Should I appeal an initial denial of benefits?

Usually. If you’re unhappy with the Social Security administration’s response to a claim for benefits, the administrative review process could help you. All requests for review must be submitted in writing, and time limits may apply; you usually have 60 days to appeal at each step. First you should request that the initial determination be reconsidered. You can then submit new information and evidence for your claim. This will take another 4 to 6 months, and generally results in a second denial.

If you are denied again, you can ask for a hearing before an administrative law judge at the office of hearings and appeals. It takes about 7 months more to get to a hearing in South Carolina right now. This is where most claimants hope to win their case. Because of the difficulties you face if you lose at this point, it is crucial that you present the best case you possibly can.

If you lose before the administrative law judge, you are in a lot of trouble. The next appeal step is to the Appeals Council in Washington. Presently this is taking more than a year in most cases. The overall success statistics are low; and many firms do not handle appeals beyond the hearing level. However, with aggressive case development to specifically refute the findings of the judge, a case can be won at this level. It is about impossible to win at this level without an attorney.

If you lose at the Appeals Council level you can file a civil action in a federal district court. This absolutely requires an attorney.

One thing you should be careful about is a rule called “res judicata.” This is a complicated subject, but the bottom line is that once you go a certain distance in the process and lose – generally to the hearing – if you do not appeal, it becomes more difficult, and sometimes impossible, to win a claim later. The moral is that you should be careful about filing a claim unless you are serious about it. This is a somewhat more serious problem in the Fourth Judicial Circuit – the Carolinas, the Virginias, and Maryland – than it is in some other areas. On the other hand, do not wait to file a claim if you are truly disabled. You can lose eligibility if you wait too long. If you need help with an application and live in South or North Carolina, please call us at 1-800-775-3985 or click here to e-mail us.