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Summary

Reconsideration is the first level of appeal in most states after denial of a claim for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). There is a different procedure in Alabama, Alaska, California (Los Angeles area), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York (Albany and Brooklyn areas), and Pennsylvania. (To learn more about the procedure in those states, see: Disability Redesign Prototype).

The letter denying your application for SSDI will tell you:

  • The reason for the denial of your claim. As a general matter, the reason will be that you are not eligible financially or not eligible medically.
  • The procedure for appealing the decision.
  • The deadline for filing the appeal. Social Security allows 60 days following a denial to file for Reconsideration.

It is generally worth filing for a Reconsideration.

Maximize your chances of getting an approval by taking the following steps:

Step 1. Consider using a disability lawyer to help.

Step.2. Create timelines.

Step 3. Pull together new evidence depending on the reason for the denial and whether you are applying for SSDI and/or SSI.

Step 4. When you complete the Request For Reconsideration Form, answer the questions in a manner that supports your argument.

If Reconsideration is denied, your next level of appeal is before an Administrative Law Judge.

  • The denial will describe the procedure and include a form called Request for a Hearing Before an Administrative Law Judge (which you can see at: www.ssa.gov/online/ha-501.html offsite link.)
  • Before you complete the form, to maximize your chances for a positive outcome, see Administrative Law Judge.
  • Social Security allows your 60 days plus 5 days for mailing time from the date of the denial to submit your request for an Administrative Law Judicial Hearing.

For more information, see:

How The Reconsideration Process Works

Reconsideration is basically a request to Social Security to reconsider the initial denial of a claim.

When an SSDI claim is denied, your paperwork is returned to the local Social Security office. The paperwork is held for 60 days unless you request an appeal during that time period.

A reconsideration is requested by stating in writing the reasons you think the Social Security decision is wrong. You are permitted to include evidence that is intended to persuade Social Security that the decision should be reversed and your request granted.

When a request for reconsideration is received, Social Security sends your case back to DDS, where it will be assigned to a different claims examiner. The new examiner will reevaluate your case and request additional medical reports if you visited any new doctors since the submission of our initial application.

The examiner will issue his or her decision without a hearing.

How To Request A Reconsideration

In order to start a Reconsideration, you must file a Reconsideration Disability Report (SSA-3441-F6) which you can obtain at www.ssa.gov/online/ssa-3441.html offsite link. You will also have to file an Authorization to Release Medical Information (SSA-827) which you can obtain at: www.ssa.gov/online/ssa-827.pdf offsite link .

The Reconsideration Disability Report simply updates your information. It requests a listing of your doctors where Social Security can find records. It also asks briefly about your daily activities, work, and any changes since you first applied.

Just completing the forms is not likely to win you a reversal if there's no new medical records for Social Security to review. For tips on how to complete the questions, see Forms Used To Start A Claim.

If you don't have any attachments, you can complete the forms online. However, if there are attachments, it is preferable to send the entire package by a means which will provide you a receipt, such as U.S. Mail, return receipt requested.

Make a copy of everything before sending it to social security.

Be sure that the reconsideration is received by social security before the deadline!

Send the form and attachments by Certified Mail, Return Receipt Requested, or by another means which supplies a delivery receipt.

How To Maximize Your Chances Of Obtaining Approval Of Your Claim During A Reconsideration

Step 1. Consider using a disability lawyer to help with a request for a reconsideration

A disability lawyer is one who works with Social Security disability cases frequently. A disability lawyer can help analyze the record; identify problems that may have caused your denial and help correct the situation.

Lawyers in this situation generally work on a contingency basis - they don't get paid unless you do. Fee requests must be approved by Social Security.

If you need help finding a disability lawyer, contact The National Organization of Social Security Claimants' Representatives (NOSSCR) at www.nosscr.org offsite link.

If you don't hire a lawyer to do the reconsideration for you, at least ask a lawyer or other expert such as a social worker to review your papers before submitting them to Social Security.

Step 2. Create Timelines

Work backwards from the deadline to appeal and create dates by which you think the various steps you have to take should be done. This way you will have your own deadlines to meet when you start to prepare your Reconsideration appeal to be sure everything is done and submitted on time.

Step 3. Pull together new evidence.

See the following appropriate section which relates to the reason your claim was denied and whether it was for SSDI and/or SSI: Reason For Denial: Not Eligible Medically, Reason For Denial: Not Eligible Financially For Purposes Of Social Security Disability Insurance (SSDI), Reason For Denial: Not Eligible Financially For Purposes Of Supplemental Security Income (SSI).

Step 4. When you complete the Request For Reconsideration Form, answer the questions in a manner that supports your argument.

When you review the form you will see that most of it is self-explanatory.

The heart of the form and the key to your success in overturning a denial is the box in the middle of the page that says: "I do not agree with the determination made on the above claim and request reconsideration. My reasons are:." Here is where you want to present your argument and the facts that support it. See the particular section in this article that applies to you for advice about what should be completed.

Present any evidence you have that shows the original determination was incorrect.

Use extra sheets of paper if you need them. Carefully label each sheet with your name and Social Security Number plus the page and question number.

Reason For Denial: Not Eligible Medically

A denial due to not meeting Social Security's standard for being totally disabled is the most common reason a claim is denied. Disputing whether you are disabled will take time, research and preparation.

