Benefits Denied? How and When to Appeal

1Why this matters

Agencies make mistakes, and many decisions are made on incomplete files. A large share of Social Security disability claims denied at first are approved later on appeal, and many SNAP and Medicaid terminations are reversed once the missing information is provided. But appeals are unforgiving about time: a letter that sits unopened for two months can cost the right to challenge a decision. This guide sets out the deadlines and steps for the main programs and how to keep benefits flowing while you appeal.

2How do you appeal a Social Security decision?

Social Security decisions, including retirement, disability and SSI, have four levels of appeal, and you move to the next only if you disagree with the one before:

1. Reconsideration: a new review of your claim by someone who did not make the first decision.
2. A hearing before an administrative law judge, where you can testify and bring witnesses and new evidence.
3. Review by the Appeals Council.
4. A lawsuit in federal district court.

At each level you generally have 60 days after you receive the decision to ask for the next, and Social Security presumes you received it five days after the date on the notice. You can file most appeals online, by phone at 1-800-772-1213, or on paper. If you have a good reason for being late, such as a serious illness, ask in writing for more time and explain why.

If Social Security says your disability has ended and you appeal within 10 days of the notice, you can ask for payments to continue while the appeal is decided. For a disability denial, file the appeal rather than a new application, which usually loses your earlier filing date; our guide to how SSDI decides you are disabled explains the medical review.

3How does a SNAP fair hearing work?

A SNAP household can generally ask for a fair hearing within 90 days of the date on the notice, though states count the days from different starting points. You can ask orally or in writing. If you ask before the change takes effect, usually within the notice period of about 10 days, your benefits generally continue at the old level until the decision, though you may have to repay the difference if you lose.

The state holds the hearing, by phone or in person. You can see your case file beforehand, bring a lawyer, relative or friend, and present documents and witnesses. A decision should be issued within 60 days of your request. Our SNAP guide explains the rules the agency applies.

4How does a Medicaid fair hearing work?

States must offer a fair hearing, and the time to ask cannot be longer than 90 days from the date the notice was mailed. Some states allow less, such as 30 days, so the date on your notice controls. A state generally must decide within 90 days of your request, or faster when waiting could seriously harm your health.

If your coverage is being reduced or ended and you ask for a hearing before the effective date, you can usually keep your coverage until the decision. If you are denied Marketplace coverage or a subsidy instead, HealthCare.gov allows 90 days to appeal the eligibility decision.

5Other programs have their own deadlines

• Unemployment insurance: states set short deadlines, often 10 to 30 days, for appealing to a hearing officer; see our unemployment guide.
• Medicare claims under Original Medicare: generally 120 days to ask for a redetermination of a denied claim.
• Housing assistance: housing agencies offer an informal review or hearing, with deadlines set in their own policies and stated on the notice.
• TANF, WIC, LIHEAP and school meals: states and local agencies provide hearings under their own rules.

6What should an appeal say?

You do not have to prove everything at the start. Say that you disagree with the decision and why, and include your name, case or claim number, and the date of the notice. Then add evidence that addresses the reason given: pay stubs, bank statements, medical records, a letter from a doctor or a landlord.

If you cannot write the request yourself, most programs accept one by phone; ask the worker to note the date and send you confirmation. Ask in writing when you can, keep a copy of everything, and note the date and the name of anyone you speak to. Legal aid offices help low-income people with benefit appeals free, and notices from state agencies usually say where to find that help. For Social Security, any fee a paid representative charges must be approved by Social Security.

7Preparing for a hearing

Most hearings are informal compared with a courtroom, and many are held by phone or video. A little preparation makes a large difference:

• Ask to see your case file beforehand, so you know what the agency relied on.
• Put your evidence in date order and bring copies for the hearing officer.
• Write a few lines on what you think is wrong with the decision and what you want changed.
• For a disability hearing, make sure recent medical records are in the file and ask your doctor for a statement about your specific limitations.
• Ask for a free interpreter or a disability accommodation in advance if you need one, and ask to reschedule if you cannot attend.

8Common mistakes

• Letting a notice sit unopened until the deadline has passed.
• Filing a new application instead of an appeal, which can lose an earlier filing date and back pay.
• Asking for a hearing after the change took effect, when asking a few days earlier would have kept benefits going.
• Arguing the decision without fixing the missing document that caused it.
• Not keeping proof of when the appeal was sent.

10What this does not tell you

Deadlines run from different dates, and states apply their own procedures within federal limits, so the notice you received controls. This guide is general information, not legal advice.

Federal court deadlines and the full rules for unemployment, Medicare, housing and other programs differ from those summarized here. Check the instructions on your notice.