Reconsideration: Your First Appeal After a Disability Denial

Reconsideration is the first level of appeal after Social Security denies your disability claim. It is a full, fresh review of your file by people who had no part in the original decision. Reconsideration has a reputation as a rubber stamp of the first denial, and the approval numbers are indeed modest, but skipping it is not an option in most states, and handled well, it can either win your claim outright or build the record you will need at a hearing.

What Reconsideration Is

When you request reconsideration, your claim goes back to the state Disability Determination Services (DDS) agency that made the initial decision. A different claims examiner and a different medical or psychological consultant review everything in your file, including any new evidence you submit. They apply the same five-step evaluation Social Security uses at every level: whether you are working above the substantial gainful activity limit, whether your condition is severe, whether it meets or equals a listed impairment, whether you can do your past work, and whether you can adjust to other work.

Because the same agency applies the same rules to a similar file, many reconsiderations end the same way the initial claim did. That is exactly why the smart strategy is to make sure the file is not similar, by adding meaningful new evidence.

Success Rates: Modest, but Not Zero

Approval rates at reconsideration have historically hovered around 13 to 15 percent nationally. Treat that as an estimate, the figure moves year to year and varies by state, but the message is consistent: most reconsiderations are denied. Do not let that discourage you. Reconsideration is usually a required step on the road to a hearing, where approval rates are dramatically higher, and a well-supported reconsideration request sometimes wins, especially when the initial denial was based on a thin medical record that has since been filled in.

How to File

You have 60 days from the date you receive your denial notice (plus five days presumed for mailing) to request reconsideration. You can file in three ways:

• Online through Social Security's appeals portal, which is usually the fastest and creates an immediate record of your filing date;
• By mail or in person using Form SSA-561 (Request for Reconsideration), available from any Social Security office;
• By phone, by contacting Social Security and asking them to note your intent to appeal, then following up with the paperwork.

Along with the SSA-561, you will complete a Disability Report - Appeal (Form SSA-3441), which updates Social Security on your medical treatment, medications, and daily activities since the last decision, and a new medical release form (SSA-827) so the agency can collect updated records. Fill these out completely. Vague or blank answers are missed opportunities.

The New Evidence Strategy

Reconsideration is won or lost on the evidence, so your goal is to give the new reviewers something the first ones never saw:

• Updated treatment records. Every appointment, test, imaging study, and hospitalization since your initial application belongs in the file. Keep treating with your doctors, gaps in treatment are one of the most common reasons claims fail.
• New diagnoses and worsening symptoms. If your condition has progressed or a new condition has been identified, document it and report it on the SSA-3441.
• A detailed opinion from your treating doctor. A statement describing your specific functional limits, how long you can sit, stand, and walk, how much you can lift, how often you would miss work, is far more persuasive than a note that simply says you are disabled.
• Specialist evaluations. Opinions from specialists in your condition often carry significant weight.
• Corrections to the record. Read your denial explanation. If Social Security missed a provider, misread a job history, or never received records you know exist, fix that now.

What Happens Next

Reconsideration decisions commonly take several months, and Social Security may send you to a consultative examination if it needs more information. Attend any exam you are scheduled for; missing one can get your claim denied for failure to cooperate. If reconsideration is approved, your benefits are calculated back to your entitlement date. If it is denied, do not lose heart and do not start a new application. You will have 60 days to request a hearing before an administrative law judge, the stage where most successful claims are won. Filing the reconsideration on time keeps your original claim, and all the back pay tied to it, alive.

If you have not yet brought in a representative, reconsideration is an excellent time to do it. There is a great deal of record-building to do before a hearing, and the earlier that work starts, the stronger your position will be.