Pennsylvanians who suffer from an injury, illness or condition and are approved for Social Security disability benefits must understand that there are periodic reviews by the Social Security Administration to make certain that the benefits should continue. If the SSA determines that the person no longer has a qualifying disability, the benefits will stop. However, like when there is a denial of benefits at the initial application, a claimant can appeal to continue receiving benefits.
With an appeal, the SSA will examine the entire decision and if it is found that a mistake was made, it will be changed. There are 60 days for a claimant to request an appeal of the decision to stop payments. This will start after the letter is received saying that the benefits are stopping. There is a presumption on the part of the SSA that the letter will be received five days after its date. If the time frame is missed, the claimant must show that the letter took longer to arrive. There must be a good reason for having been late in filing the appeal.
If an appeal is requested within 10 days of getting the letter allows the claimant to request that the benefits continue while the decision is made. Again, if this time limit is missed, the request can be made if there is a good reason why the request was late. If the payments continue and the appeal is denied, the person will be asked to pay back some or all the money. If the payments were needed for living expenses and the claimant was cooperative during the process, it will not have to be paid back.
There are four levels of appeal: reconsideration, hearing, Appeals Council and federal court. Reconsideration is a complete review of the claim by someone who played no role in a prior decision. If the claim is still denied, a hearing can be held before an administrative law judge who did not take part in the previous decision. If it is denied again, the claimant can ask for the Appeals Council to review the case. It does not have to review a case it believes was decided correctly. If the Appeals Council refuses to hear the case or upholds the decision, the case can be brought to federal court.
For assistance, it is important to discuss the case with an experienced legal professional who understands the ins and outs of disability cases.
Source: ssa.gov, “Your Right to Question the Decision to Stop Your Disability Benefits,” accessed on July 12, 2017