Getting denied for disability benefits is frustrating, but it's not the end. Most people who are eventually approved had to appeal at least once. Here's how to fight back.
In this article, we'll cover:
- Why claims get denied
- The four levels of appeal
- Important deadlines
- Tips for a successful appeal
1. Why Claims Get Denied
Common denial reasons:
- Not enough medical evidence
- Disability not expected to last 12 months
- SSA thinks you can still work
- Failure to follow prescribed treatment
- Technical issues (income/resources for SSI)
- Missing information or deadlines
Understanding your denial:
- Read the denial letter carefully
- Identifies why you were denied
- Tells you how to appeal
- Includes deadlines
The good news:
- Initial denials are common (60-70%)
- Many denials are overturned on appeal
- Higher success rates at later stages
- Persistence often pays off
2. The Four Levels of Appeal
Level 1: Reconsideration
- First step after denial
- Different SSA examiner reviews your case
- Submit new evidence
- No hearing—paper review only
- Success rate: ~10-15%
Level 2: Hearing
- Before an Administrative Law Judge (ALJ)
- You can testify in person or video
- Bring witnesses and representatives
- Highest success rate: ~45-60%
- Wait time: varies by region
Level 3: Appeals Council
- Reviews ALJ decision
- May grant, deny, or remand
- No new evidence (usually)
- Paper review only
- Success rate: lower than hearing
Level 4: Federal Court
- File lawsuit in federal district court
- Need an attorney
- Reviews legal and procedural issues
- Last resort option
3. Important Deadlines
The 60-day rule:
- Must appeal within 60 days of denial
- From date you receive the notice
- SSA assumes receipt 5 days after mailing
- So effectively 65 days from mail date
Don't miss the deadline:
- Mark your calendar immediately
- File early if possible
- Late appeals may be dismissed
- Can request extension for good cause
What counts as good cause:
- Serious illness
- Incorrect SSA information
- Records destroyed by fire or disaster
- Not for simple forgetfulness
Important: If you miss the 60-day deadline, your options become very limited. File on time.
4. Tips for a Successful Appeal
Gather more evidence:
- New medical records
- Doctors' opinions on your limitations
- Test results
- Treatment notes
- Statements from people who know you
Get your doctors involved:
- Ask for detailed statements
- Specific limitations (can't stand more than 10 minutes, etc.)
- How disability affects work ability
- Consistent treatment shows commitment
Consider getting help:
- Disability attorneys (paid only if you win)
- Disability advocates
- Legal aid organizations
- Don't have to go alone
Prepare for your hearing:
- Know your medical history
- Be ready to describe limitations
- Explain your typical day
- Bring evidence organized
- Arrive early
Describe functional limitations:
- Not just "I have back pain"
- "I can only sit for 20 minutes"
- "I need to lie down twice a day"
- "I can't lift more than 5 pounds"
- Be specific and honest
During the Process
Keep applying:
- You can file a new application while appealing
- Protects your potential back pay
- Multiple paths to approval
Stay in treatment:
- Continue seeing doctors
- Follow prescribed treatments
- Shows you're doing what you can
- Non-compliance hurts your case
Document everything:
- Keep copies of all filings
- Note dates and conversations
- Track your symptoms
- Maintain a medical journal
How Purple Helps
While Purple can't help with the appeals process directly, we're here when you get approved:
- Early access to back pay deposits
- Track your first benefit payments
- Manage your benefits going forward
- SSI resource limit tracking