The disability criteria for children's SSI

Financially needy children under 18 with serious medical conditions may be eligible for Children’s SSI. A child is disabled for SSI if:

• The child is not working and earning more than the SGA level, and
• Has a medical condition or combination that cause "marked and severe functional limitations."

Medical evidence documenting the child’s medical condition is essential. 

In evaluating whether a child is disabled, SSA uses the following four-step analysis:

Step one: is the child working at the substantial gainful activity level?

If the child is working and performing SGA, then SSA considers the child to be "not disabled." SSA determines SGA for the child the same way it does for an adult. For 2024, the amount for an adult is earnings averaging over $1,550 a month. If the child is not earning at that level, proceed to step two.

Step two: does the child have a severe medical condition?

The child must have a "severe impairment." The child must have a condition which causes problems in the ability to perform basic activities. The impairment must be expected to last for 12 months or end in death. If the child has a severe impairment, proceed to step three.

Step three: does the child’s medical condition meet or equal a listed medical condition?

As with adults, SSA has determined that certain medical conditions are automatically disabling. It has identified them in the "Listing of Impairments for Children." 

The medical condition must match one of the adult or child Listings. SSA will then find the child to be disabled. SSA may find a child disabled if the condition is "medically equal" in severity. 

If the child’s condition does not meet or is not medically equal to a Listing, proceed to step four.

Step four: is the child’s medical condition functionally equal to one of the listings?

Suppose the child's condition does not meet or is not medically equal to one of the conditions in the Listings. Then, SSA may find the child to be eligible if the child's condition is "functionally equal” to a Listing.

Functionally equal means the impairment causes "marked and severe" limitations in the level of functioning, in:

• The child’s activities at home,
• At school, and
• In the community.

Medical evidence must show the child’s medical impairment. In examining the child’s ability to function, SSA will look at information from those who observe the child. Evaluations for special education services and early intervention programs are also very important. 

In determining whether a child has a marked limitation, SSA considers the child’s level of functioning in:

• Acquiring and using information,
• Attending and completing tasks,
• Interacting and relating with others,
• Moving about and manipulating objects, 
• Caring for self, and
• Health and physical well-being.

The child meets the functional equivalence test if SSA determines that the child has two marked limitations. Also, one extreme limitation in any of the domains.

SSA should examine how well the child functions. That includes what activities the child can do and whether the child is independently able to complete it. SSA asks four key questions:

1. How does the child function?
2. Which domains are involved in performing the activities in which the child has trouble in functioning?
3. Could the child’s medically documented conditions account for the limitations in the child’s activities?
4. To what degree does the impairment limit the child’s ability to function age-appropriately in each domain?

Based on the answers, SSA rates the overall severity to determine if the child is disabled.

Applying for disability benefits

You can call toll free (800) 772-1213 to make an appointment to apply at your local Social Security office. You may apply for SSDI benefits online. You can also start an SSI application online. However, you will need to go into a Social Security office to complete the application. 

When you apply, you will need to give SSA information about:

• Your medical conditions and treatment,
• How your medical conditions affect your ability to function,
• Information about your past work, and
• Information about your education.

SSA will ask you to complete a “Disability Report” form. It is very important to complete the form providing all the information requested. Medical evidence is very important in a disability case. No matter how sick you are, you will need medical evidence of your condition to obtain benefits. Therefore, it is important to seek medical treatment if you are thinking about applying for either SSDI or SSI.

SSA’s disability determination process, for adults or children, can take quite a bit of time. SSA has a presumptive eligibility process for some serious situations. For example, a person who has suffered a stroke and after three months has a great deal of difficulty walking. 

Persons who are presumptively eligible can receive up to 6 months of benefits while SSA evaluates their cases. SSA has developed a quick determination process for situations like a terminal illness. It has expanded the quick determination process in recent years. It identifies types of medical problems that are so serious anyone who has the diagnosis meets SSA’s disability criteria. Persons with these conditions should be flagged for the quick determination process. A list of these conditions is on the SSA website.

When it makes a decision on your application, SSA will send you a notice. The notice will explain whether you will receive benefits, and if so, in what amount.

