In the event that a person becomes disabled, it not only can cause extreme physical and emotional distress for the individual, it also may cause significant financial challenges. Fortunately, a disabled person may be eligible to receive financial benefits from Supplemental Security Income, known as SSI; Social Security Disability Insurance, called SSDI; or both SSI and SSDI.
Sometimes, however, those who are eligible and most deserving are initially denied the benefits to which they are entitled. People who believe they have wrongly been denied benefits should consider going through the SSI or SSDI Appeals Process.
Who is eligible for benefits?
In order to be eligible for SSDI benefits, an individual must have paid a sufficient amount into the Social Security system by working at a job that paid Social Security taxes for approximately five out of the last ten years. If the individual has paid enough into the system, meets the Social Security Administration's definition of disabled and satisfies other requirements, he or she may receive SSDI benefits.
In contrast, SSI benefits are need-based and do not require individuals to have paid Social Security taxes through work. To be eligible for SSI benefits, and individual must be disabled, blind or over age 65, with limited financial means.
What is the appeals process?
Although it is natural to feel defeated when an SSI or SSDI claim is denied, it is important to understand that the process is not over. About two-thirds of SSI and SSDI applications are denied at first, but there are options for appeal.
If an application is denied at the initial determination and the individual disagrees with the decision, he or she must file an appeal within 60 days of the decision. Then, depending on where the individual lives, the next step is reconsideration or an administrative hearing. Residents of Illinois must go through the reconsideration step described below. Missouri is in a pilot program in which people skip reconsideration and go right to a hearing.
After a request for reconsideration is filed, Disability Determinations, a state office that works with the Social Security Administration, reevaluates the individual's application and any new medical information. If the reconsideration results in another denial, or if the individual lives in a state that does not require reconsideration, the next step is to request an administrative hearing by an administrative law judge.
At the administrative hearing, the individual presents comprehensive evidence regarding his or her disability for a new ruling by the judge. If the judge denies the claim, the individual can request a review of the decision by the Social Security Appeals Council. The Appeals Council will consider the individual's file and any written arguments made supporting his or her disability claim. The Appeals Council can then affirm the administrative law judge's denial, approve the individual's claim for benefits or declare that a new hearing should be held. Finally, after exhausting all options with the Appeals Council, the individual may file a lawsuit in federal district court.
Don't give up
Depending on the outcome of an individual's claim for SSI or SSDI, the appeals process can involve a lot of government forms, and the time and effort required can be intimidating. If you are applying for SSI or SSDI benefits, or have just received a denial of your application, contact an experienced Social Security attorney who is familiar with the system and can help relieve the burden of this often complex process.