Before You Read Me: Don’t Read Me
This article is for people who were recently denied at a hearing appeal. That means, they already had a hearing and met a judge.
If you did not have a hearing yet, don’t read this article or it will make your head explode for no reason. Instead, read this article about How to Get Ready for Your Disability Hearing or read this article on a typical timeline for a disability case.
Appeals Council vs. New Application
If your appeal hearing was not successful, please do not give up hope. There have been plenty of people here who were in this situation and went on to get approved. You have two options for next step:
Option One: You can request a new hearing with an Appeals Council
Option Two: You can start a new application
This is (obviously) quite an important decision. There are a lot of little intricate pieces you may want to mull over while making this decision. There is no wrong or right way to do it. We have seen people go both directions and win their cases both ways.
Our online browsing uncovered that we cannot find one single article on the entire internet that lists all the factors involved in this decision. We are attempting to put together a list. Input, updates, and suggestions for changes are welcome!
Appeals Council – Approximately 2% are approved. 22% are remanded (sent back for another hearing with special instructions). The rest are denied.
New applications – Approximately 33% are approved. The rest are denied.
Appeals Council – Decision in approximately 12 months.
New Application – Decision in approximately 3-6 months
What Happens If You Are Not Approved
- The appeals council may decide to remand your case (22% chance this will happen). This will be another hearing with your same judge, but this time the judge will have to consider special instructions from the appeals council. The appeals council will tell the judge what they think was done wrong and ask the judge to address these points.
- Remand hearings are faster than regular hearings. They take approximately 10 months (Plus the 12 months for the appeals council. So, 22 months total).
- Or the appeals council may decide to deny your case (76% chance this will happen). In this case, you will have the option to appeal again to federal court. You will be required to have a lawyer. Please look online to learn more about federal court.
- Of course, at any time you will also have the option to give up appealing and start a new application. Please see notes below about Date Last Insured – in some situations starting a new application won’t be possible.
- This is the same as what you did last time. If you are not approved, you can request an appeal and go to an appeal hearing.
- Some states have an extra step before the hearing. It is called “reconsideration.” So, it is possible your case will get approved a that point.
- You new hearing will be the same kind of hearing as last time, but you will get a new judge and they will be looking at your new medical records.
- Wait times for hearings varies by state. Your wait time will probably be similar to what you experienced last time.
Appeals Council – In most cases, they will be looking at your PAST medical records. These are any records that were created before your hearing date. If your records are already excellent, then you may wish to continue on to appeals council. Also, if you do not have the money, health insurance, or ability to create new good medical records, then you may wish to continue on with your current application instead of starting from scratch. In some cases, they may consider new records but only if they relate to the period of time before the judge’s denial. So, if you ask your doctor to write a letter or complete a new form for you, make sure to request that they specifically note what time period this pertains to. If your case is remanded back to a judge, then the judge can consider both old and new records.
New Application – In most cases, they will primarily be looking at your CURRENT and FUTURE medical records. These are any records created after your hearing date. They may also consider previous records (particularly if you collect and submit them yourself), but the current and future records are most significant. If your past records are not strong or have some problems, you may wish to start fresh with a new application. If you have health insurance and a supportive doctor right now, that will certainly help.
Strength of Application
Appeals Council – In most cases, they will only be looking at your PAST file. If you are happy with everything in your file, and you feel your application is strong, then you may want to continue forward using this application. As mentioned above, if you have new evidence to submit (for example, if some records were missing from your file), they will consider new materials if they pertain to the time period before the hearing.
New Application – In most cases, they will only be looking at your FUTURE records, forms and materials you submit. We have met several people who were denied at a hearing, but then got approved with a new application. This is often because they knew a great deal more then when they first applied and they took their application much more seriously and did a much better job with preparing the new application. Here are a bunch of steps you can take before submitting a new application that can make a big difference.
Appeals Council – In most cases, you will keep some or all of your backpay. If the decision is fully favorable, you will keep all of it. If the decision is partially favorable, you will keep some of it. There is no way to know how much until the decision is made.
New Application – In most cases, you will lose all your backpay. You will be able to get backpay from this moment forward, but in most cases any backpay accrued up to this point will be lost.
Judges Approval Rating
Appeals Council – You will probably get the same judge! If you go this route, there is a good chance you will eventually be sent back for another hearing with a judge. You will get the same judge you had at your last hearing! This is not always true – sometimes a judge dies, retires or moves – but it is usually true.
New Application – Unless you are terribly unlucky…. You will probably get a new judge! If you continue to appeal and wind up getting a new hearing, you will be randomly assigned a judge in your area, or you may be given the option for a video conference with a judge in another area.