If you disagree with the decision made by Social Security, you can appeal. See the below Appeals section.

Working while you receive SSI or SSDI benefits

If you want to try to go back to work while you are on SSDI or SSI, it is important to try to plan ahead. You will not automatically lose your disability benefits if you go back to work. SSA has special rules called work incentives. They allow you to keep all or part of your benefits while you try out your ability to work. SSA’s rules concerning work, however, are complex and can be confusing. There are agencies in Illinois that can help you plan and determine how work earnings may affect your benefits. For agencies that can help you, see the directory of agencies on SSA’s website. 

Note: Be sure to let SSA know if you start a job or leave a job. For SSI you must also report any changes in your monthly income, your assets, or your living situation. Changes can affect the amount of your benefit. Reporting right away will help you avoid any overpayment problems with SSA. Keep a record of any change that you report. Then you can show that you made a timely report even if SSA later claims it never received it.

Working and SSDI benefits

For SSDI, there is a “Trial Work Period.” During this period you can receive full benefits regardless of how much you earn. You must report your work activity and continue to have a disabling impairment.

The [no-lexicon]Trial[/no-lexicon] Work Period is a total of nine months, not consecutive, in a 5 year period. The term “Trial Work Period” can be confusing. SSA allows you to try out your ability to work in a total of nine months without affecting your benefits. The months can be in a row or they can be spread out during the 5 year period. A month counts toward the nine-month total if you earn more than $1,110. 

After the Trial Work Period ends, there is a 36 months where you can't get a SSDI monthly payment if you earn more than $1,550. This period is called the "Extended Period of Eligibility." During these 36 continuous months, you can receive your full SSDI check for any month that:

• Your earnings fall below $1,550,
• You lose your job, or
• You become unable to continue to do your job.

If during this 36 month period, your average earnings have been at least  per month on a sustained basis. Then, SSA will continue your benefits for three more months and then will cut off all benefits. SSA can reinstate your benefits anytime during the 36 month period if your earnings go down below the $1,550 level. If your average earnings have been less than $1,550 per month on a sustained basis, your SSDI benefits will be unaffected. You will continue to receive your full SSDI payment in addition to your earnings.

After the 36 months end, if your earnings exceed the SGA threshold, your benefits will end. You will not be entitled to receive benefits in months in which your earnings drop below SGA. However, you may be entitled to expedited reinstatement if you become unable to work again.

Be sure to report all work. Unreported earnings are one of the most common reasons for overpayment. Do not assume that SSA will know you are working just because you are paying FICA taxes. Your earnings record will eventually reach SSA; in fact, this is how SSA spots overpayments. However, the information will not reach SSA in time to adjust your monthly benefits when they are paid. You must report your earnings to SSA.

Working and SSI

There is no trial work period or 36 month period of extended eligibility. If you are on SSI, your work may affect the amount of your check. However, SSA does not count the first $65/month of your earnings or one-half of the remainder. This means that SSA counts less than one-half of your earnings when figuring your SSI payment amount. This earned income disregard is in addition to the $20 disregard SSA allows for any type of income.

Examples: 

• If you receive SSI and earn $65 per month, you remain eligible for a full SSI benefit, without any reduction.
• If you earn $317 per month and have no other income, SSA first deducts the $20 disregard that applies to any type of income ($317-20=$297). Then SSA deducts the first $65 of your earned income ($297-65=$232) and only $1 for every $2 of the remaining earnings ($232/2=$116). In this example, SSI benefits would be reduced by $116.

SSA also disregards grants, scholarships, fellowships, or gifts used for tuition and educational expenses. SSA disregards earnings up to $2,290 per month for 2024 to a maximum of $9,230 per year for a student under age 22. For a full list of types of income that SSA disregards, please see the SSA website.

SSA may review your eligibility and decide that you are no longer disabled because you can work. 

If you lose your job or your wages are reduced, SSA can increase your SSI because of your reduced income. Suppose. SSA stops your SSI checks because of your earnings, but then you lose your job You can ask to start your benefits without a new application if it has been less than 12 months since you received your last SSI check. If it has been more than 12 months since your SSI stopped, you will need to file a new application for SSI.You may need to prove that you still meet the disability criteria.

