It is well known that applications for Social Security Disability Insurance and Supplemental Security Income, SSDI and SSI respectively, are often initially denied and must be appealed. As of Feb. 20, 2019, the appeals process in the state of Pennsylvania expanded to a three-level administrative appeals process from the previous two-step process.
As background, the administrative (meaning before an agency) appeals process historically consisted of three steps before the Social Security Administration or SSA after an initial application denial:
- Hearing before an administrative law judge or ALJ
- Appeals Council review
Once the claimant has exhausted all these agency remedies unsuccessfully, he or she may request review in federal court.
SSA quality initiatives
In the 1990s, the SSA started to experiment with variations on the administrative appeals process in search of improvement. One of the initiatives tested was the “reconsideration elimination model,” conducted in 10 states, including Pennsylvania. In this test, after an initial application denial, the claimant’s administrative appeal was directly to an ALJ hearing with no intermediate reconsideration step.
The SSA recently announced that it would end this test, removing five states in January and on April 20, reinstating the reconsideration step in Pennsylvania appeals. (The remaining states will have reconsideration again by March 31, 2020.)
Pros and cons
According to KYW News Radio, SSDI and SSI advocates in Pennsylvania are concerned about the return of reconsideration because it will add more time to the total appeals process, which can exceed a year or more in some cases.
According to the National Organization of Social Security Claimants’ Representatives or NOSSCR, the reconsideration decision is usually made “within four months.” NOSSCR also reports that an initial denial is only overturned and benefits granted at the reconsideration stage in about 10% of cases.
However, an experienced attorney can assist a claimant at the reconsideration stage to gather and submit additional medical and other evidence to support the disability claim. In reconsideration, all the evidence considered with the initial application plus newly submitted evidence is reviewed by a different person than the one who recommended the initial decision.