What is the Reconsideration Process for Disability Claims?

You receive a determination of your disability claim. It’s denied! Now what?

The first step in the appeals process is reconsideration.

In Arizona, 16% of disability claims are approved at the reconsideration stage. In other states, the percentage approval rate is even higher. Reconsideration can be an important step in receiving the disability benefits that you deserve. Completing the reconsideration step allows you to move to the next phase of appeals and have a hearing in your case.

Understanding the Disability Claims Reconsideration Process

Whether you are appealing a denial of your claim or a less-than-fully favorable decision, the reconsideration process allows you to appeal. Pekas Smith Disability Attorneys explains:

  • What the reconsideration process is
  • How to appeal
  • The deadline to appeal
  • What can make an appeal successful
  • Your right to an attorney

To talk to an attorney about your disability claim and reconsideration, contact Pekas Smith Disability Attorneys.

What is the Disability Reconsideration Process?

The disability reconsideration process is the opportunity to have an independent review of a disability claim determination. It assigns a person or people other than the person who made the first decision to conduct a thorough review of the information submitted in the claim. A new determination may result in an award of disability benefits.

What is disability reconsideration?

Disability reconsideration is the first appeals step for a claimant who is not happy with the initial determination of their claim.

Who can ask for disability reconsideration?

You can ask for disability reconsideration if you have applied for disability and:

  • Your claim is denied OR
  • Your claim is less than fully favorable

Less than Fully Favorable (LTFF) means an appeal of the closed period (CP), adverse onset date, or medical diagnosis.

How do you request reconsideration of a disability claim?

There are multiple ways to request reconsideration of a disability claim:

  • Complete form SSA-561, Request for Reconsideration
  • Complete form i561, Request for Reconsideration, electronic
  • Submit a statement of disagreement with the initial determination
  • Submit additional evidence relating to the claim

You or your representative may file the request in writing or electronically. Calling the 800 number or the field office isn’t sufficient to file nor is stating you plan to appeal or requesting forms. You must submit a form, a statement, or additional evidence to request reconsideration.

The Social Security Administration can’t initiate reconsideration without a request, so it’s important to file the paperwork promptly. They may initiate the correction of an error under administrative finality, but that isn’t the same as a reconsideration ruling. (See GN 04001.000).

Where do you submit your Social Security request for reconsideration?

You may submit your request for reconsideration to any Social Security Administration office.

Why can Social Security reconsideration lead to a different decision?

You might wonder why a rehearing would result in a different decision.

There are several reasons that a Social Security reconsideration request may result in a different decision. These may include the following:

  • The person’s medical condition has worsened, and they have additional medical information to submit
  • The examiner made an incorrect decision based on the information available
  • An application was missing information that could be supplemented
  • Incorrect information can be corrected

For these reasons, a significant number of claims are approved at the reconsideration level.

How long do you have to file a reconsideration request?

You must file a request for reconsideration within 60 days of receiving your initial determination.

It may be possible to receive an extension of the period, but you must have good cause, and it’s not guaranteed that your request will be granted. (See DI 27010.001 Appeal Filing Issues).

It is possible to ask for reconsideration too early. You should request an initial determination has been made. If the notice is pending release and the notice is pending online, administrators will accept the appeal.

It’s presumed that you received the notice of your determination five days after the date on the notice unless you can show that you didn’t receive it within that time frame. If you receive the notice in person, the day you receive it is considered the date of receipt.

What is the SSA policy for reconsideration?

Programs Operations Manual System SI 04020.010 et. seq. and DI 27001.001 et. seq. create policy for the reconsideration process.

Who decides a disability reconsideration request?

  • A disability hearing officer OR
  • A disability examiner with a medical or psychological consultant

Skip States for Disability Reconsideration

You may have read that there are “skip states” when it comes to disability consideration. There used to be 10 states where the reconsideration phase didn’t exist, and a disability appeal went straight to the next phase for a hearing.

However, after testing the system without the reconsideration phase, the Social Security Administration has reinstated it in all states. All states that tested removing the reconsideration phase reinstated it by March 21, 2020.

What happens if disability reconsideration is approved?

If your disability reconsideration is approved, you receive your benefits. Your benefits are paid back to your disability date, except for the five-month waiting period.

What happens if disability reconsideration is denied?

If SSI or SSDI reconsideration is denied, you may proceed to the next step of the appeals process. The next step in the SSI or SSDI reconsideration process is a hearing before an Administrative Law Judge. An attorney can advise you on the best way to proceed.

Talk to a Disability Reconsideration Attorney

At Pekas Smith Disability Attorneys, we want everyone to receive the disability benefits they deserve. We are taking new cases and invite you to talk to a disability reconsideration attorney. Contact us now.

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