Expedited reinstatement for SSDI or SSI

If less than 5 years have passed since your benefits were stopped, and you are no longer able to work. Then, you can ask for expedited reinstatement of your SSI or SSDI benefits. You can receive “provisional benefits” for up to six months while SSA determines eligiblity.

Disability-related work expenses

In figuring your work earnings, SSA will deduct any work expenses related to your disability. These deductions include any items or services that you need to work, even if it is useful daily. Be sure to keep receipts or other records of these expenses and report them to SSA. 

Examples of disability-related expenses:

• Expenses for a service animal,
• Prescription medicines,
• A wheelchair,
• Specialized work equipment,
• A specialized desk,
• Chair or computer,
• Special transportation arrangements,
• A personal attendant, or
• A job coach.

SSA review of continued disability

When SSA finds you disabled, it also classifies your case according to whether:

• Your condition is likely to improve,
• Is not expected to improve (that is, your condition is probably permanent), or
• It is possible that your condition will improve.

Using this classification, SSA marks the case to determine whether you continue to be disabled. 

SSA will plan to review your case in six months to 18 months if SSA expects your condition to improve. It will let you know that the case is scheduled for review in the same notice as the benefit approval. For example, medical improvement is expected where disability is based on a serious bone fracture. However, surgery is planned and could result in a return to work. 

In other cases, SSA will review the case at some point between three years and seven years. It depends on the type of condition you have, and whether medical improvement is possible. SSA can also begin a disability review for other reasons, including that you return to work.

If SSA is reviewing your case to decide if you still are disabled, SSA will send you a letter about your review. You will have a chance to submit medical evidence to show that you still are disabled. 

When SSA reviews your case, it starts by evaluating whether your condition has medically improved. The fact that you have done some work will not automatically mean you are no longer disabled. On the other hand, SSA may consider your work and the tasks you perform in deciding whether you are still disabled.

It is important to continue to get medical care. Also, to follow your doctors’ recommendations, unless there is a good reason not to follow those recommendations. This will help ensure that you have the medical evidence you need when your case is reviewed by SSA. Failing to follow treatment prescribed by your doctor can be a basis for ending your benefits.

If SSA decides your disability has ended, you have the right to file a request for reconsideration. You can keep receiving benefits while your appeal is pending. Note: You have 60 days to file an appeal in general. You only have 10 days to file an appeal and request that your benefits continue during your appeal. If you receive a notice terminating your benefits, act quickly to appeal. Benefits generally can continue through the date of an ALJ hearing decision, provided you request it. See the below Appeals section.

Plan for achieving self-support (PASS)

A Plan for Achieving Self Support (PASS) is a special program. It allows SSI recipients to set aside income and assets needed to achieve a specific work goal. The money and assets set aside will not act to reduce your SSI payment. The goal of your plan may be to start a business or get a job. 

To develop a plan, you first set a work goal. Figure out what you need to reach that goal, such as training, materials, car, tools, etc., and determine the cost of these items or services. Your plan to achieve your work goal may require vocational training or college education. If so, be sure to include expenses for such training and education. When you have your plan and the expenses, you can complete the PASS application. See the SSA website for the form application.

You can get help with setting up the PASS plan from:

• A vocational rehabilitation counselor,
• An organization that helps people with disabilities, or
• The local Social Security office.

You submit the completed application to the local Social Security office.

An SSA representative trained in developing PASS plans will review to determine if it is reasonable. SSA’s representative should work with you, discussing the plan and making changes if necessary. The completed plan must:

• Be in writing,
• State your work goal,
• Contain a reasonable time frame for completion, and
• Include the expenses that are necessary to achieve your work goal.

If your plan is not approved, you can appeal that decision, or you can submit a new plan.

If your plan is approved, you can then set aside some of your income to be used toward meeting your PASS goals. The funds set aside will not affect your eligibility for benefits. You should place the money in a separate bank account so that you will be able to easily account for the funds. You should always keep a receipt when you use the money for expenses allowed under your PASS plan. SSA may contact you to make sure that you are doing what the PASS plan says and that you are on track to reach your goal. You must tell the SSA office in writing about the changes and the reasons and receive approval.

