The SSI Appeal Process

November 29, 2015 - 5 minutes read

The Social Security Administration (“SSA”) makes determinations concerning eligibility for SSI or SSDI, or which affect the amount of the monthly check.  When an applicant for or a recipient of Supplemental Security Income (“SSI”) is dissatisfied with such a determination by the SSA, he or she has the right to have the decision reviewed. This begins what is known as the “administrative review process,” or “appeals process.” {20 C.F.R. § 416.1407.} The POMS also provides an overview of the appeals process. {SI 04005.010.}

Overview of the Administrative Review; From Case Review to Court of Appeals.

In general, there are three levels of the administrative review process, beginning with a request for a “reconsideration.” If one is dissatisfied with a Social Security Administration reconsideration determination, one can request a hearing before an administrative law judge, also called an “administrative law judge (ALJ) hearing.” Finally, one may request review of the ALJ hearing, by filing a request for review by the “Appeals Council.” The Appeals Council review is the last step in the administrative review process.  The next step in the appeals process is federal court.

If one is dissatisfied with the outcome of the Appeals Council review, one may then request seek review of the final SSA administrative decision, by filing an action in federal court. One has a right of appeal of an unsuccessful federal trial court decision, by way of the court of appeals. In California, such an action is brought in the Ninth Circuit Court of Appeals.

The Three Levels of Reconsideration.

 

Case Review is where the claimant (and any other parties) are given time to review the evidence contained in the SSA’s case files, and present additional evidence, either oral or written to the SSA. All the evidence is then reviewed by the SSA. The SSA employee who conducts the review then issues a reconsidered determination.  There is no face-to-face interaction with the SSA employee.

Informal Conference is where the claimant (and any other parties) can present witnesses at a face-to-face conference with the decision-maker. After conclusion of the conference, the SSA issues a reconsidered determination.

Formal Conference is where the claimant (and the other parties) may request issuance of a subpoena, compelling attendance at the conference by adverse witnesses, from whom the claimant can solicit testimony. The claimant can also, testify, subpoena disclosure of documents from other persons, and cross-examine adverse witnesses. After conclusion of the conference, the SSA issues a reconsidered determination.

Application of the Three Levels of Reconsideration.

The specific administrative process one follows depends upon the stage at which one is at with their SSI case. If the matter arises before one is receiving SSI (at the application stage), i.e., applying for SSI, there are two types of processes: when the issue is a non-medical one, the applicant gets a case review or an informal conference. If the issue is a medical one, the applicant only receives a case review. {20 C.F.R. § 416.1413a.}

But when the matter arises after one has been found eligible for SSI, and the SSA decides to “suspend, reduce or terminate” SSI benefits, the SSI recipient will receive a letter advising him or her of the specific action the SSA will take. The recipient must file an appeal within 60 days of the date the notice is received. (There are circumstances under which one can extend the 60–day period, see § 416.1411(b).) Again the type of due process remedy depends upon whether the issue is medical or non-medical. If the issue is a medical one, the recipient can have a disability hearing. If the issues are non-medical, the recipient can choose a case review, informal conference or formal conference. {20 C.F.R. § 416.1413b.}

 

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