Whether or not you are disabled, and exactly when you became disabled enough to qualify for benefits, is a very subjective issue despite Social Security's attempts to make it objective. Your goal will be to use records that Social Security hasn't seen, and/or reinterpret records Social Security already has.

  • First, the denial letter will list each doctor whose records were used by Social Security. Check the list against the list of doctors about which you informed Social Security. Then review the list of medical records described in the letter.
  • In order to find medical records that Social Security has not seen, get copies of the medical records each doctor filed, plus copies of any medical records that were not filed or were filed but that Social Security did not list.
    • When looking for additional medical information Social Security has not seen, keep in mind that all of your medical problems do not have to come from the same condition. For example, if you are dealing with a physical condition, consider submitting records from your therapist treating you for depression or other mental condition.
  • Get a letter from your doctor.
    • Show your doctor the denial letter and review the medical records with him or her. Point out where you think the documentation of your symptoms is weak. Also point out items you may have reported to your doctor that didn't make it into the record. Ask your doctor to write a letter identifying from a medical point of view:
    • His/her opinion of your inability to work.
    • Exactly what keeps you from working and how each of those items specifically keeps you from working. To learn more, see Physician's Statement.
  • Get third party testimony.
    • Especially if you didn't submit any with your initial application, obtain letters from people you work with as well as people you live with or are close to. Ask them to write their observations about why you can't work and any changes in you they've noticed. Ask them to be specific and to pinpoint dates as much as they recall. For samples, see Affidavits and Statements From Friends And Co-Workers.
  • Pull together other evidence.
    • A great source of other supporting evidence can be work or school records which sometimes contain a wealth of information about job performance and psychological testing. Any records that were generated before applying for Social Security benefits will be given greater weight than those which are generated afterward.
  • If the question is the onset date of your disability (the date your disability started), go through the medical records to show that you had the same symptoms at the earlier time as you did at the time Social Security used to declare you disabled.
  • If the question is whether you have a mentally disabling condition. or have a physical condition which also causes a mentally disabling condition, be sure to describe the full extent of the limitations you are experiencing. It may be hard to admit the limitations. Many people tend to under describe such conditions. 
    • Describe how your life is impacted, including:
      • Your interactions with other people 
      • Your everyday life including life at home, preparing meals, taking your medications consistently
      • Remembering things or processing information 
      • Your ability to work. 
    • Give specific examples.

Reason For Denial: Not Eligible Financially For Purposes Of Social Security Disability Insurance (SSDI)

When the question is whether you meet the financial eligibility requirements for a Social Security program -- such as whether you earned enough credits to qualify for SSDI -- the appeal is pretty cut and dried. It's an argument over numbers. If you can prove your numbers are right, you'll win. If not, Social Security's numbers will prevail.

When looking for evidence to support your position, remember that in the absence of some pretty convincing proof, Social Security's numbers are presumed to be correct.

Social Security may claim that you did not pay into Social Security for enough quarters to qualify. Or your benefit could be lower than you think it should be because Social Security missed five years of earnings on which you paid taxes. In order to prove your case, Social Security will generally not accept your word without additional evidence.

If you were an employee

Look for paycheck stubs which will show how much was paid in F.I.C.A. tax each pay period.

  • If you can't find them, the W-2 form you receive from an employer will show the amount of tax that was paid. If you don't have a separate file for W-2 forms, look at your tax return for the year in question. A W-2 should have been attached.
  • If all else fails, request a statement from the employer that shows how much was paid in F.I.C.A. taxes.

If you were self-employed: Your tax return would indicate how much you paid into the system in the particular year.

Reason For Denial: Not Eligible Financially For Purposes Of Supplemental Security Income (SSI)

The proof needed depends on the reason for the rejection. The most common reason for denial of SSI due to financial ineligibility is a misunderstanding of what is income.

Perhaps the way you reported something caused Social Security to mistakenly call it income or resources when it was not.

Perhaps income has been deemed to exist, when it didn't. For instance in the areas of free rent or gifts/in kind assistance:

  • Free Rent: Sometimes benefits are denied because Social Security claims that because you live rent-free, the value of your rent should be included in your income so that your total income exceeds the SSI minimum. To dispute this, you will need proof that you are not living rent-free. Two examples of situations where it could appear an applicant lives rent free, but doesn't, are:
    • A written agreement showing that the claimant has been loaned money from the property owner each month equal to the amount of rent. The agreement would have to include a statement that the transaction is a loan, a rate of interest and a date on which the loan will be repaid.
    • A written agreement showing that the claimant is loaned money each month equal to the rent, and that the loan plus interest will be paid from the death benefit of a life insurance policy that is described in the agreement. (For your information, you can still obtain life insurance despite your health history. See How To Obtain Life Insurance.)
  • Other in-kind or gift assistance: Many people think that unless they are given cash, it doesn't count as income. If you are denied SSI for this reason, re-read Supplemental Security Income (SSI) to see if your gifts may be exempt.

If Your Reconsideration Appeal Is Denied

If Reconsideration is denied, your next level of appeal is before an Administrative Law Judge.

The denial will describe the procedure and include a form called Request for a Hearing Before an Administrative Law Judge (which you can see at: www.ssa.gov/online/ha-501.html offsite link.)

Before you complete the form, to maximize your chances for a positive outcome, see Administrative Law Judge.

Social Security allows your 60 days plus 5 days for mailing time from the date of the denial to submit your request for an Administrative Law Judicial Hearing.