You should contact your local SSA office if you would like more information about creating a PASS plan.

How working affects Medicaid

If you are eligible for SSI benefits, you may also be eligible for Medicaid coverage. For information about Medicaid, see the section "Medicaid for Adults." However, Medicaid is a "needs based" program. You can lose your coverage or a have a "spend-down" if you have income other than SSI. There are several ways you can continue to get medical assistance even if you are working. 

You can continue to get Medicaid while you work if your earnings don’t make you ineligible for SSI benefits. Under SSA 1619(a), even if you earn over the threshold representing substantial gainful activity , you can still be eligible for SSI benefits. Under that circumstance, you can remain eligible for SSI benefits so long as:

• You have been eligible for SSI for at least one month before starting work
• You continue to be disabled
• Your income doesn’t exceed the amount that would cause you to be otherwise ineligible for SSI, and 
• You meet all other non-disability related requirements for eligibility.  

If you continue to receive SSI benefits under Section 1619(a), SSA should notify DHS of your participation. DHS should continue your Medicaid without requiring you to spend-down to meet required income levels. You should seek legal help if DHS stops your Medicaid or tells you that you will have a spend-down.

If your earnings are too high to continue to qualify for SSI, you may still qualify for Medicaid.  Section 1619(b) of the SSA allows you to keep your coverage without a spend-down if your earnings are less than a certain limit. To be eligible under 1619(b), you must:

• Have been eligible for SSI for at least one month before starting work
• Continue to be disabled
• Need Medicaid coverage to be able to work
• Earn less than a certain limit and
• Continue to meet the SSI rules on assets

If you think you might be eligible, you should ask SSA to perform an assessment and notify DHS. Your Medicaid benefits should not be terminated until SSA makes a 1619(b) decision. You should seek legal help if DHS stops your Medicaid or tells you that you will have a spend-down.

Health benefits for workers with disabilities (HBWD)

If you are not eligible for these Medicaid programs, you may qualify for Health Benefits for Workers with Disabilities if:

• You are working,
• Still have a disability, and
• You are under age 64.

HBWD provides the broad health coverage offered under the Medicaid program. Workers with countable income of up to 350% of the federal poverty guidelines may qualify for the program. 

Unlike other Medicaid programs, under HBWD you can have up to $25,000 in assets. You will need to pay a monthly premium. The amount depends on your income. 

HBWD is often used by persons with disabilities to avoid a Medicaid spend-down. If you are working and have Medicaid spend-down, you should explore applying for HBWD. In most cases, the premium you would pay for HBWD will be less than your spend-down amount.

How working affects Medicare

If you have been eligible for SSDI benefits for 24 months or more, you may also be eligible for Medicare . For more information about the Medicare program, see "The Medicare Program."

After the initial waiting period, you will remain eligible for Medicare while you receive an SSDI check. If you work and never earn enough money to stop receiving an SSDI check, your Medicare will also continue . Even if you return to work and earn enough to stop your SSDI checks, Medicare will continue for several years. You will remain eligible for Medicare during the 9 month Trial Work Period. Also, during your 36 months Extended Period of Eligibility. After the Extended Period, even if you lose SSDI, you will be eligible for Medicare. This is true for at least a total of 93 months after the completion of the Trial Work Period. This is called “Extended Medicare.” The local SSA office can tell you the exact time period of your “Extended Medicare” coverage. 

After the Extended period ends, if you are "disabled" but not 65, you may buy Medicare Part A and B. This will cost the same as the amount paid by uninsured, eligible, retired beneficiaries.

Representative payee

In certain situations, SSA will send the benefit payments to a "Representative Payee" instead of to you. SSA requires that benefits be paid to a representative payee for:

• Children under 18 (unless emancipated), and
• For adults who are unable to manage their own benefits.

For adults, SSA should base its decision on medical evidence or another sound basis. For example, a court finding that the recipient is unable to manage his own funds.

