If denied at the initial level, you can request that your claim be reviewed. This is the first step in appealing your case and is called Reconsideration. The state agency that made your initial determination will re-evaluate your case and update the medical evidence in your file. 85% of all claims that are evaluated at this stage are denied.
To have your claim reconsidered, you must submit three forms:
- Reconsideration Disability Report (SSA-3441-F6) – This form consists of a series of questions that allow you to provide any new or additional information about your medical condition and to list any medical providers whose records weren’t used in the initial decision.
- Request for Reconsideration (SSA-561-U2) – This is the actual request for review; however, it can practically guarantee another denial if you aren’t careful. The form gives you three lines on which to explain why you don’t agree with the denial. I have never seen a denial overturned because of three lines of information.
- Authorization to Disclose Information to the Social Security Administration (SSA-827) – These are the same medical releases you signed with the initial application. They again want several copies (one for each physician plus a couple of extras) signed and not dated.
In addition, you will need to attach the following:
- Submit medical records that show your symptoms are more severe than the original medical records stated;
- Submit new medical records and test results that provide more objective proof of your condition;
- Submit documentation that shows your condition meets one of the Listings of Impairments used by Social Security;
- Submit a narrative by your treating physician stating not only that you are disabled but elaborating on everything used to arrive at that conclusion; and,
- Submit any other documentation that supports your claim, such as third party testimony, symptom diaries, etc.
Once you submit your Request for Reconsideration and accompanying documentation, the process is very similar to that used with the initial application. Your claim will be assigned to a Claims or Disability Analyst, and that person will review all the medical information and determine whether or not you are disabled. Just as with the initial application, the Analyst may request additional medical records or schedule you to have a Consultative Examination by one of their doctors.
Sixty-five days is not a lot of time, so it is necessary to work quickly to obtain all the necessary documentation to overturn your denial. Start with examining the denial letter. Although it appears to be a form letter, it really contains information important to the preparation of your appeal.
First, look at the medical records they used in their examination of your claim. They will be listed in the Notice of Denial. What is missing? Did they miss one of the specialists? Your therapist? What is not on their list that would have supported your claim? Are there additional records created after the date received that could help your claim?
Also notice whether they believe that you can return to your old job or whether you are disabled from that job, but they believe you can do other work.If geographically convenient, call your local Social Security office and make an appointment to review your file. You will be able to see exactly which records were received, plus you will be able to see the internal notes and summaries that will give you a good idea of how they arrived at their denial and what you must focus on to obtain an approval. If you had a Consultative Exam from one of their doctors, it is important that you get a copy of that report for you doctor to review and reply to.
When preparing your Reconsideration appeal, start with the Listing of Impairments and the medical records you will need to show how your symptoms prevent you from doing any kind of work. (See Getting Disability Benefits Under Social Security with HCV in the Benefits Archives of this site.) Assemble your documentation and submit it with the required Reconsideration forms.
It is recommended that you provide a cover letter that outlines the records you are submitting and what they include that supports your claim for disability.
Once your information is received you need to follow up with the process just as with the initial application since this level of appeal is a replay of the initial application process. (See Helping Your Social Security Claim Through the System in the Benefits Archives of this site.)
Don’t take the denial personally. Social Security is not saying that you are not disabled; they are not saying you are able to work; and they are certainly not saying that your symptoms don’t exist. They are examining medical records, which are not always the most complete or easy to read. The people who review your claim have certain steps they must follow and certain information they must find. If they don’t find it, they have no choice but to deny your claim. If you work with the Analyst handling your reconsideration appeal, you can frequently provide her with the information she needs to approve your claim.
Spend time and effort on Reconsideration. Many people, especially attorneys, will advise you to not waste time on the Reconsideration step, but just file the necessary forms and wait for the denial. They will caution that about 80% of all Reconsiderations are denied. However, I personally believe that very advice is what has helped create these distorted statistics. If you follow the advice in the columns on this website and study some of the many sites dedicated to Social Security disability, including Social Security’s own site at www.ssa.gov, you have a good chance of being one of the 20% that gets approved and of avoiding the necessity of waiting over a year to get to the next level of appeal as well as having to share your benefits with an advocate/attorney.
Following this second denial a claimant has 60 days to request a hearing before an administrative law judge, which takes us to the next phase – the Social Security Benefits Hearing.