understanding what Social Security is telling you about your case, or you are overwhelmed by paperwork and deadlines, or
  • You already had SSI or SSDI, but Social Security stopped it or started taking money back for any reason.

If you are in any of these situations, contact us at Legal Services Vermont. We can discuss your case and give you advice and/or referral to a lawyer or advocate to help you with your case.

To start the appeal process, follow the steps!

Use the Next button to move to the next step.

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Updated: Mar 03, 2023