Payee responsibilities

A representative payee is required to use your monthly benefit to pay your expenses each month, including:

• Rent,
• Utilities,
• Telephone,
• Food,
• Clothing,
• Transportation costs, and
• Medical co-pays.

If the benefit payments exceed your needs, the payee is required to save the extra money in a safe manner. For example, savings bonds or a savings account, separate from the payee’s own funds. SSA requires payees to file periodic reports explaining how the money has been spent or invested. They can require receipts or other proof.

A payee must notify SSA about facts that may affect your eligibility or amount of benefits This includes such things as:

• Other sources of income you receive,
• Changes in address,
• Work activity,
• Death,
• Marriage, or
• If you move to or from a hospital, nursing home or other institution.

You need to report these changes yourself if the payee does not do so. SSA can hold a payee responsible for overpaid benefits because the payee's failed to provide notice.

Selecting the representative payee

If you are under age 18: For a child with a disability, the parent or legal guardian caring for the child is the preferred payee. SSA may consider a parent who is not living with the child but supporting them or is otherwise strongly involved . SSA may also consider another relative or stepparent. If no such person is available, SSA may appoint a social agency or institution as payee.

If you are over age 18: You have the right to request your representative payee. Although there are no specific qualifications, the payee cannot have been convicted of a felony. The payee should be someone who sees you on a regular basis. Someone you can easily contact if you need something. SSA has guidelines ranking the potential payees. They generally prefer a spouse or other relative who has a strong concern for the person's welfare. If no such person is available, SSA will consider making a close friend the payee. If no such person is available, SSA may appoint an agency or institution as payee.

Compensating the representative payee

It is sometimes difficult for SSI or SSDI recipients to find someone who is able to be their payee. When that happens, a social service agency may be available to be the payee. In order to encourage these agencies, the SSA will allow them to charge a fee of up to $25 per month. The agency must get written approval from the SSA before the agency can collect any fee.

The SSA rules do not allow any payee other than an approved social service agency to collect a fee.

Objecting to representative payment

If SSA plans to make representative payment, they will send you a written notice telling you. Suppose you feel that you do not need a payee, or if you object to the proposed payee. In that case, you may request a personal conference with staff at your SSA office to present information. You will then receive a written determination. If you disagree with the determination, you may request Reconsideration, and pursue an appeal .

Ending representative payment

At any time, you can ask the SSA to terminate representative payment. You must show that you are physically and mentally capable of handling your own funds. You will be required to present a statement from your doctor or other proof. If you have a legal guardian, SSA cannot stop representative payment unless you obtain a court order.

Changing the representative payee

SSA may appoint a new payee if:

• The payee dies,
• The payee is unable to serve, or
• The payee simply no longer wishes to be the payee.

SSA may remove the payee at any time that the payee fails to properly serve your interests. Also, if a more appropriate person to serve as payee becomes available. You should notify your local SSA office if you feel the payee should be changed. Your benefits may be interrupted if your payee is removed and a new one is not rapidly available.

Special rules for the representative payee of a child receiving SSI

A payee has the duty to ensure a child receives medically necessary care for the disabling condition. SSA can remove the payee if he or she fails to seek this care without good cause.

Dedicated accounts for retroactive SSI benefits of disabled children

When a child's claim is approved, SSA must determine whether the child is eligible for retroactive SSI benefits. Those are benefits for the time from the application for SSI to the time the claim is approved. If the child is entitled to a lump sum back benefit award that equals 6 times the maximum benefit amount. Those benefits must be placed into a special separate bank account. This special account is called a "dedicated account." Any interest earned must remain in the account. 

The payee may use the money only for items directly related to the child's disability. This includes:

• Medical care,
• Education,
• Job skills training,
• Modifications to a home,
• Personal needs assistance,
• Special equipment,
• Therapy, or
• Rehabilitation care.

It is not a good idea for the payee to deposit other money, like their own money, into the account. Any money in the account is subject to SSA’s limits on use.

A payee should get pre-approval from SSA before taking any money for an item other than those listed. The payee must repay money used from a child’s account that is not related to the disability.

