Disability

Disability denial: Appeal or file a new claim?

Applying for Social Security Administration (SSA) disability benefits only to have your claim denied is discouraging and frustrating. Deciding what to do next can be confusing. Generally, if your claim is denied and you still believe you have a case, you have two options:

  1. You can appeal the decision.
  2. You can refile an initial application.

Which choice is best for you?

disability denial

First, make sure you understand the steps in SSA’s appeals process. The stage of appeal you are at is an important factor in deciding whether to appeal or refile. There are five stages of review in the disability application process: initial application, reconsideration, Administrative Law Judge (ALJ) hearing, Appeals Council review, and Federal District Court review. Most people denied at or before the ALJ stage choose to appeal and those denied after that stage choose to refile. Read on to learn more about why.

Initial or reconsideration denial

If you face disability denial at the initial application or reconsideration stages, there are more benefits to appealing the decision than to filing a new application. Appealing a denial protects your original filing date, which SSA uses to calculate back pay if your claim is approved. This enables you to collect benefits owed to you during the entire appeals process. (The maximum back payment you can collect is 12 months prior to your protected filing date.) If you file a new claim, you lose the protected filing date and any associated benefits. This could be a difference of thousands of dollars. Also, in order to file a new claim, you have to first wait through the 60-day appeal window.

Also note that you have a stronger chance of approval on appeal if you have additional evidence or a new diagnosis. You should continue to submit updated medical evidence throughout the appeals process because it can change the outcome of your case without having to go through the hassle of filing a new claim.

Administrative Law Judge level denial

disability denialWhile there are many benefits to appealing an SSA disability denial, filing a new claim is better in some instances. If your claim is denied at the ALJ stage, it is usually better to file a new claim than appeal the decision. SSA’s Appeals Council does not have to hear your case even if you appeal, and a decision can take up to two years. You cannot file a new claim while an appeal is pending, so you would have to wait for a final decision to be made to take any further action.

Also, filing a new claim if your 60-day window to appeal a decision passes can help. You can submit what SSA considers a “good cause” request to reopen your claim, but Social Security ultimately has discretion to decide whether or not to grant a good cause reopening. Submitting a request for good cause to reopen your case will likely delay the decision-making process and your claim could still be denied again.

Also note: If your appeal is denied and you submit a request for an ALJ hearing, you will have time to appoint a legal representative if desired. A representative can make legal arguments and address any issues that were missed in your previous filings. Learn more about legal representatives and why one might be useful to you here.

Res judicata and DLI

In general, when deciding whether or not to appeal a disability decision, you can ask yourself these questions:

  • Has your 60-day appeal deadline passed?
  • Have your conditions changed since you first applied?
  • Do you have new medical evidence that you have not submitted to Social Security?
  • Do you have any new conditions that Social Security did not consider in their decision?

These factors are important because of res judicata, a rule in civil law and an administrative policy that prevents a person from filing the same claim with the same facts after it is denied. This rule applies regardless of the stage at which your claim was denied. Remember: If you file a new claim instead of appealing a denial and do not provide any new evidence or diagnosis that changes your claim, Social Security can deny your claim without reviewing it.

Finally, and most importantly, you should consider your “date last insured” (DLI). It will determine if you are even eligible to refile at the initial level. If your DLI is in the past you will not be able to file a new application because of res judicata. In that circumstance, appealing the decision would likely be your only option.

You have many factors to consider when deciding whether to appeal a disability decision or file a new application. Always keep in mind that you only have 60 days to make a decision and file an appeal so there is no time to waste. If you have questions, or if you wish to apply for Social Security disability benefits or appeal a decision, the Disability team at CVC can help!

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