You may wish to consider how your judge compares to other judges in your area. Would you prefer the same judge or a new one? List of approvals and denials from judges:
Appeals Council – Yes, you would like a lawyer if possible. It is difficult to get a successful outcome at an appeals council without a lawyer. If your lawyer wants to continue with your case and take it to appeals council, it is worth considering trying this route. If your lawyer does not wish to continue, you can inquire about finding a new lawyer. However, many lawyers will not take on an appeals council cases.
New Application – No, you do not need a lawyer. This is good because you probably won’t be able to find a lawyer to take your case right now. If your hearing was recent, there is no way for a lawyer to make money right now. However, as you can tell from many of the stories on this site, you absolutely do not need a lawyer to be successful with a new application. If you are able to put in a little thought, time and energy, you can do more to help yourself than a lawyer can do to help you at this stage anyway. If you continue on to appeal, you should be able to get a lawyer later on.
How to Get Approved
Appeals Council – In most cases, the appeals council does not consider if you are sick or disabled or unable to work. The council cares the most about ONE THING: Did the judge make any policy or procedure mistakes in your case? The best approach is to look through all the documentation and come up with one or more specific mistakes the judge made and write down what the mistake was and which policy they did not follow correctly. Now you can see why you probably need a lawyer to help you here J Here is an excellent article on common mistakes a judge can make. If you can prove that your judge made one of more of these mistakes, you may have a good case for appeals council.
New Application – They are deciding if you are disabled and unable to work or unable to work full time. The look at a number of factors, but ONE THING they care about the most: Do your medical records prove that you are disabled? They will also consider other evidence you send them.
Appeals Council – You have 60 days to file your request for appeal
New Application – No Deadline. You can apply any time, but you may want to consider your Date Last Insured. (see below)
It’s a good idea to request your case file, including all medical records and documents related to your hearing. You can also request an audio transcript of the hearing.
You may be able to get this through your lawyer. Important: you don’t want copies of the medical records your lawyer has, you want copies of your Social Security file. Just because your lawyer has something, does not guarantee it is in your file.
You can also request your file from the judge’s office (ODAR). You can also try your local Social Security office. You can make the request over the phone to have it mailed to you.
If you discover that any important medical records are missing, you may wish to collect those records yourself now. You can submit them to Social Security along with a note that these records were missing from your file when the decision was made.
Figure Out If You are Applying for SSI or SSDI
SSI and SSDI are two different programs. Just to confuse you, they sound the same and you apply for them the exact same way!
If you don’t know what you are applying for, you really want to find out or this next section won’t make sense.
You may be able to find out by asking your lawyer, or calling Social Security and seeing if they can tell you which program you are eligible for. You can also learn more about the difference here.
Figure Out Your Date Last Insured
Now that you know what you are applying for, there is one last important thing to check. It is called your “Date Last Insured.”
If You Are Applying for SSI – Goods News! You do not have to worry about this AT ALL. You can relax and ignore the rest of this page.
If You Are Applying for SSDI – Social Security has a special policy called “Date Last Insured”. It is a deadline for applying for SSDI. The date is based on how much you worked, how long you worked, and how much time has passed. Your Date Last Insured can expire. If this happens, you may hear the words “Your Date Last Insured has expired” or “Your work credits have expired.” If you don’t know your Date Last Insured, you can call Social Security and ask: what is your “Date Last Insured”.
Now That You Know Your Date Last Insured
If Your Date Last Insured Is Far in the Future
You are safe. You are free to start a new application, or you are free to go to Appeals Council. No problems either way.
If Your Date Last Insured Is Coming Up In the Next Year or Two
Your Date Last Insured may expire while you are waiting for the Appeals Council process. Once this happens, you it may be more difficult to start a new application. Keep an eye on your Date Last Insured and make sure to make a good decision for yourself before it passes.
If Your Date Last Insured Has Already Past
Your Date Last Insured has expired. You have a few options:
- Option One: Do not start a new application. Request an appeal instead. You have a 60 day deadline to make the request. It does not matter if your date has expired, as long as you continue appealing your case and your medical records prove you were disabled before the Date passed.
- Option two: Start a new application, but forget about SSDI. Apply for SSI instead. You can only do this if you are poor. If you are married, your spouse must also be poor. If you are approved, your monthly check will probably be lower than it would have been on SSDI.
- Option three: This is a bit of a long shot: Start a new application. Then get denied. Then go to an appeal hearing. Then convince the judge to reopen your old case from before your Date Last Insured expired. We have only met one person who has done this.
Some people have no choice. They MUST go to appeals council, because they cannot file a new application.
From what we have seen, this most often happens to people that are married. If your spouse works and makes too much income, then you cannot apply for SSI. If your date last insured has expired, then you cannot apply for SSDI either. Unless you get divorced or live separately, you can’t apply for anything!
If appeal is your only option, please make sure not to miss the deadline for returning your appeal form.