At Martone Law Firm we assist claimants at all levels of the appeals process. Social Security generally allows only 60-days to appeal an unfavorable determination and many claimants are discouraged when they receive the denial letter and are reluctant to appeal or do not understand the appeals process. Missing a deadline to appeal an unfavorable decision is detrimental to your claim for disability. An unrepresented claimant may miss a deadline to appeal and instead start their claim over, resulting in a reduction of potential back benefits or bar their claim completely if the date last insured for SSDI is expired.
After the initial determination, Social Security allows 60-days to request a reconsideration. At the reconsideration level, additional information about the claimant’s conditions is provided and Disability Determination Services (DDS) makes another medical determination. It generally takes 3 to 6 months for the reconsideration process, however, this may vary depending on the number of claims being processed. DDS generally sends duplicate forms from the initial determination to get updates on the person’s conditions, work activity if any, and functional limitations. You may also be sent for a consultative examination with one of Social Security’s contracted physicians. If the reconsideration determination is a denial of the claim, Social Security allows 60-days to request a hearing.
If a claimant is denied benefits by an Administrative Law Judge after a hearing, there is another 60-day appeal window to request review by the Appeals Council. The Appeals Council consists of adjudicators and judges in Falls Church, Virginia who evaluate all requests for review from claimant’s who have been denied benefits by an Administrative Law Judge. The most common reasons the Appeals Council accepts cases for review are an error of law, or the decision is not based on substantial evidence. The Appeals Council will also review a case if there appears to be an abuse of discretion by the Administrative Law Judge, there is a broad policy or procedural issue that may affect the general public interest, or the Appeals Council receives new and material evidence that related to the period on or before the date of the hearing decision and there is a reasonable probably that the additional evidence would change the outcome of the decision. The Appeals Council generally does not consider new information, unless it is specifically related to the time period reviewed by the Administrative Law Judge and there must be a good reason why the information was not available at the hearing.
If the Appeals Council denies review, the claimant has 60-days to file a civil action in U.S. District Court (federal court), which is explained further in another section.
There may be good reasons why a claimant was unable to appeal within the 60-days and therefore allow for a late appeal to be processed. Some examples of good cause to miss a deadline to appeal are you were seriously ill, there was a death or serious illness in your immediate family, you did not get a copy of the decision, or some other unusual, unexpected, or unavoidable circumstance beyond your control prevent you from appealing.
Attorneys at Martone Law Firm can assist you with identifying whether you have good cause for missing the deadline and get your claim back on track without starting over and losing potential benefits. Contact the Martone Law Firm today to find out how we can help you appeal your unfavorable determination.