Overpayment of benefits

It is common for recipients to receive a notice that they have received benefits to which they were not entitled. This is called an "overpayment." Usually, SSA will require you to pay back any overpaid benefits. SSA will reduce your current benefits until the money is paid back. SSA has other ways to collect overpayments too. For example, if you file taxes and expect a refund, the government may take that refund. Overpayments occur when recipients have new sources of income and their benefits are not promptly reduced. If you don’t promptly report changes in your case that affect your benefits, you may also receive an overpayment. 

If you receive a notice of overpayment, you have the right to appeal. You should file an appeal if you believe that SSA is wrong in saying that you received an overpayment. Also, if you believe that the amount of the overpayment is less than SSA claims. The deadline for filing an appeal is 65 days from the date on the notice of overpayment. See the below Appeals section.

Even if you agree that you received an overpayment, you can ask that you not be required to pay the money back. This is called a "Request for Waiver of Recovery of Overpayment," commonly called a "waiver." You may request a waiver at any time, by completing a written form available at your local SSA office.

In order to qualify for a waiver, you must prove that you were not responsible for causing the overpayment. You must show that:

• You did your best to properly report all necessary information to SSA,
• You did not accept benefits that you knew you were not entitled to receive, and
• It would be unfair to make you pay back the money, either because you cannot afford to do so. Alternatively, because you have taken certain actions thinking that you were entitled to the overpaid benefits.

You should clearly explain your side of the story when you file a request for a waiver. Staff at the SSA office can help you complete the form. You are entitled to file an appeal if your request for a waiver is denied. SSA must stop collection action while your appeal is pending, even if SSA has already started.

How to protect or enforce your rights: appeals

Decisions that you can appeal

SSA denies many applications for disability benefits. Denials often occur because there was not enough medical evidence to prove a disabling problem. More than 50% of appeals are successful. If SSA denies your claim, strongly consider filing an appeal. Many people give up, wait a period of time, and reapply. In most cases, it is a better decision to file an appeal rather than to wait and to reapply.

You should also consider appeals in other cases. You can appeal if you believe that SSA wrongly reduced or terminated your benefits. Also, if SSA takes wrongful actions, such as finding an overpayment or requiring a representative payee.

Suppose you are already receiving benefits, and SSA sends you a notice to reduce or terminate. In that case, you may be able to keep your benefits while you appeal. You will need to act quickly to appeal, usually within ten days of receipt of the notice. Indicate on the appeal form that you wish to continue to receive your benefits during the appeal. For example, if SSA decides you are no longer disabled and sends you a notice, you may choose to keep your benefits until a judge issues a decision. 

There levels of the Appeal Process are as follows:

Requests for reconsideration

Whenever SSA denies your application or reduces your benefits, the agency will send you a notice. You have 65 days from the date on the notice in which to make a written "Request for Reconsideration." At the reconsideration stage, SSA will review your claim and may ask you to submit to further medical examination. At this stage, be sure to let SSA know about any treatment or doctor’s visits you had since you applied. Look at the notice and its description of the sources of medical information it considered in making its decision. If information from your treating doctors or hospital records aren't listed but would show your disability. Then, let SSA know so that it will get the missing records and consider them at this stage of appeal.

Request for an ALJ hearing

If you are denied after Reconsideration, SSA will send you another notice. You have 65 days from the date on that notice to make a written request for a hearing before an ALJ. ALJs are administrative judges hired by SSA to conduct hearings. 

If you request an ALJ hearing, you can appear with witnesses and testify about your problems and how they affect you. The ALJ may arrange for a medical or vocational expert to attend the hearing and testify. After the hearing, the ALJ will notify you in writing of the decision and explain the reasons. You may not receive the decision for several months. 

Establishing disability under SSA’s rules is a complex process. It is important to give the ALJ all the medical information that shows you meet the criteria. You do not need to have a lawyer. However, it can be very helpful to have a lawyer represent you to show how you meet the criteria. 

A large percentage of cases are approved at the ALJ hearing stage of the appeal process.

