IMA POLICY MANUAL
PART IV: NON-FINANCIAL ELIGIBILITY REQUIREMENTS
EXHIBIT IV-10 GENERAL INFORMATION ABOUT THE SSA APPEALS PROCESS
When the SSA determines that a client is not disabled/blind for SSI purposes, the client may appeal that determination at SSA.
The SSA appeals process consists of three steps:
- Reconsideration
- Hearing
- Appeals council
SSA has no time limits for making decisions on appeals.
The client, however, has 60 days from the date s/he receives notice to appeal each of the following SSA actions:
- Determinations
- Reconsideration decisions
- Hearing decisions
Reconsideration is completed at the SSA. An SSA employee other than the one who decided the client was not disabled/blind reviews the determination. Most considerations uphold the original decision.
Hearings are conducted by an administrative law judge (ALJ). The ALJ renders a new decision based on a review of the material, questions asked at the hearing, testimony of witnesses, and new evidence submitted. Approximately 60 percent of all SSA disability denials are overturned at the hearing level.
The Appeals Council can deny or dismiss an appeal from the hearing level or grant the request by issuing a new decision or remanding the case back to an ALJ. Most appeals are denied or dismissed at this step.
If the Appeals Council upholds the ALJ's decision, there are no further appeals at SSA. The client may contest SSA's decision at the appropriate federal district court.
