How to Appeal a Denied Disability Claim

Disability and Healthcare Planning | by Jules Buxbaum | Friday, January 31, 2025

How to Appeal a Denied Disability Claim can feel like a daunting task for individuals who rely on these benefits. If you find yourself struggling with a recent denial, you’re not alone.

In fact, many applicants face setbacks before obtaining an approval. You can explore options to move forward by checking out your next steps if your disability benefits are denied.

Why Disability Claims Often Get Denied

Disability claims get denied for several reasons, ranging from missing medical records to a belief that you can perform other work. According to the Social Security Administration (SSA), only about 22% of initial applications are approved at the outset (SSA, 2022).

Some denials occur because the office believes your condition does not significantly reduce your work capacity. Others happen for technical reasons, such as your income exceeding specific thresholds. Understanding the underlying reason is vital, since it helps you structure a clear appeal.

Stages of the Appeal Process

The Social Security Administration has four main levels of appeal: Reconsideration, Administrative Law Judge (ALJ) hearing, Appeals Council review, and Federal Court review. Each stage offers a new opportunity to present medical evidence and strengthen your claim.

Statistics show that nearly 87% of reconsideration requests are denied, while ALJ hearings have an approval rate of around 49% (Disability Services of America, 2023). Although the first stage after denial can be discouraging, progress is possible if you keep going.

Reconsideration: Your First Step Forward

Reconsideration requires filing a formal request within 60 days of the denial date. A different examiner reviews your file, so submit any new documents that highlight the seriousness of your condition. Be certain your records detail ongoing treatments or changes in your diagnosis.

This step takes around three to five months on average. While the approval rate at this level is lower than 15%, it’s still worth trying. If your reconsideration is denied again, you can move to the next stage.

Collecting Fresh Medical Evidence

Solid medical evidence carries considerable weight. Additional test results, updated doctors’ notes, and new referrals can address weaknesses in your initial claim. Some claimants choose to consult specialists for more in-depth evaluations.

The goal is to build a complete picture of why your condition limits everyday work activities. If you had inconsistent paperwork the first time, clarify what changed and include stronger details in all submissions.

Administrative Law Judge Hearing

If the SSA denies your reconsideration, the next level is a hearing before an Administrative Law Judge. Presenting your case in front of a judge often proves more successful than earlier stages, with approximately 49% of claimants receiving an approval (Disability Services of America, 2023).

This hearing is less formal than a typical courtroom proceeding and follows a non-adversarial style. However, you must be prepared to testify and possibly answer questions from vocational or medical witnesses hired by the SSA.

When to Seek Professional Representation

An attorney or qualified advocate can gather all relevant documents, prepare you for questioning, and cross-examine any expert witnesses. According to one study, represented claimants are 2.9 times more likely to be awarded benefits than those who go it alone (LaTour, 2023).

If you’re unsure whether you can handle the legal aspects, consider seeking representation. They usually work on a contingency fee basis, so you only pay if you win your case.

Managing Strict Deadlines

Do not forget that each appeal stage limits you to about 60 days for filing. Missing these deadlines typically forces you to start over. The SSA does allow “good-cause exceptions,” but these are not guaranteed.

Keep all notices from the SSA, mark your calendar for the 60-day window, and submit everything within that timeline. Failing to appeal on time can significantly extend the entire process.

Appeals Council and Federal Court Review

Should an ALJ deny your claim, you can request a review by the Appeals Council. However, the council can decide not to take the case if it believes the judge’s decision was correct. Only about 1% of appeals at this level get approved outright (Disability Services of America, 2023).

If the council denies your request or upholds the denial, the final option is a Federal Court lawsuit. A federal judge analyzes whether the SSA followed proper rules and had enough evidence to back its decision. About 45% of these cases result in a remand for more review, although the process can take a year or longer (LaTour, 2023).

Short-Term vs. Long-Term Claim Modalities

Appealing a denied short-term disability claim might look different from appealing a long-term one. Workplace insurance plans, for example, might impose additional guidelines or deadlines.

For more on this topic, see our overview of short-term vs. long-term coverage. Each plan’s requirements can vary, so fully grasp the specifics of your policy before proceeding.

Making Your Future Financial Plans

The appeals process often takes months—or even years—leaving you in financial uncertainty. Some individuals continue to refine their broader long-range planning during this time.

If you live in a location with different state-level complexities, you can explore application tips for disability benefits in NY, NC & FL. Staying proactive can save you additional hassle later.

Impact on Retirement Strategies

The longer an appeal goes on, the more your retirement planning can be affected. You may need to make temporary decisions about savings or portfolio allocations.

For insights on this, check how the impact of disability income on future retirement can shape your finances. Although waiting for a final response is stressful, you can still refine your overall financial picture.

Consider a Custom Approach with 2Pi

Many applicants worry about running out of savings before their disability claim comes through. A personalized financial plan that accounts for different outcomes can give you some relief. That’s one reason we created the 2Pi Financial Planning Engine at https://www.2pifinancial.com/2pi-financial-planner.

This tool lets you input your current assets, potential disability benefits, and retirement timeline. It then calculates withdrawal amounts, success probabilities, and ways to extend your savings. Adjust risk preferences or retirement age to see how each factor changes your forecast. Having a plan, even with uncertain benefits, can be a great buffer.

Key Takeaway

Appealing a denied disability claim involves a multistage process where every step requires new evidence and proper documentation. Although it may feel discouraging to tackle reconsideration or a hearing, real change often happens once you bring updated records to the right decision-maker.

Keep your paperwork organized, act quickly within deadlines, and explore professional representation if needed. If you’d like further guidance on eligibility questions, visit our resource on qualifying for Social Security disability benefits for even more insights.

With the determination to keep going—and a better grasp of why claims get denied—your appeal stands a stronger chance of leading to a successful outcome.

References

1. SSA (2022). “What You Need to Know About SSI and SSDI.” Available at: https://www.ssa.gov/pubs/marketing/EN-05-10607.pdf

2. Disability Services of America (2023). “Appealing a Social Security Disability Denial.” Available at: https://www.disabilityservicesofamerica.com/faqs/appealing-a-social-security-disability-denial.cfm

3. LaTour, B. (2023). “How Long Does a Disability Appeal Take?” Available at: https://drbilllatouratty.com/how-long-does-a-disability-appeal-take/