Request for review by the appeals council

If the ALJ decision is not favorable, you can appeal again to the Appeals Council. You have 65 days from the date of the ALJ's notice to make a written request for review by the Council. 

At this level, a review is somewhat limited. The Appeals Council will review the ALJ hearing record and the ALJ decision to see if:

• The ALJ made an error of law,
• His decision was not supported by substantial evidence, or
• There was an abuse of discretion.

You can explain all the reasons you want the Appeals Council to consider when you submit your request for review. In your request, you can ask the Appeals Council for additional time to submit a written argument. You may also submit new evidence for the period up to the date of the ALJ's decision. You will need to explain that the evidence was not available to you earlier. 

The Appeals Council can:

• Say that the ALJ was correct in his decision,
• Approve your claim, or
• Send your case back to the ALJ with instructions on how the ALJ should handle your case.

In some cases, it may make more sense to reapply rather than appeal to the Appeals Council. It would be helpful to consult a lawyer to review the best option for you in this situation.

Lawsuits in U.S. District Court

If the Appeals Council upholds the ALJ's denial of your claim, you have 60 days to file a lawsuit. You may file a civil action in U.S. District Court where you live within 60 days after you receive notice of the Appeals Council's decision. Filing a federal lawsuit is a big task, and consulting an attorney is highly recommended. Some courts have programs to provide information to persons who want to file a lawsuit but don’t have a lawyer. 

This level of appeal is also very limited. The judge will review to see if the Appeals Council fairly considered all evidence and properly applied the law. In general, you cannot introduce new evidence at this point. You may file a written argument in support of the case. 

The judge can:

• Approve your claim,
• Deny your claim, or 
• Remand your case to the ALJ to be evaluated by the judge's instructions.

How to file an appeal with SSA

To file a request for reconsideration, request an ALJ hearing or request review by the Appeals Council, you can call SSA’s toll-free number, (800) 772-1213, or go to your local SSA office. Tell the representative you want to appeal the decision made on your case, and explain what the decision was. Have the decision in front of you when you call. If you go to the SSA office, take the notice of decision you are appealing with you. 

SSA also offers an option to appeal a disability denial online. That includes a request for reconsideration or a request for a hearing before an ALJ online. Currently, you cannot request Appeals Council Review online.

Missing an appeal deadline

At each stage of the appeal process described above, there is a time limit within which you must file an appeal. If you miss that deadline, SSA will consider your appeal only if you show that you had "good cause" for the delay.

Good cause includes:

• A serious illness which prevents you from attending to your business,
• A death in the family,
• A fire or other emergency which disrupts your home,
• You do not know about the need to file an appeal because of your condition, or
• You do not file because of your inability to read or communicate.

If you realize that you have missed an appeal deadline, you should file your appeal in writing as soon as possible. You should include with your appeal a written explanation of the reason why the appeal was not filed in time. Also, a request for an extension of time in which to file the appeal.

Representation in the appeal process

You may be represented by a lawyer, a paralegal, or a friend in the appeal proceedings. Only a lawyer can represent you in proceedings in federal court.

Fees for legal representatives

Your representative may charge you a fee for services. The representative must file a written request with SSA seeking approval for the amount of the fee. The representative cannot collect a fee in an amount greater than the amount approved. SSA will consider the following when deciding the fee: 

• The complexity of the case,
• The amount of time involved, and
• Your representative's skill.

If you are represented by a lawyer who helps you obtain benefits and you obtain retroactive benefits. Then, SSA can pay your lawyer directly out of your retroactive benefits. The amount withheld for your lawyer's fee will be no more than 25% of your retroactive benefits. 

Where to go for more information

Statutes and regulations

The federal statute relating to the SSDI program can be found at 42 USC § § 405, 423. The federal regulations for that program can be found at 20 CFR Part 404.

The federal statute relating to the Supplemental Security Income (SSI) program can be found at 42 USC § 1381. The federal regulations for that program can be found at 20 CFR Part 416.

Other information

To apply for benefits or to file an appeal, contact your local Social Security office, or call (800) 772-1213(v) or (800) 335-0778 (TTY) for information and assistance.

More information can be found at the Social Security Administration's website.